Physician staffed helicopter emergency medical systems can provide advanced trauma life support in mountainous and remote areas

Ausserer, Julia; Moritz, Elizabeth; Stroehle, Matthias; Brugger, Hermann; Strapazzon, Giacomo; Rauch, Simon; Mair, Peter; Bonsante, Francesco; Brandstätter, Manfred; Cappello, Tomas Dal; Drüge, Gerold; Falk, Markus; Fop, Ernst; Frasnelli, Andreas; Gasteiger, Lukas; Gruber, Elisabeth; Hofer, Georg; Lunz, Wolfgang; Palma, Martín; Ploner, Franz; Rammlmair, G.; Trincanato, Alberto; Turner, Rachel; Zanon, Peter; Voelckel, Wolfgang G.; Dengg, Clemens; Kettner, Margareth

doi:10.1016/j.injury.2016.09.005

Cited by 38 publications

(32 citation statements)

References 33 publications

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“… medical interventions: • major analgesia with sedation: n = 4 (3%) • fracture reduction: n = 5 (4%) • intravenous fluid administration (> 1500 ml): n = 4 (3%) • endotracheal intubation: n = 5 (4%), (point of time not mentioned) Sherren PB [ 11 ] Prospective study. Review of physician only interventions in all missions involving hoisting of a physician, Australia, 2009 to 2012 1582 HEMS missions, 130 (8%) HEC missions with physician, 120 patients (8%) for analysis, remote and inaccessible regions of New South Wales, Australia trauma: n = 108 (90%) 63 physician only interventions in n = 48 (40%) patients: • advanced analgesia: 44 (70%) • advanced airway management: 5 (8%) (point of time not mentioned) • circulatory support: 3 (5%) • orthopedic manipulation of joints/limbs: 6 (10%) • thoracostomy: 1 (2%) • diagnostic ultrasound: 1 (2%) • hypertonic saline administration: 3 (5%) Ausserer J [ 12 ] Retrospective registry study. Review of trauma patients with the aim to identify victims sustaining major trauma during recreational activities in mountainous terrain, Austria 2011 to 2013 58 major trauma victims (Injury Severity Score ≥ 16), 40 (69%) HEC operations, in remote and mountainous areas in the State of Tyrol head/neck trauma: n = 25 (35%) chest trauma: n = 27 (37%) medical interventions: • ATLS before HEC operation: n = 30 (75%) • advanced airway management: n = 23 (40%) (point of time not mentioned) Ney L [ 6 ] Retrospective study.…”

Section: Resultsmentioning

confidence: 99%

“…Endotracheal intubation had to be performed in 19 patients (2%) before HEC removal. In contrast, the International Alpine Trauma Registry, collecting data on severely traumatized patients (ISS > 15) exclusively in the Alpine regions of South Tyrol (Italy) and Tyrol (Austria), reported a need for endotracheal intubation prior to HEC evacuation in 5 of 40 patients (13%) [ 12 ].…”

Section: Resultsmentioning

confidence: 99%

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Advanced airway management in hoist and longline operations in mountain HEMS – considerations in austere environments: a narrative review This review is endorsed by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM)

Pietsch

Knapp

Kreuzer³

et al. 2018

Scand J Trauma Resusc Emerg Med

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BackgroundProviding sufficient oxygenation and ventilation is of paramount importance for the survival of emergency patients. Therefore, advanced airway management is one of the core tasks for every rescue team. Endotracheal intubation is the gold standard to secure the airway in the prehospital setting. This review aims to highlight special considerations for advanced airway management preceding human external cargo (HEC) evacuations.MethodsWe systematically searched MEDLINE, EMBASE, and PubMed in August 2017 for articles on airway management and ventilation in patients before hoist or longline operation in HEMS. Relevant reference lists were hand-searched.ResultsThree articles with regard to advanced airway management and five articles concerning the epidemiology of advanced airway management in hoist or longline rescue missions were included. We found one case report regarding ventilation during hoist operations.The exact incidence of advanced airway management before evacuation of a patient by HEC is unknown but seems to be very low (< 5%). There are several hazards which can impede mechanical ventilation of patients during HEC extractions: loss of equipment, hyperventilation, inability to ventilate and consequent hypoxia, as well as inadequacy of monitoring.ConclusionsAdvanced airway management prior to HEC operation is rarely performed. If intubation before helicopter hoist operations (HHO) and human cargo sling (HCS) extraction is considered by the rescue team, a risk/benefit analysis should be performed and a clear standard operating procedure (SOP) should be defined. Continuous and rigorous training including the whole crew is required. An international registry on airway management during HEC extraction would be desirable.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Advanced airway management in hoist and longline operations in mountain HEMS – considerations in austere environments: a narrative review This review is endorsed by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM)

Pietsch

Knapp

Kreuzer³

et al. 2018

Scand J Trauma Resusc Emerg Med

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“…This confirms that advanced life support (ALS) is feasible at avalanche scenes, as recommended by international guidelines. [ 3 , 4 , 29 , 30 ]…”

Section: Discussionmentioning

confidence: 99%

“…These measures may improve time efficiency and increase safety by relieving the minds of the rescuers from organizational concerns and allow them to concentrate more on risk assessment and on the technical and medical aspects of the rescue. [ 6 , 29 ]…”

Section: Discussionmentioning

confidence: 99%

Identification of the technical and medical requirements for HEMS avalanche rescue missions through a 15-year retrospective analysis in a HEMS in Switzerland: a necessary step for quality improvement

Kottmann

Carron

Theiler

et al. 2018

Scand J Trauma Resusc Emerg Med

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BackgroundAvalanche rescues mostly rely on helicopter emergency medical services (HEMS) and include technical rescue and complex medical situations under difficult conditions. The adequacy of avalanche victim management has been shown to be unexpectedly low, suggesting the need for quality improvement. We analyse the technical rescue and medical competency requirements of HEMS crewmembers for avalanche rescue missions, as well as their clinical exposure. The study aims to identify areas that should be the focus of future quality improvement efforts.MethodsThis 15-year retrospective study of avalanche rescue by the Swiss HEMS Rega includes all missions where at least one patient had been caught by an avalanche, found within 24 h of the alarm being raised, and transported.ResultsOur analyses included 422 missions (596 patients). Crews were frequently confronted with technical rescue aspects, including winching (29%) and patient location and extrication (48%), as well as multiple casualty accidents (32%). Forty-seven percent of the patients suffered potential or overt vital threat; 29% were in cardiac arrest. The on-site medical management of the victims required a large array of basic and advanced medical skills. Clinical exposure was low, as 56% of the physicians were involved in only one avalanche rescue mission over the study period.ConclusionsOur data provide a solid baseline measure and valuable starting point for improving our understanding of the challenges encountered during avalanche rescue missions. We further suggest QI interventions, that might be immediately useful for HEMS operating under similar settings. A coordinated approach using a consensus process to determine quality indicators and a minimal dataset for the specific setting of avalanche rescue would be the logical next step.Electronic supplementary materialThe online version of this article (10.1186/s13049-018-0520-3) contains supplementary material, which is available to authorized users.

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“…The clinical benefits of using helicopters in emergency medical service are well known and reported in literature (see, for example, Refs. [1][2][3]). However, the VTOL capability provided by rotors with high-speed rotating blades comes at the cost of poor vibration performance [4], which degrades comfort and safety.…”

Section: Introductionmentioning

confidence: 99%

Cabin Layout Optimization for Vibration Hazard Reduction in Helicopter Emergency Medical Service

et al. 2020

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Helicopter Emergency and Medical Service (HEMS) vehicles require a specially configured cabin that supports the quick transport of a rescue team to the site of an emergency and return of patients back to a full capacity hospital, while sustaining the patients’ health using specifically designed, but otherwise state-of-the-art life-support equipment. The effectiveness and safety of the service may be challenged by the vibratory level, which could be improved by optimally positioning the affected subjects within the cabin. However, the bare dynamical response of the airframe can lead to erroneous evaluation of vibration performance, since pilots, crew, patients, and medical equipment dynamically interact with the helicopter through their interfaces with the structure. Therefore, layout optimization of a HEMS vehicle for low vibration requires the capability to efficiently analyze a large set of candidate coupled helicopter-interface-subject configurations, reaching a suitable trade-off between model detail and computational cost. This work presents an effective vibration rating of medical helicopters to support vibration hazard reduction by minimization of cabin interior accelerations. The tool is able to model high-fidelity rotorcraft aeroservoelasticity, easily connect formulations representing the dynamics of humans, equipment, and their interfaces, and calculate the vibration performance of the resulting coupled models. The approach is applied to a medium-weight helicopter to find its lowest vibration HEMS configuration. It is demonstrated that the optimal positioning of HEMS subjects can significantly reduce vibration hazard and improve operation safety, nearly as effectively as the application of vibration attenuation solutions with a fixed cabin layout.

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Physician staffed helicopter emergency medical systems can provide advanced trauma life support in mountainous and remote areas

Cited by 38 publications

References 33 publications

Advanced airway management in hoist and longline operations in mountain HEMS – considerations in austere environments: a narrative review This review is endorsed by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM)

Advanced airway management in hoist and longline operations in mountain HEMS – considerations in austere environments: a narrative review This review is endorsed by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM)

Identification of the technical and medical requirements for HEMS avalanche rescue missions through a 15-year retrospective analysis in a HEMS in Switzerland: a necessary step for quality improvement

Cabin Layout Optimization for Vibration Hazard Reduction in Helicopter Emergency Medical Service

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