The first seven years of nationally organized helicopter emergency medical services in Finland – the data from quality registry

Saviluoto, Anssi; Björkman, Johannes; Olkinuora, Anna; Virkkunen, Ilkka; Kirves, Hetti; Setälä, Piritta; Pulkkinen, Ilkka; Laukkanen-Nevala, Päivi; Raatiniemi, Lasse; Jäntti, Helena; Iirola, Timo; Nurmi, Jouni

doi:10.1186/s13049-020-00739-4

Cited by 41 publications

(79 citation statements)

References 38 publications

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“…After the establishment of a nationally organized HEMS in Finland in 2012, they discovered that a higher rate of requests were cancelled, compared to other countries. This could be due to over triage [ 37 ] and is an example of prehospital organizational changes which had an unintentional effect in a different area in the prehospital emergency service. Denmark uses anaesthesiologists in rapid response vehicles spread geographically around the country, in contrast to Norway’s use of GPs in the OOH services [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Helicopter emergency medical service (HEMS) activity after increased distance to out-of-hours services: an observational study from Norway

et al. 2020

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Background Organizational changes in out-of-hour (OOH) services may have unintended consequences for other prehospital services. Reports indicate an increased use of helicopter emergency medical services (HEMS) after changes in OOH services in Norway due to greater geographical distances for the on-call doctors. We investigated whether HEMS dispatches increased when nine municipalities in Sogn og Fjordane County merged into one large inter-municipal OOH district. Methods All primary dispatches of the HEMS in the county between 2004 and 2013 were included. We applied interrupted time series regression to monthly aggregated data to evaluate the impact of the organizational change 1 April 2009. The nine target municipalities were compared to the rest of the municipalities in the county, which served as a control group. A quasipoisson model adjusted for seasonality was found to be most applicable. Results We included 8,751 dispatches, 5,009 (57.2%) of which were completed with a patient encounter. Overall, we found no alteration in requests for HEMS after 2009 (p = 0.251). Separate analyses of the target municipalities and control group revealed no significant increase after 2009 (p = 0.400 and p = 0.056, respectively). When categorizing the municipalities into urban or rural, we found a general increase in HEMS dispatches for the rural group over the 10-year span (p = 0.045) but no added increase after 2009 (p = 0.502). The urban subgroup showed no change. Distance from the OOH service in regards to travel increased within the nine municipalities after 2009, median [quartiles] (5.0[3.0, 6.2] km vs 26.5[5.0, 62.2] km, p < 0.001). Conclusion After relocating nine local OOH services into one large inter-municipal OOH district, we found no increase in requests for HEMS.

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Section: Discussionmentioning

confidence: 99%

Helicopter emergency medical service (HEMS) activity after increased distance to out-of-hours services: an observational study from Norway

et al. 2020

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“…The HEMS system and the FHDB have been described in more detail recently. 16 Since 2012, all HEMS operations have been nationally organised by FinnHEMS.…”

Section: Methodsmentioning

confidence: 99%

Short-term and long-term survival in critical patients treated by helicopter emergency medical services in Finland: a registry study of 36 715 patients

et al. 2021

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ObjectivesThis study aimed to describe the short-term and long-term mortality of patients treated by prehospital critical care teams in Finland.Design and settingWe performed a registry-based retrospective study that included all helicopter emergency medical service (HEMS) dispatches in Finland from 1 January 2012 to 8 September 2019. Mortality data were acquired from the national Population Register Centre to calculate the standardised mortality ratio (SMR).ParticipantsAll patients encountered by Finnish HEMS crews during the study period were included.Main outcomesMortalities presented at 0 to 1 day, 2 to 30 days, 31 days to 1 year and 1 to 3 years for different medical reasons following the prehospital care. Patients were divided into four groups by age and categorised by gender. The SMR at 2 to 30 days, 31 days to 1 year and 1 to 3 years was calculated for the same groups.ResultsPrehospital critical care teams participated in the treatment of 36 715 patients, 34 370 of whom were included in the study. The cumulative all-cause mortality at 30 days was 27.5% and at 3 years was 36.5%. The SMR in different medical categories and periods ranged from 23.2 to 72.2, 18.1 to 22.4, 7.7 to 9.2 and 2.1 to 2.6 in the age groups of 0 to 17 years, 18 to 64 years, 65 to 79 years and ≥80 years, respectively.ConclusionsWe found that the rate of mortality after a HEMS team provides critical care is high and remains significantly elevated compared with the normal population for years after the incident. The mortality is dependent on the medical reason for care and the age of the patient. The long-term overmortality should be considered when evaluating the benefit of prehospital critical care in the different patient groups.

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“…Patients who suffer from OHCA represent one of the largest categories encountered by Finnish HEMS 1 . After a return of spontaneous circulation (ROSC), post‐resuscitation syndrome, with the associated cardiovascular distress, can ensue.…”

Section: Discussionmentioning

confidence: 99%

“…We included data from all six HEMS units operating in Finland. The Finnish HEMS system and its characteristics have recently been described in detail elsewhere 1 . In brief, it consists of five physician‐staffed units and one paramedic‐staffed unit, based at the University Hospitals and Lapland, respectively.…”

Section: Methodsmentioning

confidence: 99%

“…However, Helicopter Emergency Medical Services (HEMS) are an expensive and often limited resource that should be used rationally. HEMS aims to offer their services to the most critically ill to provide more sustainable outcomes 1 . The treatment of critically ill prehospital patients is a clinical team‐work effort with limited laboratory and imaginary options.…”

Section: Introductionmentioning

confidence: 99%

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Shock index as a predictor for short‐term mortality in helicopter emergency medical services: A registry study

Björkman

Raatiniemi

Setälä

et al. 2021

Acta Anaesthesiol Scand

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Background The value of shock‐index has been demonstrated in hospital triage, but few studies have evaluated its prehospital use. The aim of our study was to evaluate the association between shock‐index in prehospital critical care and short‐term mortality. Methods We analyzed data from the national helicopter emergency medical services database and the Population Register Centre. The shock‐index was calculated from the patients' first measured parameters. The primary outcome measure was 1‐ and 30‐day mortality. Results A total of 22 433 patients were included. The 1‐day mortality was 7.5% and 30‐day mortality was 16%. The median shock‐index was 0.68 (0.55/0.84) for survivors and 0.67 (0.49/0.93) for non‐survivors (P = .316) at 30‐days. Association between shock‐index and mortality followed a U‐shaped curve in trauma (shock‐index < 0.5: odds ratio 2.5 [95% confidence interval 1.8‐3.4], shock‐index > 1.3: odds ratio 4.4 [2.7‐7.2] at 30 days). Patients with neurological emergencies with a low shock‐index had an increased risk of mortality (shock‐index < 0.5: odds ratio 1.8 [1.5‐2.3]) whereas patients treated after successful resuscitation from out‐of‐hospital cardiac arrest, a higher shock‐index was associated with higher mortality (shock‐index > 1.3: odds ratio 3.5 [2.3‐5.4). The association was similar for all ages, but older patients had higher mortality in each shock‐index category. Conclusion The shock‐index is associated with short time mortality in most critical patient categories in the prehospital setting. However, the marked overlap of shock‐index in survivors and non‐survivors in all patient categories limits its predictive value.

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The first seven years of nationally organized helicopter emergency medical services in Finland – the data from quality registry

Cited by 41 publications

References 38 publications

Helicopter emergency medical service (HEMS) activity after increased distance to out-of-hours services: an observational study from Norway

Helicopter emergency medical service (HEMS) activity after increased distance to out-of-hours services: an observational study from Norway

Short-term and long-term survival in critical patients treated by helicopter emergency medical services in Finland: a registry study of 36 715 patients

Shock index as a predictor for short‐term mortality in helicopter emergency medical services: A registry study

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