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Guinzburg A, Gelikas S, Tsur AM, Nadler R, Sorkin A, Avital G, Radomislensky I, Bodas M, Segal D, Benov A, Chen J. The association between helicopter emergency medical services and early casualty survival: a nationwide study. Eur J Emerg Med 2022; 29:397-403. [PMID: 35900102 DOI: 10.1097/mej.0000000000000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Helicopter emergency medical services (HEMS) allow for shorter transport duration in long-distance evacuations and facilitate advanced en-route medical care access. Studies comparing HEMS with ground emergency medical services (GEMS), including the outcome of prehospital mortality, are lacking. OBJECTIVE This study aimed to evaluate the association between HEMS and early mortality in Israel. SETTING A retrospective cohort study was conducted of the cross-referenced Israel Defense Forces Trauma Registry and Israel National Trauma Registry databases. OUTCOME MEASURES AND ANALYSIS Univariable logistic regression was used to assess the association between HEMS and early mortality, defined as mortality within 1 day of the injury. Regression analysis was further performed stratifying by event type (military or civilian) or type of injury (penetrating or nonpenetrating). RESULTS A total of 2344 casualties were included in the study, of whom 756 (32.3%) were evacuated by air. Early mortality rates were 90/1588 (5.7%) and 37/756 (4.9%) in GEMS and HEMS groups, respectively. Regression analysis found no significant analysis between HEMS and early mortality [OR, 0.86 (95% CI, 0.57-1.26)]. Stratified by event type, a nonsignificant association between HEMS and early mortality was demonstrated for combat [OR, 1.69 (95% CI, 0.79-3.92)] and noncombat [OR, 0.73 (95% CI, 0.4-1.25)] events. HEMS was associated with decreased early mortality among casualties with a penetrating injury [OR, 0.59 (95% CI, 0.34-0.98)] but not associated with early mortality among casualties with a nonpenetrating injury [OR, 0.84 (95% CI, 0.43-1.52)]. CONCLUSION HEMS was not associated with a decrease in early mortality among trauma casualties in this study encompassing the prehospital and hospital scenes. There was a positive trend and a decrease in mortality from penetrating injuries. Further research to ascertain which casualties benefit from HEMS is warranted and will allow for more precise use of this expensive resource.
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Affiliation(s)
- Ariel Guinzburg
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan
| | - Shaul Gelikas
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan
| | - Avishai M Tsur
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan
- Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv
| | - Roy Nadler
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan
- Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv
| | - Alex Sorkin
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan
- Department of Plastic Surgery, Shamir Medical Center, Zerifin
| | - Guy Avital
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv
| | - Irina Radomislensky
- The National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Hashomer
| | - Moran Bodas
- The National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Hashomer
- Department of Emergency Management and Disaster Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv
| | - David Segal
- Meir Medical Center, Kfar Saba
- Sackler School of Medicine, Tel Aviv University, Tel Aviv
| | - Avi Benov
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Jacob Chen
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan
- Meir Medical Center, Kfar Saba
- Sackler School of Medicine, Tel Aviv University, Tel Aviv
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Characteristics and Demographics of Patients Requiring Emergent Air Medical. Emerg Med Int 2022; 2022:3044891. [PMID: 35273813 PMCID: PMC8904089 DOI: 10.1155/2022/3044891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/27/2022] [Indexed: 11/21/2022] Open
Abstract
Background As integrated health systems become more common, interfacility patient transfers will increase and air transport programs will be prioritized. Understanding characteristics of patients triaged to air medical transport will assist with resource allocation and needs assessment. The objective of this study was to investigate the demographics and clinical characteristics of patients that presented to the emergency department (ED) and subsequently required emergent air medical interfacility transport. Methods This was a retrospective, multicenter study conducted at eight hospitals within Northwell Health, the largest academic health system in New York state. The study was conducted between December 1, 2014, and July 31, 2020, and included patients who presented to an ED and subsequently required emergent air medical interfacility transport. Results Overall, the median age was 37 years (IQR 4–66), and 231 (54%) subjects were males. The majority of subjects (59%) had no reported comorbidities, arrived by ambulance (52%), and were emergency severity index triage 2 (48%). Frequent indications for transfer were nontraumatic neurologic (37%), pulmonary or respiratory (13%), trauma (12%), and cardiovascular (12%). Most patients were not ventilated before transport (71%). The median time to call for transport at the sending institution was 2:42 hours (IQR 1:14–6:54), and the median length of stay was 4:12 (IQR 2:31–8:48). Most patients were subsequently admitted (96%) at the receiving institution to an intensive care unit (72%). Conclusions This study describes patients' demographic and clinical characteristics who required emergent air medical transport. Helicopter transport is costly, and data from these patients may further help our understanding of who is transported by air and how important air transport is to the health system.
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Hatzfeld JJ, Hildebrandt G, Maddry JK, Rodriquez D, Bridges E, Ritter AC, Gardner CL, Bebarta VS, Cap AP. Top 10 Research Priorities for U.S. Military En Route Combat Casualty Care. Mil Med 2021; 186:e359-e365. [PMID: 33399866 DOI: 10.1093/milmed/usaa480] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/12/2020] [Accepted: 01/04/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Within the Military Health System, the process of transporting patients from an initial point of injury and throughout the entire continuum of care is called "en route care." A Committee on En Route Combat Casualty Care was established in 2016 as part of the DoD Joint Trauma System to create practice guidelines, recommend training standards, and identify research priorities within the military en route care system. MATERIALS AND METHODS Following an analysis of currently funded research, future capabilities, and findings from a comprehensive scoping study, members of a sub-working group for research identified the top research priorities that were needed to better guide evidence-based decisions for practice and policy, as well as the future state of en route care. RESULTS Based on the input from the entire committee, 10 en route care research topics were rank-ordered in the following manner: (1) medical documentation, (2) clinical decision support, (3) patient monitoring, (4) transport physiology, (5) transfer of care, (6) maintaining normothermia, (7) transport timing following damage control resuscitation or surgery, (8) intelligent tasking, (9) commander's risk assessment, and (10) unmanned transport. Specific research questions and technological development needs were further developed by committee members in an effort to guide future research and development initiatives that can directly support operational en route care needs. The research priorities reflect three common themes, which include efforts to enhance or increase care provider capability and capacity; understand the impact of transportation on patient physiology; and increase the ability to coordinate, communicate, and facilitate patient movement. Technology needs for en route care must support interoperability of medical information, equipment, and supplies across the global military health system in addition to adjusting to a dynamic transport environment with the smallest possible weight, space, and power requirements. CONCLUSIONS To ensure an evidence-based approach to future military conflicts and other medical challenges, focused research and technological development to address these 10 en route care research gaps are urgently needed.
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Affiliation(s)
| | - George Hildebrandt
- U.S. Army Medical Evacuation Proponency, Futures and Concepts Center - Army Futures Command, Ft. Rucker, AL 36362, USA
| | - Joseph K Maddry
- 59th Medical Wing/Science & Technology, Joint Base San Antonio-Lackland, TX 78236, USA.,US Army Institute of Surgical Research, JBSA-Fort Sam Houston, TX 78234, USA
| | - Dario Rodriquez
- USAF School of Aerospace Medicine, Wright-Patterson Air Force Base, OH 45433, USA
| | - Elizabeth Bridges
- University of Washington School of Nursing, - Seattle, WA 98195, USA
| | - Anne C Ritter
- Combat Casualty Care Research Program, Ft Detrick, MD 21702, USA
| | - Cubby L Gardner
- Air Force Medical Readiness Agency, Falls Church, VA 22042, USA.,Combat Casualty Care Research Program, Ft Detrick, MD 21702, USA
| | - Vikhyat S Bebarta
- University of Colorado School of Medicine, Aurora, CO 80045, USA.,59th Medical Wing/Science & Technology, Joint Base San Antonio-Lackland, TX 78236, USA
| | - Andrew P Cap
- US Army Institute of Surgical Research, JBSA-Fort Sam Houston, TX 78234, USA
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Dominguez OH, Grigorian A, Lekawa M, Schubl SD, Chin T, Kim DY, de Virgilio C, Nahmias J. Helicopter Transport Has Decreased Over Time and Transport From Scene or Hospital Matters. Air Med J 2020; 39:283-290. [PMID: 32690305 DOI: 10.1016/j.amj.2020.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/28/2020] [Accepted: 04/14/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Several reports have found helicopter emergency medical services (HEMS) to be associated with a lower risk of mortality compared with ground emergency medical services (GEMS); however, most studies did not control for transport time or stratify interfacility versus scene. We hypothesize that the HEMS transport rate has decreased nationally and that the risk of mortality for HEMS is similar to GEMS when adjusting for transport time and stratifying by scene or interfacility. METHODS The Trauma Quality Improvement Program (2010-2016) was queried for adult patients transported by HEMS or GEMS. Multivariable logistic regression was used. RESULTS The HEMS transport rate decreased by 38.2% from 2010 to 2016 (P < .001). After controlling for known predictors of mortality and transport time, HEMS was associated with a decreased risk of mortality compared with GEMS for adult trauma patient transports (odds ratio = 0.74; 95% confidence interval [CI], 0.71-0.77; P < .001). Compared with GEMS, HEMS transports from the scene were associated with a decreased risk of mortality (OR = 0.63; 95% CI, 0.60-0.66; P < .001), whereas HEMS interfacility transfer was associated with an increased risk of mortality (OR = 1.22; 95% CI, 1.14-1.31; P < .001). CONCLUSION The rate of HEMS transports in trauma has decreased by nearly 40% over the past 7 years. Our results suggest that HEMS use for scene transports is beneficial for the survival of trauma patients.
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Affiliation(s)
- Oscar Hernandez Dominguez
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA.
| | - Areg Grigorian
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA
| | - Michael Lekawa
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA
| | - Sebastian D Schubl
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA
| | - Theresa Chin
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA
| | - Dennis Y Kim
- Department of Surgery, University of California, Harbor-Los Angeles, Los Angeles, CA
| | - Christian de Virgilio
- Department of Surgery, University of California, Harbor-Los Angeles, Los Angeles, CA
| | - Jeffry Nahmias
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA
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Roman J, Shank W, Demirjian J, Tang A, Vercruysse GA. Overutilization of Helicopter Transport in the Minimally Burned—A Healthcare System Problem That Should Be Corrected. J Burn Care Res 2019; 41:15-22. [DOI: 10.1093/jbcr/irz143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Eighty-eight percent of all patients burned in North America suffer burns of less than 20% TBSA. These patients may need care at a burn center, but barring any inhalation injury or polytrauma, these patients do not require helicopter transport (HEMS). We sought to identify a cohort of patients suffering smaller burns who do not benefit from HEMS to establish significant health care system savings. A 5-year retrospective analysis of data collected from our trauma registry was performed. Patients were separated into two groups: HEMS and ground transport (EMS). A subanalysis was performed between those with smaller burns (<20% TBSA and no ICU/OR requirement). ED disposition, hospital length of stay, distance transported, and cost was analyzed. Of 616 burn patients presenting to our center, 13% were transported by HEMS, 46% by ambulance, and 61% by private vehicle. Of those transported via HEMS, 38% had been evaluated and treated at an outside hospital before transfer. Patients transported via HEMS had larger burns (13 vs 9 %TBSA; P = .002) and deeper burns (P < .001), longer hospital stays (P = .003), higher ICU admission rates (P < .001), and mortality rates (P = .003) compared with those transported by EMS. Transport distance was a mean 5.5 times greater (88 vs 16 mi) in the HEMS group (P < .001). Within this cohort, 53% of patients transported via HEMS suffered smaller burns, compared with 73% transported by EMS. A subanalysis of the smaller burns cohort showed increased distances of transport via HEMS (91 vs 18 mi; P < .001) and increased rates of admission from the ED in the EMS group (93% vs 68% by HEMS; P = .005), yet no difference in length of stay, or rates of early discharge, defined as <24-hour hospital stay. Fully 1/4 of those transported via HEMS with smaller burns were discharged from the ED after burn consultation, debridement, and dressing. Mortality in both was nil. Average cost per helicopter transport was US$29K. Accurate triage and burn center consultation before scene transport or hospital transfer could help identify patients not benefiting from HEMS yet safely transferrable by ground, or better served by early clinic follow-up, which would reduce cost without compromising care in this cohort. Annual patient savings approximating US$444K could be multiplied were non-HEMS transport universally adopted for smaller burns.
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Affiliation(s)
| | | | | | | | - Gary A Vercruysse
- Department of Surgery, University of Michigan Medical Center, Ann Arbor
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Madiraju SK, Catino J, Kokaram C, Genuit T, Bukur M. In by helicopter out by cab: the financial cost of aeromedical overtriage of trauma patients. J Surg Res 2017; 218:261-270. [PMID: 28985859 DOI: 10.1016/j.jss.2017.05.102] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/12/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Helicopter transport of injured patients is controversial and costly. This study aims to show that a complex trauma algorithm leads to significant aeromedical overtriage at substantial cost. Our secondary outcomes were to compare adjusted mortality and outcomes between air and ground transport and determine predictors of overtriage. MATERIALS AND METHODS A 6-y retrospective analysis was conducted of all trauma activations at a Level I center. Patients were dichotomized by transportation method as well as trauma activation criteria. Overtriage was defined as those who were discharged from the emergency department, medically admitted without injuries, or admitted to observation status only. Overtriage and associated charges were calculated for each patient cohort, and multivariate regression models were created to derive adjusted mortality rates and predictors of overtriage. RESULTS A total of 4218 patients were treated with 28% arriving by helicopter. Overtriage increased significantly from 51% to 77% with lower tier activation criteria (P < 0.001). Median charges for air-evacuated patients was $10,478 (versus $1008 ground). Eliminating overtriage of air patients would result in a cost savings of $1,316,036 annually. Adjusted mortality between air and ground transport was not significantly different (8.5% versus 10.9%, P = 0.548). Predictors of overtriage included decreasing age, Injury Severity Score, Head Abbreviated Injury Score, nonoperative treatment, and lower tier activation criteria. CONCLUSIONS Significant overtriage (52%) and unnecessary air evacuation of minimally injured patients occurs at great financial cost. Revision of trauma activation protocols may result in more judicious air transport use and significant reductions in health care costs.
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Affiliation(s)
| | - Joseph Catino
- Trauma/Critical Care, Delray Medical Center, Delray Beach, Florida
| | - Candace Kokaram
- Trauma/Critical Care, Delray Medical Center, Delray Beach, Florida
| | - Thomas Genuit
- FAU Charles E. Schmidt College of Medicine, Boca Raton, Florida
| | - Marko Bukur
- Trauma/Critical Care, Bellevue Hospital Center, New York, New York
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Perry SE. A Historical Perspective on the Transport of Premature Infants. J Obstet Gynecol Neonatal Nurs 2017; 46:647-656. [PMID: 28441512 DOI: 10.1016/j.jogn.2016.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2016] [Indexed: 10/19/2022] Open
Abstract
A premature newborn was first transported via helicopter from place of birth to a specialty nursery 50 years ago. Since that time, the care of high-risk and premature newborns has evolved, but specialized services are not always available at the birth site. As a result, the demand for newborn transfer continues to grow. Today, neonates are transported to tertiary centers via ground ambulances, helicopters, and airplanes by highly trained personnel using sophisticated incubators and equipment.
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Overuse of helicopter transport in the minimally injured: A health care system problem that should be corrected. J Trauma Acute Care Surg 2015; 78:510-5. [PMID: 25710420 DOI: 10.1097/ta.0000000000000553] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mortality benefit has been demonstrated for trauma patients transported via helicopter but at great cost. This study identified patients who did not benefit from helicopter transport to our facility and demonstrates potential cost savings when transported instead by ground. METHODS We performed a 6-year (2007-2013) retrospective analysis of all trauma patients presenting to our center. Patients with a known mode of transfer were included in the study. Patients with missing data and those who were dead on arrival were excluded from the study. Patients were then dichotomized into helicopter transfer and ground transfer groups. A subanalysis was performed between minimally injured patients (ISS < 5) in both the groups after propensity score matching for demographics, injury severity parameters, and admission vital parameters. Groups were then compared for hospital and emergency department length of stay, early discharge, and mortality. RESULTS Of 5,202 transferred patients, 18.9% (981) were transferred via helicopter and 76.7% (3,992) were transferred via ground transport. Helicopter-transferred patients had longer hospital (p = 0.001) and intensive care unit (p = 0.001) stays. There was no difference in mortality between the groups (p = 0.6).On subanalysis of minimally injured patients there was no difference in hospital length of stay (p = 0.1) and early discharge (p = 0.6) between the helicopter transfer and ground transfer group. Average helicopter transfer cost at our center was $18,000, totaling $4,860,000 for 270 minimally injured helicopter-transferred patients. CONCLUSION Nearly one third of patients transported by helicopter were minimally injured. Policies to identify patients who do not benefit from helicopter transport should be developed. Significant reduction in transport cost can be made by judicious selection of patients. Education to physicians calling for transport and identification of alternate means of transportation would be both safe and financially beneficial to our system. LEVEL OF EVIDENCE Epidemiologic study, level III. Therapeutic study, level IV.
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Glassberg E, Nadler R, Erlich T, Klien Y, Kreiss Y, Kluger Y. A Decade of Advances in Military Trauma Care. Scand J Surg 2014; 103:126-131. [DOI: 10.1177/1457496914523413] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: While combat casualty care shares many key concepts with civilian trauma systems, its unique features mandate certain practices that are distinct from the civilian ones. Methods: This is a review of the most current literature on combat casualty care, based on computer database searches for studies on combat casualty care and military medicine. Studies were selected for inclusion in this review based on their relevance and contribution. Results: Over the last decade, meticulous, international data collection and research efforts have led to significant improvements in military trauma care. Combat medicine has focused on the causes of preventable deaths and targeted on bleeding control and resuscitation strategies, as well as improved evacuation. En route care and forward surgical interventions have resulted in unprecedented low fatality rates and the saving of more lives. Conclusion: This overview of the developments in combat casualty care in recent years emphasizes medical practices that are characteristic of combat medicine, yet with the potential to save lives in other scenarios, as well.
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Affiliation(s)
- E. Glassberg
- Surgeon General’s Headquarters, Israel Defense Forces, Ramat Gan, Israel
| | - R. Nadler
- Surgeon General’s Headquarters, Israel Defense Forces, Ramat Gan, Israel
| | - T. Erlich
- Surgeon General’s Headquarters, Israel Defense Forces, Ramat Gan, Israel
| | - Y. Klien
- Department of General Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Y. Kreiss
- Surgeon General’s Headquarters, Israel Defense Forces, Ramat Gan, Israel
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
| | - Y. Kluger
- Department of General Surgery, Rambam Medical Center, Haifa, Israel
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O'Connell KM, De Jong MJ, Dufour KM, Millwater TL, Dukes SF, Winik CL. An Integrated Review of Simulation Use in Aeromedical Evacuation Training. Clin Simul Nurs 2014. [DOI: 10.1016/j.ecns.2013.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hinkelbein J, Spelten O, Neuhaus C, Hinkelbein M, Özgür E, Wetsch WA. Injury severity and seating position in accidents with German EMS helicopters. ACCIDENT; ANALYSIS AND PREVENTION 2013; 59:283-288. [PMID: 23845407 DOI: 10.1016/j.aap.2013.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 05/25/2013] [Accepted: 05/28/2013] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Accident rates and fatality rates for Helicopter Emergency Medical Service (HEMS) missions have been investigated recently, but none of these studies considered the influence of the seating position in the helicopter. The aim of the present descriptive and observational study was to analyze injury severity depending on the seating position during HEMS accidents in Germany. MATERIAL AND METHODS Data from the German Federal Agency for Flight Accident Investigation was gathered for a period of 40 years (from 1970 to 2009). The seating position in the aircraft during the accident and the resulting injury severity (i.e., 1=no; 2=slight; 3=severe; and 4=fatal) were recorded. Injury severity was compared using the Fisher's exact test. P values <0.05 were considered statistically significant. RESULTS A total of n=99 accidents were investigated (n=61 accidents did not lead to any injuries in the occupants, n=7 accidents resulted in minor, and n=6 in severe injuries, and lethal injuries resulted from n=15 accidents). The occupant in the "patient" position was most likely to suffer from deadly injuries (44.9%), followed by the HEMS crew member rear seat (25.0%), compared to lower lethality rates in the other seating positions (9.4-11.2%). Sitting on the HEMS crew member rear seat also was associated with the highest percentage of severe and minor injuries (12.5% each). CONCLUSIONS In HEMS accidents, the patients' position and the HEMS crew member rear seat were found to be at the highest risk for fatal or severe injuries. These results support the urgent requirement of a large international data base for HEMS accidents as a basis for further studies to improve the safety in HEMS missions.
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Affiliation(s)
- Jochen Hinkelbein
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany; Working Group "Emergency Medicine and Air Rescue", German Society of Aviation and Space Medicine, Munich, Germany; Medical Faculty Mannheim, Ruprecht Karls University of Heidelberg, Mannheim, Germany.
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Spelten O, Wetsch WA, Hinkelbein J. Helicopter Emergency Medical Services (HEMS) missions: The (un)safest location in case of an accident is…. Resuscitation 2012. [DOI: 10.1016/j.resuscitation.2012.08.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Helicopter emergency medical service in fars province: the referral trauma center of South of iran. IRANIAN RED CRESCENT MEDICAL JOURNAL 2012; 14:300-4. [PMID: 22829990 PMCID: PMC3398638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 01/10/2012] [Indexed: 12/04/2022]
Abstract
BACKGROUND Considering the limited available resources, high cost of the helicopter emergency medical service (HEMS), and high load of trauma patients especially in our centers, a careful assessment of HEMS in our center seemed to be necessary for trauma patients. METHODS From April 2001 to September 2007, the data of all patients transferred by HEMS were extracted including: Annual number of services, clinical category, number of proper or improper services, and rescue time for HEMS and ground ambulance. The criteria for the properly transferred group included: Death or being operated in the first 24 hours of admission, admission in ICU care units, and transfer of more than three patients in one mission. Others were considered as improper group. RESULTS In this period through 185 flights, 225 victims were transferred. The most common reason of HEMS dispatching was trauma. The most difference of rescue time between ground ambulance and HEMS was recorded in Lamerd that was transferring patients with HEMS needed 3 hours less than ground ambulance. However, in Sarvestan, Dashte-Arjan, and Marvdasht, transferred patients with ground ambulance needed less time than air transfer. Most of transferred patients were from Kazeroon, Nourabad and Lamerd respectively while 46.3% of patients were in the proper group, and the rest were considered as improper group. CONCLUSION Our study revealed that helicopter dispatch to the cities like Lamerd, Lar, Khonj, Abadeh can be more effective, whereas, for the towns like Marvdasht, Dashte-Arjan, Sarvestan, Sepidan, Saadatshar, Tang Abolhayat use of HEMS should be limited to specific conditions. Our study showed inclusion of physicians in the decision making team increased the number of transferred cases.
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Incidents, accidents and fatalities in 40 years of German helicopter emergency medical system operations. Eur J Anaesthesiol 2012; 28:766-73. [PMID: 21760517 DOI: 10.1097/eja.0b013e328348d6a8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Currently, approximately 100 000 helicopter emergency medical service (HEMS) missions for patients are undertaken in Germany each year. Compared to the early years, risk has reduced significantly, but is still higher than commercial aviation or other airborne operations. OBJECTIVE The aim of the present study was to evaluate helicopter accidents and fatalities related to HEMS operations. DESIGN Retrospective study of HEMS accidents in Germany. SETTING Analysis of accidents in the published flight accident reports of the German Federal Agency for Flight Accident Investigation (40-year period from 1970 to 2009). Data were collected by telephone interview with the operators, manual search of publications and by supplemental internet information. MAIN OUTCOME MEASURES Data were analysed per 10 000 missions. For statistical analysis, Fisher[Combining Acute Accent]s exact test was used. A P value less than 0.05 was considered significant. RESULTS During the period analysed, a total of 1.698 million HEMS missions (1970 vs. 2009: 61 vs. 98 471) were flown by a mean of 50 ± 27 (1 vs. 81) helicopters. To date, missions resulted in a total of 99 accidents with a mean of 2.4 ± 1.7 accidents per year (range 0-7). The accident rate was 0.57 (0-11.4) per 10 000 missions and the fatal accident rate was 0.11 (0-0.5). Some 64% of missions did not result in any injuries to occupants, whereas 19.2% were fatal. From the accidents analysed, 43.4% were due to collision with an obstacle during landing, take-off or hovering. Landing was the phase of flight most often associated with accidents (44.4%). CONCLUSION The present study is the largest on HEMS accidents and the only one analysing an entire 40-year time course beginning with inception. In comparison to previous data, a significantly lower accident rate per 10 000 missions was found. Gathering data on the early years is nearly impossible, and further analysis is required to calculate the risk of fatality or identify injury patterns.
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Taylor CB, Stevenson M, Jan S, Liu B, Tall G, Middleton PM, Fitzharris M, Myburgh J. An investigation into the cost, coverage and activities of Helicopter Emergency Medical Services in the state of New South Wales, Australia. Injury 2011; 42:1088-94. [PMID: 21459379 DOI: 10.1016/j.injury.2011.02.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Revised: 02/18/2011] [Accepted: 02/18/2011] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND CONTEXT Helicopter Emergency Medical Services (HEMS) have been incorporated into modern health systems for their speed and coverage. In the state of New South Wales (NSW), nine HEMS operate from various locations around the state and currently there is no clear picture of their resource implications. The aim of this study was to assess the cost of HEMS in NSW and investigate the factors linked with the variation in the costs, coverage and activities of HEMS. METHODS We undertook a survey of HEMS costs, structures and operations in NSW for the 2008/2009 financial year. Costs were estimated from annual reports and contractual agreements. Data related to the structure and operation of services was obtained by face-to-face interviews, from operational data extracted from individual HEMS, from the NSW Ambulance Computer Aided Despatch system and from the Aeromedical Operations Centre database. In order to estimate population coverage for each HEMS, we used GIS mapping techniques with Australian Bureau of Statistics census information. RESULTS Across HEMS, cost per mission estimates ranged between $9300 and $19,000 and cost per engine hour estimates ranged between $5343 and $15,743. Regarding structural aspects, six HEMS were run by charities or not-for-profit companies (with partial government funding) and three HEMS were run (and fully funded) by the state government through NSW Ambulance. Two HEMS operated as 'hub' services in conjunction with three associated 'satellite' services and in contrast, four services operated independently. Variation also existed between the HEMS in the type of helicopter used, the clinical staffing and the hours of operation. The majority of services undertook both primary scene responses and secondary inter-facility transfers, although the proportion of each type of transport contributing to total operations varied across the services. INTERPRETATION This investigation highlighted the cost of HEMS operations in NSW which in total equated to over $50 million per annum. Across services, we found large variation in the cost estimates which was underscored by variation in the structure and operations of HEMS.
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Affiliation(s)
- Colman B Taylor
- The George Institute for Global Health, Camperdown, NSW, 2050, Australia.
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Sullivent EE, Faul M, Wald MM. Reduced Mortality in Injured Adults Transported by Helicopter Emergency Medical Services. PREHOSP EMERG CARE 2011; 15:295-302. [DOI: 10.3109/10903127.2011.569849] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Taylor CB, Stevenson M, Jan S, Middleton PM, Fitzharris M, Myburgh JA. A systematic review of the costs and benefits of helicopter emergency medical services. Injury 2010; 41:10-20. [PMID: 19853251 DOI: 10.1016/j.injury.2009.09.030] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 09/21/2009] [Accepted: 09/21/2009] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Helicopter emergency medical services (HEMS) are popular in first world health systems despite inconsistent evidence in the scientific literature to support their use. The aim of the current study was to perform a systematic review of economic evaluations of HEMS, in order to determine the economic cost of HEMS and the associated patient-centered benefits. METHOD A systematic review was performed of studies that provided a cost estimate of HEMS. The inclusion criteria consisted of English language articles that estimated both the costs and outcomes of a HEMS and fulfilled pre-specified criteria in relation to a cost analysis, cost-minimisation, cost-effectiveness or cost-benefit evaluation. Identified studies were synthesised according to the patient diagnosis (trauma, non-trauma or non-specific) and the type of HEMS transport under review (primary scene retrieval or secondary inter-facility transport). All costs were converted to US dollars and indexed for inflation. RESULTS Fifteen studies met the inclusion criteria. Among all studies the annual cost of HEMS ranged from $115,777 to $5,571,578. Five studies showed HEMS to be a more expensive transport alternative without an associated benefit while eight studies provided cost-effectiveness ratios of $3292 and $2227 per life year saved for trauma, $3258 per life saved and $7138 and $12,022 per quality adjusted life year for non-trauma and $30,365 and $91,478 per beneficial mission for non-specific patient populations. One study also evaluated the cost of HEMS to societal benefit, producing a ratio of 1:6. INTERPRETATION The cost and effectiveness of HEMS varied considerably between studies. Despite generally being more expensive than ground transport, a number of studies found HEMS to be cost-effective. However, given the variation in the intervention design, context and study methods between studies it was not possible to assess the cost-effectiveness of HEMS in general. Given the variation inherent in the health systems in which HEMS operate, synthesis and extrapolation of study findings across differing health environments is difficult. To address economic and clinical evidence in relation to HEMS, future research that is tailored to account for local system factors is required.
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Affiliation(s)
- Colman B Taylor
- The George Institute for International Health, Sydney, NSW, Australia.
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Bellini C. An historical perspective of early Italian air medical transport. Air Med J 2008; 27:286-292. [PMID: 18992688 DOI: 10.1016/j.amj.2008.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2007] [Revised: 04/22/2008] [Accepted: 07/16/2008] [Indexed: 05/27/2023]
Abstract
The early times of aviation medicine were dominated by military actions and needs. This article describes the pioneering era of Italian air medical transport during the period between World War I and early World War II.
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Affiliation(s)
- Carlo Bellini
- Neonatal Intensive Care Unit and Department of Pediatrics, University of Genoa, G. Gaslini Institute, Genoa, Italy.
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Aeromedical retrieval for critical clinical conditions: 12 years of experience with the Royal Flying Doctor Service, Queensland, Australia. J Emerg Med 2008; 36:363-8. [PMID: 18814993 DOI: 10.1016/j.jemermed.2008.02.057] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Revised: 02/07/2008] [Accepted: 02/18/2008] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Royal Flying Doctor Service (RFDS) has been providing emergency aeromedical retrieval services in Queensland, Australia since 1928. STUDY OBJECTIVES This article details service and delivery structure plus a description of 12 years of experience managing patients with critical clinical conditions. METHODS This study is a retrospective longitudinal analysis of the demographics and diagnostic classification of all cases of critical clinical severity conducted March 1, 1994 through February 28, 2006. RESULTS There were a total of 72,054 retrievals, with trauma the single most common clinical diagnosis. There were 4259 retrievals for patients with critical clinical conditions (6%). The most common categories of clinical diagnosis were: trauma with 1493 (35.1%), respiratory diseases 1386 (32.5%), and circulatory diseases 908 (21.3%). Trauma accounted for 69 of the 90 (77%) primary retrievals from locations without health care facilities. The death rate in transport was 1%, with most of these involving males from locations with minimal health facilities. CONCLUSION The RFDS in Queensland is an effective provider of fixed-wing aeromedical retrieval services, operating in an unusual environment with vast distances, low population density, and a high number of Indigenous people.
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Abstract
OBJECTIVE To review the indications and outcomes of pregnant women requiring emergency air transfer to the Women's Hospital, IWK Health Centre, Halifax, Nova Scotia. METHODS A two-year (2003 and 2004) review of all antenatal and intrapartum air transfers to the Women's Hospital, IWK Health Centre, Halifax, via the Nova Scotia Department of Health Emergency Health Services (EHS) LifeFlight Program. Charts were reviewed for indications for maternal transfer and perinatal outcomes. RESULTS There were 121 maternal air transfers, representing 1.3% of all deliveries at the Women's Hospital. The primary reasons for transfer were threatened preterm labour (PTL) (41%); preterm premature rupture of the membranes (PPROM) (21%); hypertensive disease/hemolysis, elevated liver enzymes, and low platelets (HELLP) (16.5%); antepartum hemorrhage (13%); and others (8.5%). Of the women transferred, 63% delivered at the Women's Hospital, and 37% returned for delivery to their home hospital. Women transferred for threatened PTL were significantly less likely than those transferred for all other reasons to need delivery at the Women's Hospital (RR 0.44 [0.30-0.65], P < 0.0001). CONCLUSION In almost two thirds of cases, the indications for emergency air transport of pregnant women are threatened PTL or PPROM. The application of fetal fibronectin testing in cases of suspected PTL has the potential to reduce the need for maternal air transfer.
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Affiliation(s)
- Louai Jony
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS
| | - Thomas F Baskett
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS
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Caldow SJ, Parke TRJ, Graham CA, Munro PT. Aeromedical retrieval to a university hospital emergency department in Scotland. Emerg Med J 2005; 22:53-5. [PMID: 15611548 PMCID: PMC1726520 DOI: 10.1136/emj.2004.016618] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Rural and island areas of Scotland benefit from the availability of the Scottish Ambulance Service paramedic staffed helicopter for transfers and primary scene responses. There are a small number of patients who require advanced airway management, invasive procedures, or critical care interventions to stabilise them before transport to definitive care. At present these additional skills are provided on an ad hoc basis by senior medical staff drawn from intensive care and emergency medicine at the receiving hospitals. Given the potential difficulties of training paramedics to use these infrequently used skills it may be preferable to establish a formalised system to access suitably trained medical staff. This case series illustrates the clinical challenges and potential benefits of such a service and discusses the practicalities involved.
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Affiliation(s)
- S J Caldow
- Department of Accident and Emergency Medicine, Southern General Hospital, Glasgow G51 4TF, UK
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Semonin-Holleran R. Flight nursing: providing patient care during air transport. ACCIDENT AND EMERGENCY NURSING 1994; 2:134-9. [PMID: 7953844 DOI: 10.1016/0965-2302(94)90159-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Stone CK. The air medical crew: is a flight physician necessary? THE JOURNAL OF AIR MEDICAL TRANSPORT 1991; 10:7-10. [PMID: 10115693 DOI: 10.1016/s1046-9095(05)80502-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The configuration of the air medical crew has been debated since the inception of hospital-based programs in the 1970s. Today, the majority of programs use non-physician crew members with a nurse/paramedic mix as the most common team. The medical literature contains little scientific basis to support or reject the use of physicians as crew members. The key to an effective air medical team, despite the configuration, is adequate training and ongoing flight experience. Unless future studies define the role of physicians on the medical team, the air medical crew configuration will be determined by each flight program based on their perception of individual needs and available resources.
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Affiliation(s)
- C K Stone
- East Carolina University School of Medicine, Greenville, N.C
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