Incidents, accidents and fatalities in 40 years of German helicopter emergency medical system operations

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'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. Eur J Anaesthesiol 2011;28:766-77

Success rates and endotracheal tube insertion times of experienced emergency physicians using five video laryngoscopes: a randomised trial in a simulated trapped car accident victim

Context No randomised controlled trial has yet compared different video laryngoscopes in respect of the success rates and the time taken to achieve endotracheal intubation in trapped car accident victims. Objective The aim of the present study was to evaluate whether five video laryngoscopes facilitate tracheal intubation more quickly or more securely than conventional laryngoscopy. Design Prospective, controlled, randomised crossover trial. Setting An airway manikin was placed on the driver's seat of a compact car. Access was possible only through the opened driver's door. Participants Twenty-five experienced anaesthetists. Intervention Tracheal intubation in a simulated trapped patient using video laryngoscopes in a typical out-of-hospital setting. Main outcome measures Times to achievement of a view of the glottis, tracheal intubation, cuff inflation, first ventilation and tracheal tube position were compared using a standard Macintosh laryngoscope or Glidescope Ranger, Storz C-MAC, Ambu-Pentax AWS, Airtraq and McGrath Series 5 video laryngoscopes in a randomised order. Wilcoxon signed-rank test and McNemar test were used for statistical analysis. A P value of less than 0.05 was considered statistically significant. Results Twenty-five anaesthetists (35.1 +/- 7.3 years; 16 male, nine female) with an intubation experience of 374 +/- 96 intubations per year and an experience of 9.1 +/- 7.3 years participated. Glottic view, tracheal intubation, cuff inflation and first ventilation were achieved most rapidly with the Macintosh laryngoscope, although the Airtraq and Pentax AWS video laryngoscopes were not significantly slower. Times were significantly longer when the Glidescope Ranger, McGrath Series 5 or Storz C-MAC video laryngoscopes were used (P<0.05), failure to place the endotracheal tube correctly was significantly commoner with the McGrath Series 5 than with the Macintosh (P=0.031). Conclusion When attempting to intubate a trapped car accident victim, video laryngoscopes provide a better view of the glottis, but some delay tracheal intubation significantly. The devices with a tube guide (Airtraq and Ambu Pentax AWS) enable tracheal intubation to be achieved significantly faster and with a lower failure rate than devices without a tube guide. No video laryngoscope outperformed direct laryngoscopy with a Macintosh laryngoscope in this simulation study. Trial registration Clinicaltrials.gov NCT01182740. Eur J Anaesthesiol 2011;28:849-85