Helicopter Emergency Medical Services: effects, costs and benefits

Advanced prehospital medical care with air transport was introduced in the Netherlands in May 1995. The fi rst helicopter Mobile Medical Team, also called Helicopter Emergency Medical Service (HEMS) was a joint venture initiative of the VU Medical Center in Amsterdam and the Algemene Nederlandse WielrijdersBond (ANWB). The medical team consisted of a trauma surgeon or anaesthesiologist and a specialised trauma nurse, whereas, the ANWB Medical Air Assistance (MAA) helicopter company supported the prehospital medical care by providing a helicopter and a helicopter pilot. The HEMS team was on stand-by during daylight hours, from 7.00 – 19.00 hours, and able to take off within 2 minutes after an emergency call. This provisional Helicopter Emergency Service was connected to a study on cost-effectiveness from 1995 till 1998. In this study the cost-effectiveness of HEMS was established f

Inventarisatiestudie naar de behoefte aan assistentie door het Mobiel Medisch Team in de avond en nacht

Samenvatting Inleiding: Tot 2005 kon men uitsluitend gedurende de dag een beroep doen op professionele aanvullende prehospitale hulpverlening. In 2005 ontstond een voor Nederland unieke situatie waarbij het Mobiel Medisch Team (MMT) ook ’s nacht paraat inzetbaar was. Het doel van deze studie was inzicht te krijgen in de kwantitatieve en kwalitatieve aspecten van grondgebonden MMT inzetten in de nacht, tussen 19.00 en 7.00 uur. Methode: In een beschrijvend cohortonderzoek werden alle patiënten waarvoor in 2005 tussen 19.00 en 7.00 uur MMT-assistentie werd gevraagd in de regio Zuid West Nederland geïncludeerd. Van de geïncludeerde patiënten werden prospectief (pre)hospitale data gedocumenteerd, en na 1 jaar geanalyseerd. Resultaten: Gedurende de studieperiode werd in de avond en nacht 235 keer om assistentie gevraagd, waarvan 69 aanvragen werden geannuleerd. Zevenenzestig procent van deze nachtelijke inzetten vond plaats op basis van de inzetcriteria die gebaseerd zijn op de aard van het ongeval, en 33% op basis van de toestand van de patiënt. Drieënzestig procent van de inzetten vond plaats tussen 19.00 uur en middernacht. De mediane Injury Severity Score was 10 (4-25) met een mortaliteit van 16 %. Drieëntwintig procent van de patiënten werd geïntubeerd. Conclusie: Deze studie laat zien dat er ook gedurende de avond en nacht aanzienlijke behoefte is aan gespecialiseerde medische hulp ter aanvulling op de ambulancezorg. De kwalitatieve behoefte aan zorg is vergelijkbaar met de zorgvraag overdag. Het handelen van het nachtelijk grondgebonden MMT was potentieel levensreddend. Extrapolatie van deze regionale resultaten levert een behoefteraming op van jaarlijks 505 daadwerkelijke MMT assistenties in heel Nederland tussen 19.00 uur en 7.00 uur

Accuracy of conventional imaging of penetrating torso injuries in the trauma resuscitation room

Chest X-ray (CXR), abdominal ultrasound, cardiac ultrasound, and abdominal X-ray are the most frequently used imaging modalities to radiologically evaluate patients with penetrating torso trauma. The aim of this study was to evaluate the accuracy of these imaging modalities. From January 2001 until January 2005, all consecutive patients with penetrating torso injuries presenting at the emergency department of a level 1 trauma center were included. Imaging modalities (chest/abdominal X-ray, abdominal/cardiac ultrasound), were compared retrospectively with a 'gold standard' (i.e. computed tomography or surgery within 2 h after arrival) or outcome of conservative treatment. The accuracy of the imaging modalities was calculated. Three hundred and eighteen patients were included. On the basis of 299 CXRs, the sensitivity for diagno

Survival benefit of physician-staffed Helicopter Emergency Medical Services (HEMS) assistance for severely injured patients

Background: Physician-staffed Helicopter Emergency Medical Services (HEMS) provide specialist medical care to the accident scene and aim to improve survival of severely injured patients. Previous studies were often underpowered and showed heterogeneous results, leaving the subject at debate. The aim of this retrospective, adequately powered, observational study was to determine the effect of physician-staffed HEMS assistance on survival of severely injured patients. Methods: All consecutive severely injured trauma patients (ISS >15) between October 1, 2000 and February 28, 2013 were included. Assistance of physician-staffed HEMS was compared with assistance from the ambulance paramedic crew (i.e., EMS group) only. A regression model was constructed for calculating the expected survival and survival benefit. Results: A total of 3543 polytraumatised patients with an ISS >15 were treated at the Emergency Department, of whom 2176 patients remained for analysis; 1495 (69%) were treated by EMS only and 681 (31%) patients received additional pre-hospital care of HEMS. The model with the best fit and diagnostic properties (H–L coefficient 2.959, p = 0.937; AUC 0.888; PPV 71.4%; NPV 88.0%) calculated that 36 additional patients survived because of HEMS assistance. This resulted in an average of 5.33 additional lives saved per 100 HEMS dispatches for severely injured patients. Conclusion

Helicopter emergency medical services (HEMS): Impact on on-scene times

BACKGROUND: This study compared prehospital on-scene times (OSTs) for patients treated by nurse-staffed emergency medical services (EMS) with OST for patients treated by a combination of EMS and physician-staffed helicopter emergency medical services (HEMS). A secondary aim was to investigate the relationship between length of OST and mortality. METHODS: All trauma patients treated in the priority 1 emergency room of a Level I trauma center between January 2002 and 2004 were included in the study. To determine OST and outcome, hospital and prehospital data were entered into the trauma registry. OSTs for EMS and combined EMS/HEMS-treated patients were compared using linear regression analysis. Logistic regression analysis was used to compare mortality rates. RESULTS: The number of trauma patients included for analysis was 1,457. Of these, 1,197 received EMS assistance only, whereas 260 patients received additional care by an HEMS physician. HEMS patients had longer mean OSTs (35.4 vs. 24.6 minutes; p < 0.001) and higher Injury Severity Scores (24 vs. 9; p < 0.001). After correction for patient and trauma characteristics, like the Revised Trauma Score, age, Injury Severity Scores, daytime/night-time, and mechanism of trauma, the difference in OSTs between the groups was 9 minutes (p < 0.001). Logistic regression analyses showed a higher uncorrected chance of dying with increasing OST by 10 minutes (OR, 1.2; p < 0.001). This apparent effect of OST on mortality was explained by patient and trauma characteristics (adjusted OR, 1.0; p = 0.89). CONCLUSIONS: Combined EMS/HE

Lives Saved by Helicopter Emergency Medical Services: An Overview of Literature

Introduction: The objective of this review is to give an overview of literature on the survival benefits of Helicopter Emergency Medical Services (HEMS). The included studies were assessed by study design and statistical methodology. Methods: A literature search was performed in the National Library of Medicine's Medline database, extending from 1985 until April 2007. Manuscripts had to be written in English and describe effects of HEMS on survival expressed in number of lives saved. Moreover, analysis had to be performed using adequate adjustment for differences in case-mix. Results: Sixteen publications met the inclusion criteria. All indicated that HEMS assistance contributed to increased survival: Between 1.1 and 12.1 additional survivors were recorded for every 100 HEMS uses. A combination of four reliable studies shows overall mortality reduction of 2.7 additional lives saved per 100 HEMS deployments. Conclusion: Literature shows a clear positive effect on survival associated with HEMS assistance. Efforts should be made to promote consistent methodology, including uniform outcome parameters, in order to provide sufficient scientific evidence to conclude the ongoing debate about the beneficial effects of HEMS

Validity of helicopter emergency medical services dispatch criteria for traumatic injuries: A systematic review

Objective. This review provides an overview of the validity of Helicopter Emergency Medical Services (HEMS) dispatch criteria for severely injured patients. Methods. A systematic literature search was performed. English written and peer-reviewed publications on HEMS dispatch criteria were included. Results. Thirty-four publications were included. Five manuscripts discussed accuracy of HEMS dispatch cr

Prehospital interventions: Time wasted or time saved? An observational cohort study management in initial trauma care

Objective: Preclinical actions in the primary assessment of victims of blunt trauma may prolong the time to definitive clinical care. Th

Voorspellende factoren van functionele beperkingen na ernstig letsel

OBJECTIVE: To assess the health-related quality of life and prognostic factors of disability in survivors of severe trauma one year after injury. DESIGN:Prospective cohort study. METHOD: All severely-injured trauma patients presenting at a level I trauma centre during a 30-month period and surviving 30 days after admission were included. The EuroQol-5D (EQ-5D) and Health Utilities Index (HUI) were used to determine the health status 12 months after injury. RESULTS: 362 patients were included during the study period, 246 of whom returned the follow-up assessments (response rate: 68%). The median EQ-5D utility score was 0.73 (EQ-5D Dutch general population norm: 0.88). The HUI2, HUI3 and EQ-5D Visual Analogue Scale scores were 0.81, 0.65 and 70, respectively. One year after trauma only 22% of the patients reported no functional limitation in the 5 domains of the EQ-D5. Females and patients with co-morbidity at the time of the injury had a higher risk of low scores after 1 year. CONCLUSION: One year after severe injury, the functional outcome and quality of life of trauma patients were far from normalized. Female gender and comorbidity were predictors of poorer functional outcome

Willingness to pay for lives saved by helicopter emergency medical services

Introduction. Currently, policy makers in the Netherlands are discussing the possibility to expand the availability of Helicopter Emergency Medical Services (HEMS) from 12 hours to 24 hours per day. For this, the preferences of the general public towards both the positive effects and negative consequences of HEMS should be taken into account. Therefore, the willingness to pay (WTP) for lives saved by HEMS was calculated. Methods. A discrete choice experiment (DCE) was performed in order to explore the preferences of respondents towards (expansion of) HEMS availability. The attributes: costs (for HEMS) per household number of additional lives saved (by HEMS), number of noise disturbances (caused by HEMS) during day time or night time were used. A written questionnaire was presented to 150 individuals by convenience sampling. Result. One hundred and thirty-six (91%) of the 150 individuals completed the DCE questionnaire. The marginal WTP for one additional life saved (in a month) was 3.43 (95% CI; 2.96-3.90) per month per household. Overall, the WTP for expansion to a 24-hour availability of HEMS can therefore be estimated at 12.29 (∼ US$ 17.50) per household per month. Conclusion. The WTP derived from this study is by far exceeding the 1-1.5 Million-euro necessary per HEMS per year for the expansion from a daytime HEMS to a 24-h availability in the Netherlands. Respondents are willing to pay for lives saved by HEMS in spite of increases in flights and concurrent noise disturbances. These results may be helpful for the decision-making process,