Treatment, Transport, and Primary Care Involvement when Helicopter Emergency Medical Services Are Inaccessible: a Retrospective Study

Overview

Journal Scand J Prim Health Care

Specialty Public Health

Date 2018 Oct 10

PMID 30296878

Citations 3

Authors

Dag Stale Nystoyl

Steinar Hunskaar

Hans Johan Breidablik

Oyvind Osteras

Erik Zakariassen

Affiliations

Soon will be listed here.

Abstract

Objective: To examine handling of cancelled helicopter emergency medical services (HEMS) missions with a persisting medical indication.

Design: Retrospective observational study.

Setting And Subjects: Cancelled HEMS missions with persisting medical indication within Sogn og Fjordane county in Norway during the period of 2010-2013. Both primary and secondary missions were included.

Main Outcome Measures: Primary care involvement, treatment and cooperation within the prehospital system.

Results: Our analysis included 172 missions with 180 patients. Two-thirds of the patients (118/180) were from primary missions. In 95% (112/118) of primary missions, GPs were alerted, and they examined 62% (70/112) of these patients. Among the patients examined by a GP, 30% (21/70) were accompanied by a GP during transport to hospital. GP involvement did not differ according to time of day (p = 0.601), diagnostic group (p = 0.309), or patient's age (p = 0.409). In 41% of primary missions, the patients received no treatment or oxygen only during transport. Among the secondary missions, 10% (6/62) of patients were intubated or received non-invasive ventilation and were accompanied by a physician or nurse anaesthetist during transport.

Conclusions: Ambulance workers and GPs have an important role when HEMS is unavailable. Our findings indicated good collaboration among the prehospital personnel. Many of the patients were provided minimal or no treatment, and treatment did not differ according to GP involvement. Key Points Knowledge about handling and involvement of prehospital services in cancelled helicopter emergency medical services (HEMS) missions are scarce. Ambulance workers and general practitioners have an important role when HEMS is unavailable Minimal or no treatment was given to a large amount of the patients, regardless of which health personnel who encountered the patient.

Citing Articles

GP roles in emergency medical services: a systematic mapping review and narrative synthesis.

Burrell A, Scrimgeour G, Booker M BJGP Open. 2023; 7(2).

PMID: 36931699 PMC: 10354392. DOI: 10.3399/BJGPO.2023.0002.

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

Nystoyl D, Roislien J, Osteras O, Hunskaar S, Breidablik H, Zakariassen E BMC Emerg Med. 2020; 20(1):88.

PMID: 33138780 PMC: 7607704. DOI: 10.1186/s12873-020-00377-0.

Loss of life years due to unavailable helicopter emergency medical service: a single base study from a rural area of Norway.

Zakariassen E, Osteras O, Nystoyl D, Breidablik H, Solheim E, Brattebo G Scand J Prim Health Care. 2019; 37(2):233-241.

PMID: 31033360 PMC: 6566894. DOI: 10.1080/02813432.2019.1608056.

References

Hotvedt R, Kristiansen I . Doctor-staffed ambulance helicopters: to what extent can the general practitioner replace the anaesthesiologist?. Br J Gen Pract. 2000; 50(450):41-2. PMC: 1313609. View

Lossius H, Soreide E, Hotvedt R, Hapnes S, Eielsen O, Forde O . Prehospital advanced life support provided by specially trained physicians: is there a benefit in terms of life years gained?. Acta Anaesthesiol Scand. 2002; 46(7):771-8. DOI: 10.1034/j.1399-6576.2002.460703.x. View

Nielsen E, Ulvik A, Carlsen A, Rannestad B . When is an anesthesiologist needed in a helicopter emergency medical service in northern Norway?. Acta Anaesthesiol Scand. 2002; 46(7):785-8. DOI: 10.1034/j.1399-6576.2002.460705.x. View

Huibers L, Giesen P, Wensing M, Grol R . Out-of-hours care in western countries: assessment of different organizational models. BMC Health Serv Res. 2009; 9:105. PMC: 2717955. DOI: 10.1186/1472-6963-9-105. View

Zakariassen E, Hunskaar S . Involvement in emergency situations by primary care doctors on-call in Norway--a prospective population-based observational study. BMC Emerg Med. 2010; 10:5. PMC: 2848227. DOI: 10.1186/1471-227X-10-5. View

Brown J, Stassen N, Bankey P, Sangosanya A, Cheng J, Gestring M . Helicopters and the civilian trauma system: national utilization patterns demonstrate improved outcomes after traumatic injury. J Trauma. 2010; 69(5):1030-4. DOI: 10.1097/TA.0b013e3181f6f450. View

Galvagno Jr S, Haut E, Zafar S, Millin M, Efron D, Koenig Jr G . Association between helicopter vs ground emergency medical services and survival for adults with major trauma. JAMA. 2012; 307(15):1602-1610. PMC: 3684156. DOI: 10.1001/jama.2012.467. View

Ellensen E, Hunskaar S, Wisborg T, Zakariassen E . Variations in contact patterns and dispatch guideline adherence between Norwegian emergency medical communication centres--a cross-sectional study. Scand J Trauma Resusc Emerg Med. 2014; 22:2. PMC: 3892008. DOI: 10.1186/1757-7241-22-2. View

Leutgeb R, Walker N, Remmen R, Klemenc-Ketis Z, Szecsenyi J, Laux G . On a European collaboration to identify organizational models, potential shortcomings and improvement options in out-of-hours primary health care. Eur J Gen Pract. 2014; 20(3):233-7. DOI: 10.3109/13814788.2014.887069. View

10.

Hjortdahl M, Zakariassen E, Wisborg T . The role of general practitioners in the pre hospital setting, as experienced by emergency medicine technicians: a qualitative study. Scand J Trauma Resusc Emerg Med. 2014; 22:47. PMC: 4237950. DOI: 10.1186/s13049-014-0047-1. View

11.

Zakariassen E, Uleberg O, Roislien J . Helicopter emergency medical services response times in norway: do they matter?. Air Med J. 2015; 34(2):98-103. DOI: 10.1016/j.amj.2014.11.003. View

12.

Den Hartog D, Romeo J, Ringburg A, Verhofstad M, Van Lieshout E . Survival benefit of physician-staffed Helicopter Emergency Medical Services (HEMS) assistance for severely injured patients. Injury. 2015; 46(7):1281-6. DOI: 10.1016/j.injury.2015.04.013. View

13.

Zakariassen E, Hunskaar S . Correction: Involvement in emergency situations by primary care doctors on-call in Norway--a prospective population-based observational study. BMC Emerg Med. 2015; 12:5. PMC: 3505150. DOI: 10.1186/1471-227X-12-5. View

14.

Brown J, Gestring M, Guyette F, Rosengart M, Stassen N, Forsythe R . Helicopter transport improves survival following injury in the absence of a time-saving advantage. Surgery. 2015; 159(3):947-59. PMC: 4744536. DOI: 10.1016/j.surg.2015.09.015. View

15.

Galvagno Jr S, Sikorski R, Hirshon J, Floccare D, Stephens C, Beecher D . Helicopter emergency medical services for adults with major trauma. Cochrane Database Syst Rev. 2015; (12):CD009228. PMC: 8627175. DOI: 10.1002/14651858.CD009228.pub3. View

16.

Osteras O, Brattebo G, Heltne J . Helicopter-based emergency medical services for a sparsely populated region: A study of 42,500 dispatches. Acta Anaesthesiol Scand. 2016; 60(5):659-67. PMC: 5064740. DOI: 10.1111/aas.12673. View

17.

Pakkanen T, Virkkunen I, Kamarainen A, Huhtala H, Silfvast T, Virta J . Pre-hospital severe traumatic brain injury - comparison of outcome in paramedic versus physician staffed emergency medical services. Scand J Trauma Resusc Emerg Med. 2016; 24:62. PMC: 4850640. DOI: 10.1186/s13049-016-0256-x. View

18.

Hjortdahl M, Halvorsen P, Risor M . Rural GPs' attitudes toward participating in emergency medicine: a qualitative study. Scand J Prim Health Care. 2016; 34(4):377-384. PMC: 5217286. DOI: 10.1080/02813432.2016.1249047. View

19.

Christensen E, Berlac P, Nielsen H, Christiansen C . The Danish quality database for prehospital emergency medical services. Clin Epidemiol. 2016; 8:667-671. PMC: 5098515. DOI: 10.2147/CLEP.S100919. View

20.

Hotvedt R, Kristiansen I, Forde O, Thoner J, Almdahl S, Bjorsvik G . Which groups of patients benefit from helicopter evacuation?. Lancet. 1996; 347(9012):1362-6. DOI: 10.1016/s0140-6736(96)91010-7. View