BackgroundHelicopter emergency medical services (HEMS) are a useful means of reducing inequity of access to specialist emergency care. The aim of this study was to evaluate the variations in HEMS provision across Europe, in order to inform the further development of emergency care systems.MethodsThis is a survey of primary HEMS in the 32 countries of the European Economic Area and Switzerland. Information was gathered through internet searches (May to September 2016), and by emailing service providers, requesting verification and completion of data (September 2016 to July 2017). HEMS provision was calculated as helicopters per million population and per 1000 km2 land area, by day and by night, and per US$10 billion of gross domestic product (GDP), for each country.ResultsIn 2016, the smallest and least prosperous countries had no dedicated HEMS provision. Luxembourg had the highest number of helicopters by area and population, day and night. Alpine countries had high daytime HEMS coverage and Scandinavia had good night-time coverage. Most helicopters carried a doctor. Funding of services varied from public to charitable and private. Most services performed both primary (from the scene) and secondary (interfacility) missions.ConclusionsWithin Europe, there is a large variation in the number of helicopters available for emergency care, regardless of whether assessed with reference to population, land area or GDP. Funding of services varied, and did not seem to be clearly related to the availability of HEMS.
From a total of 248 cases of cholecystectomy, 36 were found to be without stones. These cases of acalculous cholecystitis have been reviewed with regard to signs, symptoms and radiological investigations. The complications of operative treatment have been documented and the etiology of the condition discussed. As a result of favourable outcome of operative treatment in these patients, it is suggested that surgery should be considered even in the absence of positive radiological findings at an earlier date.
Isolated internal iliac artery aneurysm is a rare condition with limited evidence in the literature to support management strategy. Repair has traditionally been associated with significant morbidity. However advances in endovascular technique offer the potential for new treatment options. We report our experience of using an off-label device for endovascular repair of an isolated internal iliac artery aneurysm.
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