Appropriate and Safe Utilization of Helicopter Emergency Medical Services: A Joint Position Statement with Resource Document

Abstract

This position statement with accompanying resource document is the result of a collaborative effort of a writing group comprised of members of the Air Medical Physician Association (AMPA), the American College of Emergency Physicians (ACEP), the National Association of EMS Physicians (NAEMSP), and the American Academy of Emergency Medicine (AAEM). This document has been jointly approved by the boards of all four organizations. Patients benefit from the appropriate utilization of helicopter emergency medical services (HEMS). EMS and regional health care systems must have and follow guidelines for HEMS utilization to facilitate proper patient selection and ensure clinical benefit. Clinical benefit can be provided by Meaningfully shortening the time to delivery of definitive care to patients with time-sensitive medical conditions Providing necessary specialized medical expertise or equipment to patients before and/or during transport Providing transport to patients inaccessible by other means of transport The decision to use HEMS is a medical decision, separate from the aviation determination whether a transport can be completed safely. Physicians with specialized training and experience in EMS and air medical transport must be integral to HEMS utilization decisions, including guideline development and quality improvement activities. Safety management systems must be developed, adopted, and adhered to by air medical operators when making decisions to accept and continue every HEMS transport. HEMS must be fully integrated within the local, regional, and state emergency health care systems. HEMS programs cannot operate independently of the surrounding health care environment. The EMS and health care systems must be involved in the determination of the number of HEMS assets necessary to provide appropriate coverage for their region. Excessive resources may lead to competitive practices that can affect utilization and negatively impact safety. Inadequate resources will delay receipt of definitive care. National guidelines for appropriate utilization of HEMS must be developed. These guidelines should be national in scope yet allow local, regional, and state implementation. A National HEMS Agenda for the Future should be developed to address HEMS utilization and availability and to identify and support a research strategy for ongoing, evidence-based refinement of utilization guidelines.

An analysis of patients transported by a private helicopter emergency medical service in South Africa

“…A helicopter must shorten the time to delivery of care (whether on the scene by skilled aeromedical crew or in hospital) in order to provide any form of benefit to the patient. [2] When comparing the mean on-scene times of both the Netcare 911 HEMS operations with other similarly staffed operations, the mean on-scene times for the Netcare operations were often shorter. [7,20,21] An interesting finding was the similarity between the interfacility transfer and primary transfer on-scene times.…”

“…Some of the time-sensitive pathologies identified in previous studies were traumatic haemorrhage, ST-elevation myocardial infarction, polytrauma, traumatic brain injury, burns, stroke and paediatric emergencies. [2,19] Polytrauma patients and patients with neurological injuries also appear to derive considerable benefit from doctor-based prehospital care. [14] There can be no doubt that a helicopter is an effective option for patients who have time-sensitive pathologies and are situated in remote areas some distance away from definitive care, as the speed of the operation allows for optimal patient outcome.…”

“…[1] HEMS originated in military operations and inspired the idea of dedicated civilian air ambulances. [2,3] The use of civilian helicopters for the transport of ill or injured patients has become an important part of modern emergency care systems. [4] Since the 1970s, there have been a number of different HEMS operations across South Africa (SA) in both the private and public sectors.…”

Helicopter Emergency Medical Services Response Times in Norway: Do They Matter?

“…1 The effect of HEMS is still subject to debate although they have several theoretical advantages, such as bringing advanced medical care and medical competence to the scene, shortening the transport time, providing access to remote areas, and reducing the time elapsed until definitive care is available. [2][3][4] Several outcome studies have found positive associations with increased survival under the care of HEMS, [5][6][7] whereas the opposite effects have also been well documented. 5,8,9 However, many of these studies have been subject to methodological limitations, selection bias, and noncomparable study settings or designs.…”

“…5 A position paper by several American air medical societies initiated the process of establishing national guidelines to facilitate the beneficial effects of HEMS implementation. 4 The paper stated that clinical benefit could be provided by minimizing the time to definitive care in time-sensitive medical conditions, providing necessary competence and equipment on the scene, and accessing patients who are otherwise inaccessible by other modes of transport. 4 These objectives are consistent with national guidelines in other countries.…”