Characteristics of patients treated by the Danish Helicopter Emergency Medical Service from 2014-2018: a nationwide population-based study

Abstract

BackgroundA national Helicopter Emergency Medical Service (HEMS) was introduced in Denmark in 2014 to ensure the availability of physician-led critical care for all patients regardless of location.Appropriate dispatch of HEMS is known to be complex, and resource utilisation is a highly relevant topic. Population-based studies on patient characteristics are fundamental when evaluating and optimising a system. The aim of this study was to describe the patient population treated by the Danish HEMS in terms of demographics, pre-hospital diagnostics, severity of illness or injury, and the critical care interventions performed.MethodThe study is a retrospective nationwide population-based study based on data gathered from the Danish HEMS database. We included primary missions resulting in a patient encounter registered between October 1st 2014 and April 30th 2018.ResultsOf 13.391 dispatches registered in the study period we included 7133 (53%) primary missions with patient encounter: 4639 patients were air lifted to hospital, 174 patients were escorted to hospital by the HEMS physician in an ambulance, and in 2320 cases HEMS assisted the ground crew on scene but did not escort the patient to hospital. Patient age ranged from 0-99 years and 64% of the population were men. The median age was 60 years.The main diagnostic groups were cardio-vascular emergencies (41%), trauma (23%) and neurological emergencies (16%). In 61% of the cases, the patient was critically ill/injured corresponding to a NACA (National Advisory Committee for Aeronautics) score between 4 and 7 (both included). In more than one third of the missions a critical care intervention was performed. Ultrasound examination and endo-tracheal intubation were the critical care interventions most frequently performed (21% and 20%, respectively).ConclusionThe national Danish HEMS primarily attends severely ill or injured patients and often perform critical care interventions. In addition, the Danish HEMS provides rapid transport to highly specialised treatment for patients in the more rural parts of the country.Patients with cardio-vascular emergencies, trauma and neurological emergencies are among those patient groups most commonly seen.We conclude that the overall dispatch profile appears appropriate but emphasise that continuous development and refinement is essential.

Mortality and hospitalisation in the Danish Helicopter Emergency Medical Service (HEMS) population from 2014 to 2018: a national population-based study of HEMS triage

“…This is supported by a recent study where we demonstrated that patients escorted by HEMS had an increased severity score and more often had a critical care intervention performed compared with the assisted patients. 3 …”

“…This is supported by a recent study where we demonstrated that patients escorted by HEMS had an increased severity score and more often had a critical care intervention performed compared with the assisted patients. 3 Although the mortality at day 30 and day 365 among the assisted patients were lower compared with the airlifted patients, it was a surprise that the mortality at day 1 did not differ significantly between the two groups. The reason for this is unknown and needs to be further explored, but it should be noted that not all emergency conditions require air transportation to a university hospital even though they may be critically unwell, and hence, the patients might be correctly triaged to a DGH.…”

“…Previous studies have shown that a substantial proportion of HEMS missions are cancelled before the team arrives at the patient. [1][2][3] Little is known, however, about patient outcomes in cases where HEMS is cancelled en route. 4 In addition, some patients seen by the HEMS team are left to be handled by the ground emergency medical service (EMS) units instead of being airlifted to hospital.…”

“…In a recent study of the Danish HEMS, we found that missions where the HEMS team had patient contact represented roughly 60% of the dispatches. 3 Among these, two-thirds of the patients were airlifted to hospital. The impact of this clinical decision-making and triage by the HEMS team is not well studied.…”

Association of Helicopter vs Ground Emergency Medical Transportation With 1-Year Mortality in Denmark

“…We previously found 5 that approximately two-thirds of patients attended to by physician-paramedic–staffed Danish HEMS have severe illness or injury and that the diagnostic groups most commonly seen consist of patients with time-critical conditions, such as cardiovascular emergencies, neurovascular emergencies, and severe trauma. Furthermore, we found 5 that 14% of HEMS dispatches are rejected mainly owing to weather conditions below minimal HEMS operating requirements. Consequently, a group of patients triaged by the emergency medical dispatch centers (EMDCs) to be in need of HEMS was left to be attended solely by ground EMS (GEMS) units.…”