Developing a South African Helicopter Emergency Medical Service Activation Screen (SAHAS): A Delphi study

Abstract

Introduction Helicopter Emergency Medical Services (HEMS) are an expensive resource that should be utilised efficiently to optimise the cost-benefit ratio. This is especially true in resource-limited settings, such as South Africa. This may be achieved by implementing call-out criteria that are most appropriate to the healthcare system in which HEMS operate. Currently, there are no published evidence-based HEMS call-out criteria developed for South Africa. By identifying patients that are most likely to benefit from HEMS, their utilisation can be enhanced and adjusted to ensure optimal patient outcome. We aimed to systematically utilise expert opinions to reach consensus on HEMS call-out criteria that are contextual to the South African setting. Methods A modified Delphi technique was used to develop call-out criteria, using current literature as the basis of the study. Purposive, snowball sampling was employed to identify a sample of 118 participants locally and internationally, of which 42 participated for all three rounds. Using an online survey platform, binary agreement/disagreement with each criterion was sought. Acceptable consensus was set at 75%. Statements were sent out in the third round ascertaining whether participants agreed with the analysis of the first two rounds. Results After two rounds, consensus was obtained for 63% (36/57) of criteria, while 64% of generated statements received consensus in the third round. Results emphasised the opinion that HEMS dispatch criteria relating to patient condition and incident locations were preferential to a comprehensive list. Through collation of these results and international literature, we present an initial concept for a South African HEMS Activation Screen (SAHAS), favouring inquiry on a case-by-case basis. Discussion The combination of existing literature and participant opinions, established that call-out criteria are most efficient when based on clinical parameters and geographic considerations, as opposed to a specified list of criteria. The initial concept of our SAHAS should be investigated further.

A descriptive study of trauma patients transported by helicopter emergency medical services to a level one trauma centre

“…HEMS is an expensive service to operate, more so in a LMIC like South Africa, thus an appropriate call-out criterion is essential in improving the cost-effectiveness of this particular service [9] . It is only recently that a body of work was developed by Laatz et al.…”

“…It is only recently that a body of work was developed by Laatz et al. using a modified Delphi technique, with experts in the field, to develop the call-out criteria for the South African context, however the criteria is yet to be validated and accepted in South Africa [9] .…”

“…HEMS is considered an expensive yet invaluable asset in the pre-hospital environment for the transport of time sensitive trauma related emergencies as time to definitive treatment is key in trauma care, with the concept of the “Golden Hour” referring to the timely early management of trauma patients [9] thus we have sought to review the impact of HEMS in the management of trauma at the IALCH trauma centre, which is the only accredited level one trauma centre in the Public sector in the Province.…”

Pre-Hospital Early Warning Scores are Associated with Requirement for Medical Retrieval Services

“…(16) This clinical services provision gap contributes to delays for accessing specialist and tertiary services. (17) Retrieval medicine -the transfer of patients by specialised clinical staff utilising road-based and aeromedical platforms -provides a vital link to critical medical services, particularly for those in rural and remote locations. (18,19) The decision-making process to activate retrieval services is complex, with consideration given to presenting pathology, physiological instability, comorbidities, local availability of medical services, geography, weather and availability of retrieval resources.…”

“…(18,19) The decision-making process to activate retrieval services is complex, with consideration given to presenting pathology, physiological instability, comorbidities, local availability of medical services, geography, weather and availability of retrieval resources. (17,19) Several hours can elapse from patient presentation to decision to transfer to another facility. These delays can have a deleterious effect on patient outcomes, as well as complicating tasking decisions due to the limited availability of retrieval resources.…”