Evaluating helicopter emergency medical missions: a reliability study of the <scp>HEMS</scp> benefit and <scp>NACA</scp> scores

Raatiniemi, Lasse; Liisanantti, Janne; Tommila, Miretta; Moilanen, Sinikka; Ohtonen, Pasi; Martikainen, Matti; Voipio, Ville; Reitala, Janne; Iirola, Timo

doi:10.1111/aas.12881

Cited by 26 publications

(25 citation statements)

References 23 publications

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“…Complications were defined in accordance with the Utstein airway template detailed by Sollid et al where a complication was defined as occurring due to, but not before, commencement of TI . Injury or illness severity was defined in accordance with the National Advisory Committee for Aeronautics score (NACA‐score) . Scene time was defined as the time from the arrival of the clinicians on scene to departure of the vehicle carrying the patient.…”

Section: Methodsmentioning

confidence: 99%

Checklists in pre‐hospital advanced airway management

Klingberg

Kornhall

Gryth

et al. 2019

Acta Anaesthesiol Scand

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Background In pre‐hospital care, pre‐intubation checklists (PICL) are widely implemented as a safety measure and guidelines support their use. However, the true value of PICL among experienced airway providers is unknown. This study aims to explore possible benefits and disadvantages of PICL in the pre‐hospital setting. Methods We performed a subgroup analysis of a prospective, observational, multicentre study on pre‐hospital advanced airway management in the Nordic countries between May 2015 and November 2016. The original trial was designed to investigate the success rates of pre‐hospital tracheal intubations and the incidence of complications. Our study limited inclusion to drug assisted intubations performed by anaesthesiologists. Intubation success rates and complication rates were plotted against checklist use. Results We analyzed 588 pre‐hospital intubations for medical and traumatic emergencies. Overall, checklists were used in 60.5% of instances. Applying checklists was associated with increased success at first and second intubation attempts. There was no significant difference in the overall success rates (99.4% and 99.1%). Oesophageal misplacement was more common in the No‐PICL group (2.2% vs 0.3%) but otherwise the incidence of airway related complications did not differ between the groups. Scene time was significantly shorter in the No‐PICL group (23.6 vs 27.5 minutes). Conclusion In this retrospective study, checklist use correlated with fewer attempts at intubation when securing the airway. Despite this, we found no association between checklist use and the overall TI success rate or the incidence of serious adverse events. Scene times were shorter without PICL.

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Section: Methodsmentioning

confidence: 99%

Checklists in pre‐hospital advanced airway management

Klingberg

Kornhall

Gryth

et al. 2019

Acta Anaesthesiol Scand

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“…The National Advisory Committee for Aeronautics (NACA, a precursor institution of today’s NASA) score is a scoring system that assesses an emergency patient’s severity of injury or illness by eight levels. [ 22 , 23 ] After it has been originally introduced as a scoring system for trauma patients 24h after admission to a hospital, the modified NACA score presented by Tryba and colleagues in 1980 can be used for pre-hospital injury severity assessment as well. [ 23 , 24 ] The grades of the NACA score and their verbal descriptions (used in their German translation for this study) are provided in Table 1 .…”

Section: Methodsmentioning

confidence: 99%

“…The NACA score well predicts the mortality and the need for ventilation therapy of patients and has substantial inter-rater reliability. [ 22 – 24 ]…”

Section: Methodsmentioning

confidence: 99%

The impact of the patient’s initial NACA score on subjective and physiological indicators of workload during pre-hospital emergency care

et al. 2018

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BackgroundExcessive workload may impair patient safety. However, little is known about emergency care providers’ workload during the treatment of life-threatening cases including cardiopulmonary resuscitation (CPR). Therefore, we tested the hypothesis that subjective and physiological indicators of workload are associated with the patient’s initial NACA score and that workload is particularly high during CPR.MethodsNASA task load index (NASA-tlx) and alarm codes were obtained for 216 sorties of pre-hospital emergency medical care. Furthermore, initial NACA scores of 140 patients were extracted from the physicians’ protocols. The physiological workload indicators mean heart rate (HR) and permutation entropy (PeEn) were calculated for 51 sorties of primary care. General linear mixed models were used to analyze the association of NACA scores with subjective (NASA-tlx) and physiological (mean HR, PeEn) measures of workload.ResultsIn contrast to the physiological variables PeEn (p = 0.10) and HR (p = 0.19), the mental (p<0.001) and temporal demands (p<0.001) as well as the effort (p<0.001) and frustration (p = 0.04) subscale of the NASA-tlx were significantly associated with initial NACA scores. Compared to NACA = I, an initial NACA score of VI (representing CPR) increased workload by a mean of 389.5% (p = 0.001) in the mental and 345.9% (p<0.001) in the temporal demands, effort by a mean of 446,8% (p = 0.002) and frustration by 190.0% (p = 0.03). In line with the increase in NASA-tlx, PeEn increased by 20.6% (p = 0.01) and HR by 6.4% (p = 0.57).ConclusionsPatients’ initial NACA scores are associated with subjective workload. Workload was highest during CPR.

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“…The National Advisory Committee for Aeronautics (NACA) score is used to assess the severity of injuries or diseases and is widely used in Western European countries. The NACA score is an 8-level scale assessing the severity of vital function disorder: NACA 0 -no injury or disease; NACA 1 -body injuries or diseases not requiring medical intervention; NACA 2 -body injuries or diseases requiring medical examination and treatment, but not requiring hospitalisation; NACA 3 -body injuries or diseases not life-threatening, but requiring hospitalisation; NACA 4 -body injuries or diseases which may lead to the deterioration of vital signs; NACA 5 -body injuries or diseases with acute threat to life; NACA 6 -body injuries or diseases leading to sudden cardiac arrest; NACA 7 -body injuries or fatal diseases) [17].…”

Section: Methodsmentioning

confidence: 99%

Missions of the Helicopter Emergency Medical Service in rural and urban areas in Poland – A comparative retrospective analysis

Rzońca¹,

Gałązkowski²,

Wójcik-Fatla³

et al. 2019

Ann Agric Environ Med.

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Introduction. Mortality due to various causes, despite continuous efforts to improve the quality of medical services, is a serious problem for modern healthcare systems. Ischaemic heart disease and stroke are the cause of over 15 million deaths annually, and are therefore known as the world's number one killer. Objective. The aim of this study is to characterise the missions and the most common reasons for dispatching Helicopter Emergency Medical Service (HEMS) crews, with special emphasis on the differences between urban and rural areas. Materials and method. The study was conducted using a retrospective analysis of HEMS missions, including flights to accidents and diseases carried out by HEMS crews in Poland from January 2014-December 2018. The final analysis included 35,213 cases of HEMS missions. Results. The study group consisted mainly of male patients (66.40%), aged 50-64 (22.06%), mean age of the entire analysed group-47.71 (SD: 25.96). The main reason for HEMS missions were strokes (21.63%). Analysis of patients' clinical status revealed that the clinical status of patients treated in rural areas was more severe, which was indicated by the Glasgow Coma Scale-GCS (12.03 vs 12.35) and the Revised Trauma Scale-RTS (10.14 vs 10.60) scores. When assessed by the National Advisory Committee for Aeronautics (NACA) score, body injuries and fatal diseases were observed more often in patients in rural areas (NACA 7 6.12% vs 3.46%) (p<0.05). Conclusions. Multi-organ injuries, head traumas, sudden cardiac arrest, traumatic brain injuries, collapse and epilepsy, were more frequent reasons for HEMS missions in rural areas than in urban areas.

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Evaluating helicopter emergency medical missions: a reliability study of the HEMS benefit and NACA scores

Abstract: The HBS and NACA score had substantial inter-rater reliability. In addition, the rater-against-reference values were acceptable, though large differences were observed between individual raters and references in some clinical cases.

Cited by 26 publications

References 23 publications

Checklists in pre‐hospital advanced airway management

Checklists in pre‐hospital advanced airway management

The impact of the patient’s initial NACA score on subjective and physiological indicators of workload during pre-hospital emergency care

Missions of the Helicopter Emergency Medical Service in rural and urban areas in Poland – A comparative retrospective analysis

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