Helicopter Emergency Medical Service Simulation Training in the Extreme: Simulation-based Training in a Mountain Weather Chamber

Knapp

Kreuzer³

et al. 2018

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BackgroundProviding sufficient oxygenation and ventilation is of paramount importance for the survival of emergency patients. Therefore, advanced airway management is one of the core tasks for every rescue team. Endotracheal intubation is the gold standard to secure the airway in the prehospital setting. This review aims to highlight special considerations for advanced airway management preceding human external cargo (HEC) evacuations.MethodsWe systematically searched MEDLINE, EMBASE, and PubMed in August 2017 for articles on airway management and ventilation in patients before hoist or longline operation in HEMS. Relevant reference lists were hand-searched.ResultsThree articles with regard to advanced airway management and five articles concerning the epidemiology of advanced airway management in hoist or longline rescue missions were included. We found one case report regarding ventilation during hoist operations.The exact incidence of advanced airway management before evacuation of a patient by HEC is unknown but seems to be very low (< 5%). There are several hazards which can impede mechanical ventilation of patients during HEC extractions: loss of equipment, hyperventilation, inability to ventilate and consequent hypoxia, as well as inadequacy of monitoring.ConclusionsAdvanced airway management prior to HEC operation is rarely performed. If intubation before helicopter hoist operations (HHO) and human cargo sling (HCS) extraction is considered by the rescue team, a risk/benefit analysis should be performed and a clear standard operating procedure (SOP) should be defined. Continuous and rigorous training including the whole crew is required. An international registry on airway management during HEC extraction would be desirable.

Section: Discussionmentioning

confidence: 99%

Advanced airway management in hoist and longline operations in mountain HEMS – considerations in austere environments: a narrative review This review is endorsed by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM)

Knapp

Kreuzer³

et al. 2018

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“…Medical training, simulation-based or otherwise, depends on local initiative and commitment in most countries. There are a few simulation programs in HEMS that focus on issues like medical skills, NTS or CRM [4,6,7,9]. A study from the Norwegian HEMS showed that HEMS personnel lack simulation-based training and assessment of their NTS [12].…”

Section: Existing Training Optionsmentioning

confidence: 99%

“…6 Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany. 7 Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. 8 School of Medicine, Sigmund Freud University Vienna, Vienna, Austria.…”

Section: Acknowledgementsmentioning

confidence: 99%

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Efficacy and efficiency of indoor nighttime human external cargo mission simulation in a high-fidelity training Centre

Lischke²,

Sollid

et al. 2020

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Background: The human external cargo (HEC) operations conducted by Helicopter Emergency Medical Services (HEMS) rarely take place at night, making it difficult for crew members to attain and maintain the level of expertise needed to perform winch operations in the dark. As EASA requirements for training cannot currently be met, we evaluated whether simulation training could be an option. Methods: This paper reports on a training concept using indoor simulation for the training of nighttime HEC operations. Participants' experience and perceptions were evaluated with a survey and the procedural and economic advantages of the simulation approach were compared with those of the usual outdoor HEC training. Results: Most participants had limited exposure to real-life nighttime HEC missions before undergoing the simulation-based training. The frequency of training cycles in simulation was much higher compared to conventional training (60 cycles indoors vs. 20 outdoors for HEMS-TC, 20 cycles indoors vs. 4 outdoors for MCM). Trainees perceived that their technical and non-technical skills (NTS) improved with the training. The estimated costs of standard outdoor-based nighttime HEC training (138€ per cycle) are at least 6.5 times higher than the costs of indoor simulated training (approximately 21€ per cycle). With a change to simulation, carbon dioxide emissions could potentially be reduced by more than 35 tons. Conclusions: Indoor simulation training of night HEC operations has advantages with regard to cost-effectiveness, environmental friendliness, and self-reported improvements in skills and knowledge. Its use is feasible and could improve crew and patient safety and fulfill regulatory demands for training intensity.

“…Pit stop-like training should be drilled periodically. We encourage these organizations to establish continuous and inter-professional simulation training [20, 21], with a strong emphasis on the safety of any ALS interventions, as well as maneuvers for the HEC extrication of the injured patient. Patient and team member safety in HEC operations is a very important issue.…”

Section: Discussionmentioning

confidence: 99%

Challenges of helicopter mountain rescue missions by human external cargo: need for physicians onsite and comprehensive training

Strapazzon

Ambühl

et al. 2019

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Background Human external cargo (HEC) extrication during helicopter rescue missions is commonly used in mountain emergency medical services. Furthermore, longline or winch operations offer the opportunity to deliver professional medical care onsite. As the safety and quality of emergency medical care depends on training and experience, we aimed to investigate characteristics of mountain rescue missions with HEC. Methods We retrospectively reviewed all rescue missions conducted by Air Zermatt (a commercial rescue service in the high-alpine region of Switzerland) from January 2010 to September 2016. Results Out of 11,078 rescue missions 1137 (10%) required a HEC rescue. In 3% ( n = 29) rapid sequence induction and endotracheal intubation, in 2% ( n = 14) cardiopulmonary resuscitation, and in 0.4% ( n = 3) a chest tube insertion had to be performed onsite prior to HEC extraction. The most common medical intervention onsite is analgesia or analgosedation, in 17% ( n = 142) fentanyl or ketamine was used in doses of ≥ 0.2 mg or ≥ 50 mg, respectively. Conclusions As these interventions have to be performed in challenging terrain, with reduced personnel resources, and limited monitoring, our results point out the need for physicians onsite who are clinically experienced in these procedures and specially and intensively trained for the specific characteristics and challenges of HEC rescue missions.