Helicopter emergency medical services missions to islands and the mainland during a 3-year period in Denmark: a population-based study on patient and sociodemographic characteristics, comorbidity, and use of healthcare services

Abstract

Background The Danish Helicopter Emergency Medical Services (HEMS) is part of the Danish Emergency Medical Services System serving 5.7 million citizens with 1% living on islands not connected to the mainland by road. HEMS is dispatched based on pre-defined criteria including severity and urgency, and moreover to islands for less urgent cases, when rapid transport to further care is needed. The study aim was to characterize patient and sociodemographic factors, comorbidity and use of healthcare services for patients with HEMS missions to islands versus mainland. Methods Descriptive study of data from the HEMS database in a three-year period from 1 October 2014 to 30 September 2017. All missions in which a patient was either treated on scene or transported by HEMS were included. Results Of 5776 included HEMS missions, 1023 (17.7%) were island missions. In total, 90.2% of island missions resulted in patient transport by HEMS compared with 62.1% of missions to the mainland. Disease severity was serious or life-threatening in 34.7% of missions to islands compared with 65.1% of missions to mainland and less interventions were performed by HEMS on island missions. The disease pattern differed with more “Other diseases” registered on islands compared with the mainland where cardiovascular diseases and trauma were the leading causes of contact. Patients from islands were older than patients from the mainland. Sociodemographic characteristics varied between inhabiting island patients and mainland patients: more island patients lived alone, less were employed, more were retired, and more had low income. In addition, residing island patients had to a higher extend severe comorbidity and more contacts to general practitioners and hospitals compared with the mainland patients. Conclusions HEMS missions to islands count for 17.7% of HEMS missions and 90.2% of island missions result in patient transport. The island patients encountered by HEMS are less severely diseased or injured and interventions are less frequently performed. Residing island patients are older than mainland patients and have lower socioeconomic position, more comorbidities and a higher use of health care services. Whether these socio-economic differences result in longer hospital stay or higher mortality is still to be investigated.

Characteristics and critical care interventions in drowning patients treated by the Danish Air Ambulance from 2016 to 2021: a nationwide registry-based study with 30-day follow-up

“…The Danish Air Ambulance database used in this study is well-described. It provides high data quality in uniform data reporting and a high degree of data completeness (95.8–99.9% for variables concerning injury severity, prehospital diagnostics, and critical care interventions) [ 6 , 10 , 19 ]. Nationwide data inclusion from the Danish Air Ambulance provides a complete picture of the Danish subpopulation of drowning patients treated by a physician-staffed HEMS.…”

“…The National Advisory Committee for Aeronautics (NACA) severity score (range 0–7) correlates well with morbidity and mortality and was reported for all patients [ 17 , 18 ]. NACA scores of four or above are considered to represent a patient with severe or critical illness or injury [ 10 , 19 ].…”

“…There was no significant difference in total mission or response time between fatal and non-fatal drowning missions. The Danish Air Ambulance spent significantly more time providing medical care onscene in the group with a fatal outcome (median [IQR] 28 [21][22][23][24][25][26][27][28][29][30][31][32] minutes vs. 19 [16][17][18][19][20][21][22][23][24][25][26][27][28][29] minutes, p = 0.01). Most drowning missions treated by the Danish Air Ambulance occurred during the Danish summer months and public holidays of June-August (52%).…”

Characteristics and critical care interventions in drowning patients treated by the Danish Air Ambulance from 2016-2021: a nationwide registry-based study with 30-day follow-up

“…[17,18] NACA scores of four or above are considered to represent a patient with severe or critical illness or injury. [11,19] Data from the Danish Patient Registry on 30-day mortality were linked to all included patients with a valid civil registry number (a unique identi cation number assigned to each Danish citizen).…”