Outcomes after cancelled helicopter emergency medical service missions due to concurrencies: a retrospective cohort study

Abstract

CitationØster as Ø, Heltne J-K, Tønsager K, Brattebø G. Outcomes after cancelled helicopter emergency medical service missions due to concurrencies: a retrospective cohort study. Acta Anaesthesiologica Scandinavica 2018 doi: 10.1111/aas.13028Background: Appropriate dispatch criteria and helicopter emergency medical service (HEMS) crew decisions are crucial for avoiding over-triage and reducing the number of concurrencies. The aim of the present study was to compare patient outcomes after completed HEMS missions and missions cancelled by the HEMS due to concurrencies. Methods: Missions cancelled due to concurrencies (AMB group) and completed HEMS missions (HEMS group) in Western Norway from 2004 to 2013 were assessed. Outcomes were survival to hospital discharge, physiology score in the emergency department, emergency interventions in the hospital, type of department for patient admittance, and length of hospital stay. Results: Survival to discharge was similar in the two groups. Onethird of the primary missions in the HEMS group and 13% in the AMB group were patients with pre-hospital conditions posing an acute threat to life. In a sub group analysis of these patients, HEMS patients were younger, more often admitted to an intensive care unit, and had an increased survival to discharge. In addition, the HEMS group had a greater proportion of patients with deranged physiology in the emergency department according to an early warning score. Conclusion: Patients in the HEMS group seemed to be critically ill more often and received more emergency interventions, but the two groups had similar in-hospital mortality. Patients with prehospital signs of acute threat to life were younger and presented increased survival in the HEMS group.

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

“…Patient outcomes after HEMS cancellations in one Norwegian region has recently been described by Østerås et al 4 The study compared mortality and hospitalisation history among patients who were airlifted to hospital by HEMS with patients who were transported in a ground ambulance due to (HEMS) concurrencies. The study demonstrated a similar in-hospital mortality in the HEMS group and the ambulance group, but there was a higher incidence of ICU admittance and an increased LOS among the HEMS patients compared with the ambulance patient group.…”

“…[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.…”

A prospective observational study of why people are medically evacuated from offshore installations in the North Sea

“…Table 2 shows our findings compared with a study of a Norwegian emergency patients evacuated by HEMS. 17 Our study shows that nearly all our patients were discharged alive. Physiological scoring in the ED showed that fewer patients had a Worthing PSS score ≥1 in our study compared with the HEMS patients, among which almost 1/2 had a PSS score of at least 1.…”

“…15 16 It was also chosen to enable us to compare scores for our patient group to similar groups onshore in Western Norway. 17 The PSS score was calculated based on the patient's physiological status when arriving at the emergency department. To further assess in-hospital outcome, we collected data on length of hospital stay, number of patients who needed emergency intervention and to which hospital unit the patients were admitted.…”

“…The patients in our study tended to score lower on the Worthing PSS, had less need for early emergency interventions, were less often admitted to ICU or HDU, and had a shorter stay in the hospital compared with the patients transported by the onshore ground and helicopter ambulance service in the western region of Norway. 17 This may indicate that the offshore patient group represents a healthier patient group than the population onshore. In addition, a valid health certificate is needed to work offshore, which means that the population offshore should be healthy.…”