The Danish helicopter emergency medical service database: high quality data with great potential

Abstract

Background The Danish Helicopter Emergency Medical Service (HEMS) is part of the Danish pre-hospital response offering advanced patient care on scene and during rapid transport to definitive care. Monitoring HEMS performance and the quality of critical care has high national as well as international priority underlining the need for research in this field. The data quality of the Danish HEMS database is unknown. Furthermore, a set of quality indicators (QI) developed by an international collaboration group (EQUIPE) potentially for use in physician-staffed EMS, has recently been presented. The aim of the current study was to present the design and data quality of the Danish helicopter database, and to evaluate the coverage of available variables in the database according to the QIs proposed. Method The study included all helicopter dispatches between October 1st 2014 and April 30th 2018. The database layout and data entering procedure, as well as the key variables and data completeness were described. Furthermore, missing data and misclassifications were addressed. Lastly, the 26 QIs proposed by the EQUIPE-collaboration were evaluated for coverage in the HEMS database. Results A total of 13,392 missions were included in the study. The database includes a broad spectrum of mission- and patient-specific data related to the pre-hospital pathway of acutely ill or injured patients in a national coverage. Missing data for the majority of variables is less than 6.5%. The percentage of completed report forms has increased over time and reached 99.9% in 2018. Misclassification were observed for 294 patients in the study period corresponding to 3,7%. Less than half of the QIs proposed by the EQUIPE-collaboration group were directly available from the database. Conclusions Helicopter Emergency Medical Services in Denmark are a new and sparsely investigated health care provider. The database contains nearly all missions dispatched by the five regional Emergency Medical Dispatch Centres. Generally, the data quality is considered high with great potential for future research. Potential quality indicators as proposed by the EQUIPE-collaboration group could inspire the configuration and design of the next version of Hemsfile creating an even more solid basis for research and quality improvement. Electronic supplementary material The online version of this article (10.1186/s13049-019-0615-5) contains supplementary material, which is available to authorized users.

The first seven years of nationally organized helicopter emergency medical services in Finland – the data from quality registry

“…In the future electronic transfer of measurements could be used to reduce typing errors, however, this does not eliminate the errors in measurement per se. The rate of cancelled or denied missions in the Finnish HEMS system is substantially higher than reported elsewhere [6,7,21,22]. Technical reliability of the service seems to be excellent and it contributed to the cancellation rate minimally.…”

“…Three of the six bases in Finland are located in mostly urban areas where distances are generally short and the use of helicopter might not result in time saving [31,32]. As shown by our study, the practice of escorting a patient transported in an ambulance is more common in our system compared to other systems [6][7][8]. However, several studies have demonstrated benefit from timesaving by helicopter transportation in select patient groups [28,29,31]., raising the question whether helicopter transportation should be more frequent.…”

“…Secondly, transporting a patient by helicopter in Finland is rare compared to other services [6][7][8]. Use of helicopter can provide significant time saving [28,29].…”

“…Quality registries are a valuable source of data when evaluating the performance of any field in health care [4,5]. For this purpose, several HEMS systems utilize databases to collect and analyze mission data [6][7][8]. To enable multi-center research and comparison between systems, guidelines for data collection have been published for prehospital airway management [9,10]., cardiac arrest [11,12].…”

Letter to the editor: in response to Alstrup et. al.

“…With great interest we have read the article written by Alstrup et al [1] recently published in the Scandinavian Journal of Trauma, Resuscitation and Emergency medicine. They present the quality and potentials of their helicopter emergency medical service (HEMS) database.…”