Volume 66, Issue 3 (2 2008)
Tehran Univ Med J 2008, 66(3): 146-157 |
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Alavi E, Pilehvari Z, Bahrami M. Standards of Helicopter Emergency Medical Service (HEMS) for patient transport in urban areas: Review article. Tehran Univ Med J 2008; 66 (3) :146-157
URL: http://tumj.tums.ac.ir/article-1-616-en.html
URL: http://tumj.tums.ac.ir/article-1-616-en.html
Abstract: (10865 Views)
Background: Aeromedical transport provides immediate advanced medical treatment for certain critically ill and injured patients, bringing about rapid treatment and decreasing the time of hospitalization. With the great expense of helicopter emergency medical services (HEMS), research and review of experience is conducted to determine areas in which the enforcement of standards will enable the effective and optimal use of HEMS.
Methods: We examined peer-reviewed published articles in French, English and Persian journals and medical texts to determine the best use of, and standards for, HEMS.
Results: We found that HEMS effectively improves health care in three categories of services: the rapid transportation of medical personnel/equipment to an accident and of patients to the hospital (primary response) meeting road ambulances at an intermediate point coming from a hospital or accident to transport patients to a hospital (secondary response) the planned urgent inter-hospital transfers of critically ill patients for specialized care (tertiary response). HEMS standards have been set for: the flight equipment and crew, the types of emergencies to which HEMS should respond, the optimal length of time for each part of the mission (call out time, response time, on-scene time, transport time, and total rescue time) and the affect on patient survival. Some other standards include: algorithms for patient screening, flight heights for different diseases and injuries, rooftop and parking garage helipad at hospital, approach of flight paths and the facility at the touchdown area. HEMS standard medical equipment includes those needed for telemedicine and basic and advanced life support. Standard drugs on board the HEMS vehicle depends on the type of the missions selected for HEMS. The area of medical crew members, as well as their fundamental and the continuing training, also has standards that must be met. The standard scoring system for severity of injury, and finally, the standard method for the annual calculation of the cost and benefit of using HEMS in a specified region have also been considered.
Conclusion: As trauma is a common reason for requesting HEMS in Iran, the decrease in "Golden Hour" response time for trauma patients is a priority. HEMS is expensive and enforcing standards also requires increased effort and expense. Nevertheless, both can reduce the morbidity, mortality and expense for longer hospital stays. Thus, the proper telemedicine and life support equipment and drugs, as well as algorithms for patient screening can improve HEMS efficacy. Furthermore, enforcing proper communication and record keeping regarding trauma severity for HEMS missions allows hospitals to predict the proper immediate treatment for incoming patients and its future need for HEMS services.
Methods: We examined peer-reviewed published articles in French, English and Persian journals and medical texts to determine the best use of, and standards for, HEMS.
Results: We found that HEMS effectively improves health care in three categories of services: the rapid transportation of medical personnel/equipment to an accident and of patients to the hospital (primary response) meeting road ambulances at an intermediate point coming from a hospital or accident to transport patients to a hospital (secondary response) the planned urgent inter-hospital transfers of critically ill patients for specialized care (tertiary response). HEMS standards have been set for: the flight equipment and crew, the types of emergencies to which HEMS should respond, the optimal length of time for each part of the mission (call out time, response time, on-scene time, transport time, and total rescue time) and the affect on patient survival. Some other standards include: algorithms for patient screening, flight heights for different diseases and injuries, rooftop and parking garage helipad at hospital, approach of flight paths and the facility at the touchdown area. HEMS standard medical equipment includes those needed for telemedicine and basic and advanced life support. Standard drugs on board the HEMS vehicle depends on the type of the missions selected for HEMS. The area of medical crew members, as well as their fundamental and the continuing training, also has standards that must be met. The standard scoring system for severity of injury, and finally, the standard method for the annual calculation of the cost and benefit of using HEMS in a specified region have also been considered.
Conclusion: As trauma is a common reason for requesting HEMS in Iran, the decrease in "Golden Hour" response time for trauma patients is a priority. HEMS is expensive and enforcing standards also requires increased effort and expense. Nevertheless, both can reduce the morbidity, mortality and expense for longer hospital stays. Thus, the proper telemedicine and life support equipment and drugs, as well as algorithms for patient screening can improve HEMS efficacy. Furthermore, enforcing proper communication and record keeping regarding trauma severity for HEMS missions allows hospitals to predict the proper immediate treatment for incoming patients and its future need for HEMS services.
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