Treatment, transport, and primary care involvement when helicopter emergency medical services are inaccessible: a retrospective study

Figures & data

Table 1. Demographic and mission data from 180 cases for which HEMS was unavailable. Stratification by primary and secondary missions^a.

	All patients		Patients from primary mission		Patients from secondary mission
	N = 180		N = 118		N = 62
Gender	N	(%)	N	(%)	N	(%)
Female	71	(39)	47	(40)	24	(39)
Median age	Years	IQR	Years	IQR	Years	IQR
Male	56	32–72	54	38–71	62	21–73
Female	61	30–72	64	31–73	58	16–67
Total	59	31–72	57	36–72	60	20–71
Diagnostic group	N	(%)	N	(%)	N	(%)
Cardiology	63	(35)	46	(39)	17	(27)
Neurology	34	(19)	28	(24)	6	(10)
Surgery	10	(6)	2	(2)	8	(13)
Infection	13	(7)	3	(3)	10	(16)
Breathing difficulties	7	(4)	6	(5)	1	(1)
Obstetric	12	(7)	2	(2)	10	(16)
Intoxication	3	(1)	2	(2)	1	(1)
Trauma	27	(15)	23	(19)	4	(7)
Other	11	(6)	6	(5)	5	(8)
Site/Scene	N	(%)	N	(%)	N	(%)
Home dwelling	76	(42)	76	(64)	0	(0)
Public area	29	(16)	29	(25)	0	(0)
Casualty clinic/Nursing home	11	(6)	11	(9)	0	(0)
Local hospital	35	(19)	0	(0)	35	(57)
County hospital	27	(15)	0	(0)	27	(43)
Other	2	(1)	2	(2)	0	(0)
Destination	N	(%)	N	(%)	N	(%)
Discharged on-scene	3	(2)	3	(3)	0	(0)
Dead on-scene	5	(3)	5	(4)	0	(0)
Casualty clinic	5	(3)	5	(4)	0	(0)
Local hospital	33	(18)	33	(27)	0	(0)
County hospital	74	(41)	57	(48)	17	(27)
University hospital	52	(29)	15	(13)	37	(60)
Remain in hospital	8	(4)	0	(0)	8	(13)
Supervision by health personnel during transport^b	N	(%)	N	(%)	N	(%)
Ambulance workers only	121	(67)	94	(80)	27	(44)
+General practitioner	21	(12)	21	(18)	0	(0)
+Anaesthesiologist	10	(6)	1^c	(1)	9	(15)
+Midwife	8	(4)	1	(1)	7	(11)
+Nurse anaesthetist	7	(4)	0	(0)	7	(11)
+Hospital physician	1	(1)	0	(0)	1	(1)
+Other	3	(2)	1	(1)	2	(3)
Missing	9	(5)	0	(0)	9	(15)

^aPrimary mission: patient outside hospital. Secondary mission: patient in need of interhospital transport

^bHighest level of health personnel in contact with the patient during transport. Ranking: Anesthesiologist, GP/hospital physician, nurse anaesthetist/midwife and other.

^cMission during which an anaesthesiologist from the hospital called out to a patient living near the hospital.

Table 2. Treatment provided on primary missions according to general practitioner (GP) response and involvement.

	GP response on primary missions (N = 118)
	GP involvement
	On site^a (N = 70)		Conferred with ambulance (N = 13)		GP not involved (N = 35)		p Value
Treatment	n	%	n	%	n	%
No treatment	17	(24)	3	(23)	11	(31)	0.490
Oxygen only	11	(16)	2	(15)	4	(11)	0.774
MONA^b	19	(27)	4	(31)	10	(29)	1.000
CPR^c	4	(6)	0	(0)	0	(0)	0.317
Single treatments^d
Nitro-glycerine	17	(24)	3	(23)	9	(26)	0.817
Morphine	20	(29)	4	(31)	13	(37)	0.385
O2 on mask	16	(23)	0	(0)	3	(9)	0.181
O2 nose catheter	31	(44)	7	(54)	16	(46)	1.000
Drugs in nebulizer	3	(4)	0	(0)	0	(0)	0.555
Ringer acetate	18	(26)	2	(15)	1	(3)	0.007
Acetylsalicylic acid	17	(24)	4	(31)	10	(29)	0.654
Clopidogrel	12	(17)	0	(0)	7	(20)	0.423
Metoclopramide	22	(31)	4	(31)	11	(31)	1.000
Neck collar	5	(7)	1	(8)	4	(11)	0.476
Data missing	1	(1)	0	(0)	1	(3)

Comparison between GP involved and GP not involved using Fischer’s exact test. Fisher’s exact test was used for statistical analysis of GP involvement. Multiple treatments are possible.

^aIncludes call-outs and consultation at GP’s office or out-of-hour service clinic.

^bMONA: morphine, oxygen, nitro-glycerine, acetylsalicylic acid was ordinated.

^cCardiopulmonary resuscitation.

^dOne or more treatment was given.

Figure 1. Flow chart of primary mission, showing alerts, GP responses, and transport options.

Table 3. Treatment provided by health personnel group in primary missions

	Primary missions (N = 118)
Health personnel	N	%
Ambulance workers	11	(9)
General practitioner	83	(69)
Hospital physician	7	(6)
HEMS anaesthesiologist	9	(8)
Other	2	(2)
Missing	8	(6)

A physician was considered responsible if on scene or after telephone conferral with ambulance workers.

Ambulance workers can administer certain treatments that are pre-delegated by a physician when protocol criteria are fulfilled.