Loss of life years due to unavailable helicopter emergency medical service: a single base study from a rural area of Norway

Figures & data

Figure 1. Map of the geographical area with hospitals, roads and HEMS bases. Link to map of HEMS bases in Norway with 30 minutes flying time circles. http://www.luftambulanse.no/sites/default/files/LAT-kart-2015.pdf

Figure 2. Flowchart showing included missions and patients.

Table 1. Demographic data on included patients. In the first assessment the patients (n = 184) were divided by the experts between the groups “possible life years lost” and “no life years lost”; gender, mission type, patient’s location and type of patient when HEMS was alerted.

	Possible life years lost^a (N = 52)		No life years lost (N = 132)
Variables	n	(%)	n	(%)	P value
Gender					0.83
Female	21	(40)	51	(39)
Type of mission					0.87
Primary mission	34	(65)	88	(67)
Location					0.52
Home	23	(44)	54	(41)
Primary health care	4	(8)	11	(8)
Public place	8	(16)	24	(18)
Hospital	17	(32)	43	(33)
Type of patient					0.01
Cardiology	27	(52)	38	(29)
Neurology	14	(26)	22	(17)
Trauma	3	(6)	24	(18)
Infection	3	(6)	10	(8)
Surgery	3	(6)	7	(5)
Obstetrics	1	(2)	11	(8)
Other	1	(2)	10	(8)
Breathing difficulties	0		7	(5)
Intoxication	0		3	(2)

Pearson Chi-Square tests were used to analyse for statistically significant differences between the groups.

^aPossible life years lost after first round of classification.

Table 2. Patients with an estimated loss of life years, main emergency medical condition, reasons for estimated loss of life years and mission type for 9 missions.

Estimated loss of life	Main emergency medical
years	condition (ICD-10)	Reason for loss of life years	Mission type
9.5	Abdominal haemorrhage (I72.8)	Survived to hospital admission (Førde) from local hospital, delayed by 1h 40 min than if transported by helicopter. Surgical procedures were available, but the patient suffered circulatory collapse and died of haemorrhage in the ER at Førde hospital. Autopsy demonstrated a ruptured, dissecting aneurysm in a. mesenterica sup.	Secondary
5.0	Cerebral infarction (I63.3)	Delayed start of thrombolytic treatment. Sequelae; hemiparesis, aphasia and apraxia.	Primary
2.0	Cerebral haemorrhage (I61.8)	The patient did not reach PCI centre and suffered a cerebral haemorrhage as side effect of thrombolytic treatment. Sequelae (after evacuation of hematoma): hemiparesis.	Secondary
1.0	Cerebral infarction (I63.9)	Delayed start of thrombolytic treatment and lack of facilities for thrombectomy. Sequelae: hemiparesis, facial paralysis.	Primary
0.3	Myocardial infarction (I21.4)	The patient arrived at local hospital 2 hours after estimated air transport arrival to PCI centre, too late for thrombolytic treatment. He received conservative treatment only. If transported to HUS, revascularization within 3-4 hours after debut of symptoms would have been possible, reducing infarction size and improving life expectancy. Sequelae: major damage apically with akinesia and thin-walled myocardium.	Primary
0.2	Myocardial infarction (I21.1)	Revascularization delayed by 1h 30m. Earlier treatment would have reduced the infarction size, and the transport delay influenced life expectancy. Sequelae: concentric hypertrophy and anterolateral hypokinesia.	Primary
0.2	Myocardial infarction (I21.0)	The time from debut of symptoms was >6 h at arrival, with ST elevations still present. There was still indication for acute PCI, but not for thrombolytic treatment. The abortion of air transport resulted in conservative treatment; revascularization was performed 6 days later. An acute PCI could have decreased infarction size and improved life expectancy. Sequelae: anterolateral hypokinesia	Secondary
−0.1 −0.2	Myocardial infarction (I21.0)	Both patients with gained life years received thrombolytic treatment with documented good clinical outcome (pain relief, normalization of ECG and flow in the actual artery at the following coronary angiography) within a shorter time than possibly obtained by revascularization after helicopter transport to the PCI centre.	Primary

All patients were adults (47–80 years).

ICD-10 is an international classification of diseases retrieved from hospital records of the patients. Mission type; Primary mission is response to a patient outside hospital and secondary mission is inter-hospital transport.