Auckland HEMS Helicopter Emergency Medical Services Christopher Denny, MD, MSc, FRCPC, FACEP, FACEM...
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Transcript of Auckland HEMS Helicopter Emergency Medical Services Christopher Denny, MD, MSc, FRCPC, FACEP, FACEM...
Auckland HEMSHelicopter Emergency Medical ServicesChristopher Denny, MD, MSc, FRCPC, FACEP, FACEM
SMO Emergency Medicine, Auckland City Hospital, ADHB
Disclosure
• Senior Medical Officer in Emergency Medicine, Auckland City Hospital
• HEMS Medical Director, Auckland Rescue Helicopter Trust (ARHT)
• Clinical Team Leader, New Zealand Medical Assistance Team (MOH NZMAT)
OBJECTIVES1. Increase awareness of Auckland HEMS
2. Explore Pre-Hospital and Retrieval Medicine
3. Compare patient care on the road with in hospital
Introduction
• 1970: Auckland established the first civilian rescue helicopter service in the southern hemisphere
• Rescue helicopter originally based on the west coast of Auckland @ Piha
• Now the busiest rescue helicopter trust in New Zealand• The only service in NZ with a doctor as a core member of
the flight crew
ADHB & ARHT
• Memorandum of Understanding established in 2011• Specialists in Emergency Medicine, Critical Care and
Anaesthetics• Purpose: to augment the clinical capabilities of the flight
crew
HEMS Mission profiles
Trauma43%
Medical 55%
SAR1% Interfacility 1%
Mission type
Helicopters
• BK-117 x 2• Cruise speed 120 knots (222km/hr)• Cruise altitude ~1500 feet
• Crew configuration: Pilot, crewman, paramedic & doctor• Instrument Flight Rules (IFR) capable• Winch capable• 600lb capacity
Why doctors?
Critical interventions
• Airway: Rapid sequence intubation (RSI), video laryngoscopy (VL), surgical airway
• Breathing: Mechanical ventilation, chest drains• Circulation: Tranexamic acid (TXA), Point-of-care
ultrasound (POCUS), blood products• Disability: Reduction of dislocations and fractures;
ultrasound-guided regional nerve blocks, field amputations, antidote therapies
Accelerating time to definitive care
• Time to critical intervention:• Airway management• CT• Operating theatre• Interventional radiology
Clinical governance
Evidence
• Galvagno. JAMA 2012: HEMS and Survival after Major Trauma.• 223,475 patients in USA with age >15y & ISS>15• HEMS Odds Ratio for survival 1.16, 95%CI 1.14-1.17
(ARR 1.5%)
Seamless care
• From roadside to bedside in definitive care• Standardized communications (METHANE, MIST,
SBAR)
Disaster preparedness
• Coordinated Incident Management System (CIMS)• Inter-agency collaboration with St John Ambulance, NZ
Fire Services, Police SAR• Aeromedical reconnaissance
High performing teams
• “To turn a team of experts into an expert team.”• Eduardo Salas
Teamwork
• High task interdependency• Cooperation, coordination, communication, cognition,
coaching and conflict
The future
• Integration• Coordination• Clinical networks