Are physicians required during HEMS winch rescue missions?

Introduction

A winch-capable helicopter emergency medical service (HEMS) offers several advantages over standard rescue operations. Little is known about the benefit of physician winching in addition to a highly trained paramedic. We analysed the mission profiles and interventions performed during rescues involving the winching of a physician in the Greater Sydney Area HEMS (GSA-HEMS).

Methods

All winch missions involving a physician from August 2009 to January 2012 were identified from the prospectively completed GSA-HEMS electronic database. A structured case-sheet review for a predetermined list of demographic data and physician-only interventions (POI) was conducted.

Results

We identified 130 missions involving the winching of a physician, of which 120 case sheets were available for analysis. The majority of patients were traumatically injured (90%) and male (85%) with a median age of 37 years. Seven patients were pronounced life extinct on the scene. A total of 63 POI were performed on 48 patients. Administration of advanced analgesia was the most common POI making up 68.3% of interventions. Patients with abnormal RTSc² scores were more likely to receive a POI when compared with those with normal RTSc² (P = 0.03). The performance of POI had no effect on median scene times (45 vs. 43 minutes; P = 0.51). See Tables 1 and 2.

Conclusion

Our high POI rate of 40% coupled with long rescue times and the occasional severe injuries supports the argument for winching doctors. Not doing so would deny a significant proportion of patients time-critical interventions, advanced analgesia and procedural sedation.

Table 1 Demographic data, timings and Coded Revised Trauma Score (RTSc²)

Table 2 Interventions performed