title: HEMS in Slovenia: one country, four models, different quality outcomes.
abstract: OBJECTIVE
  The objective of this study was to determine the quality of patient care using quality indicators in 4 different Slovenian helicopter emergency medical service (HEMS) models.
  
  
  METHODS
  This was a cross-sectional study of all 4 HEMS in Slovenia. We collected data on quality for the period from July 2003 to August 2008, in a sample of all eligible patients that were managed by HEMS during the study period (N = 833). We obtained the following data on emergency operations: the time and organizational features of the operation; the description of the patients' condition; and the on-site diagnostic and treatment procedures. We used the following as quality indicators: the number of resuscitated patients that were intubated; the number of patients with a Glasgow Coma Scale (GCS) score of # 8 that were intubated; the number of patients with acute coronary syndrome that received treatment with morphine, oxygen, nitroglycerine, and aspirin (MONA); the number of patients with a National Advisory Committee on Aeronautics (NACA) scale score of $ 4 with an intravenous line; the number of patients with a NACA score of $ 5 that were given oxygen; and the number of patients with a NACA score of $ 4 that were given appropriate analgesic treatment.
  
  
  RESULTS
  Across all HEMS bases, 36 (87.8%) resuscitated patients were intubated; 122 (81.9%) patients with GCS # 8 were intubated; 149 (89.2%) patients with ACS were given MONA treatment; 52 (92.9%) patients with a NACA score of $ 4 were given an intravenous line; 254 (92.7%) patients with a NACA score of $ 5 were given oxygen; and 18 (32.7%) trauma patients with a NACA score of $ 4 were given intravenous analgesics. The quality of patient management in HEMS in Slovenia is affected by the callout procedure, the presence or absence of a fixed rope, the type of helicopter operator, and the provider of the doctor in the helicopter team.
  
  
  CONCLUSIONS
  The data from our study indicates that the quality of patient management in HEMS in Slovenia is high. It also seems that organizational factors play a role in the quality management of patients in HEMS as well, but their effect remains unclear and needs further evaluation.
authors.affiliation: Department of Family Medicine, Medical School, University of Maribor, Slovenia. zalika.klemenc-ketis@uni-mb.si
authors.forename: Zalika
authors.initials: Z
authors.lastname: Klemenc-Ketis
authors.forename: Iztok
authors.initials: I
authors.lastname: Tomazin
authors.forename: Janko
authors.initials: J
authors.lastname: Kersnik
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy; D017732:Air Ambulances / Q000458:organization & administration / Q000592:standards*; D000401:Aircraft; D003430:Cross-Sectional Studies; D015600:Glasgow Coma Scale; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D058687:Out-of-Hospital Cardiac Arrest; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D012121:Respiration, Artificial / Q000379:methods; D017524:Slovenia