Are physicians required during winch rescue missions in an Australian helicopter emergency medical service?
BACKGROUND
A helicopter emergency medical service (HEMS) capable of winching offers several advantages over standard rescue operations. Little is known about the benefit of physician winching in addition to a highly trained paramedic.


OBJECTIVE
To analyse 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 (POIs) 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 dead at the scene. A total of 63 POIs were performed on 48 patients. Administration of advanced analgesia was the most common POI making up 68.3% of interventions. Patients with abnormal RTSc(2) scores were more likely to receive a POI than those with normal RTSc(2) (84.8% vs 15.2%; p=0.03). The performance of a POI had no effect on median scene times (45 vs 43 min; p=0.51).


CONCLUSIONS
Our high POI rate of 40% (48/120) coupled with long rescue times and the occasional severe injuries support the argument for winching Physicians. Not doing so would deny a significant proportion of patients time-critical interventions, advanced analgesia and procedural sedation.
Department of Pre-hospital Care, Greater Sydney Area Helicopter Emergency Medical Service (GSA-HEMS), , Sydney, New South Wales, Australia.
Peter Brendon
PB
Sherren
Clare
C
Hayes-Bradley
Cliff
C
Reid
Brian
B
Burns
Karel
K
Habig
D000328:Adult; D017732:Air Ambulances / Q000706:statistics & numerical data; D001315:Australia; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D011446:Prospective Studies; D000078329:Workforce
Environmental Medicine, Mountain Rescue; Major Trauma Management; Prehospital Care, Doctors In PHC; Prehospital Care, Helicopter Retrieval; Trauma