title: Injury severity and seating position in accidents with German EMS helicopters.
abstract: BACKGROUND
  Accident rates and fatality rates for Helicopter Emergency Medical Service (HEMS) missions have been investigated recently, but none of these studies considered the influence of the seating position in the helicopter. The aim of the present descriptive and observational study was to analyze injury severity depending on the seating position during HEMS accidents in Germany.
  
  
  METHODS
  Data from the German Federal Agency for Flight Accident Investigation was gathered for a period of 40 years (from 1970 to 2009). The seating position in the aircraft during the accident and the resulting injury severity (i.e., 1=no; 2=slight; 3=severe; and 4=fatal) were recorded. Injury severity was compared using the Fisher's exact test. P values <0.05 were considered statistically significant.
  
  
  RESULTS
  A total of n=99 accidents were investigated (n=61 accidents did not lead to any injuries in the occupants, n=7 accidents resulted in minor, and n=6 in severe injuries, and lethal injuries resulted from n=15 accidents). The occupant in the "patient" position was most likely to suffer from deadly injuries (44.9%), followed by the HEMS crew member rear seat (25.0%), compared to lower lethality rates in the other seating positions (9.4-11.2%). Sitting on the HEMS crew member rear seat also was associated with the highest percentage of severe and minor injuries (12.5% each).
  
  
  CONCLUSIONS
  In HEMS accidents, the patients' position and the HEMS crew member rear seat were found to be at the highest risk for fatal or severe injuries. These results support the urgent requirement of a large international data base for HEMS accidents as a basis for further studies to improve the safety in HEMS missions.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany; Working Group "Emergency Medicine and Air Rescue", German Society of Aviation and Space Medicine, Munich, Germany; Medical Faculty Mannheim, Ruprecht Karls University of Heidelberg, Mannheim, Germany. Electronic address: jochen.hinkelbein@uk-koeln.de.
authors.forename: Jochen
authors.initials: J
authors.lastname: Hinkelbein
authors.forename: Oliver
authors.initials: O
authors.lastname: Spelten
authors.forename: Christopher
authors.initials: C
authors.lastname: Neuhaus
authors.forename: Mandy
authors.initials: M
authors.lastname: Hinkelbein
authors.forename: Enver
authors.initials: E
authors.lastname: Özgür
authors.forename: Wolfgang A
authors.initials: WA
authors.lastname: Wetsch
mesh_terms: D000060:Accidents, Aviation / Q000401:mortality / Q000706:statistics & numerical data*; D017732:Air Ambulances; D005858:Germany; D006801:Humans; D015601:Injury Severity Score; D056888:Patient Positioning; D011187:Posture; D012307:Risk Factors
keywords: Accident consequences; Air rescue; Emergency Medicine; HEMS accidents