title: A 5-year analysis of the helicopter air mercy service in Richards Bay, South Africa.
abstract: BACKGROUND
  A helicopter emergency medical service (HEMS) was established in 2005 in Richards Bay, KwaZulu-Natal, South Africa, to provide primary response and inter-facility transfers to a largely rural area with a population of 3.4 million people.
  
  
  OBJECTIVE
  To describe the first 5 years of operation of the HEMS.
  
  
  METHODS
  A chart review of all flights from 1 January 2006 to 31 December 2010 was conducted.
  
  
  RESULTS
  A total of 1 429 flights were undertaken; 3 were excluded from analysis (missing folders). Most flights (88.4%) were inter-facility transfers (IFTs). Almost 10% were cancelled after takeoff. The breakdown by age was 61.9% adult, 15.1% paediatric and 21.6% neonate. The main indications for IFTs were obstetrics (34.5%), paediatrics (27.9%) and trauma (15.9%). For primary response most cases were trauma (72.9%) and obstetrics (11.3%). The median on-scene time for neonates was significantly longer (48 min, interquartile range (IQR) 35 - 64 min) than that for adults (36 min, IQR 26 - 48; p < 0.001) and paediatrics (36 min, IQR 25 - 51; p < 0.02). On-scene times for doctor-paramedic crews (45 min, IQR 27 - 50) were significantly longer than for paramedic-only crews (38 min, IQR 27 - 57; p < 0.001).
  
  
  CONCLUSIONS
  The low flight-to-population ratio and primary response rate may indicate under-utilisation of the air medical service in an area with a shortage of advanced life support crews and long transport distances. Further studies on HEMSs in rural Africa are needed, particularly with regard to cost-benefit analyses, optimal activation criteria and triage systems.
authors.forename: P A
authors.initials: PA
authors.lastname: D'Andrea
authors.forename: D J
authors.initials: DJ
authors.lastname: van Hoving
authors.forename: D
authors.initials: D
authors.lastname: Wood
authors.forename: W P
authors.initials: WP
authors.lastname: Smith
mesh_terms: D017732:Air Ambulances; D004632:Emergency Medical Services / Q000458:organization & administration*; D006801:Humans; D010360:Patient Transfer / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012424:Rural Population; D013019:South Africa