title: Utilisation of a Helicopter Emergency Medical Service (HEMS) for equestrian accidents in a regional major trauma network in the United Kingdom.
abstract: BACKGROUND
  The utilisation of Helicopter Emergency Medical Services (HEMS) in response to equestrian accidents has been an integral part of operations for many years throughout the UK. The recent establishment of major trauma networks in the UK has placed great emphasis on the appropriate tasking of HEMS units to cases where added benefit can be provided and the incidence of time critical injury in cases of equestrian accidents has been shown to be low. This study assesses the impact made on the utilisation of the different HEMS resources for cases of equestrian accidents within the West Midlands following the launch of the regional trauma network.
  
  
  METHODS
  We present a retrospective analysis of all equestrian accidents attended by Midlands Air Ambulance (MAA) between 1 April 2012 and 1 April 2013. Data were abstracted from the MAA operational database relating to mission activations/scene attendances; team configuration (physician led and Critical Care Paramedic (CCP) led); on-scene interventions; mission timings and patient conveyance by helicopter.
  
  
  RESULTS
  A total of 114 activations involved equestrian accidents (6% of overall workload). The contribution of equestrian accidents to overall workload was similar for physician led and CCP-led (69/1069) platforms (5% vs. 6%, p=0.50). Only three patients (3%) required pre-hospital RSI during the period analysed and there were no recorded cases of ketamine administration for analgesia/conscious sedation. In approximately half of all scene attendances patients did not require any medication to be administered by the HEMS team. The vast majority of incidents occurred in rural locations with over 80% of patients conveyed to hospital by helicopter. The average mission time for scene attendances resulting in conveyance by helicopter was in excess of 90 min on both types of platform.
  
  
  CONCLUSIONS
  There is a clear requirement for the design and implementation of informed and intelligent tasking models to respond to the need for assistance in equestrian accidents. Such models may include preferential deployment of non-physician led HEMS resources to equestrian accidents or the utilisation of other local or regional resources, such as those with specially adapted vehicles with off road capability, to offer alternative solutions to access/egress challenges posed in such cases.
authors.affiliation: Midlands Air Ambulance, Unit 16 Enterprise Trading Estate, Pedmore Road, Brierley Hill, West Midlands DY5 1TX, United Kingdom. Electronic address: carl_mcqueen@hotmail.com.
authors.forename: Carl
authors.initials: C
authors.lastname: McQueen
authors.affiliation: Midlands Air Ambulance, Unit 16 Enterprise Trading Estate, Pedmore Road, Brierley Hill, West Midlands DY5 1TX, United Kingdom. Electronic address: nick.crombie@midlandsairambulance.com.
authors.forename: Nick
authors.initials: N
authors.lastname: Crombie
authors.affiliation: Midlands Air Ambulance, Unit 16 Enterprise Trading Estate, Pedmore Road, Brierley Hill, West Midlands DY5 1TX, United Kingdom. Electronic address: stef.cormack@midlandsairambulance.com.
authors.forename: Stef
authors.initials: S
authors.lastname: Cormack
authors.affiliation: Midlands Air Ambulance, Unit 16 Enterprise Trading Estate, Pedmore Road, Brierley Hill, West Midlands DY5 1TX, United Kingdom. Electronic address: drarungeorge@gmail.com.
authors.forename: Arun
authors.initials: A
authors.lastname: George
authors.affiliation: West Midlands Ambulance Service NHS Foundation Trust, Millennium Point, Waterfront Business Park, Waterfront Way, Brierley Hill, West Midlands DY5 1LX, United Kingdom. Electronic address: steve.wheaton@wmas.nhs.uk.
authors.forename: Steve
authors.initials: S
authors.lastname: Wheaton
mesh_terms: D000059:Accidents; D000293:Adolescent; D000328:Adult; D017732:Air Ambulances / Q000458:organization & administration; D000401:Aircraft; D000818:Animals; D001265:Athletic Injuries / Q000453:epidemiology / Q000628:therapy*; D004632:Emergency Medical Services; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data; D006736:Horses; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology
keywords: Equestrian accidents; Helicopter Emergency Medical Service; Rapid sequence intubation; Trauma