title: The epidemiology of amputation injuries in the Austrian helicopter emergency medical service: a retrospective, nationwide cohort study.
abstract: OBJECTIVE
  Data on the epidemiological characteristics of traumatic amputations in prehospital emergency care, especially in the context of air rescue, are scarce. Therefore, we aimed to describe the epidemiology of total and subtotal amputation injuries encountered by the OEAMTC helicopter emergency medical service (HEMS) in Austria, based on an almost nationwide sample.
  
  
  METHODS
  We retrospectively reviewed all HEMS rescue missions flown for amputation injuries in 2009. Only primary missions were analyzed.
  
  
  RESULTS
  In total, 149 out of 16,100 (0.9 %) primary HEMS rescue missions were for patients suffering from amputation injuries. Among these, HEMS physicians diagnosed 63.3 % (n = 94) total and 36.9 % (n = 55) subtotal amputations, with both groups showing a predominance of male victims (male:female ratios were 8:1 and 6:1, respectively).The highest rate occurred among adults between 45 and 64 years of age (35.6 %, n = 53). The most common causes were working with a circular saw (28.9 %, n = 43) and processing wood (16.8 %, n = 25). The majority of the cases included digital amputation injuries (77.2 %, n = 115) that were mainly related to the index finger (36.2 %, n = 54). One hundred forty patients (94.0 %) showed a total GCS of more than 12. Amputations were most prevalent in rural areas (84.6 %, n = 126) and between Thursday and Saturday (55.0 %, n = 82). The replantation rate after primary air transport was low (28 %).
  
  
  CONCLUSIONS
  In the HEMS, amputation injuries are infrequent and mostly not life-threatening. However, HEMS crews need to maintain their focus on providing sufficient and fast primary care while facilitating rapid transport to a specialized hospital. The knowledge of the epidemiological characteristics of amputation injuries encountered in the HEMS gained in this study may be useful for educational and operational purposes.
authors.affiliation: Section of Plastic, Aesthetic and Reconstructive Surgery, General Hospital Wr. Neustadt, Wr. Neustadt, Austria. selighf@gmail.com.|Department of Anaesthesiology and General Intensive Care and Pain Therapy, Medical University of Vienna, Vienna, Austria. selighf@gmail.com.|Clinic for Hand Surgery, Rhön-Klinikum AG, Bad Neustadt/Saale, Salzburger Leite 1, 97616, Bad Neustadt/Saale, Germany. selighf@gmail.com.
authors.forename: H F
authors.initials: HF
authors.lastname: Selig
authors.affiliation: Department of Anaesthesiology and General Intensive Care and Pain Therapy, Medical University of Vienna, Vienna, Austria.|Department of Anesthesiology, Washington University School of Medicine, St. Louis, USA.
authors.forename: P
authors.initials: P
authors.lastname: Nagele
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, AUVA Trauma Center, Salzburg, Austria.|OEAMTC Christophorus Air Rescue Service, Vienna, Austria.
authors.forename: W G
authors.initials: WG
authors.lastname: Voelckel
authors.affiliation: OEAMTC Christophorus Air Rescue Service, Vienna, Austria.|Department of Anaesthesiology, Emergency Medicine and General Intensive Care, General Hospital Wr. Neustadt, Wr. Neustadt, Austria.
authors.forename: H
authors.initials: H
authors.lastname: Trimmel
authors.affiliation: Department of Anaesthesiology and General Intensive Care and Pain Therapy, Medical University of Vienna, Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Hüpfl
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.|Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
authors.forename: D B
authors.initials: DB
authors.lastname: Lumenta
authors.affiliation: Section of Plastic, Aesthetic and Reconstructive Surgery, General Hospital Wr. Neustadt, Wr. Neustadt, Austria.|Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
authors.forename: L P
authors.initials: LP
authors.lastname: Kamolz
keywords: Air rescue; Amputation injury; Epidemiology; Prehospital; Traumatic amputation
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