title: Utilisation of helicopter emergency medical services in the early medical response to major incidents: a systematic literature review.
abstract: OBJECTIVE
  This systematic review identifies, describes and appraises the literature describing the utilisation of helicopter emergency medical services (HEMS) in the early medical response to major incidents.
  
  
  METHODS
  Early prehospital phase of a major incident.
  
  
  METHODS
  Systematic literature review performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Web of Science, PsycINFO, Scopus, Cinahl, Bibsys Ask, Norart, Svemed and UpToDate were searched using phrases that combined HEMS and 'major incidents' to identify when and how HEMS was utilised. The identified studies were subjected to data extraction and appraisal.
  
  
  RESULTS
  The database search identified 4948 articles. Based on the title and abstract, the full text of 96 articles was obtained; of these, 37 articles were included in the review, and an additional five were identified by searching the reference lists of the 37 articles. HEMS was used to transport medical and rescue personnel to the incident and to transport patients to the hospital, especially when the infrastructure was damaged. Insufficient air traffic control, weather conditions, inadequate landing sites and failing communication were described as challenging in some incidents.
  
  
  CONCLUSIONS
  HEMS was used mainly for patient treatment and to transport patients, personnel and equipment in the early medical management of major incidents, but the optimal utilisation of this specialised resource remains unclear. This review identified operational areas with improvement potential. A lack of systematic indexing, heterogeneous data reporting and weak methodological design, complicated the identification and comparison of incidents, and more systematic reporting is needed.
  
  
  BACKGROUND
  CRD42013004473.
authors: Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway.
authors: Anne Siri
authors: AS
authors: Johnsen
authors: Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
authors: Sabina
authors: S
authors: Fattah
authors: Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway.
authors: Stephen J M
authors: SJ
authors: Sollid
authors: Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway London's Air Ambulance, Royal London Hospital, Barts Health Trust, London, UK.
authors: Marius
authors: M
authors: Rehn
mesh_terms: D000401:Aircraft; D004190:Disasters; D004632:Emergency Medical Services / Q000379:methods*; D006801:Humans; D014187:Transportation of Patients / Q000379:methods*
keywords: Air ambulances; Disasters; Helicopter emergency medical services; Major incidents; Mass casualty incidents