title: Retrospective analysis of 616 air-rescue trauma cases related to the practice of extreme sports.
abstract: BACKGROUND
  Extreme sports (ESs) are increasingly popular, and accidents due to ESs sometimes require helicopter emergency medical services (HEMSs). Little is known about their epidemiology, severity, specific injuries and required rescue operations.
  
  
  OBJECTIVE
  Our aims were to perform an epidemiological analysis, to identify specific injuries and to describe the characteristic of prehospital procedures in ES accidents requiring HEMSs.
  
  
  METHODS
  This is a retrospective study, reviewing all rescue missions dedicated to ESs provided by HEMS REGA Lausanne, from 1 January 1998 to 31 December 2008. ES were classified into three categories of practice, according to the type of risk at the time of the fall.
  
  
  RESULTS
  Among the 616 cases meeting inclusion criteria, 219 (36%) were clearly high-risk ES accidents; 69 (11%) and 328 (53%) were related to potential ES, but with respectively low or indeterminate risk at the time of the fall. In the high-risk ES group, the median age was 32 years and 80% were male. Mortality at 48h was 11%, almost ten times higher than in the other two groups. The proportion of potentially life-threatening injuries (the National Advisory Committee for Aeronautics (NACA) score≥4) was 39% in the high-risk ES group and 13% in the other two groups. Thirty per cent of the cases in the high-risk ES group presented an Injury Severity Score (ISS) >15, compared with 7% in the other groups. Thoracolumbar vertebral fractures were the most common injuries with 32% of all cases having at least one, involving the T12-L2 junction in 56% of cases. The other most frequent injuries were traumatic brain injuries (16%), rib fractures (9%), pneumothorax (8%) and femoral (7%), cervical (7%), ankle (5%) and pelvic (5%) fractures. Median time on site for rescue teams was higher in the confirmed high-risk ES group, with 50% of prehospital missions including at least one environmental difficulty.
  
  
  CONCLUSIONS
  High-risk ESs led to high-energy accidents, characterized by a large proportion of severe injuries and axial traumas (spine, thorax, pelvis and proximal femur). We identified a considerable percentage of thoracolumbar vertebral fractures, mainly in the T12-L2 junction. HEMSs dedicated to high-risk ESs implied longer and more complex interventions.
authors.affiliation: Emergency Department, Lausanne University Hospital, CH-1011 Lausanne, Switzerland. Electronic address: gael@gosteli.ch.
authors.forename: Gaël
authors.initials: G
authors.lastname: Gosteli
authors.affiliation: Emergency Department, Lausanne University Hospital, CH-1011 Lausanne, Switzerland. Electronic address: bertrand.yersin@chuv.ch.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Yersin
authors.affiliation: University of Health Sciences (HESAV), Av. de Beaumont 21, CH-1011 Lausanne, Switzerland. Electronic address: cedric.mabire@hesav.ch.
authors.forename: Cédric
authors.initials: C
authors.lastname: Mabire
authors.affiliation: Emergency Department, Lausanne University Hospital, CH-1011 Lausanne, Switzerland. Electronic address: mathieu.pasquier@chuv.ch.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Pasquier
authors.affiliation: Swiss Air Rescue, CH-8058 Zurich-Airport, Switzerland. Electronic address: Roland.Albrecht@rega.ch.
authors.forename: Roland
authors.initials: R
authors.lastname: Albrecht
authors.affiliation: Emergency Department, Lausanne University Hospital, CH-1011 Lausanne, Switzerland. Electronic address: pierre-nicolas.carron@chuv.ch.
authors.forename: Pierre-Nicolas
authors.initials: PN
authors.lastname: Carron
mesh_terms: D000328:Adult; D017732:Air Ambulances / Q000706:statistics & numerical data*; D000401:Aircraft; D001265:Athletic Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009051:Mountaineering; D009104:Multiple Trauma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D018635:Rescue Work / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D013557:Switzerland / Q000453:epidemiology; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014218:Triage
keywords: Emergency medical services; Extreme sports; Fall; Prehospital; Trauma