title: Physician staffed helicopter emergency medical systems can provide advanced trauma life support in mountainous and remote areas.
abstract: BACKGROUND
  In remote and mountainous areas, helicopter emergency medical systems (HEMS) are used to expedite evacuation and provide pre-hospital advanced trauma life support (ATLS) in major trauma victims. Aim of the study was to investigate feasibility of ATLS in HEMS mountain rescue missions and its influence on patient condition at hospital admission.
  
  
  METHODS
  58 major trauma victims (Injury Severity Score ≥16), evacuated by physician staffed HEMS from remote and mountainous areas in the State of Tyrol, Austria between 1.1.2011 and 31.12.2013.
  
  
  RESULTS
  Pre-hospital time exceeded 90min in 24 (44%) cases. 31 (53%) patients suffered critical impairment of at least one vital function (systolic blood pressure <90mmHg, GCS <10, or respiratory rate <10 or >30). 4 (6.9%) of 58 patients died prior to hospital admission. Volume resuscitation was restrictive: 18 (72%) of 25 hypotensive patients received ≤500ml fluids and blood pressure was increased >90mmHg at hospital admission in only 9 (36%) of these 25 patients. 8 (50%) of 16 brain trauma patients with a blood pressure <90mmHg remained hypotensive at hospital admission. Endotracheal intubation was accomplished without major complications in 15 (79%) of 19 patients with a Glasgow Coma Scale score <10. Rope operations were necessary in 40 (69%) of 58 cases and ATLS was started before hoist evacuation in 30 (75%) of them.
  
  
  CONCLUSIONS
  The frequent combination of prolonged pre-hospital times, with critical impairment of vital functions, supports the need for early ATLS in HEMS mountain rescue missions. Pre-hospital endotracheal intubation is possible with a high success and low complication rate also in a mountain rescue scenario. Pre-hospital volume resuscitation is restrictive and hypotension is reversed at hospital admission in only one third of patients. Prolonged pre-hospital hypotension remains an unresolved problem in half of all brain trauma patients and indicates the difficulties to increase blood pressure to a desired level in a mountain rescue scenario. Despite technical considerations, on-site ATLS is feasible for an experienced emergency physician in the majority of rope rescue operations.
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
authors.forename: Julia
authors.initials: J
authors.lastname: Ausserer
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Moritz
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
authors.forename: Matthias
authors.initials: M
authors.lastname: Stroehle
authors.affiliation: EURAC Institute of Mountain Emergency Medicine, Drususallee 1, 39100 Bolzano, Italy.
authors.forename: Hermann
authors.initials: H
authors.lastname: Brugger
authors.affiliation: EURAC Institute of Mountain Emergency Medicine, Drususallee 1, 39100 Bolzano, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Strapazzon
authors.affiliation: EURAC Institute of Mountain Emergency Medicine, Drususallee 1, 39100 Bolzano, Italy.
authors.forename: Simon
authors.initials: S
authors.lastname: Rauch
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. Electronic address: p.mair@tirol-kliniken.at.
authors.forename: Peter
authors.initials: P
authors.lastname: Mair
mesh_terms: D061906:Advanced Trauma Life Support Care / Q000458:organization & administration* / Q000639:trends; D017732:Air Ambulances; D001317:Austria; D004632:Emergency Medical Services; D055416:Evidence-Based Emergency Medicine / Q000379:methods / Q000458:organization & administration* / Q000639:trends; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009051:Mountaineering / Q000592:standards*; D009104:Multiple Trauma / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010820:Physicians; D055813:Wilderness Medicine / Q000379:methods / Q000458:organization & administration* / Q000639:trends
keywords: Advanced trauma life support; Emergency physician; Endotracheal intubation; Helicopter; Mountain rescue; Trauma; Volume resuscitation