Search Results (43)

Background: Emergency aeromedical services, including helicopter emergency medical service (HEMS) and medical emergency evacuation (MEDEVAC), are critical to time-sensitive care. Dispatch decisions are complex and consequential, determining whether, which, and under what conditions to deploy aeromedical resources. This study reviews modelling approaches for emergency aeromedical dispatch. Methods: Following PRISMA, studies between 2003 and 2026 (June) were screened, yielding 42 studies. Models were classified as predictive and learning-based, sequential decision, and prescriptive optimisation-based, with solution techniques, operational applications, and policy contexts analysed. Results: Markov decision process and approximate dynamic programming models dominate the sequential decision literature, particularly in military MEDEVAC. Prescriptive models support resource allocation, base location, coverage planning, and dispatch optimisation, while predictive and AI/ML-based approaches remain limited but emerging. Key challenges include computational complexity, data uncertainty, policy fragmentation, and ethical concerns. Sequential models reflect dispatch’s dynamic, stochastic nature, where current deployments constrain future resource availability. Priority-aware policies outperform closest-unit rules, but limited real-world validation hinders adoption. Conclusions: This review maps methods and provides evidence-based guidance for researchers and dispatch organisations selecting decision support models. Future opportunities include AI-assisted dispatch, hybrid predictive–prescriptive modelling, real-time adaptive algorithms, sustainability-oriented optimisation, improved helicopter landing zone identification, and standardised ethical and regulatory frameworks. Full article

Background: Syncope in older adults is a frequent and diagnostically challenging presentation in prehospital emergency care, particularly in geographically remote areas with limited access to advanced cardiac services. While many syncopal episodes are benign, some are caused by life-threatening conduction disorders such as complete atrioventricular block (CAVB), which may manifest with seizure-like activity due to severe cerebral hypoperfusion. Case Presentation: We report the case of a 70-year-old man with a history of hypertension, residing in a remote rural area, who experienced a nocturnal tonic–clonic episode followed by recurrent loss of consciousness. Due to difficult ground access, a helicopter emergency medical service (HEMS) team was deployed. On arrival, the patient was hypotensive and severely bradycardic, with recurrent syncopal episodes. Electrocardiography (ECG) confirmed CAVB with a slow escape rhythm. Temporary transvenous pacing was initiated but required progressively higher output, up to approximately 80 mV, with intermittent loss of capture, indicating a high risk of pacing failure and asystole. The patient was transported by helicopter to a tertiary interventional cardiology center, where he experienced additional syncopal episodes before undergoing emergent implantation of a permanent single-chamber ventricular pacemaker (VVI). Permanent pacing resulted in immediate hemodynamic stabilization, and no further syncopal or seizure-like episodes were observed. Conclusions: In geriatric patients presenting with convulsive syncope, cardiac causes such as CAVB must be rapidly identified. Unstable temporary pacing with high capture thresholds represents a life-threatening condition requiring urgent permanent pacemaker implantation. HEMS plays a critical role in ensuring timely access to definitive cardiac care in geographically isolated regions. Full article

Background/Objectives: Damage Control Resuscitation (DCR) is a critical strategy in the management of severe trauma, focusing on the optimisation of the patient’s physiological condition. This study reviews current DCR strategies, emphasizing the mitigation of the “diamond of death”—hypothermia, acidosis, coagulopathy, and hypocalcemia—while addressing complex disturbances like respiratory distress syndrome (ARDS) and (acute kidney injury) AKI in high-ISS (Injury Severity Score) patients. Methods: A systematic review of 59 contemporary sources was conducted, encompassing clinical trials (e.g., CRASH-2), military-to-civilian protocol translations, and guidelines from the C and European Resuscitation Council. The analysis focused on pre-hospital interventions, in-hospital transfusion protocols, and the impact of transport logistics on survival. Results: Evidence highlights that aggressive crystalloid resuscitation (over 5 L) significantly increases mortality, favoring balanced blood component therapy (1:1:1 ratio) or Whole Blood guided by viscoelastic testing like rotational thromboelastometry (ROTEM) or thromboelastography (TEG). Pre-hospital success is driven by rapid hemorrhage control via tourniquets, early administration of Tranexamic Acid (TXA), no aggressive crystalloids, permissive hypotension, proactive calcium supplementation is recommended in early care. Furthermore, the integration of Helicopter Emergency Medical Services (HEMS) is independently associated with improved survival in multi-organ trauma by reducing time to definitive care and facilitating “en-route” damage control. Conclusions: The evolution of rescue strategies focused on mitigating the effects of the diamond of death, combined with the implementation of permissive hypotension and optimized HEMS logistics, constitutes the foundation of a modern model aimed at minimizing mortality in multi-organ trauma. Full article

Introduction: Currently, REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) is an emerging technique for resuscitation in patients presenting severe pathology in hemodynamic shock refractory to conventional treatments. The REBOA technique consists of inserting a balloon through the femoral artery to temporarily occlude the aorta and thus control massive bleeding and improve perfusion of vital organs in critical situations such as hemorrhagic shock. Although it is not a definitive technique, its use buys time before the implementation of a definitive treatment when possible. This makes REBOA an ideal technique for the philosophy of out-of-hospital emergency services and more particularly in the HEMS (Helicopter Emergency Medical Service) environment. On the other hand, REBOA has been postulated as one of the basic pillars in the resuscitation of severe trauma patients with hemorrhagic shock and of the doctrine of damage-control resuscitation in non-compressible torso and lower limb hemorrhage. Objective: To evaluate the potential feasibility of REBOA implementation in patients attended by HEMS teams in Castilla-La Mancha, Spain. Method: A retrospective observational study was conducted analyzing medical and nursing reports from HEMS units between 1 January and 31 December 2023. A statistical study of the variables collected was carried out using statistical techniques appropriate to the pre-specified study variables. A descriptive analysis of the population was performed. Frequency results are expressed in absolute terms, as percentages and confidence intervals. Continuous variables are expressed as mean (SD) and median (range) according to normality test (Kolmogorov–Smirnov test). For the study of the relationship between the different variables, Chi-square or Analysis of Variance is used if they are parametric. Descriptive and inferential statistics were performed using SPSS v24. Results: A total of 103 patients (72.81% men, mean age 57.7 years) were identified as potential REBOA candidates. On arrival of the emergency services the mean SI (shock index) of the patients was 1.36 (SD +/− 0.380). On arrival at the hospital, the mean SI was 1.25 (SD +/− 0.601). Of the series, 57 (55.33%) patients suffered cardiorespiratory arrest (CRA) at some point during pre-hospital care. Of the total number of patients, 38 were patients presenting severe trauma criteria (characterized by life-threatening injuries, with RTS score ≤ 11, shock index > 0.9, or ISS ≥ 16, indicating severe physiological or anatomical alterations), of which 26 (68.4%) did not go into CRA, while 12 (31.6%) did. Of the total number of patients, 65 (63.1%) did not meet severe trauma criteria, but did present medical criteria for REBOA placement, of which 55 (53.4%) were patients who at some point during attendance presented CRA. Although the shock index showed a slight decrease after healthcare without statistical significance or relevant correlation, a highly significant association was observed between severe trauma and cardiorespiratory arrest (p < 0.001). Conclusions: It could be affirmed that it may have been feasible to implement REBOA in 4.47% (103) of the patients attended by the HEMS healthcare team of Castilla-La Mancha. This could help to reduce the morbimortality and mortality of critical patients in medical helicopters. More studies are needed to corroborate this assertion. Full article

Background: Rapid helicopter air ambulance (HAA) response is a cornerstone of emergency medical logistics, yet the “time-to-care” metric remains highly sensitive to uncertainties in base posture, readiness, and operational disruptions. This study evaluates how these factors jointly influence response-time reliability and identifies strategies for improving service performance. Methods: A Monte Carlo simulation was developed to model the end-to-end HAA mission chain, including dispatch, wheels-up delay, en-route flight, and patient handoff, while accounting for uncertainty from weather, airspace congestion, and flight dynamics. Scenario experiments incorporated training improvements and alternative response protocols (Ground vs. Airborne Standby). Results: Simulation results indicate that operational factors reduced mean and tail response times, with Airborne Standby reducing the probability of exceeding a 45 min threshold by over 90% in urban night scenarios. Performance gains were most prominent in rural service areas and night operations, where disruption risks were highest. Conclusions: The findings offer evidence-based guidance for EMS logistics planners by clarifying how standby policies and readiness enhancements mitigate logistical risks. Full article

Background/Objectives: Severe traumatic brain injury (TBI) carries high mortality, and outcomes are particularly poor when prehospital cardiopulmonary resuscitation (CPR) is required. Because these patients are often excluded from research, epidemiological data and prognostic insights are limited. This study aimed to describe characteristics and outcomes of patients with suspected severe TBI who received prehospital CPR. Methods: We performed a sub-analysis of the prospectively collected multicenter BRAIN-PROTECT registry, including all patients with suspected severe TBI who underwent prehospital CPR and were transported to a participating trauma center. Results: A total of 256 patients with suspected severe TBI who received prehospital CPR were included. Early mortality was high, with 22.6% declared dead in the emergency department and an additional 28.9% within 24 h, resulting in 48.5% 24 h survival. Thirty-day mortality was 79.9%. Among survivors, 45.7% achieved moderate disability or good recovery at discharge. Outcomes, 30-day mortality, and neurological status at discharge did not differ between isolated and non-isolated TBI. Characteristics often seen in survivors included shockable initial rhythm, reactive pupils, and lack of anisocoria. All patients without prehospital return of spontaneous circulation died. Conclusions: Although overall 30-day mortality was high, survival among patients for whom resuscitation was attempted and who reached hospital care was not negligible, and a substantial proportion of the survivors achieved moderate to good neurological recovery. Prehospital ROSC and shockable rhythms were associated with better outcomes, suggesting that resuscitation may be valuable and warranted in selected patients with potentially reversible conditions. Further studies are needed to better define prognostic factors and guide management in this highly vulnerable population. Full article

The civil and military use of autonomously or remotely controlled unmanned aerial vehicles (UAVs) has become standard in many sectors. However, their role as supplementary vehicles for helicopter emergency medical services (HEMS) or search and rescue (SAR)—particularly when aiding individuals in hard-to-reach terrains—remains underexplored and in need of further innovation. The feasibility of using UAVs in such operations depends on multiple factors, including legislative, economic, and market conditions. However, the most critical considerations are external factors that impact UAV flight, such as meteorological conditions (wind speed and direction), the designated operational area, the proficiency of the pilot–operator, and the classification and certification of the UAV, particularly if it has been modified for such missions. Additionally, the feasibility of the remote or autonomous control of the UAV in mountainous environments plays a crucial role in determining their effectiveness. Establishing a specialized simulation environment to address these challenges is essential for assessing UAV performance in mountainous regions. This is particularly relevant in the Slovak Republic, a very rugged landscape, where the planned expansion of UAV-assisted rescue operations must be preceded by thorough testing, flight verification, and operational planning within protected landscape areas. Moreover, significant legislative changes will be required, which can only be implemented after the comprehensive testing of UAV operations in these specific mountain environments. Full article

Background: The World Health Organization (WHO) estimates that 180,000 patients die from burns every year, which is considered a serious public health issue. Patients with burns require immediate pre-hospital care and transport to specialized treatment facilities. The aim of this study was to outline the profile of the burn patient from the perspective of the Polish Medical Air Rescue (PMAR), as well as to analyze the medical procedures being implemented. Methods: The study includes 2154 interventions by air emergency medical teams (AEMS) which provided aid for burn patients. The analysis covered the period from 2018 to 2022, including nationwide data made available from the IT systems of the PMAR. Statistical design was used, allowing for correlations of variables, at a significance level of p < 0.05. Results: Patients’ ages ranged from 1 month to 96 years (mean 35.05; SD ± 26.88). Adult patients (n = 1409; 65.41%) constituted the vast majority. The number of interventions to children below 1-year-old was noticeable (n = 394; 18.29%). Men were the most likely to suffer burns, up to three times more often than women (n = 1574, 73.07% vs. n = 570, 26.46%. T29—burns to multiple body areas (n = 890)—and T21—burns to the trunk (n = 255)—were most frequently reported as diagnoses according to the ICD-10 classification. A statistically significant association was found between age group and ICD-10 diagnosis (p < 0.001). The vast majority of patients were transported from the scene directly to Burn Treatment Centers (n = 1373; 63.74%). Treatment of pain by helicopter emergency medical services (HEMS) crews appeared to be effective (p < 0.001), and other interventions consisted of administering medications—ketamine (23.72%), rocuronium bromide (15.78%), propofol (14.02%)—and procedures such as sedation (30.87%), as well as intubation (13.42%) and mechanical ventilation (13.23%). Conclusions: The burn patient profile indicates men with a mean age of 35 years. Nevertheless, HEMS crews often carry out missions to infants and newborns. The most common diagnosis was extensive body burns. In 63.74% of the missions, patients were transported to the Burn Treatment Center. The HEMS crews implement effective pharmacological analgesia, and handle rescue medications and procedures to stabilize the patient’s condition. Full article

Background/Objectives: The impacts of the coronavirus disease 2019 (COVID-19) pandemic on patients using helicopter emergency medical services (HEMS) regarding tracheal intubation and patient management remain unclear. Thus, we aimed to investigate this matter in Japan. Methods: In this retrospective, observational study, we analyzed 2277 patients who utilized HEMS in Tochigi Prefecture during 2018–2022. We included only patients who required tracheal intubation. We categorized patients from February 2020 to January 2022 in the pandemic group and those from February 2018 to January 2020 in the control group. We compared the interval from arrival at the scene to leaving the scene (on-scene time) and secondary variables between the two groups. Results: A total of 278 eligible patients were divided into the pandemic group (n = 127) and the control group (n = 151). The on-scene time was lower during the pandemic than that before (25.64 ± 9.19 vs. 27.83 ± 8.74 min, p = 0.043). The percentage of patients using midazolam was lower (11.8% vs. 22.5%, p = 0.02) and that of patients using rocuronium bromide was higher (29.1% vs. 6.0%, p < 0.001) during the pandemic. In contrast, the type of intervention other than tracheal intubation and the type of transportation to the hospital did not differ between the groups. Conclusions: The COVID-19 pandemic was associated with changes in the mission time of and the frequency of certain drugs administered by the HEMS. However, the type of intervention and the type of transportation did not differ. Further research is needed on changes in patient prognosis and condition due to the effects of the COVID-19 pandemic. Full article

Background/Objectives: Severe traumatic brain injury (TBI) is a frequent cause of morbidity and mortality worldwide. In the Netherlands, suspected TBI is a criterion for the dispatch of the physician-staffed helicopter emergency medical services (HEMS) which are operational 24 h per day. It is unknown if patient outcome is influenced by the time of day during which the incident occurs. Therefore, we investigated the association between the time of day of the prehospital treatment of severe TBI and 30-day mortality. Methods: A retrospective analysis of prospectively collected data from the BRAIN-PROTECT study was performed. Patients with severe TBI treated by one of the four Dutch helicopter emergency medical services were included and followed up to one year. The association between prehospital treatment during day- versus nighttime, according to the universal daylight period, and 30-day mortality was analyzed with multivariable logistic regression. A planned subgroup analysis was performed in patients with TBI with or without any other injury. Results: A total of 1794 patients were included in the analysis, of which 1142 (63.7%) were categorized as daytime and 652 (36.3%) as nighttime. Univariable analysis showed a lower 30-day mortality in patients with severe TBI treated during nighttime (OR 0.74, 95% CI 0.60–0.91, p = 0.004); this association was no longer present in the multivariable model (OR 0.82, 95% CI 0.59–1.16, p = 0.262). In a subgroup analysis, no association was found between mortality rates and the time of prehospital treatment in patients with combined injuries (TBI and any other injury). Patients with isolated TBI had a lower mortality rate when treated during nighttime than when treated during daytime (OR 0.51, 95% CI 0.34–0.76, p = 0.001). Within the whole cohort, daytime versus nighttime treatments were not associated with differences in functional outcome defined by the Glasgow Outcome Scale. Conclusions: In the overall study population, no difference was found in 30-day mortality between patients with severe TBI treated during day or night in the multivariable model. Patients with isolated severe TBI had lower mortality rates at 30 days when treated at nighttime. Full article

In the domain of Advanced Air Mobility (AAM), Simplified Vehicle Operations (SVOs) promise a reduction in handling complexity and training time for pilots. Designing a usable human–machine interface (HMI) for pilots of SVO-enabled aircraft requires a deep understanding of task and user requirements. This paper describes the results of two user research methods to gather these requirements. First, a traditional Helicopter Emergency Medical Service (HEMS) mission was examined using a Hierarchical Task Analysis (HTA). The findings were used to formulate a theoretical HTA for a single-piloted electric Vertical Take-Off and Landing (eVTOL) system in such a scenario. In the second step, qualitative interviews with seven subject matter experts (pilots and paramedic support) in HEMS operations produced vital user requirements for HMI development. Key findings emphasize the necessity of a simplified information presentation and collision avoidance support in the HMI. Full article

Timely emergency medical service (EMS) is critical to mitigate outcomes of severe traffic crashes, especially in rural areas. The urban–rural inequality of the EMS infrastructure has been one of the factors contributing to a higher death rate for patients in rural road crashes. To address the spatial imbalance of EMS infrastructure, this study aimed to provide a methodological framework for evaluating the existing EMS infrastructure by taking South Korea’s EMS infrastructure expansion plans as the case study. Specifically, this study developed a road crash data-driven methodology to promote spatial balance and economical expansion of EMS infrastructure of all types, including EMS stations, hospitals, the helicopter fleet, and landing spots. Geographically weighted binary logit regression and spatial analysis identified strategic locations for prioritizing the EMS infrastructure expansion using crash victim data and road networks to close the gap between urban and rural areas. The analysis of access to existing EMS infrastructure showed that the 16 to 20 min EMS response time, including on-scene time and transport time ranging from 11 to 15 min, are significantly associated with higher crash fatalities. The results also suggested that EMS stations and heliports are inadequate to meet the EMS time thresholds in the central province of Korea. The findings of this research could inform policymakers as they are working toward expanding the EMS infrastructure and creating a more equitable EMS response when it comes to transporting rural road crash patients. Full article

Unmanned aerial vehicle technology is the most advanced and helpful in almost every area of interest in human work. These devices become autonomous and can fulfil a variety of tasks, from simple imaging and obtaining data to search and rescue operations. The most challenging environment for search and rescue operations is the mountainous area. This article is devoted to the theoretical description and simulation tests of a prototype method of landing the light and the medium-weight UAVs used as supplementary devices for SAR (search and rescue) and HEMS (helicopter emergency medical service) in hard-to-reach mountainous terrains. The autonomous flight of a UAV in mountainous terrain has many specifics, and it is usually performed according to predetermined map points (pins) uploaded directly into the control software of the UAV. It is necessary to characterise each point flown on the chosen flight route line in advance and therefore to know its exact geographical coordinates (longitude, latitude and height of the point above the terrain), and the control system of UAV must react to the change in the weather and other conditions in real time. Usually, it is difficult to make this forecast with sufficient time in advance, mainly when UAVs are used as supplementary devices for the needs of HEMS or MRS (mountain rescue service). The most challenging phase is the final approach and landing of the UAV, especially if a loss of GNSS (global navigation satellite system) signal occurs, like in the determined area of the Little Cold Valley in the Slovak High Tatras—which is infamous for the widespread loss of GNSS signals or communication/controlling connection between the UAV and the pilot-operator at the operational station. To solve the loss of guidance, a new method for guiding and controlling the UAV in its final approach and landing in a determined area is tested. An alternative landing navigation system for UAVs in a specific mountainous environment—the authors’ designed frequency Doppler landing system (FDLS)—is briefly described but thoroughly tested with the help of artificial intelligence. An estimation of dynamic stability is used based on the time recording of the current position of the UAV, with the help of a frequency-modulated or amplitude-modulated signal based on the author’s prototype of a precision landing system designed for mountainous terrain. This solution could overcome the problems of GNSS signal loss. The presented research primarily evaluates the success of the simulation flights for the supplementary UAV. The success of navigating the UAV to land in the mountainous environment at an exact landing point using the navigation signals from the FDLS was evaluated at more than 95%. Full article

A paradigm shift in traumatic cardiac arrest (TCA) perception switched the traditional belief of futility of TCA resuscitation to a more optimistic perspective, at least in selected cases. The goal of TCA resuscitation is to rapidly and aggressively treat the common potentially reversible causes of TCA. Advances in diagnostics and therapy in TCA are ongoing; however, they are not always translating into improved outcomes. Further research is needed to improve outcome in this often young and previously healthy patient population. Full article