Auckland HEMS

Helicopter Emergency Medical Services Christopher Denny, MD, MSc, FRCPC, FACEP, FACEM SMO Emergency Medicine, Auckland City Hospital, ADHB

• • Senior Medical Officer in Emergency Medicine, Auckland City Hospital • HEMS Medical Director, Auckland Rescue Helicopter Trust (ARHT) Clinical Team Leader, New Zealand Medical Assistance Team (MOH NZMAT)

Disclosure

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OBJECTIVES

Increase awareness of Auckland HEMS Explore Pre-Hospital and Retrieval Medicine Compare patient care on the road with in hospital

• • • • 1970: Auckland established the first civilian rescue helicopter service in the southern hemisphere Rescue helicopter originally based on the west coast of Auckland @ Piha Now the busiest rescue helicopter trust in New Zealand The only service in NZ with a doctor as a core member of the flight crew

Introduction

• • Memorandum of Understanding established in 2011 Specialists in Emergency Medicine, Critical Care and Anaesthetics • Purpose: to augment the clinical capabilities of the flight crew

ADHB & ARHT

Mission type

Interfacility 1% SAR 1% Trauma 43% Medical 55%

HEMS Mission profiles

• • • •

BK-117

x 2 • • Cruise speed 120 knots (222km/hr) Cruise altitude ~1500 feet Crew configuration: Pilot, crewman, paramedic & doctor Instrument Flight Rules (IFR) capable Winch capable • 600lb capacity

Helicopters

Why doctors?

• • • •

Airway

: Rapid sequence intubation (RSI), video laryngoscopy (VL), surgical airway

Breathing

: Mechanical ventilation, chest drains

Circulation

: Tranexamic acid (TXA), Point-of-care ultrasound (POCUS), blood products

Disability

: Reduction of dislocations and fractures; ultrasound-guided regional nerve blocks, field amputations, antidote therapies

Critical interventions

• Time to critical intervention: • • • • Airway management CT Operating theatre Interventional radiology Accelerating time to definitive care

Clinical governance

• Galvagno. JAMA 2012: HEMS and Survival after Major Trauma.

• • 223,475 patients in USA with age >15y & ISS>15

HEMS Odds Ratio for survival 1.16

, 95%CI 1.14-1.17 (ARR 1.5%)

Evidence

• • From roadside to bedside in definitive care Standardized communications (METHANE, MIST, SBAR)

Seamless care

• • Coordinated Incident Management System (CIMS) Inter-agency collaboration with St John Ambulance, NZ Fire Services, Police SAR • Aeromedical reconnaissance

Disaster preparedness

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“To turn a team of experts into an expert team.”

• Eduardo Salas

High performing teams

• • High task interdependency Cooperation, coordination, communication, cognition, coaching and conflict

Teamwork

• • • Integration Coordination Clinical networks

The future

Thank you.

www.aucklandhems.com