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Open Access Research article

Primary scene responses by Helicopter Emergency Medical Services in New South Wales Australia 2008–2009

Colman B Taylor12*, Bette Liu3, Eleanor Bruce4, Brian Burns5, Stephen Jan1 and John Myburgh13

Author Affiliations

1 The George Institute for Global Health, PO Box M201, Missenden Rd Camperdown, NSW 2050, Sydney, NSW, Australia

2 The University of Sydney, Sydney Medical School, Sydney, NSW, Australia

3 The University of NSW, Faculty of Medicine, Sydney, NSW, Australia

4 The University of Sydney, School of Geosciences, Sydney, NSW, Australia

5 Greater Sydney Area HEMS, Ambulance Service of NSW, Sydney, NSW, Australia

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BMC Health Services Research 2012, 12:402  doi:10.1186/1472-6963-12-402

Published: 15 November 2012

Abstract

Background

Despite numerous studies evaluating the benefits of Helicopter Emergency Medical Services (HEMS) in primary scene responses, little information exists on the scope of HEMS activities in Australia. We describe HEMS primary scene responses with respect to the time taken, the distances travelled relative to the closest designated trauma hospital and the receiving hospital; as well as the clinical characteristics of patients attended.

Methods

Clinical service data were retrospectively obtained from three HEMS in New South Wales between July 2008 and June 2009. All available primary scene response data were extracted and examined. Geographic Information System (GIS) based network analysis was used to estimate hypothetical ground transport distances from the locality of each primary scene response to firstly the closest designated trauma hospital and secondly the receiving hospital. Predictors of bypassing the closest designated trauma hospital were analysed using logistic regression.

Results

Analyses included 596 primary missions. Overall the HEMS had a median return trip time of 94min including a median of 9min for activation, 34min travelling to the scene, 30min on-scene and 25min transporting patients to the receiving hospital. 72% of missions were within 100km of the receiving hospital and 87% of missions were in areas classified as ‘major cities’ or ‘inner regional’. The majority of incidents attended by HEMS were trauma-related, with road trauma the predominant cause (44%). The majority of trauma patients (81%) had normal physiology at HEMS arrival (RTS = 7.84). We found 62% of missions bypassed the closest designated trauma hospital. Multivariate predictors of bypass included: age; presence of spinal or burns trauma; the level of the closest designated trauma hospital; the transporting HEMS.

Conclusion

Our results document the large distances travelled by HEMS in NSW, especially in rural areas. The high proportion of HEMS missions that bypass the closest designated trauma hospital is a seldom mentioned benefit of HEMS transport. These results along with the characteristics of patients attended and the time HEMS take to complete primary scene responses are useful in understanding the benefit HEMS provides and the services it replaces.

Keywords:
Wounds and injury; Trauma systems; Helicopter Emergency Medical Services; Patient acuity; Cost; Reimbursement