Elsevier

Air Medical Journal

Volume 31, Issue 2, March–April 2012, Pages 87-91
Air Medical Journal

Original Research
Helicopter Rescue Involving the Winching of a Physician

https://doi.org/10.1016/j.amj.2011.08.003Get rights and content

Abstract

Introduction

We sought to study the operational and medical aspects of helicopter rescue missions involving the use of a winch.

Setting

A single helicopter-based medical service of a pre-alpine region of Switzerland.

Methods

We prospectively studied consecutive primary rescue interventions involving winching of a physician, from October 1, 1998 to October 1, 2002. Demographic, medical and operational aspects as well as outcome at 48 hours were analyzed.

Results

We included 133 patients. Most (74%) were male, with traumatic injuries (77%). The median scene time of the nine severely injured patients (Injury Severity Scale [ISS] > 15) was significantly longer compared with the other patients (54 vs 37 minutes; P < .05). The main medical procedures performed were orotracheal intubation (n = 5), fracture reductions (n = 5), major analgesia with sedation (n = 4), and intravenous fluid administration of more than 1,500 mL (n = 4). Fourteen (10%) patients suffering from minor injuries were triaged by the physician and not airlifted to the hospital. All 133 patients were alive at 48 hours. Sixty-nine (52%) were still hospitalized. No secondary interhospital transfer was required.

Conclusion

Our study provides a better knowledge of injury profile, medical aspects, and outcomes of patients rescued necessitating a winching procedure.

Introduction

The use of helicopters in prehospital medical systems as well as the type of staffing is under debate.1, 2 Issues such as cost, effectiveness, safety, and resource allocation are criticized,3, 4 while dispatch criteria are under review and lack general applicability.5 Nevertheless, dispatching of a trained physician in the prehospital setting by means of road or air is common in European and Australasian health systems6, 7, 8 and has been shown to improve patient outcome in controlled settings.9, 10

Mountains cover 60% of Switzerland. Mountain-related outdoor activities such as climbing, paragliding, and trekking are popular, and accidents are therefore common. This setting implies that access to patients can be difficult or impossible by ordinary means and necessitates the use of a helicopter equipped with a winch when landing is impossible.

Previous studies in the same setting showed that a quarter of the patients rescued with a winch were severely injured. Interval between time of injury and arrival at hospital was greatly increased because of access difficulties.11

To assess the pattern and severity of injury and the relevance of medical procedures during hoisting operations, we studied consecutive helicopter rescue operations involving the use of a winch in our Swiss helicopter base.

Section snippets

Setting

The REGA is a nonprofit organization dedicated to rescue of injured patients. It includes helicopters dispatched to the scene of an accident to triage and care for the injured patients or to provide access in remote areas. Switzerland (41,000 km2) has 17 air medical bases for 7 million inhabitants. The REGA helicopter base of Lausanne, where the study took place, covers a population of 800,000 inhabitants, and is located in a pre-alpine region. It operates one single helicopter, a Eurocopter

Methods

We prospectively reviewed the medical records of helicopter rescue operations from the Lausanne base of the Swiss Air Rescue Helicopter Service (REGA). The consecutive rescue missions from October 1, 1998 to October 1, 2002 were analyzed. All patients for whom winching of the physician was performed were included. Patients lost to follow-up, those with missing data, or those pronounced dead at the scene without any resuscitation attempt were excluded. Secondary missions (ie, inter-hospital

Results

One thousand eight hundred fifty-five primary interventions were conducted during the study period. The physician had to be winched in 156 (8.4%) rescue operations. Fifteen of these patients, who were obviously dead at the scene, and eight that had incomplete files with missing data, were excluded, leaving 133 patients for analysis.

The demographics data of the 133 included patients are shown in Table 1. Most patients were male, with a male: female sex ratio of 2.8: 1. Traumatic lesions were

Discussion

Our results demonstrate that most rescues involved young male patients suffering from traumatic lesions. The injury took place in difficult or impossible to access locations. Extremities and pelvis were the most frequently encountered lesions sites. The scene time was significantly longer for the nine severely injured patients. Advanced medical procedures were performed 20 times. Fourteen (10%) patients suffering from minor injuries were triaged by the physician and not airlifted to the

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