|Title||Medical helicopter: What are the benefits and pitfalls on drowning?|
|Publication Type||Conference Paper|
|Year of Publication||2007|
|Authors||Dr Szpilman, MD, D|
|Conference Name||World Conference on Drowning Prevention|
|Publisher||International Life Saving Federation|
|Conference Location||Porto, Portugal|
The Helicopter service center of Rio de Janeiro, called CAOA, commenced operation in 1974, now has a total of 8 planes, and is a specialized government facility for different emergencies. One of those is to attend medical (advanced life support) and rescue emergencies (firefighters and lifeguards), which is done by 4 helicopters (2 medical and 2 rescuers - Eurocopter AS 350 BA) and their crews from the Fire Department (CBMERJ).
The medical team is prepared to attend pre-hospital medical emergencies (EVAM) and inter-hospital critical ill patient transportation (TIH).
The rescue chopper is equipped with a hook allowing the team to attend water (drowning), air (hang gliders), rock (climbers), or forest fire emergency situations (SAR mission) and also medical emergencies. The medical helicopter is specially configured from manufacture to be used only for medical emergencies. In some cases when a rescue needs a sequential medical intervention both crews are called together or the medical doctor (MD) crews the rescue helicopter. The medical team is comprised of one doctor, one emergency medical technician (EMT) and one pilot to attend from sunrise to sunset.
Our purpose is to answer 3 questions about drowning:
Methods: we retrospectively evaluated all flights completed by the medical team during 2004. Special attention was given to cases of emergencies and particularly to drowning.
Results: In 2004, the medical team made 407 medical/rescue flights. Including all missions it was 245 hours of flight and 452 hours of missions. From 407 events, 225 (55%) were EVAM, 178 (44%) TIH, one disaster simulation and 3 missions aborted. Patient median age was 37 (IQ 22-55) years old, and 69% were males. Concerning the EVAM missions (225), 78% were trauma. When the helicopter arrived at the site there was a basic or advanced ambulance already in attendance in 79%. From all 225 EVAM, 13 were drowning. Important information comparing EVAM and drowning are presented in table 1. Drowning figures and outcome is shown in table 2.
Discussion: The medical helicopter is a very important and sophisticated tool on giving medical attendance to drowning. It has proven to unique when an ambulance is unable to get to the scene in less than 12 minutes or when there is only basic life support (lifeguards or ambulance) at the scene. It’s evident on table 1, that the helicopter arrives faster for drowning than for other emergencies but this is a matter of distance. For drowning attendance time spent on site is almost twice, and this is the reason and the explanation for their use as the medical team gave advanced life support at the site. In grade 6(PCR) attendance can vary in duration from 5 to 130 minutes at the site, where an improvised emergency room is arranged at the beach. This seems to be than trying to do CPR while flying. Although the use of helicopters can seem to be of high value, pitfalls do exist and can turn a success into a big failure. Drowning occurs usually on crowded beaches, and to land outside a regular area could be a huge problem to all, with flying sand and dangerous objects. In table 2, figures demonstrate that a medical helicopter was called in 77% for high severity drowning (3 to 6) which increases the benefits over the risks.
|Learning Outcomes|| |
Table 1 – Trauma and drowning Comparison. (*) All basic life support
Helicopter center to accident site time
15min (IQ 10-20)
11,5 min (IQ 10-15)
Distance to accident site
31.6 km (IQ 20-40),
24 km (IQ 25-36)
Time spent on medical attendance at the site
22.4 min (IQ 15-30)
42 min (IQ 21-60)
Total flight time
26.9 min (IQ 20-30)
24,6 min (IQ 20-25)
Total rescue mission time
49.3 min (IQ 20-40)
67 min (IQ 55-91)
Ambulance at the site when helicopter arrived
First aid at the scene when helicopter arrived
Table 2 – Drowning grade and outcome.
Drowning grade (1)
Release at the site to home
One release to basic ambulance and one for hospitalization
2 hospitalizations and one death after CPR
Szpilman D. Near-drowning and drowning classification: a proposal to stratify mortality based on the analysis of 1831 cases. Chest 1997;112; issue 3