Medical helicopter: What are the benefits and pitfalls on drowning?

TitleMedical helicopter: What are the benefits and pitfalls on drowning?
Publication TypeConference Paper
Year of Publication2007
AuthorsDr Szpilman, MD, D
Conference NameWorld Conference on Drowning Prevention
Date Published09/2007
PublisherInternational Life Saving Federation
Conference LocationPorto, Portugal
Other NumbersPO-04
Abstract

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:

  1. When is a medical helicopter better for pre-hospital attendance than an ambulance?
  2. In the case of CPR for a drowning patient, should they be attended by ground response or by air?
  3. What are the pitfalls to deal with drowning using a helicopter?

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
  1. When is a helicopter better for pre-hospital attendance than an ambulance?
  2. In the case of CPR for a drowning patient, should they be attended by ground response or in the air?
  3. How and what are the pitfalls to deal with drowning using a helicopter?
Annexes

Table 1 – Trauma and drowning Comparison. (*) All basic life support

EVAM (n=212)
Drowning (n=13)

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

79%

15% (*)

First aid at the scene when helicopter arrived

79%

100% (lifeguards)

Table 2 – Drowning grade and outcome.

Drowning grade (1)
Number
Outcome

Rescue

0

----

Grade 1

1

Release at the site to home

Grade 2

2

One release to basic ambulance and one for hospitalization

Grade 3

5

Hospitalizations

Grade 4

1

Hospitalization

Grade 5

1

Hospitalization

Grade 6

3

2 hospitalizations and one death after CPR

TOTAL

13

References

Szpilman D. Near-drowning and drowning classification: a proposal to stratify mortality based on the analysis of 1831 cases. Chest 1997;112; issue 3