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Auckland HEMSHelicopter Emergency Medical ServicesChristopher Denny, MD, MSc, FRCPC, FACEP, FACEM
SMO Emergency Medicine, Auckland City Hospital, ADHB
Disclosure
• 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)
OBJECTIVES1. Increase awareness of Auckland HEMS
2. Explore Pre-Hospital and Retrieval Medicine
3. Compare patient care on the road with in hospital
Introduction
• 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
ADHB & ARHT
• Memorandum of Understanding established in 2011• Specialists in Emergency Medicine, Critical Care and
Anaesthetics• Purpose: to augment the clinical capabilities of the flight
crew
HEMS Mission profiles
Trauma43%
Medical 55%
SAR1% Interfacility 1%
Mission type
Helicopters
• 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
Why doctors?
Critical interventions
• 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
Accelerating time to definitive care
• Time to critical intervention:• Airway management• CT• Operating theatre• Interventional radiology
Clinical governance
Evidence
• 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%)
Seamless care
• From roadside to bedside in definitive care• Standardized communications (METHANE, MIST,
SBAR)
Disaster preparedness
• Coordinated Incident Management System (CIMS)• Inter-agency collaboration with St John Ambulance, NZ
Fire Services, Police SAR• Aeromedical reconnaissance
High performing teams
• “To turn a team of experts into an expert team.”• Eduardo Salas
Teamwork
• High task interdependency• Cooperation, coordination, communication, cognition,
coaching and conflict
The future
• Integration• Coordination• Clinical networks