Auckland HEMS Helicopter Emergency Medical Services Christopher Denny, MD, MSc, FRCPC, FACEP, FACEM SMO Emergency Medicine, Auckland City Hospital, ADHB.

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

Thank you.

www.aucklandhems.com