Comparison of deliberate self-harm incidents attended by Helicopter Emergency Medical Services before and during the first wave of COVID-19 in the East of England

IntroductionThere is significant interest in the mental health impact of the COVID-19 pandemic. Helicopter Emergency Medical Services (HEMS) attend the most seriously unwell and injured patients in the community; their data therefore present an early opportunity to examine self-harm trends. The primary aim was to compare the incidence of deliberate self-harm incident (DSH-I) encounters by HEMS before and during the first wave of COVID-19.MethodsData were obtained from all three East of England HEMS: total number of activations and stand-downs, number of DSH-I activations and stand-downs, self-harm mechanism and number of ‘severe’ DSH-I patient encounters, in two 61-day periods: 1 March to 30 April in 2019 (control) and 2020 (COVID-19). Severe DSH-I was defined as cardiac arrest and/or died prehospital. Proportions were compared with a Fisher’s exact test.ResultsThere were a total of 1725 HEMS activations: n=981 (control) and n=744 (COVID-19), a decrease of 24.2% during COVID-19. DSH-I patient encounters increased by 65.4%: n=26 (control) and n=43 (COVID-19). The proportion of encounters that were DSH-I and severe DSH-I both significantly increased during COVID-19: p=0.002 and p=0.001, respectively. The absolute number of hangings and falls from height both approximately tripled during COVID-19, whereas the number of other mechanisms remained almost constant.ConclusionDespite a reduction in overall HEMS patient encounters, there were significant increases in both the proportion of DSH-Is and their severity attended by HEMS during the first wave of the COVID-19 pandemic in the East of England.

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Comparing the Air Medical Prehospital Triage Score With Current Practice for Triage of Injured Patients to Helicopter Emergency Medical Services

JAMA Surgery ◽

10.1001/jamasurg.2017.4485 ◽

2018 ◽

Vol 153 (3) ◽

pp. 261 ◽

Cited By ~ 9

Author(s):

Joshua B. Brown ◽

Kenneth J. Smith ◽

Mark L. Gestring ◽

Matthew R. Rosengart ◽

Timothy R. Billiar ◽

...

Keyword(s):

Emergency Medical Services ◽

Current Practice ◽

Medical Services ◽

Helicopter Emergency Medical Services ◽

Emergency Medical ◽

Prehospital Triage ◽

Injured Patients

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Beneficial effect of helicopter emergency medical services on survival of severely injured patients

British Journal of Surgery ◽

10.1002/bjs.4756 ◽

2004 ◽

Vol 91 (11) ◽

pp. 1520-1526 ◽

Cited By ~ 85

Author(s):

S. P. G. Frankema ◽

A. N. Ringburg ◽

E. W. Steyerberg ◽

M. J. R. Edwards ◽

I. B. Schipper ◽

...

Keyword(s):

Beneficial Effect ◽

Emergency Medical Services ◽

Medical Services ◽

Severely Injured ◽

Severely Injured Patients ◽

Helicopter Emergency Medical Services ◽

Emergency Medical ◽

Injured Patients

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Reduced Mortality in Severely Injured Patients Using Hospital-based Helicopter Emergency Medical Services in Interhospital Transport

Journal of Korean Medical Science ◽

10.3346/jkms.2017.32.7.1187 ◽

2017 ◽

Vol 32 (7) ◽

pp. 1187 ◽

Cited By ~ 12

Author(s):

Oh Hyun Kim ◽

Young-Il Roh ◽

Hyung-Il Kim ◽

Yong Sung Cha ◽

Kyoung-Chul Cha ◽

...

Keyword(s):

Emergency Medical Services ◽

Medical Services ◽

Severely Injured ◽

Severely Injured Patients ◽

Helicopter Emergency Medical Services ◽

Emergency Medical ◽

Interhospital Transport ◽

Injured Patients

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When Minutes Fly by: What is the True “Golden Hour” for Air Care?

The American Surgeon ◽

10.1177/000313481808400633 ◽

2018 ◽

Vol 84 (6) ◽

pp. 862-867 ◽

Cited By ~ 2

Author(s):

Marquinn Duke ◽

Danielle Tatum ◽

Kevin Sexton ◽

Lance Stuke ◽

Ronald Robertson ◽

...

Keyword(s):

Emergency Medical Services ◽

Inflection Point ◽

Injury Severity ◽

Medical Services ◽

Inhospital Mortality ◽

Helicopter Emergency Medical Services ◽

Golden Hour ◽

Emergency Medical ◽

Injured Patients ◽

Prehospital Time

Air transport was developed to hasten patient transport based on the “golden hour” belief that delayed care leads to poorer outcome. The primary aim of our study was to identify the critical inflection point of increased nonsurvivors on total prehospital time. This was a multicenter review of adult trauma patients transported by air between November 2014 and August 2015. Primary outcome of interest was all-cause inhospital mortality. Total helicopter emergency medical services times of nonsurvivors were plotted to visualize the distribution of prehospital time. Of 636 patients included, 71 per cent were male and 86 per cent suffered blunt trauma. Among non-survivors, mortality doubled once total helicopter emergency medical services time exceeded 30 minutes (P < 0.001). Nonsurvivors presented with significantly lower median [interquartile range (IQR)] Glasgow Coma Score compared with survivors [3 (3–13) vs 15 (12–15), respectively; P < 0.001] as well as a significantly higher median (IQR) Injury Severity Score [26 (19–41) vs 12 (5–22); P < 0.001], increased incidence of penetrating mechanism of injury [21 vs 8%; P = 0.002], and higher median (IQR) shock index [0.84 (0.63–1.06) vs 0.71 (0.6–0.87); P = 0.023]. We identified an inflection point of doubling in mortality after 30 minutes. This suggests a possible threshold effect between time and mortality in severely injured patients. Revised field criteria for determining which injured patients would most benefit from helicopter transport are needed.

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HEMS dispatch: A systematic review

Trauma ◽

10.1177/1460408617721565 ◽

2017 ◽

Vol 20 (1) ◽

pp. 3-10 ◽

Cited By ~ 5

Author(s):

Georgette Eaton ◽

Simon Brown ◽

James Raitt

Keyword(s):

Systematic Review ◽

Emergency Medical Services ◽

Meta Analysis ◽

Medical Services ◽

Cochrane Library ◽

Physiological Data ◽

Helicopter Emergency Medical Services ◽

Emergency Medical ◽

The Cochrane Library ◽

Injured Patients

Introduction Helicopter emergency medical services dispatch is a contentious issue in modern prehospital services. Whilst the link between helicopter emergency medical services and improved patient outcome is well evidenced, allocation to the most appropriate incidents remains problematic. It is unclear which model of deployment is the most efficient at targeting major trauma and whether this can be improved with a change in dispatch process. The objective of this study was to have an overview of the evidence for dispatch models of helicopter emergency medical services to critically ill or injured patients. Methods This systematic review was conducted in accordance with a protocol developed from the PRISMA guidelines. MEDLINE, Embase, CINAHL and the Cochrane library were searched focusing on keywords involving dispatch of helicopter emergency medical services resources. Results Ninety-seven articles were screened and 14 articles were eligible for inclusion. Most were of low quality, with three of moderate quality. Heterogeneity in the methodology of included articles precluded meta-analysis, so a narrative review was performed. Conclusions This review demonstrates the lack of evidence surrounding helicopter emergency medical services dispatch models. Whilst it is not possible to identify a method of dispatch that will optimize helicopter emergency medical services allocation, common themes within the literature indicate that helicopter emergency medical services use is region specific and dispatch criteria should be designed to match specific systems. Additionally, mechanism of injury as well as physiological data from scene was shown to be the most accurate indicator for helicopter emergency medical services attendance.

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