A five year analysis of the rotor wing air mercy service in Richards Bay, South Africa

[摘要] ENGLISH SUMMARY : Introduction: The study describes the first five years of operation of a HEMS service in rural South Africa.Methods: A chart review of all activated flights from 1 January 2006 to 31 December 2010 wasconducted. Flights with missing patient report forms were excluded. Data collected included age,indication for flight, triage code, flight times, on-scene times, presence of doctor as part of crew, andwhether the flight was for a primary response or inter-facility transfer.Results: 1429 flights were undertaken; three records were missing. Primary response accounted for165 (11.57%) of flights. 139 (9.75%) flights were cancelled after take off (Interfacility Transfer (IFT)n=99, 7.9%; Primary n=32, 19.4%; unspecified n=8). Just over a third (n=472, 36.67%, IFT n=447,38.74%; Primary n=25, 18.80%) of patients were under twelve years old. The main indications forflight in IFT were obstetrics (n=398, 34.49%), paediatrics (n=322, 27.90%), and trauma (n=183,15.86%). In primary response trauma (n=97, 72.93%) was most common followed by obstetrics(n=15, 11.28%), and paediatrics (n=9, 6.78%). However the triage system used appeared to besubjective and inconsistent. There was a significantly longer median on-scene time for neonates (48minutes, IQR 35-64 minutes) as compared to adults (36 minutes, IQR 26-48 minutes, p<0.001) andpaediatrics (36 minutes, IQR 25-51 minutes, p<0.02). On-scene times for doctor-paramedic crews (45minutes, IQR 27-50) were significantly longer than paramedic only crews (38 minutes, IQR 27-57,p<0.001).Conclusion: The low flight per population ratios and primary response rate may indicate underutilisationof HEMS in an area where it may have a major impact considering the shortage of ALScrew and the long transport distances. There is a need for further studies into HEMS in rural Africa,looking particularly at cost-benefit analyses, optimal activation criteria, and triage systems.

[发布机构] Stellenbosch University