Missions of the Helicopter Emergency Medical Service in rural and urban areas in Poland – A comparative retrospective analysis
More details
Hide details
Medical University, Lublin, Poland
Medical University, Warsaw, Poland
Institute of Rural Health, Lublin, Poland
Patryk Rzońca   

Medical University of Lublin, Lublin, Staszica 4-6, 20-081, Lublin, Poland
Mortality due to various causes, despite continuous efforts to improve the quality of medical services, is a serious problem for modern healthcare systems. Ischaemic heart disease and stroke are the cause of over 15 million deaths annually, and are therefore known as the world’s number one killer.

The aim of this study is to characterise the missions and the most common reasons for dispatching Helicopter Emergency Medical Service (HEMS) crews, with special emphasis on the differences between urban and rural areas.

Material and methods:
The study was conducted using a retrospective analysis of HEMS missions, including flights to accidents and diseases carried out by HEMS crews in Poland from January 2014 – December 2018. The final analysis included 35,213 cases of HEMS missions.

The study group consisted mainly of male patients (66.40%), aged 50–64 (22.06%), mean age of the entire analysed group – 47.71 (SD: 25.96). The main reason for HEMS missions were strokes (21.63%). Analysis of patients’ clinical status revealed that the clinical status of patients treated in rural areas was more severe, which was indicated by the Glasgow Coma Scale – GCS (12.03 vs 12.35) and the Revised Trauma Scale – RTS (10.14 vs 10.60) scores. When assessed by the National Advisory Committee for Aeronautics (NACA) score, body injuries and fatal diseases were observed more often in patients in rural areas (NACA 7 6.12% vs 3.46%) (p<0.05).

Anthony DR. Promoting emergency medical care systems in the developing world: weighing the costs. Glob Public Health. 2011; 6(8): 906–913.
Karwan K, Michalak G, Gałązkowski R. Organization of emergency medical care for patients with multiple and multi-organ trauma in a hospital setting. Ogólnopol Przegl Med. 2013; 12: 28–31.
Turner N, Chen H, Morosanu L. Characteristics of rural users of emergency medical services in Georgia: A population- based study. J Ga Public Health Assoc 2016; 5(4): 332–338.
Rzońca P, Gałązowski R, Podgórski M. Role of Polish Medical Air Rescue in National Medical Rescue System. Disaster Emerg Med J 2017; 2(2): 64–68.
Chen X, Gestring ML, Rosengart MR, Billiar TR, Peitzman AB, Sperry JL, et al. Speed is not everything: Identifying patients who may benefit from helicopter transport despite faster ground transport. J Trauma Acute Care Surg. 2018; 84(4):549–557.
Moens D, Stipulante S, Donneau AF, Hartstein G, Pirotte O, D’orio V, et al. Air versus ground transport of patients with acute myocardial infarction: experience in a rural-based helicopter medical service. Eur J Emerg Med. 2015; 22(4): 273–8.
Stewart KE, Cowan LD, Thompson DM, Sacra JC, Albrecht R. Association of direct helicopter versus ground transport and in-hospital mortality in trauma patients: a propensity score analysis. Acad Emerg Med. 2011; 18(11): 1208–16.
Giannakopoulos GF, Kolodzinskyi MN, Christiaans HM, Boer C, de Lange-de Klerk ES, Zuidema WP, Bloemers FW, et al. Helicopter Emergency Medical Services save lives: outcome in a cohort of 1073 polytraumatized patients. Eur J Emerg Med. 2013; 20(2): 79–85.
McMullan JT, Hinckley W, Bentley J, Davis T, Fermann GJ, Gunderman M, et al. Reperfusion is delayed beyond guideline recommendations in patients requiring interhospital helicopter transfer for treatment of ST-segment elevation myocardial infarction. Ann Emerg Med. 2011; 57(3): 213–220.e1.
Galvagno SM Jr, Haut ER, Zafar SN, Millin MG, Efron DT, Koenig GJ Jr, et al. Association between helicopter vs ground emergency medical services and survival for adults with major trauma. JAMA. 2012; 307(15): 1602–10.
Kosydar-Bochenek J, Ozga D, Szymańska J, Lewandowski B. Emergency Medical Service (EMS) systems on the world and the Polish system. Zdr Publ. 2012; 122: 70–74.
Global Health Observatory (GHO) data: Causes of death, by WHO region. (accessed on 24.02.2019).
Global Health Observatory (GHO) data: Top 10 causes of death. (accessed on 24.02.2019).
Wojtyniak B, Stokwiszewski J, Goryński P, Zdrojewski T. Długość życia i umieralność ludności Polski. W: Wojtyniaka B, Goryński P. (red.): Sytuacja zdrowotna Ludności Polski i jej uwarunkowania. Wydawca Narodowy Instytut Zdrowia Publicznego – Państwowy Zakład Higieny. Warszawa 2016.
Wu S.C., Rau CS, Kuo SCH, Chien PC, Hsieh HY, Hsieh CH. The Reverse Shock Index Multiplied by Glasgow Coma Scale Score (rSIG) and Prediction of Mortality Outcome in Adult Trauma Patients: A Cross-Sectional Analysis Based on Registered Trauma Data. Int J Environ Res Public Health 2018; 15: E2346.
Loggers SA, Koedam TW, Giannakopoulos GF, Vandewalle E, Erwteman M, Zuidema WP. Definition of hemodynamic stability in blunt trauma patients: a systematic review and assessment amongst Dutch trauma team members. Eur J Trauma Emerg Surg. 2016; 30: 1–11.
Raatiniemi L, Liisanantti J, Tommila M, Moilanen S, Ohtonen P, Martikainen M, et al. Evaluating helicopter emergency medical missions: a reliability study of the HEMS benefit and NACA scores. Acta Anaesthesiol Scand. 2017; 61: 557–565.
Raatiniemi L, Liisanantti J, Niemi S, Nal H, Ohtonen P, Antikainen H, et al. Short-term outcome and differences between rural and urban trauma patients treated by mobile intensive care units in Northern Finland: a retrospective analysis. Scand J Trauma Resusc Emerg Med. 2015; 23: 91.
Strehlow MC, Newberry JA, Bills CB, Min HE, Evensen AE, Leeman L, et al. Characteristics and outcomes of women using emergency medical services for third-trimester pregnancy-related problems in India: a prospective observational study. BMJ Open. 2016; 6(7): e011459.
Cheung BH, Delgado MK, Staudenmayer KL. Patient and trauma center characteristics associated with helicopter emergency medical services transport for patients with minor injuries in the United States. Acad Emerg Med. 2014; 21(11): 1232–9.
Goldstein J, Jensen JL, Carter AJ, Travers AH, Rockwood K. The Epidemiology of Prehospital Emergency Responses for Older Adults in a Provincial EMS System. CJEM. 2015; 17(5): 491–6.
Østerås Ø, Heltne JK, Vikenes BC, Assmus J, Brattebø G. Factors influencing on-scene time in a rural Norwegian helicopter emergency medical service: a retrospective observational study. Scand J Trauma Resusc Emerg Med. 2017; 25: 97.
Kottmann A, Carron PN, Theiler L, Albrecht R, Tissi M, Pasquier M. Identification of the technical and medical requirements for HEMS avalanche rescue missions through a 15-year retrospective analysis in a HEMS in Switzerland: a necessary step for quality improvement. Scand J Trauma Resusc Emerg Med. 2018; 26: 54.
Villani M, Earnest A, Nanayakkara N, Smith K, de Courten B, Zoungas S. Time series modelling to forecast prehospital EMS demand for diabetic emergencies. BMC Health Services Research 2017; 17: 332.
Hawkes C, Booth S, Ji C, Brace-McDonnell SJ, Whittington A, Mapstone J, et al. Epidemiology and outcomes from out-of-hospital cardiac arrests in England. Resuscitation 2017; 110: 133–140.
Newgard CD, Fu R, Bulger E, Hedges JR, Mann NC, Wright DA, et al. Evaluation of Rural vs Urban Trauma Patients Served by 9–1–1 Emergency Medical Services. JAMA Surg. 2017; 152: 11–18.
Rzońca P, Gałązkowski R, Panczyk M, Gotlib J. Polish Helicopter Emergency Medical Service (HEMS) Response to Out-of-Hospital Cardiac Arrest (OHCA): A Retrospective Study. Med Sci Monit. 2018; 24: 6053–6058.
McCowan CL, Swanson ER, Thomas F, Handrahan DL. Outcomes of blunt trauma victims transported by HEMS from rural and urban scenes. Prehosp Emerg Care. 2007; 11(4): 383–8.
Kornhall D, Näslund R, Klingberg C, Schiborr R, Gellerfors M. The mission characteristics of a newly implemented rural helicopter emergency medical service. BMC Emerg Med. 2018; 18: 28.
Werman HA, Falcone RA, Shaner S, Herron H, Johnson R, Lacey P, et al. Helicopter transport of patients to tertiary care centers after cardiac arrest. Am J Emerg Med. 1999; 17: 130–134.
Chen X, Gestring ML, Rosengart MR, Peitzman AB, Billiar TR, Sperry JL, et al. Logistics of air medical transport: When and where does helicopter transport reduce prehospital time for trauma? J Trauma Acute Care Surg. 2018; 85(1): 174–181.