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