A five year analysis of the rotor wing air mercy service in Richards Bay, South Africa
Thesis (MMed)--Stellenbosch University, 2013.
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 was conducted. 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, and whether the flight was for a primary response or inter-facility transfer. Results: 1429 flights were undertaken; three records were missing. Primary response accounted for 165 (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 for flight 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 be subjective and inconsistent. There was a significantly longer median on-scene time for neonates (48 minutes, IQR 35-64 minutes) as compared to adults (36 minutes, IQR 26-48 minutes, p<0.001) and paediatrics (36 minutes, IQR 25-51 minutes, p<0.02). On-scene times for doctor-paramedic crews (45 minutes, 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 underutilisation of HEMS in an area where it may have a major impact considering the shortage of ALS crew 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.
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