What can be achieved in the aeromedical environment in 2012?

Systems The first speaker was Colonel Peter Kovats, United States Air Force, Chief of Aerospace Medicine at RAF Lakenheath UK. He spoke on Aeromedical Evacuation – ‘from point of wounding all the way home’. Colonel Kovats gave an extensive review of intra/inter-theatre air-evacuation and discussed 7656 patients injured in Operation Enduring Freedom in 2010. 15% were military coalition casualties and over 90% survived. Impressive survival rates of up to 95% with massive transfusion were presented. He suggested that key areas for improved care include craniofacial reconstruction, burn repair with cell engineered skin, prevention of compartment syndromes, healing without scaring with cell spraying, limb and digit salvage, and muscle regeneration. Cornel Kovats stated that the system has developed to deliver the same level of care in transport as in hospital. This was a persistent theme in presentations at the conference – the concept that patients condition rather than location should determine the level of care provided. Mr Graham Chalk, Lead Paramedic London’s Air Ambulance spoke knowledgably on dispatch of air ambulance services in trauma. This topic was identified at a recent consensus meeting as one of the top 5 research priorities in pre-hospital practice. Mr Chalk’s comprehensive review of the literature outlined current methods used for dispatch. The traditional dispatch using mechanism of injury was demonstrated to be a poor discriminator for HEMS dispatching. Critically, multiple studies demonstrate physiological criteria were most accurate for dispatch, but this may be critically influenced by the reliability and experience of on-scene personnel. The current approach of London’s Air Ambulance utilises clinical interrogation dispatch in addition to seven immediate dispatch criteria. The data presented suggested interrogation dispatch is as accurate as on-scene ambulance service requests but leads to dispatch on average 13 minutes quicker. Immediate dispatch was 10% less accurate, but on average 4 minutes quicker. It was concluded that criteria can be created which have sensitivity and specificity but should be used in a flexible manner by clinically experienced individuals in the clinical dispatch centre. The controversial question of pre-hospital trauma triage: only a matter of flowcharts or does provider competence matter? was addressed by Dr Marius Rehn a Senior Researcher from the Norwegian Air Ambulance. Barriers to field trauma triage were summarised, with some thoughts on how to overcome them. Some triage generalisations were of particular interest. Under-triaged patients tended to be older, whereas over-triaged patients are younger and commonly involved in road traffic collisions. It was concluded that a shift of focus is required to improve triage and point of care diagnostics may be helpful. Evidence collected using the Utstein trauma template for uniform reporting of data following major trauma may be useful in measuring the effectiveness and features of good triage. Dr Nils Petter Oveland, also from the Norwegian Air Ambulance, talked passionately about ultrasound applications in HEMS, provocatively asking is it time to dismiss the stethoscope? By describing ultrasound as a way of identifying pneumothorax, haemothorax, fracture, tendon rupture, optic nerve diameter for ICP, confirming tracheal tube placement, as well as an extended FAST protocol, he attempted to convince the audience Brighton and Sussex Medical School, Brighton, UK Full list of author information is available at the end of the article Avery and Lockey Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2013, 21(Suppl 1):A4 http://www.sjtrem.com/content/21/S1/A4