❙ Julia Ausserer, Elizabeth Moritz, Peter Mair ❙
Erfahrungen mit dem Einsatz von Notarzthubschraubern bei poly traumatisierten Alpinunfallopfern Physician Staffed Emergency Medical Helicopters to Provide Pre-Hospital Advanced Trauma Life Support in Mountain Rescue Missions
SUMMARY Physician staffed emergency medical helicopters (HEMS) are used to support mountain rescue missions, although little data are available on the feasibility and consequences of advanced trauma life support (ATLS) interventions in mountain rescue missions. Therefore we studied 58 major trauma patients rescued out of mountainous terrain by physician staffed emergency medical helicopters in the Tyrolean Alps. Prehospital mortality was 6.9 %. Total prehospital time was prolonged and exceeded 90 minutes in 41 % of all missions. Thirty-one of 58 patients (53 %) had at least one vital function critically impaired when the rescue team arrived. Endotracheal intubation at scene in patients with a Glasgow Coma Scale score ≤9 was accomplished without major complications in 15 of 19 of patients (79 %). Volume replacement therapy was restrictive and exceeded 1000 ml in only 17 %. Sixteen of 25 patients (64 %) with hypotension at scene had also a blood pressure <90 mmHg on hospital admission, including 8 patients with traumatic brain injury. Rope rescue operations were necessary in 69 % of cases and advanced trauma life support was initiated before rope rescue in 75 % of them. A prolonged total prehospital time together with the critical impairment of vital functions in half of all major trauma victims support the concept of ATLS at scene in HEMS mountain rescue missions. Prehospital airway protection with endotracheal intubation is possible with a high success and low complication rate and is accomplished in the majority of patients with severe brain trauma. Prehospital resuscitation of hypotensive patients is more demanding and hypotension is not reversed 103
