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Table 3 Difficulties, challenges and possible hazards of rescuing an intubated patient with a HEC operation

From: Advanced airway management in hoist and longline operations in mountain HEMS – considerations in austere environments: a narrative review This review is endorsed by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM)

Medical difficulties and challenges
 Airway device displacement
 Hyper−/hypoventilation
 Disconnection between airway device and resuscitation bag or respirator
 Limited monitoring possibilities (no acoustical and limited visual observation) during HEC operation
 Inability to perform any airway device corrections of false placement during HEC operation
 Complex and time-consuming securing of all medical devices (e.g., oxygen bottles, monitors, respirator etc.) for HEC operation
 Risk of hypothermia due to prolonged exposure to the elements
Non-technical difficulties and challenges, human factors
 Limited situational awareness
 Increased work load during highly complex rescue maneuvers
 Involuntarily shift of focus from safety during hoist operations to medical care
 Prolonged exposure to physical hazards (e.g., rockfall) due to prolonged time on scene
Technical difficulties and challenges
 Loss of the resuscitation bag or other medical devices, for example due to downwash or gravitational forces
 Displacement of the airway device following exposure to downwash, which could interfere with re-inflation of the BVM during manual ventilation