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

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