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Table 2 Presumptive diagnoses, monitoring, medical procedures, treatments, and destination of the 515 injured avalanche victims according to their severity. Counts and percentages are expressed by patients. Rega-Swiss Air Ambulance Helicopter Emergency Medical Service (HEMS) avalanche rescue missions between 1.01.2001 and 31.05.2016. P-values derive from the Pearson’s Chi2 calculations, when comparing the difference between the different NACA score categories

From: Identification of the technical and medical requirements for HEMS avalanche rescue missions through a 15-year retrospective analysis in a HEMS in Switzerland: a necessary step for quality improvement

 

overall

NACA severity score

P value

1–3

4

5

6

7

Injured patients, n (%) a

515

239 (40)

84 (14)

20 (3)

54 (9)

118 (20)

 

Distribution of the patients with a given presumptive diagnosis in the different NACA score categories

 

n (%) percentages are expressed by row

 

 Trauma

278 (54)

172 (62)

62 (22)

8 (3)

7 (3)

29 (10)

< 0.001

  Head

80 (16)

33 (41)

18 (23)

5 (6)

5 (6)

19 (24)

 

  Spinal

48 (9)

17 (35)

16 (33)

2 (4)

0 (0)

13 (27)

 

  Thoracic

49 (10)

17 (35)

18 (37)

1 (2)

4 (8)

9 (18)

 

  Abdominal

14 (3)

5 (36)

3 (21)

1 (7)

2 (14)

3 (21)

 

  Pelvic

31 (6)

11 (35)

12 (39)

1 (3)

1 (3)

6 (19)

 

  Femur

50 (10)

27 (54)

16 (32)

2 (4)

0 (0)

5 (10)

 

  Extremity (except femur)

142 (28)

105 (74)

33 (23)

2 (1)

0 (0)

2 (1)

 

 Hypothermia

186 (36)

75 (40)

47 (25)

17 (9)

27 (15)

20 (11)

< 0.001

 Asphyxia

102 (20)

2 (2)

3 (3)

3 (3)

26 (25)

68 (67)

< 0.001

 Miscellaneous b

16 (3)

7 (44)

2 (13)

1 (6)

2 (13)

4 (25)

0.973

Patients of each NACA score category for whom the given monitoring, procedure or treatment was done

 

n (%), percentages are expressed by column

 

Monitoring

194 (38)

      

 Pulse oximetry

123 (24)

34 (14)

47 (56)

12 (60)

25 (46)

5 (4)

< 0.001

 ECG monitoring

103 (20)

2 (1)

12 (14)

5 (25)

37 (69)

47 (40)

< 0.001

 Non-invasive blood pressure measurement

46 (9)

8 (3)

16 (19)

6 (30)

14 (26)

2 (2)

< 0.001

 Oesophageal temperature measurement

39 (8)

4 (2)

1 (1)

1 (5)

17 (31)

16 (14)

< 0.001

 End tidal CO2 measurement c

25 (5)

0 (0)

0 (0)

0 (0)

21 (39)

4 (3)

< 0.001

Immobilisation, splinting, dressing

173 (33)

      

 Vacuum mattress

140 (27)

48 (20)

49 (58)

13 (65)

25 (46)

5 (4)

< 0.001

 Cervical collar

57 (11)

17 (7)

18 (21)

7 (35)

10 (19)

5 (4)

< 0.001

 Peripheral splint

17 (3)

10 (4)

6 (7)

0 (0)

0 (0)

1 (1)

0.056

 Dressing/haemostasis

16 (3)

7 (3)

8 (10)

1 (5)

0 (0)

0 (0)

0.002

 Pelvic sling

1(0.2)

0 (0)

1 (1)

0 (0)

0 (0)

0 (0)

0.273

Procedures and treatments

327 (55)

      

 Oxygen administration (facemask or nasal cannula)

160 (31)

14 (6)

42 (50)

19 (95)

42 (78)

43 (36)

< 0.001

 Peripheral venous catheter insertion

127 (25)

38 (16)

40 (48)

12 (60)

19 (35)

18 (15)

< 0.001

 External rewarming (hot packs and/or electric blanket)

109 (21)

48 (20)

40 (48)

11 (55)

10 (19)

0 (0)

< 0.001

 Chest compression d

88 (17)

0 (0)

0 (0)

0 (0)

45 (83)

43 (36)

< 0.001

 Orotracheal intubation

77 (15)

0 (0)

0 (0)

1 (5)

44 (81)

32 (27)

< 0.001

 Ventilation e

110 (21)

0 (0)

3 (4)

4 (20)

52 (96)

51 (43)

< 0.001

 Defibrillation

21 (4)

0 (0)

0 (0)

0 (0)

14 (26)

7 (6)

< 0.001

 Intraosseous access f

18 (7)

0 (0)

1 (2)

0 (0)

11 (38)

6 (11)

< 0.001

 Mechanical chest compression g

13 (12)

0 (0)

0 (0)

0 (0)

10 (71)

3 (14)

< 0.001

 Pneumothorax decompression

1(0.2)

0 (0)

0 (0)

0 (0)

0 (0)

1 (1)

0.498

 Dislocation reduction or fracture realignment

7 (1)

0 (0)

3 (4)

1 (5)

1 (2)

2 (2)

0.074

 Infusions h

67 (12)

11 (5)

19 (23)

7 (35)

23 (43)

7 (6)

< 0.001

 Pharmaceutical agents i

125 (24)

24 (10)

38 (45)

7 (35)

30 (56)

26 (22)

< 0.001

Patients of each NACA score category who were transported to the given destination j

 

n (%), percentages are expressed by column

 

 ECLS Trauma centre

61 (12)

7 (3)

22 (26)

7 (35)

24 (44)

n.r.

< 0.001

 Non-ECLS Trauma centre

69 (13)

28 (12)

15 (18)

6 (30)

18 (33)

n.r.

< 0.001

 Non-trauma centre hospital

272 (53)

166 (70)

47 (56)

7 (35)

12 (22)

n.r.

< 0.001

  1. aNACA Scores were missing for three patients, none of which were in CA. Seventy-eight (13%) patients were uninjured (NACA score of 0)
  2. bMiscellaneous: burns (n = 0/0/1/0/1), frostbite (n = 1/1/0/0/0), drowning (n = 0/0/0/1/3), exhaustion (n = 2/1/0/0/0), nervous/psychologic (n = 4/0/0/1/0)
  3. cContinuous waveform end tidal capnography (EtCO2) was documented in 31% of the intubated patients. EtCO2 was more frequently used in patients with a NACA score of 6 compared to patients with a NACA score of 7 (48% vs. 9%, p = 0.001)
  4. dAmong patients with a NACA score of 6, two were in respiratory but not cardiac arrest. In a third patient, chest compression was made with a mechanical chest compression only
  5. eVentilation, including bag mask ventilation (with or without consecutive intubation) and manual or mechanical ventilation after intubation (no supraglotic airway device or surgical airway was used)
  6. fPercentages are calculated taking into account that data were only available from 2009 onwards
  7. gPercentages are calculated taking into account that data were only available from 2012 onwards. For four patients with a NACA score of 6, the mechanical chest compression device was used in standby mode only (i.e., installed on a patient with a sufficient circulation without compressing the chest)
  8. hNext to crystalloids, colloids were given until 2014 (n = 1/1/1/2/0)
  9. iPharmaceutical agents: analgesic agents (n = 21/34/5/1/0), catecholamines (including epinephrine, norepinephrine and phenylephrine) (n = 0/0/1/23/26), antiemetics (n = 10/10/1/0/0), hypnotics, sedatives or neuroleptics (n = 2/8/4/3/0), neuromuscular blocking agents (n = 0/0/1/2/0), antiarrhythmics (n = 0/0/0/5/0), parasympathicolytics (n = 0/0/0/2/0), bronchodilators (n = 0/1/0/0/0), antidote (n = 0/0/0/1/0), tranexamic acid (given from June 2013) (n = 0/1/0/0/0), and other agents (n = 0/0/0/0/3)
  10. jECLS: extracorporeal life support. One-hundred-eighty-seven (31%) patients were not transported to a hospital: medical practice (n = 3); non-medical place (n = 172; 40% uninjured, 18% with NACA 1–3, 40% NACA 7); unknown destination (n = 12, including six dead victims). Uninjured patients were transported to a trauma centre (n = 1), non-ECLS & non-trauma centre hospital (n = 6), non-medical place (n = 69), or unknown destination (n = 2). Eight (1%) patients were transported by terrestrial rescue, accompanied by the HEMS physician
  11. n.r not relevant
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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

ISSN: 1757-7241