BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-003335 on 19 August 2013. Downloaded from Impact of Helicopter Emergency Medical Services in major incidents: systematic literature review ForJournal: peerBMJ Open review only Manuscript ID: bmjopen-2013-003335 Article Type: Protocol Date Submitted by the Author: 02-Jun-2013 Complete List of Authors: Johnsen, Anne Siri; Norwegian Air Ambulance Foundation, Research and development; Oslo University Hospital, Ullevål, Fattah, Sabina; Norwegian Air Ambulance Foundation, Department of Research and Development; University of Tromsø, Anaesthesia and Critical Care Research Group. Faculty of Health Sciences. Sollid, Stephen; Norwegian Air Ambulance Foundation, Department of Research and Development Rehn, Marius; Norwegian Air Ambulance Foundation, 1. Department of Research and Development <b>Primary Subject Emergency medicine Heading</b>: Secondary Subject Heading: Health services research http://bmjopen.bmj.com/ ACCIDENT & EMERGENCY MEDICINE, Quality in health care < HEALTH Keywords: SERVICES ADMINISTRATION & MANAGEMENT, Organisation of health services < HEALTH SERVICES ADMINISTRATION & MANAGEMENT on September 24, 2021 by guest. Protected copyright. For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 13 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-003335 on 19 August 2013. Downloaded from Protokoll 1 2 3 4 Impact of Helicopter Emergency Medical Services in major 5 6 incidents: systematic literature review 7 8 Anne Siri Johnsen (ASJ) 1,2,3 Sabina Fattah (SF) 1,4 Stephen JM Sollid (SJMS) 1,2 Marius Rehn 1,2,5 9 (MR) 10 11 12 1) Department of Research and Development, Norwegian Air Ambulance Foundation, 13 14 Drøbak, Norway 15 For peer review only 16 17 2) Department of Health Studies, Faculty of Social Sciences, University of Stavanger, 18 Stavanger, Norway 19 20 21 3) Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway 22 23 24 4) Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, University of 25 Tromsø, Tromsø, Norway 26 27 28 29 5) Department of Anesthesiology and Intensive Care, Akershus University Hospital, 30 Lørenskog, Norway 31 32 33 34 http://bmjopen.bmj.com/ 35 36 Corresponding author (Anne Siri Johnsen, Holterv. 24, Postboks 94, 1448 Drøbak, Norway, 37 [email protected], mobile: +47 64904444, fax +47 64904445). 38 39 40 41 42 on September 24, 2021 by guest. Protected copyright. 43 Keywords: (Air ambulances, Helicopter Emergency Medical Services, Major Incidents, 44 45 Disasters, Mass Casualty Incidents) 46 47 48 49 Word count: 582 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 13 BMJ Open: first published as 10.1136/bmjopen-2013-003335 on 19 August 2013. Downloaded from Protokoll 1 2 3 ABSTRACT 4 5 Introduction: Helicopter Emergency Medical Services (HEMS) aims to bring a highly 6 specialised crew to the major incident for triage, treatment and transport. When the site is 7 8 difficult to access, HEMS may be the only mode of transportation of both personnel and 9 10 patients. We aim to systematically review literature pertaining to Helicopter Emergency 11 Medical Services (HEMS) part of handling major incidents. Further, to extract data and 12 13 appraise the methodology in the included studies. 14 15 Methods andFor analysis: Apeer systematic literature review review will be conductedonly with search phrases 16 that combine HEMS and major incidents to identify when and how HEMS have been used. 17 18 Ethics: No ethical approval is sought because this is a literature review. It will be submitted 19 20 to a peer-reviewed journal and the PRISMA guidelines will be followed. 21 Registration details: PROSPERO CRD42013004473 22 23 24 25 Article focus 26 We aim to identify and describe Helicopter Emergency Medical Services part in handling 27 28 major incidents and appraise relevant literature. 29 30 31 Key messages 32 33 Helicopter Emergency Medical Services part in major incidents may be improved by 34 http://bmjopen.bmj.com/ 35 collecting and reviewing data from previous experiences. 36 37 38 Strengths and limitations of study 39 40 The major strength of this article is that it is a systematic literature review. 41 The main limitation is that only English and Scandinavian languages are included. 42 on September 24, 2021 by guest. Protected copyright. 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 13 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-003335 on 19 August 2013. Downloaded from Protokoll 1 2 3 INTRODUCTION 4 5 A major incident is any incident where the location, number, severity or type of casualties 6 requires extraordinary resources.(1) In 2011, an estimated 332 natural disasters killed over 7 8 30 000 people, affected more than 240 million people and caused economic damages for over 9 10 300 billion US dollars, with the Tohoku earthquake and tsunami in Japan being the most 11 expensive natural disaster ever recorded.(2) 12 13 Helicopter Emergency Medical Services (HEMS) aims to bring a highly specialised crew to 14 15 the incident forFor triage, treatment peer and provide review a time-efficient way only of transporting patients 16 directly to trauma centre for definitive care.(3,4) When the site is difficult to access, HEMS 17 18 may be the only mode of transportation of both personnel and patients.(4,5) The triage system 19 20 in use has to be valid and reliable to prevent both overtriage and undertriage.(6,7) When 21 specially trained personnel perform the triage, hospitals may avoid reaching their surge 22 23 capacity.(6-10) The HEMS crew may also provide an overview of in-hospital resources, 24 25 thereby increasing the probability of getting the right patient to the right place in the right 26 time.(11) However, HEMS crew combinations may differ from country to country.(12) 27 28 We aim to review literature describing the role of HEMS in major incidents. Data extraction 29 30 and quality appraisal will aim to evaluate if this costly resource is used mainly for 31 transportation and to what extent they contribute in triage, treatment and other incident 32 33 management tasks. 34 http://bmjopen.bmj.com/ 35 36 METHODS 37 38 Study selection: 39 40 Search terms include “Air Ambulance” AND “Major Incidents” (Additional file I for search 41 strategy). The search will include papers published in the period from 1950 – date of search. 42 on September 24, 2021 by guest. Protected copyright. 43 We will scan reference lists of included articles for relevant studies. 44 45 46 Databases: 47 48 - Medline 49 50 - Embase 51 - Cochrane 52 53 - Web of Knowledge 54 55 - Swemed 56 - Norart 57 58 - Scopus 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 4 of 13 BMJ Open: first published as 10.1136/bmjopen-2013-003335 on 19 August 2013. Downloaded from Protokoll 1 2 3 - Cinahl 4 5 - PsycINFO 6 Grey literature will not be included. Previous experience has shown that this generates 7 8 a large workload without results.(13) 9 Inclusion criteria: 10 11 - Literature describing role of HEMS in major incidents. 12 13 - Original manuscripts. 14 Exclusion criteria: 15 For peer review only 16 - Articles in languages other than English and Scandinavian. 17 18 - Articles without abstract. 19 20 - Book chapters. 21 - Letters to the editor, comments and editorials. 22 23 24 25 One author (ASJ) will scan titles and abstracts and exclude articles clearly not meeting 26 inclusion criteria. The included articles will be divided to the authors in pairs (ASJ and MR, 27 28 SF and SJMS) and screened further for eligibility. Uncertain articles will be subject to 29 30 consensus between the authors, and excluded articles will be listed with reason in the final 31 article. ASJ will perform quality appraisal (box 1) and will extract pre-defined data from 32 33 included articles and enter them into a data extraction template.(14) The data extraction (box 34 http://bmjopen.bmj.com/ 35 2) has been pilot tested on 4 randomly selected articles. Included articles will be described 36 separately, but articles describing the same major incident will be compared and grouped. 37 38 Authors of included articles with e-mail listed will be contacted if necessary. 39 40 41 Box 1 42 on September 24, 2021 by guest. Protected copyright. 43 Quality appraisal 44 45 Internal validity (yes, no not applicable) 46 47 Is the author a person directly involved in the major incident medical response? 48 49 Does the literature provide reference to where the data was obtained? 50 Does the literature provide reference to how the data was obtained? 51 52 Do the authors have conflicts of interest? 53 54 Has an ethics committee approved the reporting? 55 External validity 56 57 Does the literature describe the local EMS and HEMS structure before the incident? 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 5 of 13 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-003335 on 19 August 2013. Downloaded from Protokoll 1 2 3 Is the major incident clearly described? 4 5 Are the medical resources used in the major incident response clearly described? 6 7 Does the literature report the type, number and capacity of HEMS? 8 Are there indications on missing data? 9 10 Are other limitations discussed? 11 12 Is the study design clearly explained? 13 14 15 Box 2 describesFor the different peer terms and characteristicsreview that will onlybe extracted from the included 16 17 articles.