Christopher Neuhaus

Incidents, accidents and fatalities in 40 years of German helicopter emergency medical system operations.

Context Currently, approximately 100 000 helicopter emergency medical service (HEMS) missions for patients are undertaken in Germany each year. Compared to the early years, risk has reduced significantly, but is still higher than commercial aviation or other airborne operations. Objective The aim of the present study was to evaluate helicopter accidents and fatalities related to HEMS operations. Design Retrospective study of HEMS accidents in Germany. Setting Analysis of accidents in the published flight accident reports of the German Federal Agency for Flight Accident Investigation (40-year period from 1970 to 2009). Data were collected by telephone interview with the operators, manual search of publications and by supplemental internet information. Main outcome measures Data were analysed per 10 000 missions. For statistical analysis, Fisher[Combining Acute Accent]s exact test was used. A P value less than 0.05 was considered significant. Results During the period analysed, a total of 1.698 million HEMS missions (1970 vs. 2009: 61 vs. 98 471) were flown by a mean of 50 ± 27 (1 vs. 81) helicopters. To date, missions resulted in a total of 99 accidents with a mean of 2.4 ± 1.7 accidents per year (range 0–7). The accident rate was 0.57 (0–11.4) per 10 000 missions and the fatal accident rate was 0.11 (0–0.5). Some 64% of missions did not result in any injuries to occupants, whereas 19.2% were fatal. From the accidents analysed, 43.4% were due to collision with an obstacle during landing, take-off or hovering. Landing was the phase of flight most often associated with accidents (44.4%). Conclusion The present study is the largest on HEMS accidents and the only one analysing an entire 40-year time course beginning with inception. In comparison to previous data, a significantly lower accident rate per 10 000 missions was found. Gathering data on the early years is nearly impossible, and further analysis is required to calculate the risk of fatality or identify injury patterns.

In-flight medical emergencies during airline operations: a survey of physicians on the incidence, nature, and available medical equipment

Background Data on the incidence of in-flight medical emergencies on-board civil aircraft are uncommon and rarely published. Such data could provide information regarding required medical equipment on-board aircraft and requisite training for cabin crew. The aim of the present study was to gather data on the incidences, nature, and medical equipment for in-flight medical emergencies by way of a survey of physician members of a German aerospace medical society. Materials and methods Using unipark.de (QuestBack GmbH, Cologne, Germany), an online survey was developed and used to gather specific information. Members of the German Society for Aviation and Space Medicine (Deutsche Gesellschaft für Luft- und Raumfahrtmedizin e.V.; DGLRM) were invited to participate in the survey during a 4-week period (21 March 2015 to 20 April 2015). Chi-square test was used for statistical analysis (p<0.05 was considered significant). Results Altogether, 121 members of the society responded to the survey (n=335 sent out). Of the 121 respondents, n=54 (44.6%) of the participants (89.9% male and 10.1% female; mean age, 54.1 years; n=121) were involved in at least one in-flight medical emergency. Demographic parameters in this survey were in concordance with the society members’ demographics. The mean duration of flights was 5.7 hours and the respondents performed 7.1 airline flights per year (median). Cardiovascular (40.0%) and neurological disorders (17.8%) were the most frequent diagnoses. The medical equipment (78.7%) provided was sufficient. An emergency diversion was undertaken in 10.6% of the cases. Although using a different method of data acquisition, this survey confirms previous data on the nature of emergencies and gives plausible numbers. Conclusion Our data strongly argue for the establishment of a standardized database for recording the incidence and nature of in-flight medical emergencies. Such a database could inform on required medical equipment and cabin crew training.

Perioperative Safety: Learning, Not Taking, from Aviation

June 2016 • Volume 122 • Number 6 www.anesthesia-analgesia.org 2059 Copyright

Cognitive responses to hypobaric hypoxia: implications for aviation training

The aim of this narrative review is to provide an overview on cognitive responses to hypobaric hypoxia and to show relevant implications for aviation training. A principal element of hypoxia-awareness training is the intentional evocation of hypoxia symptoms during specific training sessions within a safe and controlled environment. Repetitive training should enable pilots to learn and recognize their personal hypoxia symptoms. A time span of 3–6 years is generally considered suitable to refresh knowledge of the more subtle and early symptoms especially. Currently, there are two different technical approaches available to induce hypoxia during training: hypobaric chamber training and reduced-oxygen breathing devices. Hypoxia training for aircrew is extremely important and effective, and the hypoxia symptoms should be emphasized clearly to aircrews. The use of tight-fitting masks, leak checks, and equipment checks should be taught to all aircrew and reinforced regularly. It is noteworthy that there are major differences in the required quality and quantity of hypoxia training for both military and civilian pilots.

Probabilities for Severe and Fatal Injuries in General Aviation Accidents

and severely or fatally injured persons were obtained from 1993 to 2007. The analysis focused on both the average number of injured and average number of killed persons and the probabilities of sustaining severe or fatal injuries. SPSS® was used for statistical analysis with p < 0:05. N 5259 general aviation accidents were analyzed. Most accidents occurred in the categories for gliders (n 1930, 36.7%) and single-engine pistons (less than 2 tons; n 1929, 36.7%). The highest probabilities of sustaining severe injury were found for hot-air balloons (72.9%), gliders (15.2%), and helicopters (12.0%). The highest probabilities of sustaining fatal injury were found for aircraft of 2-5.7 tons (23.1%), helicopters (17.1%), and aircraft less than 2 tons (14.0%). Because of a lack of common denominatordataingeneralaviation,thedevelopmentofaccidentstatisticsiscomplicated,ifnotentirelyimpossible. Probabilities for severe andfatal injuries that could be expectedshould an accident occur (conditional probabilities) were calculated. These data facilitate the understanding and improvement of aviation safety.

Helicopter type and accident severity in helicopter emergency medical services missions

OBJECTIVE Whereas accident rates and fatal accident rates for Helicopter Emergency Medical Services (HEMS) were investigated sufficiently, resulting consequences for the occupants remain largely unknown. The present study aimed to classify HEMS accidents in Germany to prognosticate accident severity with regard to the helicopter model used. METHODS German HEMS accidents (1 Sept. 1970-31 Dec. 2009) were gathered as previously reported. Accidents were categorized in relation to the most severe injury, i.e., (1) no; (2) slight; (3) severe; and (4) fatal injuries. Only helicopter models with at least five accidents were analyzed to retrieve representative data. Prognostication was estimated by the relative percentage of each injury type compared to the total number of accidents. RESULTS The model BO105 was most often involved in accidents (38 of 99), followed by BK117 and UH-1D. OfN = 99 accidents analyzed, N = 63 were without any injuries (63.6%), N = 8 resulted in minor injuries of the occupants (8.1%), and N = 9 in major injuries (9.1%). Additionally, N = 19 fatal accidents (19.2%) were registered. EC135 and BK1 17 had the highest incidence of uninjured occupants (100% vs. 88.2%) and the lowest percentage of fatal injuries (0% vs. 5.9%; all P > 0.05). Most fatal accidents occurred with the models UH-1D, Bell 212, and Bell 412. DISCUSSION Use of the helicopter models EC135 and BK117 resulted in a high percentage of uninjured occupants. In contrast, the fatality rate was highest for the models Bell UH-I D, Bell 222, and Bell 412. Data from the present study allow for estimating accident risk in HEMS missions and prognosticating resulting fatalities, respectively.

Patientensicherheit in der Anästhesie

ZusammenfassungDer Begriff „Patientensicherheit“ ist in der heutigen Medizin präsenter als jemals zuvor. Darunter werden alle Prozesse zusammengefasst, die mit der Prävention und der Vermeidung unerwünschter Vorkommnisse in der Patientenversorgung im Zusammenhang stehen. Da die moderne Anästhesie spätestens seit der Deklaration von Helsinki 2010 in der klinischen Umsetzung eine Schlüsselrolle einnimmt, werden perioperativ-tätige Mediziner mit einer Vielzahl von Theorien, Modellen, Methoden und Werkzeugen konfrontiert, die eine Optimierung der Patientensicherheit ermöglichen bzw. erleichtern sollen. Die Herausforderung besteht darin, all diese zu einem funktionierenden, synergistischen Risikomanagementkonzept zusammenzufügen, das jeweilige Stärken und Schwächen der einzelnen Elemente kennt und berücksichtigt. Ziel der vorliegenden Arbeit ist es, eine systematische Übersicht der möglichen Komponenten zu vermitteln, die momentan zur Förderung der perioperativen Patientensicherheit zur Verfügung stehen.AbstractThe concept of patient safety is more of a presence in modern day medicine than ever before. All measures and processes aiming at preempting and preventing critical incidents and accidents in patient care are collectively grouped under this concept. With the Declaration of Helsinki in 2010 modern anesthesiology has undertaken a fundamental role in the clinical implementation and perioperative clinicians are confronted with a multitude of theories, models, methods and tools targeted at improving or facilitating optimized patient safety. One of the biggest challenges lies in their synergistic combination to create a functioning concept for perioperative risk management while also incorporating individual strengths and weaknesses. The aim of the present paper is to provide a structured overview of the various components presently available for increasing perioperative patient safety.

APPLICATION OF THE FIA SCORE TO GERMAN RESCUE HELICOPTER ACCIDENTS TO PREDICT FATALITIES IN HELICOPTER EMERGENCY MEDICAL SYSTEMS (HEMS) CRASHES

BACKGROUND In the past several decades, multiple studies have examined factors influencing occupant survival in aviation crashes, but only a few have addressed this question in Helicopter Emergency Medical Systems (HEMS) accidents. The four-point FIA Score is a valid tool to measure fatality risk in aviation crashes. OBJECTIVE The aim of the present study was to analyze the performance of the FIA Score when applied to German HEMS accidents, and to determine the prognostic value for fatalities and for survival. METHODS The FIA Score uses three parameters (F=fire; I=Instrument meteorological conditions; A=Away from airport) to determine the fatality risk after crashes. Data for German HEMS accidents between October 1970 and December 2009 were gathered retrospectively from the Federal Agency for Flight Accident Investigation. Accidents were graded according to the FIA Score by two emergency physician-pilots, and crash fatality rates (CFR) were calculated. RESULTS A total of 99 HEMS accidents were analyzed that occurred from September 1970 to December 2009. In 19.2% of these, at least one occupant was fatally injured. There were 63 accidents (63.6%) that took place with no injuries; 8 occurred with minor injuries (8.1%); and 9 resulted in major injuries (9.1%). A total of 72 data sets were complete and were used for analysis. Depending on the FIA Score (FIA0, FIA1, FIA2, and FIA3), CFRs of 0.0%, 8.1%, 53.3%, and 100.0%, respectively, were calculated. CONCLUSIONS The FIA Score is a valuable tool in German HEMS accident analysis. It can predict fatalities and is easy to use. Thus, it may also be a valuable tool in EMS call centers to predict survival after a crash.

[Patient safety in anesthesiology : Multimodal strategies for perioperative care].

ZusammenfassungDer Begriff „Patientensicherheit“ ist in der heutigen Medizin präsenter als jemals zuvor. Darunter werden alle Prozesse zusammengefasst, die mit der Prävention und der Vermeidung unerwünschter Vorkommnisse in der Patientenversorgung im Zusammenhang stehen. Da die moderne Anästhesie spätestens seit der Deklaration von Helsinki 2010 in der klinischen Umsetzung eine Schlüsselrolle einnimmt, werden perioperativ-tätige Mediziner mit einer Vielzahl von Theorien, Modellen, Methoden und Werkzeugen konfrontiert, die eine Optimierung der Patientensicherheit ermöglichen bzw. erleichtern sollen. Die Herausforderung besteht darin, all diese zu einem funktionierenden, synergistischen Risikomanagementkonzept zusammenzufügen, das jeweilige Stärken und Schwächen der einzelnen Elemente kennt und berücksichtigt. Ziel der vorliegenden Arbeit ist es, eine systematische Übersicht der möglichen Komponenten zu vermitteln, die momentan zur Förderung der perioperativen Patientensicherheit zur Verfügung stehen.AbstractThe concept of patient safety is more of a presence in modern day medicine than ever before. All measures and processes aiming at preempting and preventing critical incidents and accidents in patient care are collectively grouped under this concept. With the Declaration of Helsinki in 2010 modern anesthesiology has undertaken a fundamental role in the clinical implementation and perioperative clinicians are confronted with a multitude of theories, models, methods and tools targeted at improving or facilitating optimized patient safety. One of the biggest challenges lies in their synergistic combination to create a functioning concept for perioperative risk management while also incorporating individual strengths and weaknesses. The aim of the present paper is to provide a structured overview of the various components presently available for increasing perioperative patient safety.

Applying the human factors analysis and classification system to critical incident reports in anaesthesiology

The Human Factors Analysis and Classification System (HFACS) was developed as a practical taxonomy to investigate and analyse the human contribution to accidents and incidents. Based on Reasons “Swiss Cheese Model”, it considers individual, environmental, leadership and organizational contributing factors in four hierarchical levels. The aim of this study was to assess the applicability of a modified HFACS taxonomy to incident reports from a large, anonymous critical incident database with the goal of gaining valuable insight into underlying, more systemic conditions and recurring schemes that might add important information for future incident avoidance.