1. Auckland HEMS Helicopter Emergency Medical Services Christopher Denny, MD, MSc, FRCPC, FACEP, FACEM SMO Emergency Medicine, Auckland City Hospital, ADHB

2. Disclosure Senior Medical Officer in Emergency Medicine, Auckland City Hospital HEMS Medical Director, Auckland Rescue Helicopter Trust (ARHT) Clinical Team Leader, New Zealand Medical Assistance Team (MOH NZMAT)

3. OBJECTIVES 1.Increase awareness of Auckland HEMS 2.Explore Pre-Hospital and Retrieval Medicine 3.Compare patient care on the road with in hospital

5. Introduction 1970: Auckland established the first civilian rescue helicopter service in the southern hemisphere Rescue helicopter originally based on the west coast of Auckland @ Piha Now the busiest rescue helicopter trust in New Zealand The only service in NZ with a doctor as a core member of the flight crew

7. ADHB & ARHT Memorandum of Understanding established in 2011 Specialists in Emergency Medicine, Critical Care and Anaesthetics Purpose: to augment the clinical capabilities of the flight crew

8. HEMS Mission profiles

10. Helicopters BK-117 x 2 Cruise speed 120 knots (222km/hr) Cruise altitude ~1500 feet Crew configuration: Pilot, crewman, paramedic & doctor Instrument Flight Rules (IFR) capable Winch capable 600lb capacity

13. Why doctors?

15. Critical interventions Airway: Rapid sequence intubation (RSI), video laryngoscopy (VL), surgical airway Breathing: Mechanical ventilation, chest drains Circulation: Tranexamic acid (TXA), Point-of-care ultrasound (POCUS), blood products Disability: Reduction of dislocations and fractures; ultrasound-guided regional nerve blocks, field amputations, antidote therapies

16. Accelerating time to definitive care Time to critical intervention: Airway management CT Operating theatre Interventional radiology

17. Clinical governance

19. Evidence Galvagno. JAMA 2012: HEMS and Survival after Major Trauma. 223,475 patients in USA with age >15y & ISS>15 HEMS Odds Ratio for survival 1.16, 95%CI 1.14-1.17 (ARR 1.5%)

21. Seamless care From roadside to bedside in definitive care Standardized communications (METHANE, MIST, SBAR)

23. Disaster preparedness Coordinated Incident Management System (CIMS) Inter-agency collaboration with St John Ambulance, NZ Fire Services, Police SAR Aeromedical reconnaissance

25. High performing teams “To turn a team of experts into an expert team.” Eduardo Salas

26. Teamwork High task interdependency Cooperation, coordination, communication, cognition, coaching and conflict

28. The future Integration Coordination Clinical networks

30. Thank you. www.aucklandhems.com