System of Helicopter Emergency Medical Services in Nepal: A Study at Nepal Mediciti Hospital.

Objective: Nepalis have benefited from helicopter emergency medical services (HEMS) since 2013. Helicopters are coordinated from private companies for medical transport. There are no helicopters dedicated solely for emergency medical services. Private helicopter companies and hospitals collaborate to transfer patients. Mountainous terrain, traffic infrastructure problems, and distance to rural facilities designate HEMS as the preferred method for transferring patients in Nepal. This article discusses the 2 methods used to fly patients between facilities and from scene calls. The first and preferred method is when patients received medical support from trained personnel en route to the appropriate facility. This method allows for quicker access to a physician with appropriate care throughout a transfer. The second method used occurs when patients were flown with no medical team or trained care onboard the helicopter. Regardless of the method used, HEMS has proven to be beneficial because it limits out-of-hospital time, alleviates patient load from overwhelmed hospitals, and delivers patients to critical care facilities out of reach by ground emergency medical services. The aim of this study was to interpret the current system of helicopter emergency medical services in Nepal and to determine the difference in patient outcomes when transferred with care onboard and without.

Methods: This was a retrospective study of patients who were transferred by helicopter to Mediciti Hospital in Nepal from November 2017 to December 15, 2019.

Results: During the study, a total of 425 patients were transferred by helicopter. Two hundred forty-three (57.18%) patients were moved with the support of the medical team onboard. One hundred eighty-two (42.82%) were flown without medical support. Of the 243 patients, 173 (71.19%) were medical, and 70 (28.81%) had suffered traumatic injuries. From the 182 nonsupported patients, 115 (63.19%) were medical, and 67 (36.81%) were traumatic. One hundred eighty (74.07%) of the patients with medical support went to the intensive care unit (ICU). Forty-two (23.07%) without medical support went to the ICU. Ninety-one (50.55%) patients who received support went to the ICU and stayed for 1 to 5 days. Thirty-eight (90.48%) patients with no medical support en route stayed 1 to 5 days in the ICU. Of the 243 patients who received medical support en route, 69 died (28.4%) during the course of treatment in the hospital. Of the 182 who were flown without medical care during transport, 6 (3.33%) died.

Conclusion: HEMS effectiveness and usefulness are rapidly growing in Nepal. Having trained medics onboard delivering care can be beneficial. When patients are critically ill, it is preferred to fly them via helicopter with a medical crew onboard.