Interhospital aeromedical transfers: need for a specific training

Introduction: The interhospital aeromedical transfers concern mainly unstable patients presenting with multiple organ failure and among whom the intensity, as well as the difficulty of care are often underestimated. Material and method: Retrospective analysis of 2094 interhospital transfers made by the Rega helicopter of Lausanne between 2003 and 2008, with description of the pathologies, the demographic characteristics, as well as the medical and technical difficulties. Results: Male patient are overrepresented (65 vs 35%), their age being 40-80 years old. On the other hand, we note an important number (10%) of patients less than 10 years. The average time of flight is 13 minutes, with a high rate of night transfers (34%). In 73% of the cases, the transfers concern medical, especially cardiovascular and neurological situations. Trauma and surgical situations account for less than 20%. The transferred patients often require mechanical ventilation (27%), as well as invasive measure of blood pressure (11%), particularly in cases of neurological, pulmonary or cardiac diseases. In 6% of the cases, we note a haemodynamic instability, requiring the use of catecholamines. In 1% a cardiopulmonary resuscitation was initiated during the flight. The overall mortality at 48 hours is about 5%. Conclusions: In spite of relatively brief flights, the complexity and the variety of the pathologies require a specific training for the medical teams involved in the transfers, concerning the aspects of resuscitation, mechanical ventilation, and the knowledge of advanced life support in paediatrics, traumatology and cardiopulmonary intensive care.