Article Text

Download PDFPDF
Physician-staffed helicopter emergency medical services augment ground ambulance paediatric airway management in urban areas: a retrospective cohort study
  1. Alan A Garner1,2,
  2. Nicholas Bennett2,
  3. Andrew Weatherall1,2,
  4. Anna Lee3
  1. 1 CareFlight, Wentworthville, New South Wales, Australia
  2. 2 School of Medicine, University of Sydney, Sydney, New South Wales, Australia
  3. 3 Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, New Territories, Hong Kong
  1. Correspondence to Dr Alan A Garner, CareFlight, Wentworthville, NSW, 2152, Australia; alang{at}


Objectives Paediatric intubation is a high-risk procedure for ground emergency medical services (GEMS). Physician-staffed helicopter EMS (PS-HEMS) may bring additional skills, drugs and equipment to the scene including advanced airway management beyond the scope of GEMS even in urban areas with short transport times. This study aimed to evaluate prehospital paediatric intubation performed by a PS-HEMS when dispatched to assist GEMS in a large urban area and examine how often PS-HEMS provided airway intervention that was not or could not be provided by GEMS.

Methods We performed a retrospective observational study from July 2011 to December 2016 of a PS-HEMS in a large urban area (Sydney, Australia), which responds in parallel to GEMS. GEMS intubate without adjuvant neuromuscular blockade, whereas the PS-HEMS use neuromuscular blockade and anaesthetic agents. We examined endotracheal intubation success rate, first-look success rate and complications for the PS-HEMS and contrasted this with the advanced airway interventions provided by GEMS prior to PS-HEMS arrival.

Results Overall intubation success rate was 62/62 (100%) and first-look success was 59/62 (95%) in the PS-HEMS-treated group, whereas the overall success rate was 2/7 (29%) for the GEMS group. Peri-intubation hypoxia was documented in 5/65 (8%) of the PS-HEMS intubation attempts but no other complications were reported. However, 3/7 (43%) of the attempted intubations by GEMS were oesophageal intubations, two of which were unrecognised.

Conclusions PS-HEMS have high success with low complication rates in paediatric prehospital intubation. Even in urban areas with rapid GEMS response, PS-HEMS activated in parallel can provide safe and timely advanced prehospital airway management for seriously ill and injured children beyond the scope of GEMS practice. Review of GEMS airway management protocols and the PS-HEMS case identification and dispatch system in Sydney is warranted.

  • airway
  • emergency ambulance systems
  • paediatric resuscitation
  • helicopter retrieval

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors AAG, AW and AL conceived the study. AAG, AW and AL designed the protocol. AAG, NB and AW collected the data. AL, AAG, with input from AW, and NB analysed the data. AAG and AL drafted the manuscript and revised following critical review by all authors.

  • Funding This study was supported by internal funds from CareFlight and The Chinese University of Hong Kong.

  • Disclaimer The funders had no role in the design and conduct of the study, collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript, and decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Ethics approval The study was approved by the Human Research Ethics Committee of the Sydney Children’s Hospitals Network (LNR/17/SCHN/87). Written informed consent from parents or legal guardians for minor subjects was waived by the ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.