HEMS vs GEMS. By ground or by air: which is the best way to take care of traumatized patients

1 Mag
Amb vs HEMS22 years old male hit from a car on the roadside of an urban area.
The ground EMS ambulance (physician, nurse staffed), dispatched on scene, find the patient alert, oriented and spontaneously breathing. His vitals are:
GCS 15 , RR 20, SaO2 95, HR 85, SBP 110
No mention of head trauma.
Chest no sign of trauma, bilateral and equal expansion and air entry.
Pulse is strong.
He has a profound laceration with loss of substance but not evisceration on left flank and no external bleeding from the wound.
The abdomen is painful and resistant to palpation in left flank.
There is an open fracture to left tibia (VNS 9).
The ground team, after the primary survey, activates the local medical helicopter.
The place is 10 k from a level 1 Trauma Center on a local road in an urban area and the helicopter is at 10 minutes flight distance. There is a safe landing space at 500 mt from the point of the accident.
A Level 2 hospital (general surgery, orthopedics, anesthesiologist, radiology and laboratory 24/7) is at 2 km distance from the scene.
Is this a proper activation for HEMS?
What international litterature says about advantages of air medical service vs ground medical service?


So what about the case?

Comparative effectiveness of helicopter emergency medical services compared to ground emergency medical services






Severity: The patient is slightly tachycardic, and the mechanism of trauma give us some clue on possible abdominal injuries, so he need a quick transport to an hospital with a general surgery (and orthopedics naturally for the tibial fracture)
Speed: non simultaneous activation. This kind of missions become competitive on long distances (45 miles) from Level 1 Trauma center (or the appropriate hospital). So GEMS is faster anyway.
Trauma center access: no difference between HEMS and GEMS and even there is doubt on the fact that this patient really need a Level 1 Trauma Center
Crew: this patient does not need an over skilled staff for some particular procedure.
We can conclude that for the standard HEMS activation criteria, this is not an appropriate activation and the best way to reach the hospital for this patient is a ground ambulance.
Any suggestion on the theme treated is, as usual, very welcome



3 Risposte a “HEMS vs GEMS. By ground or by air: which is the best way to take care of traumatized patients”

  1. ketaminh 2 Maggio 2015 a 8:34 AM #

    L’ha ribloggato su PHARM.

  2. frenchy 4 Maggio 2015 a 2:46 AM #

    Did someone wanted to go home early? Did the timing of the call into the shift influenced the decision making process? Highly unethical but not unheard of.

    • medest118 4 Maggio 2015 a 7:46 AM #

      In the considered articles I found no mention of this confounders. When they talk about hospital discharge there is mo mention if the discharge was decided from the physicians or from the patient. In the HEMS missions table there was no discrimination based on time of the day,


Inserisci i tuoi dati qui sotto o clicca su un'icona per effettuare l'accesso:

Logo di WordPress.com

Stai commentando usando il tuo account WordPress.com. Chiudi sessione /  Modifica )

Foto Twitter

Stai commentando usando il tuo account Twitter. Chiudi sessione /  Modifica )

Foto di Facebook

Stai commentando usando il tuo account Facebook. Chiudi sessione /  Modifica )

Connessione a %s...

Questo sito utilizza Akismet per ridurre lo spam. Scopri come vengono elaborati i dati derivati dai commenti.


A Site for Intensivists and Resuscitationists


Supporting ALL Ohio EM Residencies in the #FOAMed World


Let's try to make it simple

thinking critical care

a blog for thinking docs: blending good evidence, physiology, common sense, and applying it at the bedside!


More definitive diagnosis, better patient care

Critical Care Northampton

Reviewing Critical Care, Journals and FOAMed

OHCA research

Prehospital critical care for out-of-hospital cardiac arrest


Education and entertainment for the ultrasound enthusiast




Emergency medicine - When minutes matter...

Songs or Stories

Sharing the Science and Art of Paediatric Anaesthesia


"Live as if you will die tomorrow; Learn as if you will live forever"


Navigating resuscitation

Life in the Fast Lane • LITFL

Emergency medicine and critical care education blog

emDOCs.net - Emergency Medicine Education

Our goal is to inform the global EM community with timely and high yield content about what providers like YOU are seeing and doing everyday in your local ED.

The Collective

A Hive Mind for Prehospital and Retrieval Med

Dave on Airways

Thoughts and opinions on airways and resuscitation science


A Free Open Access Medical Education Emergency Medicine Core Content Mash Up

Broome Docs

Rural Generalist Doctors Education


Emergency Medicine #FOAMed

"CardioOnline"Basic and Advanced Cardiovascular medicine" Cariology" concepts and Review -Dr.Nabil Paktin,MD.FACC.دکتـور نبــــیل "پاکطــــین

این سایت را به آن دکتوران و محصلین طب که شب و روز برای رفاه نوع انسان فداکاری می کنند ، جوانی و لذایذ زندگی را بدون چشمداشت به امتیاز و نفرین و آفرین قربان خدمت به بشر می کنند و بار سنگین خدمت و اصلاح را بدوش می کشند ، اهداء می کنم This site is dedicated to all Doctors and students that aver the great responsibility of People’s well-being upon their shoulders and carry on their onerous task with utmost dedication and Devotionاولین سایت و ژورنال انتــرنتی علـــمی ،تخـصصی ، پــژوهشــی و آمــوزشــی طبـــی در افغــانســـتان


Free Open Access Medical Education

Little Medic

Learning everything I can from everywhere I can. This is my little blog to keep track of new things medical, paramedical and pre-hospital from a student's perspective.

Prehospital Emergency Medicine Blog

All you want to know about prehospital emergency medicine

Italy Customized Tour Operator in Florence

Check out our updated blog posts at https://www.italycustomized.it/blog

EM Lyceum

where everything is up for debate . . .

Pediatric EM Morsels

Pediatric Emergency Medicine Education


Free Open Access Medical Education for Paramedics

Rural Doctors Net

useful resources for rural clinicians

Auckland HEMS

Unofficial site for prehospital care providers of the Auckland HEMS service




Prehospital Emergency Medicine

EM Basic

Your Boot Camp Guide to Emergency Medicine

KI Doc


Emergency Live

Prehospital Emergency Medicine


Academic Medicine Pearls in Emergency Medicine from THE Ohio State University Residency Program

Prehospital Emergency Medicine

 Academic Life in Emergency Medicine

Prehospital Emergency Medicine

Comments on: Homepage

Prehospital Emergency Medicine

Greater Sydney Area HEMS

The Pre-hospital & Retrieval Medicine Team of NSW Ambulance

%d blogger hanno fatto clic su Mi Piace per questo: