Air medical journal · 2026
Understanding the Current UK HEMS Provision for Patients Presenting With Nontraumatic Brain Pathology (NTBP).
СтатьяНазвание и аннотация: Перевод в очереди
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Owen Peter, Plumb James, Barrett Jack, Hannah Julian, Griggs Joanne
Аннотация
OBJECTIVE: UK helicopter emergency medical services (HEMS) are often tasked to nontraumatic brain pathology (NTBP) patients, yet national provision and triage practices are unclear.
METHODS: Cross-sectional online survey using REDCap software of UK HEMS distributed via the National HEMS Research and Audit Forum. Survey data were summarized descriptively.
RESULTS: Fourteen of a potential 21 UK HEMS responded (67%). All respondents (14 of 14; 100%) reported attending to patients with NTBP. Bypass to specialist neurocenters was reported by 7 of 14 (50%); 4 of 14 (28%) had direct admission pathways to stroke thrombectomy services. Dedicated standard operating procedures/pathways existed in 3 of 14 (21%), a formal triage tool or rule-based criteria in 1 of 14 (7%), and a commissioned pathway in 1 of 14 (7%). Clinician judgment guided bypass in 4 of 14 cases (28%); 1 service cited factors such as functional status, time since onset, Glasgow coma scale, age, frailty, or comorbidities. Core interventions were widely available: hypertonic saline, rapid sequence induction/prehospital emergency anesthesia, sedation, and vasoactive support (14 of 14; 100%) and levetiracetam and neuroprotective-ventilator strategies (13 of 14; 93%). Adjunct diagnostic methods were used infrequently, accounting for only 1 of 14 instances (7%) for each modality. These methods included biomarker point-of-care tests, ultrasound (such as transcranial color-coded duplex and optic nerve sheath assessment), pupillometry, and blood gas analysis. Reported systemic barriers encompassed variability among networks and restricted access to helipads.
CONCLUSIONS: NTBP care is routine within UK HEMS, but triage decisions are heterogeneous and infrequently supported by formal pathways or commissioned networks. Standardized, network-supported bypass criteria that potentially incorporate point-of-care diagnostics and biomarkers could be developed and evaluated. Broader, multiagency studies capturing case volume and outcomes are needed to inform national guidance.
METHODS: Cross-sectional online survey using REDCap software of UK HEMS distributed via the National HEMS Research and Audit Forum. Survey data were summarized descriptively.
RESULTS: Fourteen of a potential 21 UK HEMS responded (67%). All respondents (14 of 14; 100%) reported attending to patients with NTBP. Bypass to specialist neurocenters was reported by 7 of 14 (50%); 4 of 14 (28%) had direct admission pathways to stroke thrombectomy services. Dedicated standard operating procedures/pathways existed in 3 of 14 (21%), a formal triage tool or rule-based criteria in 1 of 14 (7%), and a commissioned pathway in 1 of 14 (7%). Clinician judgment guided bypass in 4 of 14 cases (28%); 1 service cited factors such as functional status, time since onset, Glasgow coma scale, age, frailty, or comorbidities. Core interventions were widely available: hypertonic saline, rapid sequence induction/prehospital emergency anesthesia, sedation, and vasoactive support (14 of 14; 100%) and levetiracetam and neuroprotective-ventilator strategies (13 of 14; 93%). Adjunct diagnostic methods were used infrequently, accounting for only 1 of 14 instances (7%) for each modality. These methods included biomarker point-of-care tests, ultrasound (such as transcranial color-coded duplex and optic nerve sheath assessment), pupillometry, and blood gas analysis. Reported systemic barriers encompassed variability among networks and restricted access to helipads.
CONCLUSIONS: NTBP care is routine within UK HEMS, but triage decisions are heterogeneous and infrequently supported by formal pathways or commissioned networks. Standardized, network-supported bypass criteria that potentially incorporate point-of-care diagnostics and biomarkers could be developed and evaluated. Broader, multiagency studies capturing case volume and outcomes are needed to inform national guidance.