Helicopter hoist operations in German mid-range mountains retrospective analysis of incidence, medical characteristics, and mission tactics

Background: Helicopter hoist operations (HHO) are an important option for rescue operations in rugged and challenging terrain. German mid-range mountains are characterized by the versatility of ground conditions, few urban structures, and frequent use for local leisure activities, including the practice of more or less high-risk outdoor sports. This retrospective analysis aims to investigate the incidence of rescue missions in German mid-range mountains requiring HHO. The contributing air rescue bases' operational tactics and the underlying medical characteristics, such as injury patterns and the provided medical care, are also reported.

Methods: This study is a retrospective analysis of the documentation of HHO missions carried out at the air rescue bases in Freiburg, Nuremberg, and Bautzen staffed by emergency physicians between 01/2020 and 07/2022. Data was extracted from the German Air Rescue database. To assess the topics of interest, we conducted basic descriptive statistics.

Results: Data selection retrieved 410 HHO-associated rescue missions. A total of 304 datasets, including HHO, were suitable for further statistical processing. Air rescue base Freiburg contributed 152, Nuremberg 63, and Bautzen 89 missions. HHO missions showed an increased frequency in the summer season and from Friday to Sunday. In this collective, 75% of the underlying diagnoses were trauma-associated; in 33% of all patients, traumatic injury of the pelvis or lower limb occurred. 28% of the patients were in a potential or actual life-threatening condition and were scored NACA 4 or higher. The rates of invasive medical treatment, such as endotracheal intubation (5%) or venous access (79%), were considerably higher than in overall emergency missions. In terms of mission tactics and cooperation with mountain rescue services, different approaches of the three air bases resulted in differences regarding first-on-scene rates and time spans.

Conclusion: The results show a relevant year-round need to deploy emergency medical expertise to inaccessible terrain in the three regions examined. Detailed analysis showed relevant differences in operational tactics between the three bases and potential for optimization. Simultaneous alerting of the hoist helicopter and reliable and precise coordination with other rescue organizations involved, especially the local mountain rescue service and the rescue coordination center, can help to shorten both the treatment-free interval and the prehospital time for patients in inaccessible terrain.

Trial registration: The study is registered at DRKS (DRKS00033493).