Aeromedical evacuation of injured hikers in Hong Kong

Abstract

Abstract:

BACKGROUND: Hiking is a very popular sport in Hong Kong. Serious injuries can sometimes occur in the remote areas not accessible to roads. Aeromedical evacuation service is run by the Government Flying Service (GFS) with emergency physicians and nurses as volunteers in Hong Kong. In this paper we describe the profile and outcome of injured hikers rescued by the GFS.

METHODS: In this retrospective review, nature of the complaints, medical team composition, vital signs, clinical assessment and diagnosis on site were collected from the GFS medical record. Demographic data, final diagnoses and outcomes of the patients were retrieved from emergency department (ED) and hospital discharge records.

RESULTS: A total of 275 cases were recruited for the 3-year period from January 2003 to December 2005. The mean age of the group was 39 years (range 1-83) with more males (159, 58%) than females. Heat illnesses, injuries and medical problems each constituted about one third of the cases. Lower limb injuries accounted for nearly half of the injuries. About 30% of the rescued hikers did not register to be seen at the ED. Only 48 hikers (17.5%) required admission and four were admitted to intensive/coronary care units for heat stroke and acute coronary syndrome. Five cases of pre-hospital cardiac arrest were recorded.

CONCLUSION: Most hikers evacuated by the GFS did not suffer from serious conditions. GFS should still be prepared for the occasional cases that require advanced life support.

Key words: Aeromedical evacuation, Hikers

Tai Wai Wong, Ping Fat Lau, Chor Chiu Lau. Aeromedical evacuation of injured hikers in Hong Kong[J]. World Journal of Emergency Medicine, 2010, 1(3): 176-179.

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References 7

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Nature of chief complaints	Number (%)
Injury (including falls)	83 (30)
Dizziness	64 (23)
Fatigue	30 (11)
Collapse/syncope	23 (8)
Lost	17 (6)
Muscle cramp	12 (4)
Bee sting	10 (3.6)
Chest pain	8 (3)
Nausea/vomiting/abdominal pain	7 (2.5)
Shortness of breath	5 (2)
Others	16 (6)

Vital signs (No. of readings available*)	Number (%)
Systolic BP at scene ≤ 95 mmHg (120)	11 (8)
Pulse rate at scene ≤ 60/min (191)	4 (2.1)
Pulse rate at scene > 100/min (191)	80 (42)
Pulse rate at scene > 120/min (191)	25 (12)
Temperature at scene > 37.5 C (69)	26 (35)
GCS at scene ≤ 8 (229)	5 (2.2)
GCS 9-14 (229)	12 (5.6)

Clinical diagnosis	Number (%)
Heat related illnesses
Heat exhaustion	89 (32)
Heat cramp	4 (1.5)
Heat stroke	3 (1)
Lower limb injuries
Fractures	19 (7.4)
Patella dislocation	1 (0.4)
Soft tissue injuries	29 (11)
Head /neck/torso injuries
Closed head injury	11 (4)
Scalp laceration	3 (1.2)
Skull fracture	2 (0.7)
Nasal bone fracture	1 (0.4)
Face injury	2 (0.7)
Spinal cord injury	2 (0.7)
Torso injury	5 (2)
Upper limb injuries
Fractures	3 (1.2)
Dislocations	3 (1.2)
Soft tissue injuries	2 (0.7)
Medical complaints
Chest pain/ACS	11 (4)
Dizziness/convulsion	13 (5)
Vasovagal attack/syncope	4 (1.5)
Cardiac arrest	4 (1.5)
Others
Lost	15 (5.5)
Bee sting	12 (4.4)
Fatigue/exhaustion/muscle cramp	10 (4)
Abdominal pain	4 (1.5)
Diagnosis missing	23 (8.4)

Age	Sex	Presentation	Final diagnosis	Remarks
55	M	Dizziness/collapse	Cardiac arrest	CPR en route
				Certified at ED
34	F	Collapse	Cardiac arrest	CPR en route
				Certified at ED
26	F	Collapse	Cardiac arrest	CPR en route
				Certified at ED
Adult	F	Fall from height	Fracture skull	Certified by GFS AMO
			Cardiac arrest
42	M	Shortness of breath	Heat stroke	Admitted to ICU; home 7days later
32	F	Collapse, convulsion	Heat stroke	Admitted to ICU; home 5 days later
29	M	Dizziness, chest discomfort	Acute myocardial infarction	Admitted CCU: STEMI
57	M	Chest pain	Acute myocardial infarction	Admitted medical: NSTEMI
55	M	Chest pain	Acute coronary syndrome	Positive treadmill
54	M	Fall from height	Dislocated cervical spine, cord compression, tetraplelgia	Posterior spinal fusion done; discharged to rehabilitation after 2 months
51	F	Fall from height	Fracture of 6-8 ribs on the right; right pneumothorax	Admitted to ICU for monitoring
67	M	Fall	Central cord syndrome	MRI showed spinal stenosis; home 9 days with neck collar.

Outcome	Number (%)
Discharged from ED	94 (34)
Discharged after observation in ED	26 (9.5)
Discharged from GFS	49 (18)
Admitted to wards	44 (16)
Admitted to ICU/CCU	4 (1.5)
Dead	5 (2)
Disappeared	11 (4)
Discharged against medical advice	9 (3.3)
Missing	33 (12)