Changes in the helicopter medical service system of L'Aquila (Italy), after the fatal helicopter crash on Monte Cefalone (January 24, 2017). A retrospective study

Introduction: The use of helicopter emergency medical services is useful for rescuing or transporting highly time-dependent disease patients, from urban remote areas or harsh environments in the hospital, providing advanced pre-hospital life support in an emergency setting. Study objective: This study aims to identify changes in mission characteristics, crew composition, and operational procedures within the helicopter emergency medical service (HEMS) system of L'Aquila, Italy, to identify operational patterns, mission characteristics, crew composition and patient outcomes over time, with specific attention to changes implemented after the Monte Cefalone incident. Methods: Changes in the characteristics of the rescued patients, the helicopter missions, the crew members and the type of interventions were analysed. T-test or chi-square test were used to compare data before and after the incident. Results: Three thousand three hundred and ninety-two records were reviewed. Following the crash, a pilot was added to the crew. Two hundred and thirteen missions were classified as cancelled: 47 before and 166 after the crash. The cancellations due to the lack of horizontal visibility were: 4 out of 47 (8.5 %) and 24 out of 166 (14.5). Most of the rescued victims had trauma: 45 % before and 50 % after the crash. The helicopter flights were prevalent in harsh environments. After the accident, the percentage of missions in harsh environment decreased from 80 % to 64 %. The type of rescue and operations changed significantly (p < 0.001). The proportion of hospitalized patients increased from 60 % to 93 % while the recorded deaths in place were similar (6 % vs 7 %). A decrease in the number of transport refusals, from 4 % to 0.4 %, was reported. Conclusion: The results of our research highlighted that the helicopter emergency medical service of L'Aquila continued to fly in safety, for patient rescue and hospitalization despite being subjected to harsh conditions and environments, and despite the accident.