Crew and interventions
Crew
The Helicopter Emergency Medical Service (HEMS) crew consists of a pilot and technical crew member, as well as a physician and a bachelor’s or master’s degree nurse.
Medical crew
The medical crew members, physician and a bachelor’s or master’s degree nurse are provided by the Teaching Institute of Emergency Medicine of the City of Zagreb and the institutes of emergency medicine of the Osijek-Baranja, Primorje-Gorski Kotar, and Split-Dalmatia counties, depending on the location of the helicopter base.
Based on a previously conducted public call for expression of interest in training for the needs of work in the HEMS, a total of one hundred employees (50 physicians and 50 bachelor’s or master’s degree nurses) were selected to work in the HEMS.
HEMS team Zagreb
HEMS team Osijek
HEMS team Rijeka
HEMS team Split
Physicians working in HEMS are predominantly specialists in emergency medicine, anaesthesiology, reanimatology, and intensive care medicine, while nurses have a bachelor’s or master’s degree in nursing. All of them are educated in standardised medical procedures for providing emergency medical care and have many years of experience in emergency medicine. In addition to HEMS, they also work in other workplaces, including emergency departments and out-of-hospital emergency medical service.
The specific knowledge required for working in a helicopter, ensuring the safety of HEMS operations for both the crew and emergency patients, has been acquired through training provided by the HEMS service provider in Croatia (EliFriulia S.p.A., Eliance Helicopter Global Services SL, and Eli-Adriatik d.o.o.) in accordance with European Union guidelines.
Flight crew
Pilots and technical crew members are provided by the HEMS service provider.
Interventions
The HEMS conducts three types of emergency air medical interventions:
Primary intervention
Based on a layperson’s call to the emergency medical dispatch centre and according to systematic triage guidelines, the HEMS team is dispatched to the site alone or simultaneously with the EMS team. Medical dispatch centres use the Croatian Index for receiving emergency calls for medical dispatch units modified for HEMS triage. The HEMS team provides emergency medical assistance to the patients on the site of intervention and during their helicopter transportation to hospitals of the highest level of acute healthcare.
Secondary intervention
The HEMS team is dispatched when assistance is requested by the terrestrial EMS crew already on-scene, for example:
- If the situation is worse than it appeared initially
- If there is a need for additional assistance
- If time to finish treatment is critical for patient outcome
- If the patient’s condition requires extended transport time to the specific hospital specialist service.
The HEMS team transports emergency patients to further hospital treatment.
Interhospital medical transport intervention
Transportation of a critically ill patient from any hospital facility to another hospital centre to continue critical care support. The purpose of it is to upgrade clinical care and provide specialist services, investigations and interventions that are not available at the host hospital. It includes transfers to hospitals with neurotrauma or burn units, hospitals with CAT LABs, and hospitals with stroke units for recanalization therapy (intravenous thrombolytic drug treatment or endovascular mechanical thrombectomy).
Also, HEMS interhospital transport serves for longer distance transfers of critically ill or injured patients who need timely access to definitive treatment, require intervention that can only be carried out at the receiving hospital or are not time-critical but have a high risk of deterioration requiring care that’s provided the best at the receiving hospital.