A prospective survey of critical care procedures performed by physicians in helicopter emergency medical service: Is clinical exposure enough to stay proficient?

Abstract

Background: Physicians in prehospital care must be proficient in critical care procedures. Procedure proficiency requires a combination of training, experience and continuous clinical exposure. Most physicians in helicopter emergency medical service (HEMS) in Norway are well-trained and experienced anaesthesiologists, but we know little about their exposure to critical care procedures in the prehospital arena. This knowledge is required to plan clinical training and in-hospital practice to maintain core competences for a HEMS physician. Methods: We collected survey data on critical care procedures performed by physicians at three HEMS bases in Norway for a one-year period. To correct for differences in duty time between physicians, the expected number of procedures performed in a full time engagement at each HEMS base was calculated. Data was analysed using descriptive statistics and expected procedure volume at each base was compared using one-way between group analysis of variance. Results: We received data from 82.7 % of the duty hours in the study period. Physicians at Oslo University Hospital HEMS had the highest volume of procedures in most categories and were expected to perform a majority of the procedures at least once a year. There were significant differences in procedure volume between the bases in 25 procedures. Conclusions: Physicians in Norwegian HEMS perform critical care procedures with variable frequencies. The low procedure volume in some cases and variance between bases indicate the need for a tailored procedure maintenance training and relevant in-hospital clinical practice.