Helicopter emergency medical service (HEMS) for the management of road traffic accidents-related trauma: Optimizing the location of landing areas and helipads

The timely post-impact care and the related transportation to healthcare facilities are key objectives for mitigating injuries and deaths resulting from motor vehicle crashes. Several advanced and efficient emergency operations centers (EOC) exploit the potential of a helicopter emergency medical service (HEMS) to supplement the ground fleet for life-threatening or urgent and emergency situations. Although daytime HEMS missions operating under visual flight rules (VFR) in the visual meteorological conditions (VMC) along the shortest flight path and landing as close as possible to the scene are a well-established practice, one of the priorities is the rational use of the helicopter in marginal weather conditions, at night, or whenever natural or artificial obstructions represent potential flight hazards. This involves exploiting the potential of HEMS rendez-vous missions. In this perspective, the authors proposed two mathematical models to optimize the location of certified helipads, having a transfer point function, by maximizing the coverage (MaxCoverage) of a geographic area and minimizing the total delay (MinSumD) of the interventions considering the reasonable total pre-hospital time thresholds of 45 and 60 min. The models were applied to an Italian real-world case study using an anonymized emergency medical database: electronic pre-hospital care records (4,155 events), attributable to road traffic accidents that took place in the province of Parma (Emilia Romagna, Italy) in 7 years, were considered as input data. The simulations, defining the optimal number and location of helipads for rendez-vous missions, offer analytical supports to operators and public agencies for providing on the one hand a broad spectrum of intervention strategies and facilitate the decision-making, and giving on the other hand planning and design tools for the HEMS implementation and strengthening.