The Helicopter Emergency Medical Service (HEMS) accident rate has driven operators from around the world to address the management of risks inherent to their operations. In-flight decision-making, pre-flight planning, failure to follow standard operating procedures, delayed remedial actions, and misinterpretation of environmental cues are all areas that need to be addressed for safe HEMS operations. HEMS operations are complex, being a joint exercise between the flight crew, paramedics and supporting agencies. Operations occur around-the-clock, in all-weather conditions, and often with no fore-warning. In a time critical operation, where precious minutes may cost lives, operators must decide which cases warrant a HEMS response and if so, whether the conditions are safe to conduct the mission. Intelligent systems are an emerging field offering benefits to a multitude of applications. This research forms a comprehensive investigation of the application of 'intelligent systems' to the pre-mission analysis of HEMS operations. The research has resulted in the development of a prototype decision support system capable of assisting in the pre-mission analysis of HEMS operations. The prototype system is capable of supporting flight coordinators and crew in the decision-making processes prior to HEMS operations and can potentially improve emergency medical services to the community.

Inadvertent tracheal tube misplacement and particularly endobronchial intubation are well-known complications of emergency endotracheal intubation (ETI) in pediatric trauma patients, which require repositioning of the tube to avoid impairment of gas exchange. The main aim of study was to identify the frequency of tube misplacement and associated factors of pediatric trauma patients who received ETI either by prehospital physician-staffed emergency medical service (EMS), or at emergency department (ED) admission to a single level-1 trauma center. Sixty-five patients (median age 14 years and median injury severity score 29) were included. Of these, 30 underwent helicopter EMS ETI, 29 ground EMS ETI, and 6 ED ETI. Seventeen cases (26%) of tracheal tube misplacement were recognized. After multivariable analysis, tracheal tube misplacement was independently negatively associated with body weight (OR 0.86; 95% CI, 0.76–0.99; p = 0.032) and helicopter EMS ETI (OR 0.20; 95% CI, 0.04–0.97; p = 0.036). Two of nineteen patients received tube thoracostomy due to endobronchial intubation. Mortality and length of stay were comparable in patients with misplaced tubes and correctly placed tubes. The results suggest that particularly small children require attention to avoid tracheal tube misplacement, which emphasizes the need for special training. Helicopter EMS physicians’ expertise might be beneficial in prehospital pediatric trauma patients requiring advanced airway management.