ETD

• Helicopter Emergency Medical Services (HEMS)
• in-flight defibrillation
• Out-of-Hospital Cardiac Arrest (OHCA)
• survey

The article concerning in-flight defibrillation and it is based both on historic data and results of literature research. It allows authors to confirms the relative rarity of the procedure and poses the problem of the potential safety risks that could be mitigated by the adoption of specific internal protocol based on aviation regulations.
Helicopter medical rescue (HEMS) plays an increasingly role in the management of prehospital emergencies. On board, healthcare assistance maneuvers are limited and essential, favoring on-site stabilization before take-off. In this article we want to pay attention to the management of a particular category of patients, those at risk of serious and life-threatening cardiac arrhythmias, which may require advanced maneuvers even during the flight, in particular defibrillation.
The medical devices used in air ambulances have been built up to date for stationary or vehicular use on land, and no defibrillator currently in production is designed to meet the criteria of the DO-160D. The operator who intends to use these electromedical equipment on board must therefore refer to checks carried out individually for each type of equipment on each aircraft in service or on aircraft of the same type operating in identical configuration and operations.
Trentino Province (Italy) has an HEMS system based on three Helicopters. We conducted a retrospective analysis about in-flight defibrillation. In the last 14 years (2010-2024) 33613 HEMS missions were analyzed. Cardiovascular disease in general represents 24% (7972 cases) of interventions. Of these, 2616 were cardiac arrest patients who required CPR maneuvers. Of all the patients who required defibrillation (410), 23 (5%) were subjected to electric shock during helicopter transport. The specific analysis of the data of this last category highlights: 18 primary and 5 secondary interventions; 21 cardiovascular and 2 traumatic etiologies. The male gender is more represented (91%).
In no case have problems been reported of interference with the instrumentation on board or damage to property or people.
This data confirms the relative rarity of the procedure and poses the problem of the electromagnetic compatibility of in-flight defibrillation that could be approved by specific protocols in order to mitigate the potential safety risks.
A national survey has been carried out in HEMS bases to investigate local practices: the presence of a specific protocol for on board defibrillation is present in 90% of Italian HEMS bases, but they vary greatly among different bases. The implementation of a national protocol would be considered useful by the survey responders in terms of standardiziation of care, medico-legal asects, increased operators saftey, training and education.