Page 45 - JSOM Fall 2025

access, the proportion of imminent life-threatening cases is A 2012 study by McMahon et al. noted that in-flight vibra-
close to the proportion in this study. tion made non-invasive blood pressure measurement less ac-
curate. Unlike systolic blood pressure (SBP), mean arterial
11
Importance of Helicopter Use in SAR Missions pressure (MAP) measured non-invasively was a more reliable
During SAR missions, access to casualties is sometimes impos- marker. Clinician awareness that MAP may provide more re-
sible by road. Helicopters are often the only means of extract- liable data would improve patient monitoring and anticipa-
ing and stabilizing isolated patients. Their winching capability tion of hemodynamic complications during flight, depending
7
is regularly used when it is impossible to reach the casualty by on the pathology. Use of amines could therefore rely more on
land or sea. In our study, 26 of the 33 trauma patients had to MAP figures than the systolic pressure. Currently, visual blood
be winched out because the helicopter could not land. Most pressure alarms are already in place, making it easier to mon-
winches occurred over the Mediterranean Sea or the Atlantic itor patients in flight. 12
Ocean, where mooring was not feasible.
Limitations
Medical helicopters provide added benefits to severe trauma A significant limitation of our study was incomplete mission
patients. Weinlich et al. found that hospital mortality was documentation, which prevented full analysis of some cases.
8
significantly reduced in patients evacuated by air, and that Although the age of the data may also be a minor limitation,
mortality worsens significantly with increased time spent in newer data is not currently available, and historically, the mis-
prehospital care. Helicopters reduced the time between mis- sion profiles have remained somewhat constant. Finally, data
sion activation and hospital arrival by 15 minutes on aver- collection stops at the end of the mission. We did not recover
age. In our study, the average time from trigger to arrival on any information concerning long-term patient survival and
the scene was 79 minutes, and 33 (18.9%) triggers were for recovery.
trauma. Given their rapid evacuation and on-board physicians
able to treat and appropriately refer patients to appropriate Conclusion
hospital centers, SAR missions have their place in the frame-
work of the care of polytrauma patients. According to our estimates, a total of 61 patients were in
life-threatening danger upon arrival of the SAR medical teams
SAR also improves the prognosis of patients in neurological between 2015 and 2019. This accounts for more than one-third
distress. If patients are stable and conscious, medical proce- of the patients rescued during the study period. The speed of
dures must be limited on site, but the medical team remains evacuation ensured by the helicopter’s rapid release chain and
essential for permanent patient monitoring. Prolonged on- its ability to fly at any time are important assets, particularly
scene time is significantly linked to clinical deterioration in for patients with multiple trauma or neurological injuries. The
stroke patients; therefore, early treatment reduces neurologi- ability to winch in at night, take off in all weather conditions,
9
cal sequelae. SAR missions for suspected non-life-threatening and overfly the sea at a distance from the coast makes SAR
strokes enable real-time monitoring of neurological deteriora- missions unique and distinguishes them from rescue missions
tion and shorten the time taken to administer treatment. Neu- conducted by civilian medical aid services. These data confirm
rological distress was the cause for departure in 25 (14.3%) of the need for a deployable medical team competent in emer-
cases in this study. gency medicine, trained to work together, and aware of the
difficulties of helicopter-based emergency care.
In some clinically serious situations, the added value of hav-
ing a doctor on board the helicopter is considerable. During Author Contributions
transport, early administration of treatments (e.g., antihyper- EG conducted the research and wrote the article. OT super-
tensive drugs) or performance of technical procedures helps vised this work and helped in the process of submission.
limit the risks of cerebral involvement and cerebral hypoper-
fusion. In France, SARs are physician-led and nurse-s upported Disclosures
(there is no French role equivalent to paramedics, and ambu- The authors have nothing to disclose.
lanciers do not have the same training or scope of practice as
emergency medical technicians in the United States). In our Funding
study, interventions that could only be performed by physi- No funding was received for this work.
cians included amines (n=12; 6.9%), osmotherapy or throm-
bolysis (n=2 each; 1.1% each), needle decompression (n=1; References
0.6%), and (in most cases) orotracheal intubation (n=10; 1. Ministère des Armées. Missions permanentes en métropole. Ac-
5.7%), reflecting the importance of physician presence during cessed August 12, 2025. https://www.defense.gouv.fr/air/missions/
flight. missions-permanentes/missions-permanentes-en-metropole/
missions-permanentes-en-metropole.
2. Carfantan C, Gehant M, Pegaz PY, Bourgeois B, Clement J, Bancarel
Procedures J. Les missions de secours héliportés du Centre Médical des Armées
None of the patients in this investigation were in hemorrhagic de Solenzara. Ann Fr Médecine d’Urgence. 2016;6(3):193–199.
shock on arrival, which explains the absence of lyophilized 3. Leveau P. La classification clinique des malades du SMUR
plasma use. This finding aligns with Schober et al., where (CCMS) : un outil d’évaluation qualitative de l’activité du SMUR.
10
only 2.6% of trauma patients analyzed had undergone pri- Journal Européen des Urgences et de Réanimation. 1999;12:148–
mary hemostasis (tourniquets or compressive dressings). On 152. https://www.em-consulte.com/article/109595.
the other hand, tranexamic acid was used for a wide range of 4. Pasquier M, Geiser V, De Riedmatten M, Carron PN. Helicopter
indications, suggesting its use was worthwhile. In this study, rescue operations involving winching of an emergency physician.
Injury. 2012;43(9):1377–1380. doi:10.1016/j.injury.2011.06.196
three patients (1.7%) received tranexamic acid and one (0.6%) 5. Østerås Ø, Brattebø G, Heltne JK. Helicopter-based emergency
received a transfusion. medical services for a sparsely populated region: a study of 42,500

Search and Rescue Missions Conducted by the French Army | 43