[Helicopter and emergency physician at the accident site. Medical comparison between altitude and flat land emergency care].

In-field intensive care reduces lethality and morbidity in severe trauma. We analyze and compare 400 medical helicopter rescue flights in the region of Basel and 325 medical air-rescues in the mountains of Interlaken. The presence of a physician in the helicopter is based on an interventional concept, with clinical diagnosis, monitoring and early intensive in-field care. Compared to the mountains, we find a predominance of road accidents (44%) in the region of Basel, with more head injuries (47.3%) and more polytrauma (19.4%) and thoraxtrauma (20.5%). In the mountains, with a majority of sport accidents (65.5%), pelvis and extremity injuries (73.4%) prevailed. As a consequence of inaccessible accident sites in the mountains, 23% of the rescues had to be performed by winch. An endotracheal intubation was performed in 35.5% of the patients in the Basel region, and in 11.6% in the mountains. Fixation of fractures and hemostasis was performed in both regions in 22% and 12% of the cases. In spite of high rates of severe conditions in both regions (57% in Basel, 17% in the mountains), the low mortality prior to and during air transport (2.5% in the Basel and 2.7% in the Interlaken region) confirms the necessity of the concept of early in-field intensive therapy. This concept allows good analgesia, is save and comfortable for the patients. The presence of a physician in the air rescue team has to be recommended not only for rescues in the plain, but also in the mountains.