First Nighttime Primary Helicopter Emergency Medical Services (HEMS) Mission in Pediatric Severe Traumatic Brain Injury: Establishing a Functional Night Landing Network in a Resource-Limited Setting

Severe traumatic brain injury (TBI) in pediatric patients is a time-dependent condition in which early airway management and rapid access to neurosurgical care are considered important to reduce the risk of secondary brain injury. The potential utility of Helicopter Emergency Medical Services (HEMS) is closely related to the availability of adequate landing sites, particularly during nighttime operations. In Calabria (Southern Italy), nighttime HEMS activity has historically been limited by a marked lack of certified hospital helipads, especially within tertiary (hub) centers. We report the case of a pediatric patient involved in a bicycle-versus-car collision, presenting with severe TBI (Glasgow Coma Scale (GCS) score of 6), managed during one of the first nighttime primary HEMS missions performed after the recent regional implementation of alternative illuminated landing sites. Due to the absence of hospital-based nighttime landing facilities, a rendezvous point was performed at a municipal sports field, 1 of approximately 20 sites recently identified and equipped across the region to support nighttime operations. On HEMS arrival, the patient exhibited impaired consciousness and inadequate airway protection. Rapid sequence intubation (RSI) was performed on scene, followed by helicopter transport to a tertiary neurosurgical center, where urgent surgical evacuation of an epidural hematoma was carried out. The patient showed favorable neurological recovery, with no clinically evident major focal neurological deficits after a three-day postoperative intensive care stay. This case highlights the operational feasibility and potential clinical value of nighttime primary HEMS missions in a structurally constrained environment. The implementation of a distributed network of alternative landing sites, mainly based on sports facilities, may represent a preliminary operational step toward a more functional regional H24 HEMS system, partially compensating for the lack of dedicated hospital helipads. Early advanced airway management combined with rapid transfer to neurosurgical care may have contributed to the favorable outcome in this patient; however, the clinical evolution was likely influenced by multiple factors, including the presence of a surgically treatable epidural hematoma and timely neurosurgical evacuation.