Feasibility of Performing Rapid Sequence Intubation During Helicopter Flight in an AW169: A High-Fidelity Pilot Simulation Study

Q3 Nursing

Air Medical Journal Pub Date : 2026-07-01 Epub Date: 2026-06-22 DOI:10.1016/j.amj.2026.04.002

Allan M. McHenry, Joanne E. Griggs, Sophie Mitchinson, Kat Hunter, Richard Lyon, Air Ambulance Charity Kent Surrey Sussex

{"title":"Feasibility of Performing Rapid Sequence Intubation During Helicopter Flight in an AW169: A High-Fidelity Pilot Simulation Study","authors":"Allan M. McHenry, Joanne E. Griggs, Sophie Mitchinson, Kat Hunter, Richard Lyon, Air Ambulance Charity Kent Surrey Sussex","doi":"10.1016/j.amj.2026.04.002","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>Rapid sequence intubation (RSI) in helicopter emergency medical services (HEMS) is conventionally performed at the scene before transport, potentially delaying time to definitive care. The feasibility of performing RSI during flight in civilian HEMS operations has not been established in the United Kingdom. We evaluate the feasibility, safety, and temporal efficiency of performing simulated in-flight RSI in an AW169 helicopter under operational flight conditions.</div></div><div><h3>Methods</h3><div>A prospective proof-of-concept study using high-fidelity simulation was conducted across 2 phases (May 2023, January 2025) at the Air Ambulance Charity Kent Surrey Sussex. Eight simulations were completed by 4 distinct clinical teams comprising operationally experienced HEMS physicians and paramedics. Scenarios replicated a standardized traumatic brain injury scenario requiring RSI during the return transit phase. The primary outcome was time from RSI checklist initiation to confirmed intubation. Secondary outcomes included overall mission times, safety events, and crew-perceived feasibility assessed via post-scenario questionnaires.</div></div><div><h3>Results</h3><div>All simulations (8/8, 100%) achieved successful first-pass intubation. Median time from checklist initiation to confirmed intubation was 5 minutes (interquartile range [IQR]: 5-7). Median total mission time from base departure to RSI completion was 42 minutes (IQR 40-44). No safety events, procedural complications, or communication failures occurred. Crew questionnaires (93% response rate) confirmed unanimous perceived feasibility, with participants identifying adequate workspace, effective communication, and manageable equipment accessibility.</div></div><div><h3>Conclusion</h3><div>High-fidelity simulation demonstrates that in-flight RSI is technically feasible in an AW169 helicopter, with consistent procedural times and no safety events. These findings may support further evaluation of in-flight RSI as a complementary strategy for time-critical patients where scene-based airway management may delay definitive care.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 4","pages":"Pages 363-369"},"PeriodicalIF":0.0000,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Air Medical Journal","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1067991X26001458","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/6/22 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"Nursing","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

Rapid sequence intubation (RSI) in helicopter emergency medical services (HEMS) is conventionally performed at the scene before transport, potentially delaying time to definitive care. The feasibility of performing RSI during flight in civilian HEMS operations has not been established in the United Kingdom. We evaluate the feasibility, safety, and temporal efficiency of performing simulated in-flight RSI in an AW169 helicopter under operational flight conditions.

Methods

A prospective proof-of-concept study using high-fidelity simulation was conducted across 2 phases (May 2023, January 2025) at the Air Ambulance Charity Kent Surrey Sussex. Eight simulations were completed by 4 distinct clinical teams comprising operationally experienced HEMS physicians and paramedics. Scenarios replicated a standardized traumatic brain injury scenario requiring RSI during the return transit phase. The primary outcome was time from RSI checklist initiation to confirmed intubation. Secondary outcomes included overall mission times, safety events, and crew-perceived feasibility assessed via post-scenario questionnaires.

Results

All simulations (8/8, 100%) achieved successful first-pass intubation. Median time from checklist initiation to confirmed intubation was 5 minutes (interquartile range [IQR]: 5-7). Median total mission time from base departure to RSI completion was 42 minutes (IQR 40-44). No safety events, procedural complications, or communication failures occurred. Crew questionnaires (93% response rate) confirmed unanimous perceived feasibility, with participants identifying adequate workspace, effective communication, and manageable equipment accessibility.

Conclusion

High-fidelity simulation demonstrates that in-flight RSI is technically feasible in an AW169 helicopter, with consistent procedural times and no safety events. These findings may support further evaluation of in-flight RSI as a complementary strategy for time-critical patients where scene-based airway management may delay definitive care.

查看原文本刊更多论文

在AW169直升机飞行期间执行快速序列插管的可行性：高保真飞行员模拟研究。

目的：直升机紧急医疗服务（HEMS）中的快速顺序插管（RSI）通常在运输前在现场进行，可能会延迟到最终护理的时间。在英国，民用医疗急救系统在飞行过程中进行重复性肢体损伤的可行性尚未确定。我们评估了在作战飞行条件下，在AW169直升机上执行模拟飞行中RSI的可行性、安全性和时间效率。方法：在苏塞克斯郡肯特郡的空中救护慈善机构进行了一项前瞻性的概念验证研究，使用高保真度模拟进行了两个阶段（2023年5月和2025年1月）。8个模拟由4个不同的临床小组完成，包括操作经验丰富的HEMS医生和护理人员。场景复制了一个标准化的创伤性脑损伤场景，在返回运输阶段需要RSI。主要观察指标是从RSI检查表开始到确认插管的时间。次要结果包括总体任务时间、安全事件和通过场景后问卷评估的机组人员感知的可行性。结果：所有模拟（8/8,100%）首次插管成功。从检查表开始到确认插管的中位时间为5分钟（四分位数间距[IQR]: 5-7）。从基地出发到RSI完成的总任务时间中位数为42分钟（IQR 40-44）。没有发生安全事件、程序并发症或通信故障。机组人员的问卷调查（93%的回复率）一致确认了可行性，参与者确定了足够的工作空间、有效的沟通和可管理的设备可及性。结论：高保真仿真表明，飞行中RSI在AW169直升机上技术上是可行的，具有一致的程序时间和无安全事件。这些发现可能支持进一步评估飞行中RSI作为时间紧迫患者的补充策略，因为基于场景的气道管理可能会延迟最终护理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Air Medical Journal Nursing-Emergency Nursing

CiteScore

1.20

自引率

0.00%

发文量

112

审稿时长

69 days

期刊介绍： Air Medical Journal is the official journal of the five leading air medical transport associations in the United States. AMJ is the premier provider of information for the medical transport industry, addressing the unique concerns of medical transport physicians, nurses, pilots, paramedics, emergency medical technicians, communication specialists, and program administrators. The journal contains practical how-to articles, debates on controversial industry issues, legislative updates, case studies, and peer-reviewed original research articles covering all aspects of the medical transport profession.