Air Medical Journal最新文献

{"title":"Point of Care Laboratory Testing and its Effect on Confidence in Clinical Decision Making","authors":"Karen R. Bourdon RN, BSN ,&nbsp;Chase J. Canter BS, FP-C","doi":"10.1016/j.amj.2025.06.011","DOIUrl":"10.1016/j.amj.2025.06.011","url":null,"abstract":"<div><h3>Background</h3><div>Performing and interpreting point of care laboratory testing is an advanced skill that requires additional training outside of a critical care transport providers primary education. Providers must be knowledgeable and confident in their ability to perform all clinical tasks to exude competence. Limited evaluations of self-efficacy and perceived confidence exist in the CCT, point-of-care testing realm.</div></div><div><h3>Objective</h3><div>This study aims to evaluate perceived confidence in clinical decision making of providers utilizing point-of-care testing (POCT) in the CCT setting.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was administered to providers of a CLIA licensed critical care transport team. The survey was of electronic format, queried demographics and subjective concepts using a psychometric response scale. The survey was anonymous and voluntary. Both critical care nurses/paramedics of this CLIA licensed agency, who operate under an EM, FAEMS medical director, who is the certified laboratory director, were eligible to participate in the survey. Providers not employed at the agency prior to receiving CLIA licensure were excluded.</div></div><div><h3>Results</h3><div>Survey participants included critical care nurses (70%) and critical care paramedics (30%), all whom (n=10) self-identified as board certified through BCEN or IBSC. Experience in critical care transport varied finding 0-3 years (40%), 4-7 years (30%), and 10+ years (30%). All survey participants agreed or strongly agreed with concepts regarding POCT and its positive effect on patient safety and quality of care with recent laboratory results. Likewise, all participants agreed or strongly agreed their clinical acumen increased as did their confidence interpreting laboratory results because of required quarterly education. Participants found the availability of POCT increased their confidence in clinical decision making as well as made clinical decision making easier. 30% of providers attested to questioning the appropriateness of the care they provided prior to having POCT availability with 50% answering neutral and 20% disagreeing to that statement.</div></div><div><h3>Conclusion</h3><div>This survey highlights the positive impact of POCT on CCT providers confidence in clinical decision making. The results demonstrate that POCT enhances clinical acumen and fosters greater confidence among providers when interpreting laboratory results, while improving patient safety and care quality. The findings suggest that ongoing education and access to POCT contributes to the providers sense of subjective competence, making clinical decisions more streamlined. However, a portion of providers expressed uncertainty in the appropriateness of care before the availability of POCT, indicating areas for further investigation into the impact of POCT on patient safety and clinical outcomes. This survey underscores the importance of continued tra","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Page 436"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Workloads of Night Shift and Day Shift Workers in Critical Care Ground Transport","authors":"Zane Z. Grimm RN, BSN, CFRN ,&nbsp;Nolan R. Suchora RN, BSN, CFRN","doi":"10.1016/j.amj.2025.06.012","DOIUrl":"10.1016/j.amj.2025.06.012","url":null,"abstract":"<div><h3>Background</h3><div>With the expansion of critical care ground transportation call volumes will increase. The increase in volume as a trend in healthcare is shifted towards daylight shift workers compared to their counterparts. Having the added aspect of transport distance in interfacility transportation adds an increased workload with increasing distances.</div></div><div><h3>Objective</h3><div>We aim to examine the relationship between distance traveled and patient volume to determine the correlation in workload between night shift workers and day shift workers in the interfacility critical care transport setting. The value of this information may be utilized to determine appropriate staffing levels and/or the need for crew downtime.</div></div><div><h3>Methods</h3><div>Utilizing quantitative data including call volume and Total transport mileage from a critical care transport service.</div></div><div><h3>Results</h3><div>A total of 1293 patients were treated and transported 78,838.78 miles via critical care ground ambulance. Day shift workers transported 701 or 54% of the total patients. These patients were transported a total of 41,427.06 miles averaging 59.09 miles per patient. Night shift workers transported 592 patients or 46% of the total patients. These patients were transported a total of 36,298.42 miles averaging 61.31 miles per patient. Dayshift workers averaged 1.92 transports per shift compared to the 1.62 transports per shift of the night shift workers. The night shift workers, however, averaged 37.8 miles per shift compared to the 30.7 miles of day shift workers.</div></div><div><h3>Conclusion</h3><div>Night shift workers in critical care ground transportation travel more miles with a lesser volume compared to their counterparts in the daytime who transport a higher quantity with lesser mileage, resulting in equal workloads.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Page 436"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General Information","authors":"","doi":"10.1016/S1067-991X(25)00247-0","DOIUrl":"10.1016/S1067-991X(25)00247-0","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Page 329"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simulation-Based Rapid Plan-Do-Study Act Cycles for Airway Management Checklist Development and Quality Improvement","authors":"Jesse Conterato ,&nbsp;Ryan K. Newbury ,&nbsp;Andrew D. Cathers ,&nbsp;Craig F. Tschautscher ,&nbsp;Brittney Bernardoni","doi":"10.1016/j.amj.2025.06.010","DOIUrl":"10.1016/j.amj.2025.06.010","url":null,"abstract":"<div><h3>Objective</h3><div>Intubation of critically ill patients is a high stakes procedure. Across the healthcare industry, procedural checklists have been recognized as a successful tool for improving patient safety and outcomes. While intubation checklists may improve patient outcomes and reduce complications, the content comprising a checklist is not standardized and varies widely. This novel approach to intubation checklist development embeds quality improvement Plan-Do-Study-Act (PDSA) cycles within healthcare team-based intubation simulations to efficiently elicit feedback and garner buy-in from relevant stakeholders.</div></div><div><h3>Methods</h3><div>Plan: A multidisciplinary group of critical care transport (CCT) providers drafted the initial intubation checklist using a modified Delphi process reviewing checklists from external CCT transport programs.</div></div><div><h3>Do</h3><div>This draft checklist was then trialed in two simulation-based educational sessions for CCT providers at a single institution. During each session, four groups of CCT providers rotated through an intubation workshop. During each workshop, providers utilized the intubation checklist in three brief simulated intubation scenarios of escalating complexity.</div></div><div><h3>Study</h3><div>After each intubation scenario, the participants provided semi-structured feedback regarding content and use of the checklist.</div></div><div><h3>Act</h3><div>Between intubation workshops, this feedback informed serial modifications to the checklist. This iterative process of refining, trialing, and soliciting feedback repeated over eight cycles.</div></div><div><h3>Results</h3><div>Feedback from providers addressed multiple components of the checklist, including both its functionality and clinical implications. Changes were made to simplify wording in order to improve clarity and length of the checklist. Participant feedback also informed resequencing of checklist items to produce a more natural flow within clinical scenarios. The visual characteristics of the checklist, including color and font, were modified to improve visual tracking and flow. The clinical and operational implications of including certain checklist items were discussed, including the use of specific equipment and medications.</div></div><div><h3>Conclusion</h3><div>Integrating quality improvement processes into educational simulation facilitated efficient intubation checklist development. Utilizing PDSA cycles embedded within simulation, rapid iterative adjustments were made over two 3 hour sessions based on end-user feedback from CCT providers. Additionally, soliciting provider feedback promoted team engagement and buy-in for future implementation of this intubation checklist in patient care.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Pages 435-436"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Description of Critical Care Transport First Pass Endotracheal Intubation Failures","authors":"Abby L. Blake DO ,&nbsp;Kalle J. Fjeld MD ,&nbsp;Pietra Oelke ,&nbsp;Matthew A. Roginski MD, MPH ,&nbsp;Patricia R. Atchinson DO","doi":"10.1016/j.amj.2025.06.005","DOIUrl":"10.1016/j.amj.2025.06.005","url":null,"abstract":"<div><h3>Objective</h3><div>Describe first pass endotracheal intubation failures as well as associated patient and procedural factors in a rural critical care transport service.</div></div><div><h3>Methods</h3><div>Retrospective chart review of patients ≥18 years intubated by a mixed rotor wing and ground critical care transport service (nurse-paramedic teams) between January 2017 and June 2024. Direct and video laryngoscopy was available during the study period. The primary outcome was incidence of first pass failure. One intubation attempt was defined as the insertion of the laryngoscopy past the lips. First pass failure was defined as failure to place an endotracheal tube through the vocal cords on the first intubation attempt. Secondary outcomes included reason for failure as well as association of patient and procedural factors with failure.</div></div><div><h3>Results</h3><div>There were 389 intubations performed with 53 (13.6%) first pass failures. The most common reasons for failure were hypoxia (7, 13.2%), contamination (22, 41.5%), and anatomy (32, 60.4%). Multiple reasons for failure were cited in 15 first pass intubation attempts (28.3%). There was an association between first pass failure and predicted difficult airway OR 2.66 (95% CI 1.47-4.80). There was no association between operator type and first pass success rate. There was no association of first pass failure with bougie use, direct laryngoscopy, location of intubation, or pre-intubation hypoxia.</div></div><div><h3>Conclusion</h3><div>First pass failure occurred in approximately one in eight intubations. This descriptive analysis of intubation failure provides a starting point for further quality improvement work. Future work should incorporate systematic review of intubations with objective data (i.e. video-recorded laryngoscopy) and the use of an airway failure taxonomy to describe performance errors and allow for iterative quality improvement in a learning healthcare system.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Page 433"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications and Adverse Events During Primary and Secondary ECMO Retrieval Missions: A Single Center Retrospective Analysis","authors":"Katie Johnston MSN, CFRN, C-NPT, EMT-P ,&nbsp;Matthew Plourde MS, BSN, RN, CCRN, CFRN ,&nbsp;Kyle Danielson MPH, MN, RN, CFRN, CMTE ,&nbsp;Richard Utarnachitt MD ,&nbsp;Jenelle Badulak MD ,&nbsp;John W. Scott MD, MPH, FACS ,&nbsp;Megan Robinson BSN, RN ,&nbsp;Patricia L. Anderson MSN, RN, CCRN ,&nbsp;Eileen Bulger MD, FACS ,&nbsp;Jay D. Pal MD, PhD ,&nbsp;Michael S. Mulligan MD ,&nbsp;Michael J. Lauria ND, NRP, FP-C","doi":"10.1016/j.amj.2025.06.006","DOIUrl":"10.1016/j.amj.2025.06.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Extracorporeal Membrane Oxygenation (ECMO) can be an effective, lifesaving intervention to rescue the most critically ill patients with severe respiratory and/or circulatory failure. As a result of increased demand and technological advances, the implementation of ECMO as a therapeutic modality has increased significantly. With this proliferation of ECMO, the need to transport these patients to experienced ECMO centers has also increased. These transports, however, are clinically and logistically complicated. Data on the number and nature of complications during transportation of ECMO patients is limited. The aim of this single-center, retrospective analysis was to better quantify and describe complications and adverse events associated with ECMO transportation in a relatively new, multidisciplinary regional ECMO transport program.</div></div><div><h3>Methods</h3><div>This was a single-center, retrospective analysis of existing quality assurance data as part of routine clinical quality and process improvement measures. The data was reviewed from February 1, 2024 – January 31, 2025. We reviewed missions where the ECMO Transport Team was activated and deployed for ECMO retrieval. Documentation from a structured, standardized debrief form and clinical documentation was reviewed. Adverse events were identified based on the U.S. Department of Health and Human Services definition and in accordance with previously published literature related to adverse events in ECMO transport. These events were then categorized based on type of event including adverse events related to the ECMO circuit, other medical equipment, patient specific clinical events, Human Factors (communication, medication errors, etc), and transport operations. Given the time-sensitive nature of these patients’ disease process we also included logistical adverse events that may have delayed care.</div></div><div><h3>Results</h3><div>30 ECMO Transport Team activations/deployments were reviewed between February 1, 2024 and January 31, 2025. The mission types included 12 (40%) primary ECMO retrieval missions, 13 (43%) secondary transports, 4 (13%) missions where the patient was transported without cannulation, and 1 (3%) mission where no patient was transported. There was 1 death in transport. 25 (83%) transports experienced at least 1 complication, but only 3 (9%) of transports experienced a severe complication or adverse event that resulted in significant and immediate risk to the patient. The median complication/adverse event score was 2, the average was 3.2 (SD 9.2).</div></div><div><h3>Conclusions</h3><div>Complications and adverse events in this cohort of patients with exceptionally high acuity was common. However, most complications were minor and did not present significant risk to patients. Primary and secondary retrieval of these complex patients can be performed safely by a well-trained and coordinated multidisciplinary team.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Page 434"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Construction of a Low-Cost Perfusion Cadaver for Ultrasound Guided Vascular Access Training","authors":"Jason Herman DNP, RN, TCRN, CFRN, NE-BC,&nbsp;Casey Langford BSN, RN, CFRN, TCRN, CEN,&nbsp;Guy Minshall NRP, FP-C,&nbsp;Jamie Hinojosa MD, MS,&nbsp;Jay Kovar MD, FACEP","doi":"10.1016/j.amj.2025.06.004","DOIUrl":"10.1016/j.amj.2025.06.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Ultrasound guided vascular access in the prehospital industry is increasing in prevalence. Currently there are only a few ways to train a clinician prior to attempting cannulation on a living person. Low fidelity models do not simulate a realistic attempt at gaining vascular access on a human. Through the utilization of a fresh frozen or lightly embalmed cadaver this gap in training could be remedied.</div></div><div><h3>Background</h3><div>Ultrasound guided vascular access is a relatively common procedure within the scope of emergency medicine and prehospital nurses and paramedics. The gold standard training model of how to properly train clinicians on how to place ultrasound guided vascular access has yet to be established. Currently, you can find didactic training and ultrasound training limbs. These models have shown improvement in successful cannulation but have learning curves that do not mimic a real patient. This is why we set out to create a relatively low-cost perfusion cadaver for ultrasound guided vascular access. Hospitals and prehospital organizations that already have access to cadaver labs can use this model to increase trainee competence and confidence with placement of ultrasound guided vascular access.</div></div><div><h3>Educational Methods</h3><div>We created a perfusion cadaver by utilizing a lightly embalmed tissue specimen and placing a triple lumen catheter into the right femoral artery for infusion and a double lumen catheter in the left femoral vein for draining. The pump utilized to create flow within the cadaver was a Vivosun 800 GPH submersible pump on its lowest setting. The pump was connected to the triple lumen catheter, which was in the right femoral artery through system of hoses and a 3mL syringe. The distal latex tube required a loose knot to be tied into it to help lessen the overall flow. We infused water into the right femoral catheter using the submersible pump in a 30-gallon bucket. The triple lumen catheter was connected to two 10 drop iv sets with both drip chambers cut off. The drop sets ends were placed into a 28 French chest tube to lengthen the overall drainage system, which drain into the original 30-gallon bucket. This helped the reservoir to remain filled and the fluid to be cycled back through the system. The learners were then able to practice ultrasound guided vascular access under observation by facilitators able to offer realtime feedback.</div></div><div><h3>Results</h3><div>Flight clinicians were able to successfully visualize and cannulate the brachial artery under ultrasound guidance, allowing needle visualization. Flight clinicians reported subjective increase in procedural confidence and competence after practicing on a perfused cadaver.</div></div><div><h3>Conclusion</h3><div>The utilization of a perfused cadaver could grant subjective improvement of confidence and competence in ultrasound guided vascular access with relatively low additional cost associ","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Page 433"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Design and Implementation of a Multidisciplinary Regional Extracorporeal Life Support Transport Team","authors":"Matthew Plourde MS, BSN, RN, CCRN, CFRN ,&nbsp;Michael J. Lauria MD, NRP, FP-C ,&nbsp;Katie Johnston MSN, CFRN, C-NPT, EMT-P ,&nbsp;Mikaela Hagberg MHA, BSN, RN, CEN, CFRN ,&nbsp;Kyle Danielson MPH, MN, RN, CFRN, CMTE ,&nbsp;Jenelle Badulak MD ,&nbsp;John W. Scott MD, MPH, FACS ,&nbsp;Megan Robinson BSN, RN ,&nbsp;Patricia L. Anderson MSN, RN, CCRN ,&nbsp;Eileen Bulger MD, FACS ,&nbsp;Jay D. Pal MD, PhD ,&nbsp;Michael S. Mulligan MD ,&nbsp;Richard Utarnachitt MD","doi":"10.1016/j.amj.2025.06.008","DOIUrl":"10.1016/j.amj.2025.06.008","url":null,"abstract":"<div><div>Venovenous (VV) and venoarterial (VA) extracorporeal membrane oxygenation (ECMO) are effective, lifesaving interventions for refractory, severe respiratory and/or circulatory failure. Access to these therapeutic modalities is traditionally limited to tertiary and quaternary medical centers with highly trained subspecialties and substantial ECMO volumes. The Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) region of the United States is a vast and largely rural area in the northwestern United States that encompasses nearly 27% of the country’s landmass. In April 2024 the University of Washington Medicine ECMO Program officially launched an ECMO Transport Team that can perform primary (remote cannulation) and secondary ECMO retrieval missions with 24/7 availability. The team is a concerted effort between the University of Washington Medical Center at Montlake, Harborview Medical Center, and Airlift Northwest. We describe the unique design of a multidisciplinary team of surgeons, intensivists, emergency physicians, ECMO specialists, flight nurses, and other support staff capable of providing ECMO services across the region and bridging significant disparities in care for the most critically ill patients. In addition, we review the education, training, and key logistic elements of the program that facilitate implementation.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Pages 434-435"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Transport Altitude on Outcomes in Traumatic Brain Injury: The HEIGHT-TBI Study","authors":"Vasisht Srinivasan MD, FACEP ,&nbsp;Courtney Gomez MD ,&nbsp;Jane Hall PhD ,&nbsp;Kyle Danielson MPH, MN, ARNP ,&nbsp;Abhijit Lele MBBS, MD, MSCR, FNCS ,&nbsp;Richard Utarnachitt MD ,&nbsp;Andrew Latimer MD ,&nbsp;Bryce Robinson MD","doi":"10.1016/j.amj.2025.06.007","DOIUrl":"10.1016/j.amj.2025.06.007","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Many patients with traumatic brain injury (TBI) require aeromedical transport to trauma centers for specialized care. However, the effects of flight on TBI patients have not been previously studied. We examined how altitude influences outcomes in adult TBI patients who required helicopter transport to the regional trauma center.</div></div><div><h3>Methods</h3><div>State trauma registry and aeromedical transport records were retrospectively reviewed to identify TBI patients flown to the regional level I trauma center over a five-year period (2017 – 2022). Multivariable logistic regression was performed to evaluate associations between the coprimary exposures (altitude and flight duration) and coprimary outcomes (in-hospital mortality and percentage of patients discharged to home versus skilled nursing facilities) while adjusting for patient characteristics and injury severity. Secondary analyses examined interactions between hypotension and altitude.</div></div><div><h3>Results</h3><div><strong>1,010 flights and 1,007 patients were identified (age: 53.6 ± 21.5 years; sex: 30.7%</strong> women; race: 90.1% white) with mean flight duration of 22.8 ± 11 mins and median altitude of 2200 ± 1300 ft. Hypoxemia (SpO2 &lt; 94%) was observed in 29.5% of transports, and hypotension (SBP &lt; 110 mmHg) in 34.9%. In-hospital all-cause mortality was 17.4% (N=175) and 54% (N=544) were discharged home. The main analyses showed increased mortality and discharge to SNF versus home associated with flights above 6,000 ft for all comers (adjusted OR=4.3, 95% CI: 1.1–16.5; aOR=3.2; 95% CI: 1.1–9.6, respectively). Secondary analyses suggested concomitant hypotension was associated with poorer outcomes at all higher altitudes starting at 1,500-3,000 ft, compared to flights below 1,500 ft (adjusted OR=4.4, 95% CI: 2.3–8.6; aOR=2.7; 95% CI: 1.6–4.5, respectively).</div></div><div><h3>Conclusion</h3><div>Transport altitude may affect mortality in TBI and compound the deleterious effects of hypotension. Further study is needed for better understanding of the effects of hypobaric transport and the implications for acute brain injury.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Page 434"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Quality Encompassing Stroke Team (QuEST) Project: Defining Stroke Quality Care within the Inter-Hospital Setting for Air Medical Providers","authors":"Mikaela Hagberg MHA, BSN, RN, CEN, CFRN ,&nbsp;Matthew Plourde MS, BSN, RN, CCRN, CFRN ,&nbsp;Kyle Danielson MPH, MN, RN, CFRN, CMTE ,&nbsp;David Gallagher MBA, MHA, BSN, RN, CPHQ ,&nbsp;Michael J. Lauria MD, NRP, FP-C ,&nbsp;Richard Utarnachitt MD","doi":"10.1016/j.amj.2025.06.009","DOIUrl":"10.1016/j.amj.2025.06.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Emergency Medical Services (EMS) first integrated into the stroke notification system in the mid-90s by using 911 telephone triggers to respond to strokes as an acute emergency. EMS systems have different performance metrics compared to hospitals that define success and quality in caring for stroke patients. Examples of these metrics are documentation of a stroke scale, pre-arrival notification, and determining a blood glucose level. Primary Stroke Centers (PSC) were developed in 2004, and Comprehensive Stroke Centers (CSC) developed in 2012. To become a PSC or CSC, the American Heart Association/American Stroke Association and The Joint Commission have defined eligibility requirements and quality metrics to measure success and quality care. Despite established quality metrics for stroke centers, no clear recommendations or guidelines exist for quality metrics and comprehensive quality stroke care within the air medical industry.</div></div><div><h3>Methods</h3><div>A literature review was completed in PubMed with articles from 2012-2022 and included all countries, military, combat, and natural disasters. Retrieved articles surrounding stroke quality metrics focused on ground transport or in-hospital care. There are no published metrics that define quality stroke care in the inter-hospital setting for air medical providers. We completed a retrospective data analysis of stroke patient transfers from January 1, 2019 – June 2, 2023, excluding pediatric patients and ground transports. Metrics from pre-hospital and in-hospital care areas included blood glucose, last known well, FAST, LAMS, and bedside times.</div></div><div><h3>Results</h3><div>A sample size (n=2041) transported patients with hemorrhagic and ischemic strokes were evaluated. The volume of patients was equivocal year over year, and quarter over quarter. Bedside times were consistent; scene calls (10 mins) and interfacility transports (20 mins). Glucose documentation was compliant at 98.24%. FAST documentation was lacking at 45.56%, and LAMS documentation at 38.18%, revealing opportunities for education and quality improvement. Our KPIs address operational, educational, clinical and regulatory requirements allowing us to shift our focus to critical care metrics that promote better patient outcomes.</div></div><div><h3>Conclusion</h3><div>While some of the quality metrics from the pre-hospital and in-hospital areas can be applied to the inter-hospital space, they don’t take account for the unique HEMS environment. More research is required to establish formal recommendations that consider the complexities of the air medical transport. Our analysis reveals that documentation of pre-hospital quality metrics such as FAST and LAMS was less frequent. Until better evidenced based quality metrics are established, air medical programs should consider extrapolating pre-hospital and in-hospital metrics and tracking compliance.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Page 435"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}