Air Medical Journal最新文献

{"title":"Evaluation of an Acuity Matrix Tool for Critical Care Transport","authors":"Darren Braude MD, MPH, EMT-P ,&nbsp;Margaret O’Donnell RN, BSN, MBA ,&nbsp;Ryan Huebinger MD","doi":"10.1016/j.amj.2025.10.009","DOIUrl":"10.1016/j.amj.2025.10.009","url":null,"abstract":"<div><h3>Objective</h3><div>Determining patient acuity before interfacility transport allows for better use of assets and personnel if it can be done accurately and reliably. We developed an acuity matrix to be used at the time of dispatch and sought to validate it against actual findings upon patient contact and compare dispatcher and flight crew determinations.</div></div><div><h3>Methods</h3><div>Lifeguard is a public, not-for-profit, university-owned, fixed-wing, rotor-wing, and ground transport agency. Lifeguard has its own communications center staffed by paramedics. At the time of call intake, before crew notification, our dispatchers recorded their determination of acuity. After dispatch, but before departure, the flight crew recorded their determination of acuity. After completion of the transport, the flight crew recorded the final determination of acuity. Results were compared using Gwet’s agreement coefficient (AC) with quadratic weighting.</div></div><div><h3>Results</h3><div>The matrix was implemented in April 2023. Between April 2023 and September 2023, there were 825 total dispatches and 674 with complete data. Dispatchers had excellent agreement (89.1%) with the medical crew on initial tier assignment (Gwet’s AC, 0.96; 95% confidence interval [CI], 0.94–0.97) with 5.7% overtriage and 5.2% undertriage. Dispatchers also had excellent agreement (85.9%) with final acuity (Gwet’s AC, 0.94; 95% CI, 0.93–0.96); they overtriaged 6.7% and undertriaged 7.4%. Medical crew had excellent agreement (92.9%) with final acuity (Gwet’s AC, 0.97; 95% CI, 0.96–0.98); they overtriaged 4.3% and undertriaged 2.9%.</div></div><div><h3>Conclusion</h3><div>Flight crew and paramedic dispatchers can accurately and consistently determine patient acuity based only on dispatch information with outstanding agreement. This tool may have a role in triaging multiple transport requests, assigning the appropriate asset and personnel, determining when it is reasonable to expect crew to stay over time, and conducting utilization review.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 3","pages":"Pages 180-184"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147806699","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":"Physical Distance Between the Helipad and Cardiac Catheterization Laboratory: A Cause for Delay in Helicopter Air Ambulance Activated Patients with STEMI","authors":"Megan Ostlie MD ,&nbsp;Jennifer Ginsberg MD ,&nbsp;Joseph Sharp DO ,&nbsp;Nancy Buderer MS ,&nbsp;William Krebs DO, RDMS, EMT-P","doi":"10.1016/j.amj.2026.01.010","DOIUrl":"10.1016/j.amj.2026.01.010","url":null,"abstract":"<div><h3>Objective</h3><div>Decreased time to cardiac catheterization improves survival and limits cardiac tissue damage in ST Elevation myocardial infarction (STEMI). Emergency medical services delays account for half of treatment delays in STEMI. Helicopter air ambulance (HAA) can reduce the time to percutaneous intervention (PCI), and therefore may reduce mortality. The impact of physical distance between the PCI hospital helipad and the PCI laboratory on the door-to-door-to-balloon time (DDBT) for cardiac intervention in STEMI patients transported through HAA from remote community hospitals to PCI facilities was assessed.</div></div><div><h3>Methods</h3><div>This was a retrospective chart review of interfacility STEMI patients where HAA was activated to reduce DDBT from January 1, 2020, to January 1, 2023. The HAA agency under review transports STEMI patients to 2 PCI centers. There is a significant difference in the distance between the helipad and the PCI laboratory at the 2 hospitals. Descriptive statistics were used to compare DDBT as well as the time from HAA arrival at the PCI hospital helipad to the cardiac catheterization laboratory.</div></div><div><h3>Results</h3><div>Data were available for 91 STEMI cases. The median time for DDBT was 89.9 minutes with a median time of 10.5 minutes from helipad arrival to catheterization laboratory (Table 1). Of the 91 cases, 69 (76%) were from hospital A and 22 (24%) were from hospital B. There was no detectable difference in the distribution of DDBT times between hospitals (<em>P</em> = .47). Helipad arrival times to cardiac catheterization laboratory were significantly longer for hospital A than hospital B (<em>P</em> &lt; .001). The median time for hospital A was 11.0 minutes (interquartile range, 9.2–14.0) compared with hospital B, which had a median of 5.4 minutes (5.0–7.3).</div></div><div><h3>Conclusion</h3><div>The physical distance a PCI laboratory is located from the helipad can be a significant addition to ischemic time for STEMI patients.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 3","pages":"Pages 173-175"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147806701","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":"Using Discharge From the Emergency Department or Admission of Less Than 24 Hours as a Metric for Inappropriate Helicopter Emergency Medical Services Utilization in Adult Trauma Patients Transported to the Emergency Department","authors":"Thomas Kolman BS,&nbsp;Kevin Young BS,&nbsp;Lauren Nickel PhD,&nbsp;Timothy Lenz MD","doi":"10.1016/j.amj.2026.01.004","DOIUrl":"10.1016/j.amj.2026.01.004","url":null,"abstract":"<div><h3>Objective</h3><div>The Commission on Accreditation of Medical Transport Systems has used patients being admitted for less than 24 hours at the receiving facility as a surrogate marker for improper helicopter emergency medical services (HEMS) utilization, therefore triggering a review to determine proper HEMS utilization. Recent guidelines modified this to use discharge directly from the emergency department (ED) after transfer as a marker for inappropriate HEMS utilization. This study aimed to evaluate which metric is associated with better adherence to Wisconsin (WI) HEMS utilization criteria in adult trauma patients transported to the ED.</div></div><div><h3>Methods</h3><div>This was a retrospective chart review of 1,520 transports by a midwestern HEMS service to a level 1 adult trauma center between January 1, 2013, and December 31, 2022. Charts with a disposition of discharge home, admission of less than 24 hours, or death in the ED were evaluated for adherence to WI HEMS utilization guideline criteria.</div></div><div><h3>Results</h3><div>A total of 287 patients met the inclusion criteria. Most patients were transported directly from the scene; 53% of transports met utilization criteria. Interfacility transports were more likely to meet utilization criteria than scene transports. Patients admitted for less than 24 hours were more likely to meet utilization criteria than patients discharged directly from the ED. This significance occurred for both scene and interfacility transports. Patients transported after a motor vehicle crash were less likely to have met utilization criteria.</div></div><div><h3>Conclusion</h3><div>Patients admitted for less than 24 hours were more likely to have met WI HEMS utilization guidelines than patients discharged from the ED. The relatively low adherence rate to the WI HEMS utilization guidelines suggests that stricter guidelines may be necessary to reduce overtriaging in HEMS transport.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 3","pages":"Pages 199-207"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147806710","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":"Refractory Hypoxemia and Resuscitation in the Setting of Catastrophic Hemorrhage From Uterine Rupture: A Case Study","authors":"Jennifer E. Guyther MD ,&nbsp;Ava A. Omidvar MD, MPH, FP-C ,&nbsp;James J. Smith BA ,&nbsp;Cody Winniford BS, FP-C ,&nbsp;Benjamin J. Lawner DO, MS, EMT-P","doi":"10.1016/j.amj.2026.01.005","DOIUrl":"10.1016/j.amj.2026.01.005","url":null,"abstract":"<div><div>Catastrophic hemorrhage from uterine rupture is a rare but life threatening obstetric emergency. Patients often present in extremis with concurrent hemodynamic instability. The case study describes the retrieval of a critically ill patient and the challenges encountered during patient transfer and resuscitation. The patient was profoundly hypovolemic and hypoxemic and required intensive therapies such as massive transfusion and adjustments to mechanical ventilation. The case review highlights therapies relevant to the practice of critical care transport medicine including damage control resuscitation. Novel hemorrhage control techniques such as resuscitative endovascular balloon occlusion of the aorta were also considered. Finally, the case report describes complications linked to ongoing resuscitation including transfusion associated circulatory overload. The case emphasizes the utility of multidisciplinary collaboration for complex patient retrievals.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 3","pages":"Pages 278-282"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147806703","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":"Time Intervals in Helicopter Emergency Medical Services in Iran: A Systematic Review and Meta-Analysis","authors":"Ali Sahebi PhD ,&nbsp;Hamideh Ebrahimi PhD ,&nbsp;Halimeh Kamali PhD ,&nbsp;Hojjat Farahmandnia PhD ,&nbsp;Sajjad Alizadeh MD ,&nbsp;Maryam Karami PhD","doi":"10.1016/j.amj.2025.11.004","DOIUrl":"10.1016/j.amj.2025.11.004","url":null,"abstract":"<div><h3>Objective</h3><div>Helicopter Emergency Medical Services (HEMS) play a crucial role in providing timely emergency care, leading to improved patient outcomes. This study aimed to analyze HEMS time intervals in Iran through a systematic review and meta-analysis.</div></div><div><h3>Methods</h3><div>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search was conducted in various databases up to August 2025. Ten studies were included for quality assessment and meta-analysis using a random-effects model. Data analysis was performed using STATA 14 software.</div></div><div><h3>Results</h3><div>The meta-analysis revealed that the mean response time, on-scene time, and transport time for HEMS in Iran were 19.55 minutes, 10.46 minutes, and 14.63 minutes, respectively. The overall mean HEMS time was reported as 50.59 minutes. Meta-regression analysis revealed a decreasing trend in response and on-scene times over the years, whereas transport time and overall HEMS time exhibited an increasing trend.</div></div><div><h3>Conclusion</h3><div>HEMS in Iran demonstrate acceptable operational times, but improvements in triage, fleet enhancement, and the establishment of a national HEMS registry are needed to enhance efficiency and evidence-based decision-making.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 3","pages":"Pages 260-265"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147806767","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":"Utility of Prehospital Emergency Resuscitative Thoracotomy in Trauma Patients: An Analysis Using the Japanese Society for Aeromedical Services Registry","authors":"Daisuke Ueno MD, PhD,&nbsp;Yasukazu Shiino MD, PhD,&nbsp;Satomi Miyamoto MD, PhD,&nbsp;Jiro Takahashi MD, PhD","doi":"10.1016/j.amj.2026.02.006","DOIUrl":"10.1016/j.amj.2026.02.006","url":null,"abstract":"<div><h3>Objective</h3><div>Emergency resuscitative thoracotomy (ERT) is a crucial intervention employed in prehospital settings to address life-threatening conditions, such as cardiac tamponade, hemorrhage, and air embolism. Despite its critical nature, the efficacy of prehospital ERT in enhancing survival rates compared with in-hospital procedures remains controversial.</div></div><div><h3>Methods</h3><div>This retrospective analysis was conducted using data from the Japanese Society for Aeromedical Services Registry between January 2020 and December 2022. After excluding nontraumatic cases, non-ERT cases, and records with missing data, 143 prehospital ERT cases were identified. The cohort was categorized into survivors (<em>n</em> = 3) and nonsurvivors (<em>n</em> = 140) based on patient outcomes. Comparative analyses were conducted on variables such as age, injury severity, time intervals, and transportation modalities using the Wilcoxon rank-sum test and Pearson’s chi-square test, with the statistical significance set at <em>P</em> &lt; .05.</div></div><div><h3>Results</h3><div>The overall survival rate after prehospital ERT was 2.1% (3 of 143). Only a few variables, such as hospital length of stay, showed statistically significant differences between the groups; most patient characteristics and prehospital time intervals did not. The patients who experienced cardiac arrest at the time of contact with the emergency medical service (EMS) contact had a survival rate of 0%, whereas those who arrived at the hospital with vital signs had the highest survival rate (11.1%). The presence of vital signs upon hospital arrival and the rapid initiation of intervention were identified as key factors influencing survival.</div></div><div><h3>Conclusion</h3><div>These findings suggest that prehospital ERT provides limited survival benefits, with a 0% survival rate in cases of cardiac arrest at EMS contact. Therefore, further research is essential to refine the patient selection criteria and optimize ERT deployment to improve prehospital patient outcomes.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 3","pages":"Pages 235-240"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147806771","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":"Sound and Vibration Exposure During Fixed-Wing Aircraft Neonatal Patient Transport","authors":"Keely Gibb BEng ,&nbsp;Eric Chen PhD ,&nbsp;Andrew Law PhD ,&nbsp;Eleanor Gerson MASc ,&nbsp;Kim Greenwood MASc ,&nbsp;Jean Ngoie PhD ,&nbsp;Stephanie Redpath MBChB ,&nbsp;Adrian D.C. Chan PhD ,&nbsp;James R. Green PhD ,&nbsp;Robert G. Langlois PhD","doi":"10.1016/j.amj.2026.01.015","DOIUrl":"10.1016/j.amj.2026.01.015","url":null,"abstract":"<div><h3>Objective</h3><div>Specialized transport systems are used for newborns who require medical care. These complex systems are subjected to vehicle-specific vibration and sound during transport. Prolonged exposure to high levels of sound and vibration can be harmful to humans. This study aimed to quantify the sound and vibration levels experienced within a fixed-wing aircraft (Pilatus PC-12) during neonatal transport.</div></div><div><h3>Methods</h3><div>A dedicated flight test was performed in a PC-12. Acceleration and sound data were captured in the cabin at the approximate position of the neonatal patient transport system, were it loaded. Resultant motions of the transport system and patient were estimated using experimentally derived transfer functions.</div></div><div><h3>Results</h3><div>Vertical vibration was most significant, and the average motion of the cabin floor and pilot seat was comparable in the 1 to 80 Hz frequency range. The greatest motion occurred during segments of rough turbulence, when patient levels were estimated to reach the ISO 2631 “very uncomfortable” threshold. Sound levels exceeded the 60 dBA limit recommended by the CSA Group and the European Committee for Standardization across all phases of flight, peaking at 89.3 dBA during a short-field landing.</div></div><div><h3>Conclusion</h3><div>Measured cabin sound exceeded recommended limits, and vertical accelerations reached levels considered uncomfortable under ISO 2631, highlighting the potential risk to this physiologically vulnerable population, compelling further research into vibration mitigation strategies. Aircraft acceleration data have enabled more extensive laboratory testing of the transport system. Establishing neonatal-specific whole-body vibration guidelines remains essential to fully understand and address the clinical implications of these exposures.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 3","pages":"Pages 218-225"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147806708","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(26)00127-6","DOIUrl":"10.1016/S1067-991X(26)00127-6","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 3","pages":"Page 158"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147806909","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":"Natural Experiment Outcomes Studies in Rotor Wing Air Medical Transport","authors":"Muhammad Taufan Umasugi B.Sc.N, RN, MHSc,&nbsp;I. Made Winarta BScH, MEpid,&nbsp;Endah Fitriasari BScN, RN, MNS,&nbsp;Sahrir Sillehu BSc, MHS, PhD","doi":"10.1016/j.amj.2026.01.008","DOIUrl":"10.1016/j.amj.2026.01.008","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 3","pages":"Pages 289-290"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147806700","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":"Evaluation of Prehospital Endotracheal Intubation in Pediatric Patients in a German Helicopter Emergency Medical Service: An Analysis of 920 Cases","authors":"Melanie Rudolph MD ,&nbsp;Florian Reifferscheid MD, MHBA ,&nbsp;Leopold Kies ,&nbsp;Jörg Braun MD ,&nbsp;Grietje Beck PhD ,&nbsp;Bernd Landsleitner MD ,&nbsp;Tom Terboven PhD ,&nbsp;Marcus Rudolph MD","doi":"10.1016/j.amj.2026.02.010","DOIUrl":"10.1016/j.amj.2026.02.010","url":null,"abstract":"<div><div>Management of the pediatric airway is a challenging procedure in prehospital emergency medicine. This retrospective study evaluates prehospital airway management in 920 pediatric patients in a German helicopter emergency medical service (HEMS) system from 2012 to 2021. Prehospital pediatric intubation was a rare event (0.2% of all missions). Good visualization of the glottis (Cormack-Lehane I or II) was possible in 96.3% of the intubations. The first-pass intubation success was 86.6%; all children could finally be intubated successfully. The use of muscle relaxants significantly improved first-pass success in prehospital emergency anesthesia (90.1% vs. 83.1%; <em>P</em> = .002). We recognized a low rate of the use of aids such as stylet, bougie, or video laryngoscopy. The use of video laryngoscopy increased over the years, but did not translate into a higher first-attempt success rate. When taking over children with an already managed airway, HEMS teams found tube malplacement in 8.4% of the cases in primary missions. In the analyzed data, pediatric airway management was on a comparable level with adult airway management. Nevertheless, room for improvement and a need for further studies were identified.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 3","pages":"Pages 253-259"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147806768","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}