Air Medical Journal最新文献

{"title":"Implementation of Direct Admission to the Operating Room Procedure for Children Transported With Airway Emergencies","authors":"Lauren G. Harkins BSN, RN ,&nbsp;Erin M. Herstine MD ,&nbsp;Philomena M. Costabile BSN, RN ,&nbsp;Bridget Devlin BSN, RN ,&nbsp;Pooja Bhatia BSN, RN, CEN ,&nbsp;David E. Tunkel MD ,&nbsp;Bruce L. Klein MD ,&nbsp;Susanna Scafidi MD ,&nbsp;Corina Noje MD","doi":"10.1016/j.amj.2024.11.004","DOIUrl":"10.1016/j.amj.2024.11.004","url":null,"abstract":"<div><h3>Objective</h3><div>Children with airway emergencies, such as aspirated foreign bodies (FBs), who present to community emergency departments usually require expeditious transfer to centers with pediatric expertise. In 2018, our hospital's transport team implemented a multidisciplinary direct admission to the operating room (OR) protocol for children transferred for emergent surgical intervention, which bypassed typical hospital entry points. We aimed to assess its impact on time to definitive care and patient outcomes.</div></div><div><h3>Methods</h3><div>We performed a retrospective chart review of all patients aged ≤18 years with suspected aspirated FB transferred to our institution for emergent surgical intervention between July 1, 2013 and March 1, 2023. We determined whether they were taken to the OR post-transfer after first being evaluated in our pediatric emergency department/intensive care unit (Standard protocol) or transported directly to the OR by the transport team (OR Transport protocol). Demographics, transport/surgical times, and clinical data were compared between the groups using <em>t</em>-test and Mann-Whitney <em>U</em> test.</div></div><div><h3>Results</h3><div>Of the 27 children who met the inclusion criteria, 14 (51.9%) were transported via the Standard protocol and 13 (48.1%) via the OR Transport protocol. Demographics, referring hospital characteristics, time of transfer request, need for mechanical ventilation pretransport, and transport mode were not different; rates of critical care transports were higher for the OR Transport group than for the Standard group (<em>P</em> = .016). Compared with the Standard group, the OR Transport group had shorter median (interquartile range) times from transport arrival to start of surgery (8 [0-15.5] vs. 94.5 [25.75-148.75] minutes, <em>P</em> &lt; .001) and from transport dispatch to surgery (103 [64.25-144] vs. 179 [115.5-265] minutes, <em>P</em> = .035). Although not statistically significant, the OR Transport group had a lower hospitalization rate after the surgery compared with the Standard group (38.5% vs. 64.3%).</div></div><div><h3>Conclusion</h3><div>Implementation of a direct admission to the OR protocol seems to expedite definitive treatment and may be associated with a decreased need for hospitalization for children with airway FBs who require interhospital transport for emergent surgical intervention.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 1","pages":"Pages 40-45"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flexible Tip Bougie for Emergency Tracheal Intubation by Paramedics and Emergency Physicians","authors":"Aditya C. Shekhar ,&nbsp;Michael Altman-Ezzard ,&nbsp;Joshua Kimbrell ,&nbsp;Jacob Stebel ,&nbsp;Evan Ashley ,&nbsp;Avir Mitra ,&nbsp;Timothy Friedmann ,&nbsp;Ethan E. Abbott ,&nbsp;Christopher Strother ,&nbsp;Jared Kutzin","doi":"10.1016/j.amj.2024.11.013","DOIUrl":"10.1016/j.amj.2024.11.013","url":null,"abstract":"<div><h3>Objective</h3><div>Given the consequences of failed intubation, there is great interest in optimizing airway management success rates. Growing evidence suggests that use of a bougie device is associated with improved airway success. Bougies with a flexible tip may increase intubation success by offering operators greater control. In this study, we performed a feasibility assessment of flexible tip bougies involving clinicians who routinely perform emergency airway management.</div></div><div><h3>Methods</h3><div>We used a feasibility simulation study design with pre- and postsurveys. Participants first completed a presession survey asking about their intubation experience and preferences. They were then given a brief demonstration of the flexible tip bougie with an opportunity to ask questions. They completed 2 intubations on an airway simulator using video laryngoscopy—one with a flexible tip bougie and one with a standard bougie. During these intubations, the time required to pass the bougie through the vocal cords and the time required to pass a tracheal tube through the vocal cords was assessed. Participants finally completed a postsession survey asking about their experiences with the flexible tip bougie.</div></div><div><h3>Results</h3><div>A total of 18 participants took part in the study. All participants rated themselves as familiar with tracheal intubation, and most (72.2%) said that they would consider using a flexible tip bougie on future intubations. Quantitatively, there was no clinically significant difference in the time needed to pass the bougie through the vocal cords (0.38 second) and the time needed to pass a tracheal tube through the vocal cords (8.24 seconds).</div></div><div><h3>Conclusion</h3><div>Our simulation-based study comparing a flexible tip bougie with a conventional bougie revealed improved operator feedback with the flexible tip bougie and a clinically insignificant temporal difference in intubation metrics. Further study is needed to better assess the benefits of a flexible tip bougie in emergency and nonemergency airway management.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 1","pages":"Pages 67-69"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unilateral Mydriasis in Helicopter Emergency Medical Services: A Case of Ophthalmic Ipratropium Exposure in Pediatric Asthmatic Cardiac Arrest Prompting Cerebral Herniation Prophylaxis","authors":"Jorden B. Dick OMS-1, NRP, FP-C","doi":"10.1016/j.amj.2024.11.001","DOIUrl":"10.1016/j.amj.2024.11.001","url":null,"abstract":"<div><div>This case report describes the medical management for a 14-year-old female patient who suffered cardiac arrest following an acute asthma exacerbation. During air medical transport, the patient developed unilateral mydriasis, a concerning finding often associated with intracranial pathology such as cerebral herniation. Immediate interventions included the administration of hypertonic saline and targeted ventilation strategies to maintain end-tidal carbon dioxide levels within a therapeutic range. Subsequent diagnostic evaluation, including imaging, revealed no neurologic abnormalities, and the mydriasis resolved spontaneously without complications. Ophthalmic ipratropium exposure was suspected as the underlying cause. This case emphasizes the importance of understanding and recognizing pharmacologic causes, such as muscarinic receptor antagonism, in the differential diagnosis of mydriasis. It also underscores the need for continuous reassessment during transport and the potential for cognitive biases to influence decision-making.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 1","pages":"Pages 111-113"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients With Anaphylaxis Transported by a Physician-Staffed Helicopter Using the Keyword Method","authors":"Chihiro Maekawa MD,&nbsp;Hiroki Nagasawa MD, PhD,&nbsp;Noriko Tanaka MD,&nbsp;Kenji Kawai MD,&nbsp;Michika Hamada MD,&nbsp;Soichiro Ota MD,&nbsp;Hiromichi Ohsaka MD, PhD,&nbsp;Kazuhiko Omori MD, PhD,&nbsp;Youichi Yanagawa MD, PhD","doi":"10.1016/j.amj.2024.11.015","DOIUrl":"10.1016/j.amj.2024.11.015","url":null,"abstract":"<div><h3>Objective</h3><div>This study retrospectively investigated the outcomes of patients with anaphylaxis transported by a staffed doctor helicopter (DH) using the keyword method, based on data from the Japan DH Registry System (JDRS).</div></div><div><h3>Methods</h3><div>Patients with anaphylaxis were selected from the JDRS database. Data collected included duration from first call to patient contact, patient demographics, vital signs, timing of DH dispatch request, medical interventions, duration of admission, and outcomes at 1 month. Subjects were divided into keyword (pre-contact) and control (post-contact) groups for comparison.</div></div><div><h3>Results</h3><div>Of 688 patients, all were evacuated from the scene, with no interhospital transports. There were no significant differences between the keyword (n = 430) and control (n = 258) groups with regard to age, sex, cardiac arrest on contact, vital signs, rate of medical intervention, and mortality rate. Duration of first call to contact and admission were significantly shorter in the keyword group. The keyword group also had a significantly higher ratio of good outcomes.</div></div><div><h3>Conclusion</h3><div>To our knowledge, this study is the first to describe the keyword method as a prognostic factor in patients with anaphylaxis transported by DH. Adoption of the keyword method by firefighting central command rooms for the DH dispatch in anaphylaxis cases should be considered.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 1","pages":"Pages 70-72"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Medical Interventions by Doctor Helicopters and Outcomes in Inflammatory Diseases Using a Doctor Helicopter Registry","authors":"Youichi Yanagawa MD, PhD,&nbsp;Chihiro Maekawa MD,&nbsp;Noriko Tanaka MD,&nbsp;Kenji Kawai MD,&nbsp;Michika Hamada MD,&nbsp;Soichiro Ota MD,&nbsp;Hiromichi Ohsaka MD, PhD,&nbsp;Hiroki Nagasawa MD, PhD,&nbsp;Kazuhiko Omori MD, PhD","doi":"10.1016/j.amj.2024.11.011","DOIUrl":"10.1016/j.amj.2024.11.011","url":null,"abstract":"<div><h3>Objective</h3><div>In Japan, patients with inflammatory diseases are transported from the field by doctor helicopters (DHs). This study aimed to retrospectively investigate the relationship between early medical intervention and outcomes in inflammatory diseases, such as respiratory, urinary tract, and gastrointestinal infections.</div></div><div><h3>Methods</h3><div>Using data collected by the Japanese Society for Aeromedical Services from DH base hospitals, cases with a discharge diagnosis of inflammatory diseases were selected. The study evaluated age, sex, request method, vital signs on DH staff contact, medical interventions, and final outcomes (cerebral performance category [CPC] at 1 month postinflammation and survival outcome). Exclusion criteria included cases of cardiac arrest at contact and those with unknown final outcomes. The cases were categorized into 2 groups based on survival or functional outcome (favorable: CPC 1-2; unfavorable: CPC 3-5), and a comparative analysis was conducted between the 2 groups.</div></div><div><h3>Results</h3><div>Of 41,592 cases in the data set, 785 cases met the inclusion criteria. The mean age was 73.8 years, with 491 male patients, 136 deaths, and 272 cases with poor outcomes. All cases were transported from the scene. Compared with the survival group, the fatal group was older and had poorer consciousness, lower blood pressure, higher rates of airway management, and higher use of vasopressors, glucose, and muscle relaxants, whereas the use of antiemetics was statistically lower. Similarly, compared with the favorable functional outcome group, the poor outcome group was older and had a higher proportion of female patients, poorer consciousness, faster respiratory rate and pulse, lower blood pressure, higher rates of airway management, and higher use of cardiopressors, glucose, and muscle relaxants, with a statistically lower use of antiemetics.</div></div><div><h3>Conclusion</h3><div>In cases where the prehospital condition was severe, medical intervention rates increased, and the outcomes for such patients were poor. Conversely, the presence or absence of antiemetic use may have influenced the outcomes.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 1","pages":"Pages 56-59"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Articles That May Change Your Practice: Prehospital Extracorporeal Membrane Oxygenation Alerts and Extracorporeal Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest","authors":"James L. Li MD, MEd, FAEMS,&nbsp;Aaron J. Lacy MD,&nbsp;Bridgette B. Svancarek MD, FAEMS","doi":"10.1016/j.amj.2024.11.003","DOIUrl":"10.1016/j.amj.2024.11.003","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 1","pages":"Pages 15-17"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Watercraft as Overwater Ambulance Exchange Points to Enhance Air Medical Evacuation","authors":"Mahdi Al-Husseini M.S., B.S.,&nbsp;Kyle H. Wray Ph.D., M.S., M.A., B.S.,&nbsp;Mykel J. Kochenderfer Ph.D., M.S., B.S.","doi":"10.1016/j.amj.2024.08.006","DOIUrl":"10.1016/j.amj.2024.08.006","url":null,"abstract":"<div><div>Ambulance exchange points are preidentified sites where patients are transferred between evacuation platforms while en route to enhanced medical care. We propose a new capability for maritime medical evacuation, which involves co-opting underway watercraft as overwater ambulance exchange points to transfer patients between medical evacuation aircraft. We partnered with the US Army's 25th Combat Aviation Brigade to demonstrate the use of Army watercraft as overwater ambulance exchange points. A manikin was transferred between 2 HH-60M medical evacuation Black Hawk helicopters conducting hoist operations over Army Logistics Support Vessel 3, which was traveling south of Honolulu, HI. The demonstration was enabled by a decision support system for dispatching aircraft, hoist stabilization technology, commercial satellite internet, military geospatial infrastructure applications, and digital medical documentation tools, the benefits of which are all discussed. Three extensions of the overwater ambulance exchange point are introduced, and civilian applications are considered.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 1","pages":"Pages 23-29"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contextualizing Pseudo-Pulseless Electrical Activity in Cardiac Arrest: A Meta-Analysis and Systematic Review","authors":"Omar Elhalwagy MBBS ,&nbsp;Ben Singer MBBS ,&nbsp;Gareth Grier MBBCh ,&nbsp;Abilius Wong MBBS","doi":"10.1016/j.amj.2024.11.010","DOIUrl":"10.1016/j.amj.2024.11.010","url":null,"abstract":"<div><h3>Objective</h3><div>Nonshockable cardiac arrest rhythms have demonstrably poor outcomes. Pseudo-pulseless electrical activity (PEA), a subset of PEA in which visible cardiac contractility is present, is being described more frequently in recent literature. Physiology suggests that presence of cardiac motion even without a palpable pulse is energetically more favorable than true PEA, which is more like asystole. Therefore, we hypothesize that there is an increase in the survivability of PEA compared with asystole which may in part be due to a subset of pseudo-PEA.</div></div><div><h3>Methods</h3><div>A PICOST research question was generated which guided the composition of a systematic review and meta-analysis in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.</div></div><div><h3>Results</h3><div>A total of 494,355 patients were identified from 12 pieces of literature. Meta-analyses revealed an overall increased survivability of PEA compared with asystole (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.52-2.86). When differentiating between location of arrest, PEA was more survivable in both in-hospital cardiac arrest and out-of-hospital cardiac arrest than asystole (out-of-hospital cardiac arrest OR 4.17, 95% CI 3.78-4.60, and in-hospital cardiac arrest OR 1.60, 95% CI 1.42-1.79). Finally, when comparing neurological outcome of PEA with asystole, PEA was more favorable (OR 3.32, 95% CI 1.39-7.94).</div></div><div><h3>Conclusion</h3><div>Pseudo-PEA may be one of the explanations attributed to better outcomes of PEA, especially neurological, due to the presence of cerebral and coronary flow. The presence of PEA likely requires evidence-based tailored management with presence of pseudo-PEA being more like a profound shock state. More evidence is required to investigate the true incidence of pseudo-PEA and its outcomes compared with true PEA.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 1","pages":"Pages 83-92"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Air Transport Medicine: From the Field","authors":"Michael P. McCartin MD,&nbsp;Stephen H. Thomas MD,&nbsp;Ira J. Blumen MD,&nbsp;Candice Schaper MSN, RN,&nbsp;Teri Campbell MSN, RN,&nbsp;Michelle Lambright BSN, RN,&nbsp;James Price MBBS,&nbsp;Ed B.G. Barnard PhD","doi":"10.1016/j.amj.2024.11.005","DOIUrl":"10.1016/j.amj.2024.11.005","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 1","pages":"Pages 12-14"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Physiological Impact of Neonatal Air Transport: A Review of The Literature","authors":"Ian Braithwaite RN(CH), BEng, MSc,&nbsp;Cath Harrison BMedSci, BM, BS, DTM&H, FRCPCH","doi":"10.1016/j.amj.2024.10.003","DOIUrl":"10.1016/j.amj.2024.10.003","url":null,"abstract":"<div><h3>Objective</h3><div>This review aims to enhance our understanding around whether neonatal air transport has an adverse physiological impact on patients.</div></div><div><h3>Methods</h3><div>A literature search included articles describing both ground and air transport. Eligible studies had to include patient outcome and/or response to the journey in such a way that the physiological impact of neonatal transport could be compared between the 2 groups.</div></div><div><h3>Results</h3><div>The search produced 13 eligible studies. Six were prospective observational cohort studies, and the remainder were retrospective. When assessing outcome, studies used a physiological stability score, the rate and severity of intraventricular hemorrhage, the type and frequency of clinical interventions during the journey, or a specific clinical parameter. Three of the studies sought to understand the physiological impact of transport by investigating the variation in the physical forces experienced.</div></div><div><h3>Conclusion</h3><div>The current published evidence does not suggest one mode of transport is preferable to another when considering patient stability and outcome. Neonatal fixed wing or helicopter transport has not been shown to be more physiologically challenging for the patient than road transport, even by teams who are regularly flying patients in the highest-risk groups (extremely preterm, in the first hours of life).</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 1","pages":"Pages 93-98"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}