Air Medical Journal最新文献

筛选
英文 中文
Proceedings: Sixth International Futures of Aviation Medicine Symposium 会议记录:第六届国际航空医学未来研讨会
Air Medical Journal Pub Date : 2024-09-01 DOI: 10.1016/j.amj.2024.07.005
Thomas Judge EMT-P , Jacqueline C. Stocking PhD, MBA, MSN, NEA-BC, FAASTN , Stephen H. Thomas MD, MPH
{"title":"Proceedings: Sixth International Futures of Aviation Medicine Symposium","authors":"Thomas Judge EMT-P ,&nbsp;Jacqueline C. Stocking PhD, MBA, MSN, NEA-BC, FAASTN ,&nbsp;Stephen H. Thomas MD, MPH","doi":"10.1016/j.amj.2024.07.005","DOIUrl":"10.1016/j.amj.2024.07.005","url":null,"abstract":"<div><p>In June 2024, leaders in aviation medicine from across the United States, Canada, and Europe met for the sixth Leonardo Helicopters/Association of Critical Care Transport: The Path to High Reliability Futures of Aviation Medicine Symposium in Miami, FL. The symposia, now held every few years, grew from the 2003 Air Medical Leadership Congress: Setting the Healthcare Agenda for the Air Medical Community. The meetings’ goal is to gather leaders to distill, debate, and synthesize the state of the science while identifying, refining, and outlining conditions facilitating favorable evolution in civilian aviation medicine. Structured as thematic panel presentations followed by interactive all-attendee roundtable discussions, the gatherings build and expand an international network of thought leaders and proven doers. Meeting attendees have a common goal—accelerating learning and practice among early and developed systems moving toward a shared worldwide agenda for the future of aviation transport medicine.</p></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 5","pages":"Pages 462-465"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239838","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}
引用次数: 0
Peri-Intubation Push-Dose Vasopressors in Critical Care Transport 重症监护转运中的插管前推注式血管加压剂
Air Medical Journal Pub Date : 2024-09-01 DOI: 10.1016/j.amj.2024.05.008
Alissa M. Bates MD , Alyson M. Esteves PharmD, BCPS, BCCCP , Kalle J. Fjeld MD , Ryan J. Ding BS , Jeremy M. Singleton RN, CFRN , Matthew A. Roginski MD, MPH
{"title":"Peri-Intubation Push-Dose Vasopressors in Critical Care Transport","authors":"Alissa M. Bates MD ,&nbsp;Alyson M. Esteves PharmD, BCPS, BCCCP ,&nbsp;Kalle J. Fjeld MD ,&nbsp;Ryan J. Ding BS ,&nbsp;Jeremy M. Singleton RN, CFRN ,&nbsp;Matthew A. Roginski MD, MPH","doi":"10.1016/j.amj.2024.05.008","DOIUrl":"10.1016/j.amj.2024.05.008","url":null,"abstract":"<div><h3>Objective</h3><p>Push-dose vasopressors are commonly administered to attenuate peri-intubation hypotension. The aim of this study was to describe the current use of push-dose vasopressors in critical care transport.</p></div><div><h3>Methods</h3><p>This was a retrospective chart review of adult patients (≥ 18 years) intubated between January 2017 and May 2023 who received push-dose vasopressors. The outcomes were incidence of push-dose vasopressor administration and the frequency of initiation or an increase in continuous vasopressor infusion.</p></div><div><h3>Results</h3><p>Of the 334 patients intubated during this period, 49 (14.7%) received push-dose vasopressors in the peri-intubation period. The mean preintubation shock index was 1.1 ± 0.5. Of those who received push-dose vasopressors, 34 (69.4%) received multiple push doses; the mean number of administrations was 2.5 ± 1.9. Most patients had persistent or recurrent hypotension (n = 39, 79.6%). Fifteen (30.6%) were started on a continuous vasopressor infusion, and 3 (11.1%) had an increase in an existing infusion postintubation.</p></div><div><h3>Conclusion</h3><p>Although push-dose vasopressors are convenient and appropriate in many settings, they inadequately address hypotension in critically ill patients with underlying shock. Further investigation is required to better elucidate the role of peri-intubation push-dose and continuous vasopressors in the critical care transport setting.</p></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 5","pages":"Pages 412-415"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239842","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}
引用次数: 0
The Impact of Location and Asset Type on the Success of Advanced Airway Management in a Critical Care Transport Environment 在重症监护运输环境中,位置和资产类型对高级气道管理成功与否的影响
Air Medical Journal Pub Date : 2024-09-01 DOI: 10.1016/j.amj.2024.06.001
Winny Li MD , Mahvareh Ahghari , Johannes von Vopelius-Feldt MD, PhD , Brodie Nolan MD, MSc
{"title":"The Impact of Location and Asset Type on the Success of Advanced Airway Management in a Critical Care Transport Environment","authors":"Winny Li MD ,&nbsp;Mahvareh Ahghari ,&nbsp;Johannes von Vopelius-Feldt MD, PhD ,&nbsp;Brodie Nolan MD, MSc","doi":"10.1016/j.amj.2024.06.001","DOIUrl":"10.1016/j.amj.2024.06.001","url":null,"abstract":"<div><h3>Objective</h3><p>Advanced airway management (AAM) is a critical component of prehospital critical care. Airway management in flight can be more challenging because of spatial, ergonomic, and environmental factors. This study examines the frequency of in-flight intubation (IFI), first-pass success (FPS) rates, and definitive airway sans hypoxia/hypotension on first attempt (DASH-1A) across different locations of airway management.</p></div><div><h3>Methods</h3><p>We conducted a retrospective database analysis of all patients transported between January 2016 and July 2021 who received AAM from a single air medical service. Patient records were reviewed for location of intubation, patient characteristics, and FPS and DASH-1A rates. The primary outcome was the frequency of IFI. The secondary outcomes included FPS and DASH-1A rates by location and type of transport asset.</p></div><div><h3>Results</h3><p>During the study period, 473 patients required AAM. Three percent (15/473) of patients were intubated in an in-flight setting, 28% (130/473) were intubated on scene, and 70% (328/473) were intubated in a health care facility. The primary reason for IFI was unanticipated cardiac arrest or clinical deterioration. The overall FPS rate was 69% (328/473), and the DASH-1A rate was 49% (194/399). Based on the location of AAM, the FPS and DASH-1A rates were the lowest for on-scene intubations (56% [74/130] and 27% [20/74], respectively). Most of the on-scene AAM took place with rotor wing flight crews.</p></div><div><h3>Conclusion</h3><p>Airway management occurs infrequently in an in-flight setting and is necessary because of patient deterioration or cardiac arrest. Based on our results, we identified opportunities for targeted AAM quality improvement and clinical governance.</p></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 5","pages":"Pages 416-420"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1067991X24001238/pdfft?md5=bdb08ca83db043757d92ae5f7cda0225&pid=1-s2.0-S1067991X24001238-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239843","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}
引用次数: 0
Articles That May Change Your Practice: Airway Management in Out-of-Hospital Cardiac Arrest 可能改变您的实践的文章:院外心脏骤停的气道管理
Air Medical Journal Pub Date : 2024-09-01 DOI: 10.1016/j.amj.2024.06.007
Russell D. MacDonald MD, MPH, FCFP, FRCPC, DRCPSC, Aaron J. Lacy MD, FAWN, Michael D. Stocker MD, MPH
{"title":"Articles That May Change Your Practice: Airway Management in Out-of-Hospital Cardiac Arrest","authors":"Russell D. MacDonald MD, MPH, FCFP, FRCPC, DRCPSC,&nbsp;Aaron J. Lacy MD, FAWN,&nbsp;Michael D. Stocker MD, MPH","doi":"10.1016/j.amj.2024.06.007","DOIUrl":"10.1016/j.amj.2024.06.007","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 5","pages":"Pages 381-382"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141706639","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}
引用次数: 0
Authors’ Response 作者的答复
Air Medical Journal Pub Date : 2024-09-01 DOI: 10.1016/j.amj.2024.08.002
Emine Tunc MD, Richard Utarnachitt MD, Andrew Latimer MD, Jessica Wall MD, MPH, MSCE, NRP
{"title":"Authors’ Response","authors":"Emine Tunc MD,&nbsp;Richard Utarnachitt MD,&nbsp;Andrew Latimer MD,&nbsp;Jessica Wall MD, MPH, MSCE, NRP","doi":"10.1016/j.amj.2024.08.002","DOIUrl":"10.1016/j.amj.2024.08.002","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 5","pages":"Page 375"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239081","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}
引用次数: 0
General Information 一般信息
Air Medical Journal Pub Date : 2024-06-17 DOI: 10.1016/S1067-991X(24)00132-9
{"title":"General Information","authors":"","doi":"10.1016/S1067-991X(24)00132-9","DOIUrl":"https://doi.org/10.1016/S1067-991X(24)00132-9","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 4","pages":"Page 269"},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141423930","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}
引用次数: 0
Establishing, Measuring, and Achieving a Minimum Proficiency Standard with Point-of-Care Ultrasound Among Clinicians in an Air Medical Transport Program 制定、衡量和实现空中医疗转运项目中临床医生使用床旁超声波的最低熟练标准
Air Medical Journal Pub Date : 2024-06-17 DOI: 10.1016/j.amj.2024.05.022
Robert Beckl BSN, CFRN, FP-C, CHSE, Allen Wolfe MSN, CNS, APRN, CFRN, CCRN, CTRN, TCRN, CMTE, FAASTN, Megan Hartigan BSN, RN, NPD-BC, Brian Dotts RN, CFRN, Johanna Thompson FP-C, Travis Sievek FP-C
{"title":"Establishing, Measuring, and Achieving a Minimum Proficiency Standard with Point-of-Care Ultrasound Among Clinicians in an Air Medical Transport Program","authors":"Robert Beckl BSN, CFRN, FP-C, CHSE,&nbsp;Allen Wolfe MSN, CNS, APRN, CFRN, CCRN, CTRN, TCRN, CMTE, FAASTN,&nbsp;Megan Hartigan BSN, RN, NPD-BC,&nbsp;Brian Dotts RN, CFRN,&nbsp;Johanna Thompson FP-C,&nbsp;Travis Sievek FP-C","doi":"10.1016/j.amj.2024.05.022","DOIUrl":"https://doi.org/10.1016/j.amj.2024.05.022","url":null,"abstract":"<div><h3>Objectives</h3><p>One of the challenges in the implementation of point-of-care ultrasound in air medical transport is establishing a minimum proficiency standard and subsequently ensuring that all clinicians meet this standard. It is also challenging to objectively measure the effectiveness of hands-on ultrasound training. The aim of this study was to evaluate the level of proficiency among all clinicians in the program, measure the effectiveness of hands-on training, and to assess the feasibility of establishing and enforcing a minimum proficiency standard for all clinicians.</p></div><div><h3>Methods</h3><p>116 flight clinicians, all previously trained in point-of-care ultrasound, participated in a training session in which they were tasked with acquiring six diagnostic ultrasound views on live models. At the beginning of the session, their performance was evaluated by a trained observer and scored. Each view was given a score of 3 points if obtained proficiently with no guidance (minimum proficiency standard), 2 points if obtained with only slight prompting, and 1 point if obtained with significant guidance from the observer. The clinicians then participated in a guided training session and those who did not previously receive a perfect score of all threes, were reevaluated and scored again. Each clinician also completed a survey before and after the session in which they rated their confidence with their ability to obtain each view.</p></div><div><h3>Results</h3><p>The average score during the initial evaluation was 2.66 with 32 of the 116 clinicians (28%) obtaining a perfect score. The average score for those who were reevaluated at the conclusion of the training was 2.91 with 55 additional clinicians obtaining a perfect score. In the initial evaluation, 14 clinicians required significant guidance with one or more views. In the reevaluation this number fell to one. At the conclusion of the training, 75% of the clinicians were able to obtain all six diagnostic views with the desired minimum proficiency. In the initial confidence survey, when averaged across the six views, 1% of clinicians rated their confidence level as not at all, 5% as slightly, 20% as somewhat, 45% as fairly, and 28 % as completely. In the follow-up survey the results were 0% not at all, 0% slightly, 4% somewhat, 25% fairly, and 71% completely.</p></div><div><h3>Conclusions</h3><p>The baseline proficiency level in obtaining the diagnostic ultrasound views approved by our program was less than desirable. However, given the fact that a single training session resulted in the increase in number of clinicians who met the minimum standard from 28% to 75%, it is feasible to achieve a 100% compliance with this standard with additional training. Future research will focus on the amount and frequency of use and training required to maintain this proficiency once achieved. Another component of minimum proficiency not discussed here is the accuracy of interpretation of the d","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 4","pages":"Page 367"},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141424611","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}
引用次数: 0
Evaluation of Point-of-Care Ultrasound in a Helicopter Emergency Medical Service Program 直升机紧急医疗服务项目中的护理点超声波评估
Air Medical Journal Pub Date : 2024-06-17 DOI: 10.1016/j.amj.2024.05.016
Mason A. Hill BS, Jarett D. Jones BS, Matthew VandeHei MD, Justin Purnell MD, Nikolai Schnittke MD, PhD, Sara Damewood MD, Hani I. Kuttab MD
{"title":"Evaluation of Point-of-Care Ultrasound in a Helicopter Emergency Medical Service Program","authors":"Mason A. Hill BS,&nbsp;Jarett D. Jones BS,&nbsp;Matthew VandeHei MD,&nbsp;Justin Purnell MD,&nbsp;Nikolai Schnittke MD, PhD,&nbsp;Sara Damewood MD,&nbsp;Hani I. Kuttab MD","doi":"10.1016/j.amj.2024.05.016","DOIUrl":"https://doi.org/10.1016/j.amj.2024.05.016","url":null,"abstract":"<div><h3>Objective</h3><p>Point-of-care ultrasound (POCUS) in the prehospital setting has rapidly expanded, including helicopter emergency medical services (HEMS). A more robust understanding of the use of prehospital POCUS and its impact on patient management is needed. The purpose of this study is to: 1) evaluate the applications of prehospital POCUS examinations, 2) assess physician accuracy in interpretation and the acceptability of the quality of performed exams, and 3) evaluate self-reported alterations in patient management.</p></div><div><h3>Methods</h3><p>This is a single-center, retrospective, observational cohort study of adult patients aged &gt;18 years transported via HEMS from March 1, 2018 to April 7, 2023, at a single academic medical center. Exclusion criteria were: patients aged &lt;18 years of age and of vulnerable populations (e.g., prisoners, pregnant women), studies with missing data (e.g., medical record numbers), and studies which were not submitted for quality assurance. All flight physicians were trained in prehospital POCUS and required to complete a standardized worksheet following the completion of each examination. Images and worksheets were reviewed weekly and assigned a score for interpretation (e.g., true positive) and whether the exam was acceptable for quality (e.g., yes/no). A second blinded reviewer interpreted all studies. An agreement analysis (Cohen's kappa) was calculated for each variable. McNemar testing was used to assess differences in the distribution of binary measures. Demographic information was obtained for each study participant.</p></div><div><h3>Results</h3><p>In total, 242 patients received POCUS for a total of 364 examinations by 26 unique users. Focused cardiac (40.4%) and thoracic (32.4%) exams were most commonly performed. Overall accuracy and acceptability for all exams performed were 97.6% and 96.1%, respectively. The accuracy of interpretation between raters demonstrated high agreement (89.2%; K=0.81, 95% CI 0.74-0.88). Acceptability of image quality was also high between raters (95.0%; K=0.38, 95% CI 0.10-0.65) without significant disagreement (p=0.25). Users self-reported alterations in patient management in 75.6% of cases (n=183), most commonly by improving diagnostic certainty (n=131, 71.6%) and altering medical management (n=62, 33.9%).</p></div><div><h3>Conclusion</h3><p>Focused cardiac and thoracic examinations were the most commonly performed POCUS examinations. Prehospital POCUS can be performed accurately by flight physicians with acceptable image quality. Users frequently reported improved diagnostic accuracy when utilizing prehospital POCUS.</p></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 4","pages":"Page 365"},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141423897","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}
引用次数: 0
Outcomes of Empiric Calcium Administration with Prehospital Blood Product Administration 经验性钙剂管理与院前血液制品管理的结果
Air Medical Journal Pub Date : 2024-06-17 DOI: 10.1016/j.amj.2024.05.014
Craig Tschautscher MD, MS, Cassandra Hardy MD, Mitchell Butterbaugh MD, Matthew Stampfl MD, Scott Hetzel MS, Brittney Bernardoni MD, Michael Spigner MD, Ryan Newberry DO, Andrew Cathers MD
{"title":"Outcomes of Empiric Calcium Administration with Prehospital Blood Product Administration","authors":"Craig Tschautscher MD, MS,&nbsp;Cassandra Hardy MD,&nbsp;Mitchell Butterbaugh MD,&nbsp;Matthew Stampfl MD,&nbsp;Scott Hetzel MS,&nbsp;Brittney Bernardoni MD,&nbsp;Michael Spigner MD,&nbsp;Ryan Newberry DO,&nbsp;Andrew Cathers MD","doi":"10.1016/j.amj.2024.05.014","DOIUrl":"https://doi.org/10.1016/j.amj.2024.05.014","url":null,"abstract":"<div><h3>Objective</h3><p>Hypocalcemia in critically ill patients has been previously shown to lead to higher transfusion needs and increased mortality. The purpose of this study was to evaluate if empiric prehospital calcium administration with concomitant blood product delivery in patients with hemorrhagic shock, improved initial in hospital ionized calcium, reduced coagulopathy, reduced blood product administration and improved 24 hour survival.</p></div><div><h3>Methods</h3><p>Our study was a convenience sample, retrospective chart review over a six year period analyzing clinical outcomes of patients pre and post protocol initiation, of empiric calcium administration with concomitant administration of blood products during aeromedical transport in a hospital based critical care transport program. T-test, Wilcoxon ranks sum test, and Chi-square tests were used for demographic and presentation differences between the two groups to demonstrate exchangeability between the control (baseline) and treatment (post-protocol change) groups. The primary outcome was initial ionized calcium levels on presentation to the receiving facility, and secondary outcomes of interest were coagulopathy, based on platelet count and INR, total blood product administration, and survival at 24 hours.</p></div><div><h3>Results</h3><p>131 patients were in the pre-implementation phase and 116 were in the post-protocol change phase. There was no significant difference in age (57.6 vs 55.0 years), sex male (62.6% vs 69.8%), initial vitals, shock index (1.0 vs 1.0) or injury severity score (33.0 vs 30.5). There was a statistically significant improvement in initial ionized calcium levels 4.2(0.6) in the control and 4.5(0.8) in the treatment group, (p=0.026). Initial INR was similar between the two groups (1.4 vs 1.5) (p=0.655), and there was no significant change in platelet count (183.0 vs 198.2 per microliter) (p=0.285). There was no change in survival rates between the control (112, 86.8%) and the treatment groups (99, 86.1%), (p=&gt;0.999). Additionally, there was no change in the amount of blood products administered in the first 24 hours of hospital stay between the two groups, control group received a total of 75 units of blood products and treatment group received 74 units (p=0.389). Of interest there was a significant increase in the amount of pressors given in the post group 27 patients in the control group and 39 patients in the treatment group requiring pressors in the first 24 hours of hospitalization (p 0.033). Not surprisingly there was a significant increase in the amount of TXA (27.6% vs 43.5%) (p=0.016), and calcium given (2.3% vs 19.1%) (p=&lt;.001) in the treatment group, during their prehospital care.</p></div><div><h3>Conclusion</h3><p>Overall, there was a statistically significant improvement in ionized calcium. However there was no significant difference in coagulopathy, based on INR and platelet count, nor a significant improvement in survival at 24 h","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 4","pages":"Page 364"},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141423895","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}
引用次数: 0
Point-of-Care Ultrasound in Helicopter Emergency Medical Services and Impact on Clinical Bedside Times 直升机紧急医疗服务中的床旁超声检查及其对临床床旁时间的影响
Air Medical Journal Pub Date : 2024-06-17 DOI: 10.1016/j.amj.2024.05.015
Jarett D. Jones BS, Mason A. Hill BS, Matthew VandeHei MD, Justin Purnell MD, Nikolai Schnittke MD, PhD, Sara Damewood MD, Hani I. Kuttab MD
{"title":"Point-of-Care Ultrasound in Helicopter Emergency Medical Services and Impact on Clinical Bedside Times","authors":"Jarett D. Jones BS,&nbsp;Mason A. Hill BS,&nbsp;Matthew VandeHei MD,&nbsp;Justin Purnell MD,&nbsp;Nikolai Schnittke MD, PhD,&nbsp;Sara Damewood MD,&nbsp;Hani I. Kuttab MD","doi":"10.1016/j.amj.2024.05.015","DOIUrl":"https://doi.org/10.1016/j.amj.2024.05.015","url":null,"abstract":"<div><h3>Objective</h3><p>Time constraints and concerns for delays in transport are often cited by helicopter emergency medical services (HEMS) providers as factors for not performing point-of-care ultrasound (POCUS). The objective of this study is to evaluate the impact of POCUS on clinical bedside times in HEMS transports.</p></div><div><h3>Methods</h3><p>This is a single-center, retrospective, observational cohort study of adult patients aged &gt;18 years transported via HEMS from March 1, 2018 to April 7, 2023, at a single academic medical center who received a POCUS examination. Exclusion criteria were: patients aged &lt;18 years of age and of vulnerable populations (e.g., prisoners, pregnant women), studies with missing data (e.g., medical record numbers), and studies which were not submitted for quality assurance. The POCUS group was matched to a cohort of patients transported in 2022 who did not receive POCUS. A linear regression model was fit to evaluate the effect of POCUS on clinical bedside time, adjusting for confounders. Covariates adjusted for included: age, sex, type of transfer (interfacility vs. scene), type of call (medical vs. scene), air vs. ground transport, red blood cell, vasopressor, or IV fluids administration, intubation, disposition, and specialty call (e.g., ECMO). Since the data for the control group was only for a single year, a second model was fit matching the same time-period for both groups. A sensitivity analysis was performed for each model.</p></div><div><h3>Results</h3><p>In total, 439 patients were included; 242 patients (55.1%) received POCUS and 197 patients (44.9%) had no POCUS performed. Overall mean clinical bedside time was 48 ± 33 minutes in the POCUS group versus 32 ± 23 minutes in the non-POCUS group. POCUS cases were more likely to be scene calls (39% vs. 14%), trauma cases (42% vs. 26%), were more likely to receive red blood cells (20% vs. 7.6%), vasopressors (44% vs. 16%), or more likely intubated in the field (48% vs. 28%). When evaluating the entire cohort, patients exposed to POCUS experienced times 21% longer than those in the non-POCUS group (β = 0.19, 95% CI 0.09-0.29, p &lt;0.001; R² = 56.6%). However, when considering only the period-matched cohort (2022, n=290), no significant difference in clinical beside times was observed in the POCUS group (β = 0.09, 95% CI -0.05-0.23, p = 0.23; R² = 56.0%). In this model, a nonsignificant increase in time was estimated to be two minutes, with the upper limit of confidence at five minutes.</p></div><div><h3>Conclusions</h3><p>In the entire cohort, patients with HEMS-performed POCUS exam had significantly longer bedside times. However, these patients were also more likely to be scene calls, trauma cases, and more critically ill compared to non-POCUS cases. When evaluating a period-matched cohort of patients in 2022, no significant differences in cases where POCUS was utilized was observed. This may be due to improved provider comfort and efficiency p","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 4","pages":"Pages 364-365"},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141423896","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}
引用次数: 0
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
相关产品
×
本文献相关产品
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信