Air Medical Journal最新文献

{"title":"High Fidelity Simulation as a Learning Tool: The Staff's Perspective","authors":"Leslie Rostedt MSN, BA, AAS, CCRN, CEN, Paramedic,&nbsp;Julius McAdams BME, PF-C, CCP-C, NRP,&nbsp;William F. Powers IV MD, FACS","doi":"10.1016/j.amj.2024.05.023","DOIUrl":"https://doi.org/10.1016/j.amj.2024.05.023","url":null,"abstract":"<div><h3>Objective</h3><p>To obtain the staff perspective regarding utilization of simulation principles incorporating prebriefing, video recorded simulation, and debriefing with guided reflection and self-evaluation.</p></div><div><h3>Methods</h3><p>A Likert survey was conducted pre- and post-simulation to obtain impressions before and evaluations after a simulation experience. Fifty-two critical care providers participated with the surveys during seventeen sessions in 2023. Responses were voluntary, results were anonymous. Prebriefing consisted of introduction to the simulator, video recording equipment, the recording process, monitoring equipment, and medical equipment. Objectives were reviewed prior to the simulation. The simulation targeted participant understanding and treatment traumatic brain injury. The debriefing process included video review with the participants utilizing protocols for self-evaluation of success with guided reflection. Compilation of data occurred after all sessions. The data specifically looked at comfort level with video recording, the ability to ask questions and receive constructive feedback, and the ability to analyze learner behaviors during the experience. In addition, learners were asked if they felt the experience was specific to their level and if they deemed it a tool that promoted learning.</p></div><div><h3>Results</h3><p>The results of the survey showed that the mean scores increased between pre-simulation and post-simulation at all data points. Video recording results demonstrated the most change. The mean score increased from 3.0 to 4.2, with decreased variability in responses after the experience. The mean increased in the ability to ask questions from 3.6 to 4.7, and the report on the constructive feedback mean changed similarly from 3.6 to 4.8. Variability for both was minimal in responses before and after the experience, focused on just two responses. Learners reported a mean score of 3.4 for the ability to analyze their behavior before, and 4.8 after the experience, with limited variability that centered on only two answers. The mean for specificity to the level of practice was reported to be 2.6 before the experience and 4.8 afterward, with responses centered around two responses. The mean for learning promotion increased from 3.5 to 4.8 from the pre-experience to post-experience with initial variability of three responses and post-experience of two responses.</p></div><div><h3>Conclusions</h3><p>Impressions to pre-Likert surveys were moderate. Concerns were specific to video recordings, especially whom had access. Only the specific participants would have access to the recording; only used for educational purposes, without impact on annual performance appraisal. Participants response to all questions noted overall increase in confidence in the post-simulation Likert. Anecdotal reports included appreciating review of the simulator capabilities and equipment before beginning the simulation and iso","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 4","pages":"Pages 367-368"},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141424577","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":"Air Transport Medicine: From the Field","authors":"Ryan Newberry DO, MPH,&nbsp;Craig Tschautscher MD,&nbsp;Brittney Bernardoni MD,&nbsp;Andrew Cathers MD,&nbsp;James Price MBBS,&nbsp;Ed B.G. Barnard PhD","doi":"10.1016/j.amj.2024.05.004","DOIUrl":"10.1016/j.amj.2024.05.004","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 4","pages":"Pages 276-278"},"PeriodicalIF":0.0,"publicationDate":"2024-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141397100","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":"Electrolyte Disorders: Causes, Diagnosis, and Initial Care—Part 3","authors":"Nicholas J. Larson BA, NREMT,&nbsp;Frederick B. Rogers MD, MS, MA, FACS,&nbsp;Jennifer L. Feeken MLIS,&nbsp;Benoit Blondeau MD, MBA, FACS,&nbsp;David J. Dries MD, MSE, FACS, MCCM","doi":"10.1016/j.amj.2024.05.007","DOIUrl":"10.1016/j.amj.2024.05.007","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 4","pages":"Pages 270-275"},"PeriodicalIF":0.0,"publicationDate":"2024-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141401461","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":"July/August 2024 Forum","authors":"","doi":"10.1016/j.amj.2024.05.009","DOIUrl":"10.1016/j.amj.2024.05.009","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 4","pages":"Pages 279-281"},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141279681","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":"REVA Air Ambulance and Seaplane Medevac Operations","authors":"Sean Bryan RN, BSN, MBA-HM","doi":"10.1016/j.amj.2024.03.017","DOIUrl":"10.1016/j.amj.2024.03.017","url":null,"abstract":"<div><p>REVA, INC (Air Ambulance) is an Air Ambulance company headquartered in Fort Lauderdale, Florida. The company was formed in 2012 after the merger of two air ambulance companies, Aero Jet International and Air Ambulance Professionals. REVA completes around 1,300 medical transports a year, primarily international. It has always been a goal to provide more support to the Bahamas and hard to reach islands, which led to REVA launching its Seaplane Medevac Operation in December of 2022. The development of this program allows them to have a medical equipped seaplane available 365 days a year to service the Bahamas and hard to reach areas.</p></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 4","pages":"Pages 282-287"},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141055268","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":"Management Considerations for Air Medical Transport Programs Transfusing RhD-Positive Red Blood Cell–Containing Products to Females of Childbearing Potential","authors":"Michael P. McCartin MD ,&nbsp;Geoffrey D. Wool MD, PhD ,&nbsp;Sarah A. Thomas ,&nbsp;Meaghan Panfil MSN, RN ,&nbsp;David Schoenfeld MD ,&nbsp;Ira J. Blumen MD ,&nbsp;Katie L. Tataris MD, MPH ,&nbsp;Stephen H. Thomas MD, MPH","doi":"10.1016/j.amj.2024.03.012","DOIUrl":"10.1016/j.amj.2024.03.012","url":null,"abstract":"<div><p>Recent years have seen increased discussion surrounding the benefits of damage control resuscitation, prehospital transfusion (PHT) of blood products, and the use of whole blood over component therapy. Concurrent shortages of blood products with the desire to provide PHT during air medical transport have prompted reconsideration of the traditional approach of administering RhD-negative red cell–containing blood products first-line to females of childbearing potential (FCPs). Given that only 7% of the US population has blood type O negative and 38% has O positive, some programs may be limited to offering RhD-positive blood products to FCPs. Adopting the practice of giving RhD-positive blood products first-line to FCPs extends the benefits of PHT to such patients, but this practice does incur the risk of future hemolytic disease of the fetus and newborn (HDFN). Although the risk of future fetal mortality after an RhD-incompatible transfusion is estimated to be low in the setting of acute hemorrhage, the number of FCPs who are affected by this disease will increase as more air medical transport programs adopt this practice. The process of monitoring and managing HDFN can also be time intensive and costly regardless of the rates of fetal mortality. Air medical transport programs planning on performing PHT of RhD-positive red cell–containing products to FCPs should have a basic understanding of the pathophysiology, prevention, and management of hemolytic disease of the newborn before introducing this practice. Programs should additionally ensure there is a reliable process to notify receiving centers of potentially RhD-incompatible PHT because alloimmunization prophylaxis is time sensitive. Facilities receiving patients who have had PHT must be prepared to identify, counsel, and offer alloimmunization prophylaxis to these patients.</p><p>This review aims to provide air medical transport professionals with an understanding of the pathophysiology and management of HDFN and provide a template for the early management of FCPs who have received an RhD-positive red cell–containing PHT. This review also covers the initial workup and long-term anticipatory guidance that receiving trauma centers must provide to FCPs who have received RhD-positive red cell–containing PHT.</p></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 4","pages":"Pages 348-356"},"PeriodicalIF":0.0,"publicationDate":"2024-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141026822","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":"A Novel Technique for Temporally Securing a Chest Tube in a Resource-Limited Environment","authors":"Harmony Osborn MD ,&nbsp;Aileen Newmyer MD ,&nbsp;William Krebs DO, RDMS, EMT-P","doi":"10.1016/j.amj.2024.03.010","DOIUrl":"10.1016/j.amj.2024.03.010","url":null,"abstract":"<div><p>In the prehospital, transport, and resource-limited setting, patients with traumatic hemothorax, pneumothorax, or cardiac arrest require emergency tube thoracostomy for stabilization and transport. With the possibility of multiple patients, limited providers, and inability to commit a 1:1 provider-to-patient ratio for safe tubeless thoracostomies, a chest tube is often the safest option. Mercy Health Life Flight Air Medical program has developed practice over decades using towel clamps and tape to achieve securement rapidly and reliably. We report on this subject as an option for temporarily securing a chest tube in the disaster, resource-poor, prehospital, or critical care transport setting.</p></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 4","pages":"Pages 345-347"},"PeriodicalIF":0.0,"publicationDate":"2024-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141038257","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":"Implementation of a Rapid Sequence Intubation Checklist Improves First-Pass Success and Reduces Peri-Intubation Hypoxia in Air Medical Transport","authors":"David J. Olvera MBA, NRP, FP-C, CMTE ,&nbsp;Michael Lauria MD, NRP, FP-C ,&nbsp;Jeremy Norman BAS, NRP, FP-C ,&nbsp;M. David Gothard MS ,&nbsp;Andrew D. Gothard BS ,&nbsp;William Bradley Weir MD, FACEP, FAEMS, FAMPA","doi":"10.1016/j.amj.2023.12.010","DOIUrl":"10.1016/j.amj.2023.12.010","url":null,"abstract":"<div><h3>Objective</h3><p><span>Rapid sequence intubation<span><span> (RSI) is a critical skill commonly performed by air medical teams in the United States. To improve safety and reduce potential patient harm, checklists have been implemented by various institutions in </span>intensive care units, </span></span>emergency departments, and even prehospital air medical programs. However, the literature suggests that checklist use before RSI has not shown improvement in clinically important outcomes in the hospital. It is unclear if RSI checklist use by air medical crews in prehospital environments confers any clinically important benefit.</p></div><div><h3>Methods</h3><p><span><span>This institutional review board–approved project is a before-and-after observational study conducted within a large helicopter ambulance company. The RSI checklist was used by flight crewmembers (flight paramedic/nurse) for over 3 years. Data were evaluated for 8 quarters before and 8 quarters after checklist implementation, spanning December 2014 to March 2019. Data were collected, including the self-reported use of the checklist during intubation attempts, the reason for intubation, and correlation with difficult airway predictors (HEAVEN [Hypoxemia, Extremes of size, Anatomic disruption, Vomit, </span>Exsanguination<span>, Neck mobility/Neurologic injury] criteria), and compared with airway management before the implementation of the checklist. The primary outcome was improved first-pass success (FPS) when compared among those who received RSI before the checklist versus those who received RSI with the checklist. The secondary outcome was a definitive airway sans </span></span>hypoxia improvement noted on the first pass among adult patients as measured before and after RSI checklist implementation. Post-RSI outcome scenarios were recorded to analyze and validate the effectiveness of the checklist.</p></div><div><h3>Results</h3><p>Ten thousand four hundred five intubations were attempted during the study. FPS was achieved in 90.9% of patients before RSI checklist implementation, and 93.3% achieved FPS postimplementation of the RSI checklist (<em>P</em> ≤ .001). In the preimplementation epoch, 36.2% of patients had no HEAVEN predictors versus 31.5% after RSI checklist implementation. These data showed that before RSI checklist implementation, airways were defined as less difficult than after implementation.</p></div><div><h3>Conclusion</h3><p>The implementation of a standardized RSI checklist provided a better identification of deterring factors, affording efficient and accurate actions promoting FPS. Our data suggest that when a difficult airway is identified, using the RSI checklist improves FPS, thereby reducing adverse events.</p></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 3","pages":"Pages 241-247"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139817095","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":"Pediatric Critical Care Referrals for Tertiary Inpatient and Transport Services in Canada's Maritime Provinces: A Retrospective Cohort Study","authors":"Stephanie Craig MD, MPH ,&nbsp;Jennifer Foster MD ,&nbsp;Julien Gallant RRT, BHSc, BSc ,&nbsp;Neeraj Verma MBBS, DNB ,&nbsp;Kristina Krmpotic MD, MSc","doi":"10.1016/j.amj.2024.01.002","DOIUrl":"10.1016/j.amj.2024.01.002","url":null,"abstract":"<div><h3>Objective</h3><p><span>Accurate triage of children referred for tertiary pediatric </span>critical care services is crucial to ensure optimal disposition and resource conservation. We aimed to explore the characteristics and level of care needs of children referred to tertiary pediatric critical care inpatient and transport services and the characteristics of referring physicians and hospitals to which these children present.</p></div><div><h3>Methods</h3><p><span>We conducted a 1-year retrospective cohort study of children (&lt; 16 years) with documented referral to pediatric critical care and specialized transport services at a tertiary </span>pediatric hospital from regional (24/7 pediatrician on-call coverage) and community (no pediatric specialty services) hospitals in Canada's Maritime provinces.</p></div><div><h3>Results</h3><p>We identified 205 documented referrals resulting in 183 (89%) transfers; 97 (53%) were admitted to the pediatric intensive care unit<span> (PICU). Of 150 children transferred from centers with 24/7 pediatric specialist coverage, 45 (30%) were admitted to the tertiary hospital pediatric medical unit with no subsequent admission to the PICU. Of 20 children transferred from community hospitals and admitted to the tertiary hospital general pediatric medical unit, 9 (45%) bypassed proximate regional hospitals with specialist pediatric care capacity. The specialized pediatric critical care transport team performed 151 (83%) of 183 interfacility transfers; 83 (55%) were admitted to the PICU.</span></p></div><div><h3>Conclusion</h3><p>One third of the children accepted for interfacility transfer after pediatric critical care referral were triaged to a similar level of care as could be provided at the sending or nearest regional hospital. Improved utilization of pediatric expertise in regional hospitals may reduce unnecessary pediatric transports and conserve valuable health care resources.</p></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 3","pages":"Pages 248-252"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140527168","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":"Local Anesthetic Systemic Toxicity Joint Management in the Prehospital Environment: A Case Report","authors":"Alberto Gabrieli MD ,&nbsp;Caterina Barberi MD ,&nbsp;Caterina Compostella MD ,&nbsp;Michela Azzolini RN ,&nbsp;Andrea Butturini RN ,&nbsp;Gabriele Larger RN ,&nbsp;Lara Boldo RN ,&nbsp;Matteo Paganini MD ,&nbsp;Roberta Levato RN ,&nbsp;Andrea Ventura MD","doi":"10.1016/j.amj.2024.01.009","DOIUrl":"10.1016/j.amj.2024.01.009","url":null,"abstract":"<div><p>Local anesthetic systemic toxicity (LAST) is a potentially life-threatening complication that may occur after local anesthetic injection. After reaching the systemic circulation, cardiovascular and central nervous system derangements may appear, with potentially fatal complications if left untreated. The pillars for LAST treatment are advanced life support measures, airway and seizure management, and a 20% lipid emulsion intravenous administration. When occurring in the prehospital setting, LAST is difficult to recognize, mostly because of its features overlapping with other acute conditions. Prompt treatment is also challenging because lipid emulsion may not be routinely carried on emergency vehicles. This article reports a case of LAST occurring in a dental ambulatory located in a remote location within the Italian Alps in which effective communication among different components of the same regional health care system (dispatch center, prehospital teams, and hospital network) led to fast lipid emulsion retrieval en route and on-site toxicity resolution. This case can inspire future operational changes, such as antidote networks available to prehospital emergency medicine crews, avoiding unnecessary deployment of antidotes on ambulances or helicopters, which is difficult to preserve without increasing management costs. However, to be established, such a network would need protocols to facilitate antidote retrieval, training focused on toxidromes recognition, and improved communication skills among different professionals involved in prehospital emergency medicine.</p></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 3","pages":"Pages 256-258"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140463019","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}