Air Medical Journal最新文献

{"title":"Transportation of Critically Ill Pediatric Patients as Disaster Relief by the Aeromedical Evacuation Squadron of the Japan Air Self-Defense Force","authors":"Takayuki Kurokawa MD, PhD ,&nbsp;Mikihiko Kimura MD, PhD ,&nbsp;Shinsuke Tamura MD, PhD ,&nbsp;Daisuke Yamaguchi MD ,&nbsp;Naruo Kuwada MD, PhD","doi":"10.1016/j.amj.2026.02.007","DOIUrl":"10.1016/j.amj.2026.02.007","url":null,"abstract":"<div><h3>Objective</h3><div>This study reviewed pediatric cases managed by the Aeromedical Evacuation Squadron (AMES) of the Japan Air Self-Defense Force and analyzed patient characteristics.</div></div><div><h3>Methods</h3><div>Pediatric transportation cases (<em>n</em> = 34) between 2006 and 2023 were reviewed. Data on patient age, main disease, transportation purpose and distance, and use of mechanical ventilators or extracorporeal membrane oxygenation (ECMO) were obtained by referring to the records.</div></div><div><h3>Results</h3><div>The average (standard deviation) patient age was 5.7 (5.8) years (range: 0-16 years), and 17 patients (50%) were younger than 1 year of age. Furthermore, 10 (58.8%) of these 17 children were younger than 7 months of age and 1 child was under 1 month of age. The most common diseases in the overall patient population were cardiovascular diseases (CVDs, <em>n</em> = 18) and respiratory diseases (RDs, <em>n</em> = 14). The purposes of transportation in cases of 17 patients with CVDs and 3 patients with RDs were the implantation of a ventricular assist device and lung transplantation, respectively. The average transportation distance was 453.7 (218.6) (range: 176.9–962.8) miles or 730.2 (351.8) (range: 284.7–1,549.5) km, and in 8 cases, the transportation distance was &gt; 600 miles. Of the patients, 29 (85.3%) were fitted with a ventilator, of whom 8 received ECMO (6 with CVDs and 2 with RDs). In all cases, physicians from the transporting hospitals were on board. There were no cases of cardiac arrest during the transportation.</div></div><div><h3>Conclusion</h3><div>AMES plays an important role, especially in the long-distance transportation of critically ill children.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 3","pages":"Pages 241-245"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147806770","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":"Integrating Multidisciplinary Reviews of Fatalities Into a High-Performing Air Ambulance Service","authors":"Jessica Froggatt MBBS ,&nbsp;Benjamin Swift FRCPath ,&nbsp;Gareth Grier FRCEM","doi":"10.1016/j.amj.2026.02.011","DOIUrl":"10.1016/j.amj.2026.02.011","url":null,"abstract":"<div><div>Advanced prehospital care delivered by air ambulance services in the United Kingdom aims to reduce preventable trauma deaths by bringing hospital-level interventions directly to patients. Despite these efforts, a significant proportion of patients still die in the immediate phase, and current learning frameworks focus predominantly on identifying errors rather than examining all fatalities for system-wide improvements.</div><div>This paper explores the potential of integrating multidisciplinary approaches, particularly clinicopathological correlation (CPC) meetings, into high-performing air ambulance services to enhance learning from every death. By including autopsy pathologists alongside clinicians, CPC meetings provide a robust platform to correlate prehospital findings with definitive postmortem results, improving diagnostic accuracy, clinical reasoning, and professional development. They also foster interprofessional collaboration, support clinician well-being by providing closure, and strengthen patient safety through contextualized learning beyond fault finding.</div><div>Barriers include limited data sharing, coronial processes, and inconsistent governance across independent air ambulance services. However, the successful implementation of CPC multidisciplinary team meetings demonstrates significant educational and systemic benefits, driving innovation, and quality assurance. We propose that all high-performing air ambulance services should adopt structured, regular CPC meetings with pathologist involvement, thereby embedding learning from every fatality as a cornerstone of governance, resilience, and future improvements in care.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 3","pages":"Pages 159-163"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147806911","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 High-Flow Nasal Cannula and Noninvasive Ventilation During Pediatric Interfacility Transport: Effect on Intubation Rates","authors":"Maya Gagliardi-Lacharite MD ,&nbsp;Robert Schultz RN ,&nbsp;Kendel Ridgeway DO ,&nbsp;Karin Przyklenk PhD ,&nbsp;Lauren Yagiela MD, MS ,&nbsp;Jamie Bell MD","doi":"10.1016/j.amj.2026.02.008","DOIUrl":"10.1016/j.amj.2026.02.008","url":null,"abstract":"<div><h3>Objective</h3><div>Previously, young children had limited respiratory support options during interfacility transport. Recently, high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) have become available for pediatric transport. We hypothesized that the implementation of HFNC and NIV on interfacility transport decreases the rate of intubation in infants and toddlers before and after transport to a tertiary-care pediatric intensive care unit (PICU).</div></div><div><h3>Methods</h3><div>We conducted a retrospective chart review of children aged 30 days to &lt; 36 months transported to a tertiary-care PICU from a referring hospital with respiratory distress from 2014 to 2019. Groups were analyzed before (2014–2017) and after the implementation (2017–2019) of HFNC and NIV during transport. NIV was defined as positive pressure ventilation delivered through nasal cannula. The primary outcome was to compare the pre- and postimplementation groups with regard to the rate of intubation before transport and within 48 hours of PICU admission. Secondary outcomes were the association between intubation rate and comorbidities and the comparison of length of respiratory support and hospital length of stay between the pre- and postimplementation groups.</div></div><div><h3>Results</h3><div>A total of 262 patients met criteria, 133 before and 129 after the intervention. The rate of intubation before PICU admission was 44% in the preintervention group versus 36% in patients transported after the implementation of HFNC and NIV, a trend that was not statistically significant (<em>P</em> = .19). The rate of intubation within 48 hours of PICU admission was 8% (before) and 11% (after) with no statistical significance (<em>P</em> = .48). Comorbidities were not associated with an increased rate of intubation before transport (<em>P</em> = .09) or within 48 hours of admission (<em>P</em> = .45). Hospital length of stay and length of respiratory support were not different between pre- and postintervention groups (<em>P</em> = .18 and <em>P</em> = .3, respectively). The availability of HFNC/NIV was associated with a significant decrease in the proportion of patients who received oxygen via nasal cannula or face mask during transport (46% before vs. 13% after the intervention; <em>P</em> &lt; .01).</div></div><div><h3>Conclusion</h3><div>After the introduction of HFNC/NIV during transport to a large tertiary-care hospital in a major metropolitan area, fewer nasal cannula/face masks were used during transport in favor of HFNC/NIV but no significant change in intubation rates was found.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 3","pages":"Pages 176-179"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147806915","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":"EMTALA Turns 40: How Federal Enforcement and Policy Shifts Are Reshaping Air Medical Transports","authors":"John R. Clark JD, MBA, NRP, FP-C, CCP-C, WP-C, CMTE","doi":"10.1016/j.amj.2025.11.001","DOIUrl":"10.1016/j.amj.2025.11.001","url":null,"abstract":"<div><div>The Emergency Medical Treatment and Labor Act (EMTALA), enacted in 1986, mandates that individuals presenting with emergency medical conditions receive appropriate screening, stabilizing treatment, or transfer—regardless of their ability to pay or mode of transport. As EMTALA approaches its 40th anniversary, recent legal developments, including the Idaho and Moyle cases, have tested its federal preemption and implications for emergency medical transfers. This article evaluates evolving enforcement, regulatory shifts, and operational impacts on air medical services. It highlights compliance risks, reimbursement pressures, and best practices for air medical providers navigating a complex legal landscape. The analysis underscores EMTALA’s enduring role in safeguarding emergency care and the need for coordinated legal and clinical strategies in air medical transport.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 3","pages":"Pages 164-166"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147806918","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":"Delayed Sequence Intubation and Its Role in Prehospital Emergency Medicine: A Scoping Review","authors":"Oliver Jones MBCHb ,&nbsp;Louisa Rees MBCHb ,&nbsp;Nathan Anderson MRCEM","doi":"10.1016/j.amj.2026.01.009","DOIUrl":"10.1016/j.amj.2026.01.009","url":null,"abstract":"<div><h3>Objective</h3><div>Preoxygenation is a key component of prehospital emergency anesthesia (PHEA), reducing hypoxemia and increasing safe apnea time. Delayed sequence intubation (DSI) involves the use of sedation without blunting respiratory drive to facilitate optimization, primarily oxygenation, before paralytic administration and subsequent intubation in patients with agitation who are unable to tolerate preoxygenation. This scoping review explored the evidence supporting DSI in emergency and prehospital practice.</div></div><div><h3>Methods</h3><div>A Preferred Reporting Items for Systematic Reviews and Meta-Analyses–guided scoping review was conducted. MEDLINE and Embase were searched from inception to May 5, 2025, for studies reporting DSI. Primary studies, case series, case reports, and guidelines involving adult or pediatric patients were included; reviews, editorials, and letters were excluded. Titles, abstracts, and full texts were independently screened by 2 reviewers, with disagreements resolved by a third.</div></div><div><h3>Results</h3><div>Fourteen studies met the inclusion criteria. Across these studies, 310 DSI cases were reported, including 140 performed prehospital by physician- and paramedic-led teams. Emergency department evidence suggests that DSI may reduce hypoxemia in agitated patients compared with rapid sequence intubation (RSI), with 1 randomized controlled trial reporting hypoxemia rates of 8% versus 35% (P = .001). Evidence specific to prehospital DSI was limited to retrospective studies, with no randomized controlled trials identified.</div></div><div><h3>Conclusion</h3><div>Limited evidence suggests that DSI can be performed by teams already delivering PHEA using an RSI technique and may reduce hypoxemia in those patients unable to tolerate preoxygenation. Further prospective research directly comparing RSI and DSI techniques in the prehospital setting is required to inform future practice.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 3","pages":"Pages 272-277"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147806704","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":"40 Under 40: Rising Leader in Medical Transport","authors":"","doi":"10.1016/j.amj.2026.03.051","DOIUrl":"10.1016/j.amj.2026.03.051","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 3","pages":"Pages 292-300"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147806705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Description of Critical Care Transport First Pass Endotracheal Intubation Failures","authors":"Abby L. Blake DO ,&nbsp;Kalle J. Fjeld MD ,&nbsp;Pietra Oelke ,&nbsp;Matthew A. Roginski MD, MPH ,&nbsp;Patricia Ruth A. Atchinson DO","doi":"10.1016/j.amj.2026.01.006","DOIUrl":"10.1016/j.amj.2026.01.006","url":null,"abstract":"<div><h3>Objective</h3><div>Endotracheal intubation is performed by health care providers from different training backgrounds and in diverse locations. The first pass failure rate has been reported to be variable, and complications can arise from multiple intubation attempts. This is a hypothesis-generating descriptive analysis of first pass endotracheal intubation failure performed by a critical care transport team. Secondary outcomes included patient and procedural factors associated with failure.</div></div><div><h3>Methods</h3><div>This is a retrospective chart review of adults (≥18 years) intubated by a critical care transport service between January 2017 and June 2024. One intubation attempt was defined as the insertion of the laryngoscope past the lips. First pass failure was defined as failure to place an endotracheal tube through the vocal cords on the first intubation attempt.</div></div><div><h3>Results</h3><div>There were 388 patients intubated with 54 first pass failures (13.9%). Multiple reasons for failure were cited in 20 first pass intubation failures (37.0%). The most common reasons for failure were desaturation during intubation (7; 13.0%); contamination with blood, secretions, emesis, or foreign bodies (23; 42.6%); and anatomy (33; 61.1%). There was an association between first pass failure and retrospectively documented predicted difficult airway (adjusted odds ratio, 2.96; 95% confidence interval, 1.57–5.56).</div></div><div><h3>Conclusion</h3><div>First pass failure occurred in 13.9% of intubations. This descriptive analysis serves as a starting point for further quality improvement work that includes a systematic review of intubations with objective data (ie, video-recorded laryngoscopy) and the use of an airway failure taxonomy to describe errors.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 3","pages":"Pages 208-212"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147806707","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":"IVC Ultrasound in Septic Shock: Guiding Resuscitation During Critical Care Transport—A Case Study","authors":"James R. Waller Jr BS ,&nbsp;Shaila K. Coffey MD","doi":"10.1016/j.amj.2026.02.002","DOIUrl":"10.1016/j.amj.2026.02.002","url":null,"abstract":"<div><div>Point-of-care ultrasound (POCUS) is a valuable diagnostic tool in prehospital and transport medicine, particularly for critically ill patients with hemodynamic instability. This case study illustrates the use of focused cardiac and inferior vena cava ultrasound in the prehospital transport of a patient with septic shock. The imaging obtained in flight guided both fluid management and vasopressor titration, which improved clinical decision making in a resource-limited, dynamic environment. Using the handheld Butterfly iQ+ ultrasound device facilitated high-quality images and documentation enroute, reinforcing the importance of POCUS in modern air medical practice.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 3","pages":"Pages 286-288"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147806913","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":"May-June 2026 Forum","authors":"","doi":"10.1016/j.amj.2026.03.050","DOIUrl":"10.1016/j.amj.2026.03.050","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 3","pages":"Pages 167-168"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147806916","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":"Balancing Risks and Benefits of Snake Antivenom in Retrieval Medicine","authors":"Guy Hardwick MBBS ,&nbsp;Peter Brendt FANZCA, FACEM","doi":"10.1016/j.amj.2025.10.015","DOIUrl":"10.1016/j.amj.2025.10.015","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 2","pages":"Pages 147-149"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147272299","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}