Air Medical Journal最新文献

{"title":"Trauma Scores Show Limited Utility for Predicting In-Flight Deterioration in Air Medical Patients","authors":"Benjamin Powell BSc, PGDipHSM, MBBS, GCertTM, MPH, DipPHRM, FACEM ,&nbsp;Susanna Cramb PhD","doi":"10.1016/j.amj.2024.09.002","DOIUrl":"10.1016/j.amj.2024.09.002","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to determine the utility of the Triage Revised Trauma Score (TRTS), Glasgow Coma Scale/Age/systolic Pressure (GAP) score, and Shock Index (SI) in predicting in-flight hypotension and the need for critical care interventions in air medical trauma patients.</div></div><div><h3>Methods</h3><div>A retrospective review of 3,582 air medical trauma cases from a 3-year period in Queensland was conducted. An initial TRTS, GAP score, and SI were calculated for each patient, and the lowest in-flight mean arterial pressure and systolic blood pressure were determined. The institution of in-flight critical care interventions was also recorded, including fluid resuscitation, vasopressors, and surgical procedures. The utility of the TRTS, GAP score, and SI for predicting in-flight hypotension was then examined using receiver operating characteristic curves.</div></div><div><h3>Results</h3><div>All 3 approaches showed minor predictive value, with the GAP score performing slightly better than TRTS and SI for predicting in-flight interventions. The GAP score had a receiver operating characteristic area under the curve of 0.76 compared with 0.74 for the TRTS and SI.</div></div><div><h3>Conclusion</h3><div>No score demonstrated sufficient predictive ability for deterioration in transit to be used clinically.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 6","pages":"Pages 528-534"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758903","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":"Keyword-Based Early Request for Helicopter Emergency Medical Services in Acute Aortic Dissection: A Registry-Based Study","authors":"Hiroaki Taniguchi MD,&nbsp;Hiroki Nagasawa MD, PhD,&nbsp;Tatsuro Sakai MD,&nbsp;Hiromichi Ohsaka MD, PhD,&nbsp;Kazuhiko Omori MD, PhD,&nbsp;Youichi Yanagawa MD, PhD","doi":"10.1016/j.amj.2024.09.006","DOIUrl":"10.1016/j.amj.2024.09.006","url":null,"abstract":"<div><h3>Objective</h3><div>Acute aortic dissection (AAD) is a life-threatening condition that necessitates rapid medical intervention. In Japan, helicopter emergency medical services (HEMS) are deployed using either keyword-based early requests or standard requests from ground emergency medical services (GEMS). This study evaluates the impact of these request methods on patient outcomes.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using data from the Japanese Society for Aeromedical Services registry from April 2015 to March 2020. A total of 342 AAD patients transported by HEMS were analyzed, excluding those with out-of-hospital cardiac arrest. Patients were categorized based on whether HEMS was requested using a keyword method or after initial GEMS contact. We compared the groups on time intervals, prehospital interventions, and outcomes including Cerebral Performance Category.</div></div><div><h3>Results</h3><div>The time from GEMS awareness to HEMS contact was significantly shorter in the keyword methods group compared with the control group (median 27 vs. 33 minutes, respectively; <em>P</em> &lt; .001). No significant difference was observed in the time from contact to departure from the scene. Patient characteristics, vital signs at HEMS staff contact, and medical interventions provided by HEMS staff showed no statistically significant differences. Changes in vital signs from HEMS staff contact to hospital arrival included a significant decrease in the respiratory rate and systolic blood pressure. Patients in the keyword methods group had a significantly higher proportion of favorable outcomes in terms of Cerebral Performance Category compared with the control group (77.2% vs. 66.5%, <em>P</em> = .03). However, logistic analysis did not show significant differences (odds ratio = 1.007; 95% confidence interval, 0.987-1.016; <em>P</em> = .814).</div></div><div><h3>Conclusion</h3><div>Keyword methods for early HEMS requests may appear to reduce time to specialty care and suggest improvement of outcomes for patients with AAD.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 6","pages":"Pages 544-547"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758905","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":"Articles That May Change Your Practice: Whole Blood for Traumatic Hemorrhagic Shock","authors":"Russell D. MacDonald MD, MPH, FCFP, FRCPC, DRCPSC,&nbsp;Blake A. Forte MD, MHS, MS,&nbsp;Michael D. Stocker MD, MPH,&nbsp;Aaron J. Lacy MD, FAWN","doi":"10.1016/j.amj.2024.07.010","DOIUrl":"10.1016/j.amj.2024.07.010","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 6","pages":"Pages 479-480"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758995","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":"The RACE Scale for Large Vessel Stroke Diversion to a Comprehensive Stroke Center by Helicopter Air Ambulance: A Retrospective Cohort Study","authors":"William Krebs DO, RDMS, EMT-P ,&nbsp;Melina Alexander DO ,&nbsp;Alisha Fujita DO ,&nbsp;Quinci Copeland MD ,&nbsp;Nancy Buderer MS ,&nbsp;Osama Zaidat MD ,&nbsp;Eugene Lin MD","doi":"10.1016/j.amj.2024.07.011","DOIUrl":"10.1016/j.amj.2024.07.011","url":null,"abstract":"<div><h3>Objective</h3><div>Acute ischemic stroke caused by large vessel occlusion (LVO) occurs frequently and benefits from endovascular therapies available at comprehensive stroke centers (CSCs). Prehospital stroke severity tools have been devised to detect LVO. The goal of this study was to assess the value of the Rapid Arterial Occlusion Evaluation (RACE) score in helicopter air ambulance (HAA) activation.</div></div><div><h3>Methods</h3><div>A retrospective assessment of RACE scales &gt; 4 performed by prehospital providers was used in order to activate HAAs. Descriptive statistics were obtained for patients transported, with the primary goal of determining the positive predictive values of the RACE scale for LVO occlusions. The secondary outcomes assessed if patients without LVO had other conditions requiring a CSC.</div></div><div><h3>Results</h3><div>Data from 136 subjects were analyzed; 53 (39.0%) were true LVO cases as defined by computed tomographic imaging, computed tomography angiographic imaging, or magnetic resonance imaging. Mechanical thrombectomy occurred in 30 cases (22.1%), with 63 (46.4%) requiring a neurologic intervention. There were 83 (61%) false positives (no LVO on imaging). Of these false positives, 28 (20.6%) were non-LVO strokes, 22 (16.1%) were intracranial hemorrhages, and 8 (5.9%) had neurologic conditions requiring CSC care.</div></div><div><h3>Conclusion</h3><div>A RACE scale &gt; 4 is an effective triage tool that delivers potential thrombectomy candidates to CSCs. When there is a false positive, the majority of patients require CSC care and benefit from direct transport from the scene.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 6","pages":"Pages 508-511"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758898","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":"Prof. Marius Rehn MD, PhD,&nbsp;Marit Bekkevold MD,&nbsp;Per Bredmose MD, PhD,&nbsp;Tone Solvik Olsen MD,&nbsp;Jostein Hagemo MD, PhD,&nbsp;James Price MB, BS,&nbsp;Ed B.G. Barnard PhD","doi":"10.1016/j.amj.2024.09.008","DOIUrl":"10.1016/j.amj.2024.09.008","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 6","pages":"Pages 476-477"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758993","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":"Determining What Proportion of Helicopter Emergency Medical Services–Transported Patients Are Urban Versus Rurally Based: A Retrospective 36-Year Geospatial Analysis of a Critical Care Helicopter Emergency Medical Services Organization's Patient Transports","authors":"Domhnall O'Dochartaigh MSc ,&nbsp;Elizabeth Schrekinger BSc ,&nbsp;Glenda Farnden ,&nbsp;Jon Gogan BPE (Kin) ,&nbsp;Darren Hudson MD, FRCPC","doi":"10.1016/j.amj.2024.10.004","DOIUrl":"10.1016/j.amj.2024.10.004","url":null,"abstract":"<div><h3>Objective</h3><div>There is an increased mortality rate of patients residing in rural compared with urban communities. Helicopter emergency medical services (HEMS) decrease both the time to hospital arrival and trauma mortality in patients originating from rural areas. An unreported number of urban residents are served by HEMS. Our objective was to quantify the fraction of urban residents who live in the adjoining city of a HEMS base and are transferred by helicopter while they are in rural areas.</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of HEMS charts between 1985 and 2022. Records were assessed for patients’ city and postal code. A secondary database was searched to assess mission location.</div></div><div><h3>Results</h3><div>Thirty-five thousand nine hundred seventy-one cases were analyzed; 3,871 (10.76%) cases involved patients residing within the urban area of an open HEMS base, and 32,100 (89.24%) did not. This contrasts with 2.04% of all missions conducted in urban areas. Cases flown with patients from outside of the 3 provinces were as follows: British Columbia (1,233/21,941; 5.3% of Alberta cases), international (988/35,971; 2.7% of total cases), Ontario (177/4,691; 3.6% of Manitoba cases), and other provinces combined (158/3,5971; 0.4% of total cases).</div></div><div><h3>Conclusion</h3><div>We highlight the impact of HEMS, where it serves both rural residents and all people who work in, travel through, visit, or recreate across the areas that our HEMS supports.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 6","pages":"Pages 575-577"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Isopropyl Alcohol Aromatherapy in Treating Nausea in Helicopter Emergency Medical Services Patients","authors":"David Koenig DO ,&nbsp;Kevin P. Young FP-C ,&nbsp;Robert Treat PhD ,&nbsp;J. Marc Liu MD, MPH, FAEMS ,&nbsp;Timothy Lenz MD, MPH, EMT-P, FAEMS, FACEP","doi":"10.1016/j.amj.2024.08.004","DOIUrl":"10.1016/j.amj.2024.08.004","url":null,"abstract":"<div><h3>Objective</h3><div>Isopropyl alcohol (IPA) aromatherapy provides rapid relief of nausea at minimal cost, is universally available, and has no known significant adverse effects. These attributes make it ideal for the prehospital setting. However, there is no published research on the use of IPA in critical care transport (CCT). The objective of this study was to investigate if CCT patients experience improvement of nausea with IPA aromatherapy.</div></div><div><h3>Methods</h3><div>A retrospective chart review was performed over a 2-year period on adult patients served by a Midwest CCT system that provides both air and ground transport. Data were obtained 1 year before and 1 year after a protocol change in which the first-line antiemetic was changed from intravenous ondansetron (prechange) to inhaled IPA (postchange). The IPA was administered by placing a pad under the patient's nares as they inhaled. The proportion of nausea improvement was compared between the prechange and postchange periods.</div></div><div><h3>Results</h3><div>Two hundred seventeen records were included. In helicopter emergency medical services, 33 of 50 (66.0%) patients reported improvement with ondansetron, and 13 of 21 (61.9%) reported improvement with IPA (<em>P</em> = .742). Patients transported by ground emergency medical services showed improvement in 65 of 73 (89.0%) cases for ondansetron and 40 of 73 (54.8%) for IPA (<em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>There was no difference in the proportion of nausea improvement between ondansetron and IPA in helicopter emergency medical services patients. In ground emergency medical services patients, more patients had nausea improvement with ondansetron compared with IPA. This study suggests IPA may be a faster, more efficacious alternative for nausea relief in CCT patients.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 6","pages":"Pages 518-522"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758913","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":"Italian Search and Rescue Seaplanes From the 50s to the 70s: A Brave People and Mighty Aircraft Story","authors":"Carlo Bellini MD, PhD","doi":"10.1016/j.amj.2024.09.007","DOIUrl":"10.1016/j.amj.2024.09.007","url":null,"abstract":"<div><div>Following a previous article that described the early days of Italian air rescue and that reached up to the immediate postwar period (World War II), this article describes the search and rescue activity carried out by the Italian Grumman Albatross HU-16A from the postwar period until the end of the 70s.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 6","pages":"Pages 481-485"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758752","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":"Elevating Prehospital Traumatic Brain Injury Care: A Comparative Analysis of Civilian and Military Air Transport Guidelines","authors":"Sarthak Parikh DO ,&nbsp;Christopher G. Hendrix MD ,&nbsp;Jeremy Norman BAS, FP-C, NRP ,&nbsp;Andrew K. Kurklinsky MD","doi":"10.1016/j.amj.2024.10.002","DOIUrl":"10.1016/j.amj.2024.10.002","url":null,"abstract":"<div><h3>Objective</h3><div>Traumatic brain injuries (TBIs) are a leading cause of death and disability worldwide. Establishing TBI guidelines is crucial for prehospital management. Civilian medical practices are often influenced by military trauma guidelines. This study provides a comparative analysis of prehospital TBI management by a civilian air medical evacuation service using civilian guidelines and military clinical practice guidelines from the Joint Trauma System of the Department of Defense.</div></div><div><h3>Methods</h3><div>A retrospective review of 100 deidentified patient transport logs from a prominent civilian air medical service was conducted. The logs were compared with the service's patient care guidelines and the 2023 Joint Trauma System Clinical Practice Guidelines. Data were analyzed for adherence to 14 metrics.</div></div><div><h3>Results</h3><div>Patients showed improvement in preflight and postflight Glasgow Coma Scale scores and were managed according to recommendations on head elevation, oxygenation, blood pressure, and temperature by both organizations. Discrepancies between guidelines included differences in the management of ventilator settings, blood pressure, oxygenation, temperature, serum glucose, intracranial hypertension, suspected brain herniation, serum sodium levels, and seizure prophylaxis.</div></div><div><h3>Conclusion</h3><div>Comparing civilian and military guidelines highlights areas for potential improvements in TBI management, such as integrating advanced monitoring and the implementation of (i-STAT, Abbott Laboratories, Chicago, IL) testing in air transport to enhance patient care and outcomes.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 6","pages":"Pages 548-552"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758906","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":"November/December 2024 Forum","authors":"","doi":"10.1016/j.amj.2024.09.011","DOIUrl":"10.1016/j.amj.2024.09.011","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 6","pages":"Pages 486-487"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758753","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}