Air Medical Journal最新文献

{"title":"A Simulation-Based, Qualitative Assessment of Decision Making Among Critical Care Transport Crews","authors":"Daniel Johnson DO ,&nbsp;Heather Costigan MPH ,&nbsp;Candace Bordner MS ,&nbsp;Avram Flamm DO ,&nbsp;Lauren Van Scoy MD","doi":"10.1016/j.amj.2025.10.010","DOIUrl":"10.1016/j.amj.2025.10.010","url":null,"abstract":"<div><h3>Objective</h3><div>The breadth and complexity of care in the out-of-hospital environment are increasing. The clinical decision-making process of emergency medical services clinicians is not well understood.</div></div><div><h3>Methods</h3><div>This study aimed to analyze the process of critical care transport clinicians using simulated scenarios with structured debriefing. Members of a critical care transport team completed a simulation session during which they cared for a medical or trauma patient with airway management concerns. A standardized debriefing exploring their decision-making process was performed after the simulation session, recorded, and transcribed. Thematic analysis was performed to uncover themes related to the clinical decision making that took place.</div></div><div><h3>Results</h3><div>A total of 8 subjects (5 nurses and 3 paramedics) completed simulation sessions including 5 medical and 3 trauma scenarios. The median years of experience in critical care transport was 15. The following 3 themes emerged from the quantitative analysis: (1) participants felt that the scenarios were realistic and applicable to their daily practice, (2) participants felt that the scenarios required them to think critically, and (3) participants relied on established protocols combined with experience for their clinical decision making.</div></div><div><h3>Conclusion</h3><div>During the simulated care of complex patients with airway management concerns, critical care transport clinicians made complex decisions by using a combination of standing protocols, experience, and foundational knowledge.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 2","pages":"Pages 117-120"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147272337","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":"Association Between Prehospital Blood Transfusion in Helicopter Emergency Medical Services and Survival: A Retrospective Population-Based Cohort Study","authors":"Naoya Miura MD, MPH, PhD,&nbsp;Asuka Tsuchiya MD, MPH, PhD,&nbsp;Motohiro Matsumoto MD,&nbsp;Hiromichi Aoki MD,&nbsp;Seiji Morita MD, PhD","doi":"10.1016/j.amj.2025.11.003","DOIUrl":"10.1016/j.amj.2025.11.003","url":null,"abstract":"<div><h3>Objective</h3><div>Critical hemorrhage is a life-threatening condition in which blood transfusion is an essential lifesaving intervention. Although the importance of prehospital blood transfusion is increasingly recognized, its effectiveness remains unclear, particularly in Asian health care settings. This study aimed to characterize patients receiving prehospital blood transfusion through helicopter emergency medical services (HEMS) and evaluate their association with survival outcomes in a Japanese population-based cohort.</div></div><div><h3>Methods</h3><div>We conducted a retrospective evaluation of data from the Japanese Society for Aeromedical Services Registry from April 2020 to March 2023. This study included adult patients transported by physician-staffed HEMS. Propensity score matching (1:4) was used to adjust for confounding factors. The primary outcome measure was patient survival until hospital discharge.</div></div><div><h3>Results</h3><div>Among the 24,776 patients, 71 (0.3%) received prehospital blood transfusions using type O packed red blood cells. Transfusion recipients had lower systolic blood pressures (83 mm Hg vs. 138 mm Hg; <em>P</em> &lt; .001) and higher rates of external causes of injury (80.3% vs. 51.1%; <em>P</em> &lt; .001) than did those who did not receive a transfusion. After propensity score matching (<em>N</em> = 230), prehospital transfusion was associated with improved survival (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.05–4.18). The results of the trauma subgroup analysis showed no statistically significant association (OR, 1.88; 95% CI, 0.80–4.40).</div></div><div><h3>Conclusion</h3><div>In Japan’s physician-staffed HEMS, prehospital blood transfusion was appropriately provided to patients with hemorrhagic shock and, after adjustment for confounding factors, was associated with improved survival. These findings provide evidence supporting the potential benefits of prehospital blood transfusion in appropriately selected patients within physician-staffed air medical systems.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 2","pages":"Pages 133-139"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147272329","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":"Interhospital Transport Characteristics for Neonates With Congenital Diaphragmatic Hernia","authors":"Katrin C. Lichtsinn MD, MS ,&nbsp;Daniel A. Enquobahrie MD, MPH, PhD ,&nbsp;John Feltner MS ,&nbsp;Aditya Goparaju ,&nbsp;Megan M. Gray MD ,&nbsp;Sandy Johng MD ,&nbsp;Mihai Puia-Dumitrescu MD, MPH ,&nbsp;Rebecca Stark MD ,&nbsp;Rachel Umoren MBBCh, MS ,&nbsp;Zeenia C. Billimoria MD","doi":"10.1016/j.amj.2025.12.001","DOIUrl":"10.1016/j.amj.2025.12.001","url":null,"abstract":"<div><h3>Objective</h3><div>Congenital diaphragmatic hernia (CDH) occurs when a diaphragmatic defect develops in utero, allowing herniation of the abdominal contents into the chest cavity. As a result, many neonates with CDH are critically ill after birth owing to varying degrees of pulmonary hypoplasia, respiratory failure, pulmonary hypertension, and cardiac dysfunction. Neonates with CDH require surgical repair of the diaphragmatic defect, and those who are not born at a center with the ability to perform pediatric surgery must be transferred to one shortly after birth. Our objective was to describe transport characteristics and vital sign variability for neonates with CDH transferred after delivery.</div></div><div><h3>Methods</h3><div>This was a retrospective observational analysis of 51 neonates with prenatally diagnosed CDH born at a single delivery hospital between March 2020 and March 2024 and transported to a single tertiary referral neonatal intensive care unit. Descriptive statistics were used to compare groups by CDH severity.</div></div><div><h3>Results</h3><div>Neonates with severe CDH were transported more rapidly than those with mild or moderate CDH. During transport, more neonates with severe disease received inhaled nitric oxide, but other transport interventions were not significantly different between the groups. All neonates experienced at least 1 abnormal vital sign. A higher proportion of neonates with severe CDH had low oxygen saturation values compared with those with milder disease.</div></div><div><h3>Conclusion</h3><div>Vital sign abnormalities were universally common during transport, highlighting the physiologic instability of neonates with CDH. Understanding these transport variables will aid provider teams in decision making for these critically ill neonates.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 2","pages":"Pages 140-146"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147272292","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":"Definitive Airway Management in the Critical Care Transport Medicine Environment: An Exploratory Convenience Survey-Based Analysis of Retrieval Experts on the Profound Shock State Patient","authors":"Craig Tschautscher MD, MS ,&nbsp;Christopher Stephens MD ,&nbsp;Steven Bott MD ,&nbsp;Lesley Osborn MD ,&nbsp;Ina Schmidt MD ,&nbsp;Jason Cohen DO ,&nbsp;Benjamin Lawner DO, MS, EMT-P ,&nbsp;Adam L. Gottula MD","doi":"10.1016/j.amj.2025.10.003","DOIUrl":"10.1016/j.amj.2025.10.003","url":null,"abstract":"<div><h3>Objective</h3><div>Airway management in profoundly unstable patients, particularly those in a peri-arrest state, remains a contentious issue in out-of-hospital environments. Although there is robust literature on advanced airway procedures for acutely ill patients, literature on prehospital patients in profound shock is sparse. This study represents a survey-based analysis of critical care transport medicine (CCTM) experts to describe the challenges and strategies for intubating patients with significant hemodynamic instability.</div></div><div><h3>Methods</h3><div>Before the Air Medical Physician Symposium (AMPS) Lite, an online exploratory survey was developed from a convenience sample of AMPS attendees regarding best practices, knowledge gaps, barriers to translation, and research priorities. AMPS featured educational lectures and discussions on critical care transport topics, including definitive airway management for patients in profound shock. Participants included CCTM experts from a variety of programs across the United States and internationally. The symposium included expert panel discussions and audience ranking of these categories using electronic voting.</div></div><div><h3>Results</h3><div>The survey-based analysis highlighted the importance of understanding the physiological and pharmacological principles surrounding rapid sequence intubation and other intubation strategies. Rankings emphasized the need for research on shock dosing of sedatives and the potential for paralytic-only intubation in profoundly obtunded patients.</div></div><div><h3>Conclusion</h3><div>The study concluded that further investigation is needed to develop evidence-based guidelines for intubating patients in profound shock. The findings suggest that reduced sedation dosing and consideration of using paralytic-only intubation may mitigate the risks of cardiovascular collapse and improve patient outcomes in this critically ill patient population.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 2","pages":"Pages 105-110"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147272281","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":"Fifteen Years of Purpose: The Safety Management Training Academy’s Enduring Legacy and Future Vision","authors":"Donna York DNP, RN, FAASTN, CMTE, CAFO, CACO","doi":"10.1016/j.amj.2025.10.005","DOIUrl":"10.1016/j.amj.2025.10.005","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 2","pages":"Pages 103-104"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147272263","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":"Don’t Pay the Ferryman: International Aeromedical Transport of Patients to or From Treatments Prohibited in Their Place of Residence","authors":"Alex Veldman MD,&nbsp;Nico Lange JD,&nbsp;Andrea Ressler,&nbsp;Lynn Gordon MD,&nbsp;Yann Rouaud MD,&nbsp;Bettina Vadera MD,&nbsp;Cai Glushak MD,&nbsp;Pascaline Wolfermann","doi":"10.1016/j.amj.2025.10.014","DOIUrl":"10.1016/j.amj.2025.10.014","url":null,"abstract":"<div><div>Patients seek planned health care outside of their home country for several reasons, one being that the treatment of choice might not be legally available in their respective place of residence (eg, abortion of pregnancy, assisted dying/suicide, gender transition). The practice of traveling abroad with the intention of participating in a health-related activity that is prohibited in one’s own country but not in the destination country has been coined as circumvention.</div><div>In the context of international medical transportation, someone who assists a person in accessing a procedure that is illegal in the person’s home country, state, or jurisdiction may face significant legal consequences for facilitating a criminal act under domestic law, even if that act is not committed in the country in which it is illegal. Commercial entities engaging in international medical transportation are well advised to protect their employees and organizations from these substantial legal risks by thoroughly investigating the legal and ethical background of cross-border transports to or from treatments that are not legally available in the country of patient origin or destination. Patients who cannot travel independently may be exposed to a disadvantaged and potentially harmful situation.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 2","pages":"Pages 96-100"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147272284","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":"January-February 2026 Forum","authors":"","doi":"10.1016/j.amj.2025.11.005","DOIUrl":"10.1016/j.amj.2025.11.005","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 1","pages":"Pages 15-16"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947767","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":"Boosting Confidence Through Interagency Air Medical Simulation: A Quality Assurance Exercise of a Critical Care Helicopter Landing at a Tertiary Trauma Hospital","authors":"John Iliff FACEM ,&nbsp;Breeanna Spring MMedHlthScRes ,&nbsp;San Kumaradevan MCom ,&nbsp;David Cosford FACEM ,&nbsp;Jenny Vance FACEM ,&nbsp;Alice Richardson BA(Hons), MStats, PhD ,&nbsp;Fergus Gardiner OAM, PhD","doi":"10.1016/j.amj.2025.09.003","DOIUrl":"10.1016/j.amj.2025.09.003","url":null,"abstract":"<div><h3>Objective</h3><div>Emergency preparedness training in health care improves patient outcomes. For critically unwell patients outside the hospital setting, air medical helicopter hospital landings expedite emergency health care access. However, little is known of interagency staff experiences during this multifaceted health care provision. We captured staff experiences during the first interagency air medical helicopter landing simulation exercise between the Royal Flying Doctor Service of Australia and Royal Perth Hospital in Western Australia as a quality assurance exercise.</div></div><div><h3>Methods</h3><div>The simulation exercise yielded 21 participants (hospital and air medical clinicians, logisticians, and pilots) and 8 simulation facilitators who consented to provide data between June and October 2023. Data were collected by phone interviews and surveys and analyzed descriptively and qualitatively.</div></div><div><h3>Results</h3><div>Facilitators reported that conducting successful interagency helicopter retrieval simulations requires extensive planning and preparation. After the simulation, participants reported increased clinical confidence in their specific role, with a desire for greater exposure to diverse simulation training to optimize their future performances for real scenarios. Simulation debriefs allow for further participant clarification surrounding the overall process. They provide a medium for valuable feedback to health service providers in process refinement in the management of the critically unwell, enhancing a culture of safety.</div></div><div><h3>Conclusion</h3><div>This study highlighted that interagency simulations are a valuable exercise when multiple health service providers are involved in the management of individual patients who are critically unwell. The significant effort to organize and coordinate to create high-fidelity scenarios by facilitators is rewarded with significant benefit found by the participants in their ability to be prepared for the real-life scenario. Such findings have important implications for ongoing interagency collaboration and ongoing health care and educational strategy.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 1","pages":"Pages 45-51"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947970","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":"Effects of Transport Team Composition on Neonatal Intubation Success","authors":"Alyssa J. Averhoff DO ,&nbsp;Junghyae Lee PhD ,&nbsp;Robyn Sawyer RN ,&nbsp;Emily Mohs APRN-NP ,&nbsp;Cori Kerr APRN-NP ,&nbsp;Courtney McLean MD, MS","doi":"10.1016/j.amj.2025.09.005","DOIUrl":"10.1016/j.amj.2025.09.005","url":null,"abstract":"<div><h3>Objective</h3><div>Neonatal transport is necessary to move the smallest and sickest patients. Transport team configuration can vary among institutions. One major concern with varied team composition is the ability to intubate neonates. This study investigates team composition effects on neonatal intubation success when performed by a neonatal nurse practitioner (NNP) or critical care transport (CCT) registered nurses (RNs) and paramedics.</div></div><div><h3>Methods</h3><div>Neonates &lt;4 weeks of age who were intubated on transport between 2016 and 2023 were analyzed by retrospective chart review. Intubation success and number of attempts were compared between NNP and CCT, while controlling for confounding factors such as birth weight, age, and use of premedication or video laryngoscope.</div></div><div><h3>Results</h3><div>A total of 111 neonates were included in the study with 119 intubation procedures by transport team members. There was no difference in the overall intubation success rate between the NNP and CCT with an average of 84% (<em>P</em> = .68). An increase in first-attempt success rate with the CCT was found, which was not significant after controlling for the use of premedication and video laryngoscope.</div></div><div><h3>Conclusion</h3><div>During the study period, neonatal intubation success on transport did not differ when comparing NNP with CCT. This result supports staffing neonatal transport teams based on staffing availability.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 1","pages":"Pages 59-62"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947890","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":"Jason Cohen DO, FACEP, FCCM, FAEMS ,&nbsp;Vahé Ender FP-C, C-NPT ,&nbsp;Michael A. Frakes APRN, EMTP, FCCM, FACHE ,&nbsp;Susan R. Wilcox MD, FCCM, FAAEM ,&nbsp;James Price MBBS ,&nbsp;Ed B.G. Barnard PhD","doi":"10.1016/j.amj.2025.10.012","DOIUrl":"10.1016/j.amj.2025.10.012","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"45 1","pages":"Pages 9-11"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947765","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}