Air Medical Journal最新文献

{"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}

{"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}

{"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}

{"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}

{"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}

{"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}

{"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}

{"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}

{"title":"Disordered Eating & Body Image in Emergency Medical Services Staff","authors":"Charlotte Bisaccia EMT - IV","doi":"10.1016/j.amj.2024.05.012","DOIUrl":"https://doi.org/10.1016/j.amj.2024.05.012","url":null,"abstract":"<div><p>Past research has shown that EMS professionals are affected by many mental health issues such as PTSD, depression, anxiety, substance abuse, sleep disturbances, burnout, and even suicidal ideation. The research discussed herein assesses the levels of disordered eating and body image in EMTs/paramedics as compared to emergency department nurses using a disordered eating scale, an eating disorder scale, and a body image scale. Results showed that EMS workers had significantly lower body image satisfaction scores compared to ED nurses, and that those participants in 911/On Campus services showed lower body image scores than those in Interfacility Transport/Emergency Departments. Results trended towards showing that those with fewer lunches out of the past ten shifts had higher disordered eating. Additionally, fewer than half of participants felt that they could take regularly scheduled breaks for eating and 84.2% of participants answered “yes” or “sometimes” to the common phenomenon of “eating when and where you can” while on a shift. These results exhibit concerning issues of decreased body image across EMS professionals and deep-rooted problems with nourishment while on shift. These issues must be addressed as it is a matter of public safety to attend to the mental health of first responders so that they can attend to the critical requirements of their job.</p></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 4","pages":"Page 363"},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141424636","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":"Clinical Debriefing Impact Related to Intent to Leave and Job Satisfaction","authors":"Jason W. Herman DNP,&nbsp;Michelle Cox-Henley DNP,&nbsp;Holly Brown DNP,&nbsp;Kenyatta Brown DNP,&nbsp;Thomas Joshua PhD,&nbsp;Chelsea Lemons","doi":"10.1016/j.amj.2024.05.018","DOIUrl":"https://doi.org/10.1016/j.amj.2024.05.018","url":null,"abstract":"<div><h3>Objective</h3><p>The purpose of this quality improvement project was to determine what effect holding clinical debriefing following traumatic patient encounters has on employee intent to leave and job satisfaction.</p></div><div><h3>Methods</h3><p>This observational quality improvement project was undertaken at Augusta University AirCare a helicopter emergency medicine service, in a large, metropolitan city located in the southeast from September 12th, 2023, to October 12th, 2023. The mean of each survey section was utilized to compare the pre-and post-survey scores to determine the effect of a structured clinical debrief on employee intent to leave, burnout, and job satisfaction.</p></div><div><h3>Results</h3><p>A total of 6 flight clinicians completed the pre-test survey and 5 flight clinicians completed the post-test. Although results were not statistically significant, post-intervention scores reflected a decrease in the mean value after implementation of the STOP5 debrief model for both burnout (pre-intervention mean= 62, post intervention mean=56) and intent to leave (pre-intervention mean=17, post intervention mean= 9). However, job satisfaction mean value did not increase as expected (pre-intervention mean= 12, post-intervention mean=14), which may be due to the short implementation period between measurements.</p></div><div><h3>Conclusion</h3><p>This Doctor of Nursing Practice (DNP) quality improvement project determined that holding clinical debriefs following traumatic patient encounters may decrease employee intent to leave and burnout but did not show improvement in employee job satisfaction.</p></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 4","pages":"Pages 365-366"},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141424573","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}