Air Medical Journal最新文献

{"title":"Peri-Intubation Push Dose Vasopressors in Critical Care Transport","authors":"Alissa M. Bates MD,&nbsp;Alyson M. Esteves PharmD, BCPS, BCCCP,&nbsp;Kalle J. Fjeld MD,&nbsp;Jeremy M. Singleton RN, CFRN,&nbsp;Matthew A. Roginski MD, MPH","doi":"10.1016/j.amj.2024.05.021","DOIUrl":"https://doi.org/10.1016/j.amj.2024.05.021","url":null,"abstract":"<div><h3>Introduction</h3><p>Push dose vasopressors are administered to attenuate peri-intubation hypotension in critically ill patients. The benefit of push dose vasopressors over initiation of continuous vasopressor infusions is unclear. The aim of this study was to describe current use of push dose vasopressors in critical care transport.</p></div><div><h3>Methods</h3><p>This was a retrospective chart review of adult patients (≥18 years) intubated between January 2017 and May 2023 by a single critical care transport service who received peri-intubation push dose vasopressors. The primary outcome was incidence of push dose vasopressor administration. The secondary outcome was frequency of initiation or increase in continuous vasopressor infusion after intubation.</p></div><div><h3>Results</h3><p>Three hundred thirty-four patients were intubated during this period, 49 (14.7%) received push dose vasopressors in the peri-intubation period. The mean age was 55.8 ± 19.7 years and 28 (57.1%) were male. Forty-five (91.8%) were transported via rotor wing aircraft. Twenty-three (46.9%) were scene transports. The most common indication for intubation was trauma (n=30, 61.2%). The mean pre-intubation shock index was 1.1 ± 0.5. Of those who received push dose vasopressors, 34 (69.4%) received multiple push doses; the mean number of administrations was 2.5 ± 1.9. Forty-eight (97.9%) received push dose vasopressors prior to intubation and 36 (73.4%) received push doses post intubation. Fifteen (30.6%) were started on a continuous vasopressor infusion and 3 (11.1%) had an increase in an existing infusion post-intubation.</p></div><div><h3>Conclusion</h3><p>Push dose vasopressors were utilized in a heterogeneous manner in the peri-intubation period. It remains unclear which patients may benefit from initiation of continuous vasopressor infusion rather than push dose vasopressors. Further investigation is required to better elucidate the role of push dose and continuous vasopressors in the peri-intubation period.</p></div>","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":"141424610","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":"Transport of Patients Supported by Extracorporeal Membrane Oxygenation: An International Qualitative Analysis","authors":"Lauren Gillespie,&nbsp;Adam Gottula,&nbsp;Brittney Bernardoni,&nbsp;Andrew Cathers,&nbsp;Kolby Kolbet,&nbsp;Marcus Rudolph,&nbsp;Alberto Lucchini,&nbsp;Per Bredmose,&nbsp;Michael Frakes,&nbsp;Kyle Danielson,&nbsp;Melissa Ann Vogelsong,&nbsp;Dinis Reis Miranda,&nbsp;Michael Lauria,&nbsp;Guglielmo Imbriaco,&nbsp;William R. Hinckley,&nbsp;Brian Burns,&nbsp;Christine Brent,&nbsp;Bennett Lane","doi":"10.1016/j.amj.2024.05.011","DOIUrl":"https://doi.org/10.1016/j.amj.2024.05.011","url":null,"abstract":"<div><h3>Objectives</h3><p>Extracorporeal membrane oxygenation (ECMO) is a form of complete cardiopulmonary support that has been associated with improved survival in severe acute respiratory failure and refractory cardiac arrest. Current data provided by the Extracorporeal Life Support Organization demonstrate that the use of ECMO is increasing. However, ECMO remains a highly specialized and resource-intensive intervention with improved outcomes associated with higher ECMO center volumes, supporting the creation of regionalized care models. As such, the role of critical care transport is vital. Presently, there is little known about methods, crew configurations, protocols, and training for ECMO-capable transport teams. We aimed to descriptively analyze established ECMO transport programs across multiple countries.</p></div><div><h3>Methods</h3><p>A standardized, 27-item survey was distributed to 16 transport organizations across nine different countries. The survey included items such as transport team composition, training requirements, transport method, and various technical aspects. If available, transport organizations provided ECMO transport protocols and transport configuration schematics.</p></div><div><h3>Results</h3><p>To date, twelve ECMO programs responded from five countries (75% response rate). Most programs (83%) offer ground, 67% offer rotor-wing, and 50% offer fixed wing transport. A minority of programs (25%) were capable of any method of transport. Nearly half (42%) of programs did not require a separate ECMO team. A physician was present always or variably during ECMO transports in 67% of programs, and 92% of transport teams had a perfusionist or ECMO specialist and a nurse. All twelve programs required initial team ECMO training, and most programs also provided continuing education on an annual basis. Of the nine transport teams capable of performing ECMO cannulation, four programs (44%) could cannulate in any prehospital or in-hospital location.</p></div><div><h3>Conclusions</h3><p>Critical care transport teams play an essential role in increasing access to ECMO for patients with severe cardiopulmonary failure. There is significant variability in team composition and specialization as well as transport modality, but training requirements are commonly seen across programs. Further study is needed to define the optimal components for safe interfacility transport of ECMO patients.</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":"141424576","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":"Feasibility of Low-Fidelity Simulation for POCUS Assisted Vascular Access in the Critical Care Transport Environment","authors":"Chase J. Canter BS, FP-C,&nbsp;Scott M. Newton DNP, RN, MHA,&nbsp;Mackenzie M. McGahan DO","doi":"10.1016/j.amj.2024.05.013","DOIUrl":"https://doi.org/10.1016/j.amj.2024.05.013","url":null,"abstract":"<div><h3>Background</h3><p>Distributed mobile care teams such as emergency medical services and critical care transport teams face constraints of time, funding, staffing and access to high-fidelity training environments. Introducing skills into resource limited settings using innovative low-fidelity methods expand opportunities for development.</p></div><div><h3>Objective</h3><p>We aim to test the feasibility of low-fidelity point of care ultrasound (POCUS) simulation training for assisted peripheral intravenous (PIV) placement to develop baseline competence and confidence in critical care transport team clinicians.</p></div><div><h3>Methods</h3><p>A low-fidelity simulation model was developed using off the shelf items including canned-meat (i.e. Spam), modeling balloons, and dyed water to provide a similar image as a POCUS-PIV high-fidelity mannequin and human training subject. A convenience sample of seven staff were recruited to undergo didactic and hands-on training using the low-fidelity model. Training was led by an emergency ultrasound fellow in our affiliated hospital system. A non-compulsory post-training survey using structured questions and Likert-scale was electronically distributed to the training participants, with one hundred percent of the surveys returned.</p></div><div><h3>Results</h3><p>Use of a low-fidelity simulation model required no formal meetings or utilization of an off-site simulation center, reducing administrative burden. Low cost of simulation model supplies allowed for multiple simulators to be available, enabling concurrent use among participants which decreased total time spent in the training session. Post-training survey data indicated the following results: overall participants found that low-fidelity training developed their initial clinical decision making for completing this intervention in clinical practice. Eighty-six percent report increased confidence in placing ultrasound guided PIV after the lab. Seventy-one percent of participants identified as entry-level handheld ultrasound users. Most providers report receiving proper knowledge and skillset with the use of this low-fidelity task trainer and that the training successfully allowed them to perform the simulated intervention. One learner does remark subjectively that they did not receive proper knowledge and skillset in this lab.</p></div><div><h3>Conclusions</h3><p>A low-fidelity simulation model using off-the-shelf items allowed for successful psychomotor training for ultrasound assisted peripheral IV insertion. The low-cost simulation model allowed for multiple models to be present during training, enabling multiple repetitions to be completed when compared to having one, high-fidelity simulator. Practicing this intervention in a safe learning environment, without outside spectators, was found to promote confidence and increase self-reported likelihood of completing the intervention in clinical practice. Use of low-fidelity simulation models appears","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 4","pages":"Pages 363-364"},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141423894","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 Impact of Prehospital Trauma Education in a Conflict Zone","authors":"Kevin Collopy MHL, FP-C, CMTE,&nbsp;Ame Lozano BS, NR-P,&nbsp;Javed Ali MPH,&nbsp;Katie Biniki BSN,&nbsp;Honcharova Goncharova MD,&nbsp;Brock Jenkins BS, NRP, FP-C, CCP-C,&nbsp;Jill John-Kall MD, MSc,&nbsp;Oleksii Lopatniuk,&nbsp;Gideon Loevinsohn MD, PhD,&nbsp;Myroslav Mardarevych PhD,&nbsp;Nelya Melnitchouk MD,&nbsp;Katie Murray LLM,&nbsp;Dmytro Pedan,&nbsp;John Roberts MD,&nbsp;Meaghan Sydlowski,&nbsp;Jonathan Strong MD, MPH,&nbsp;Alexis Schmid DNP, RN, CPNP, MPH,&nbsp;Sean Kivlehan MD, MPH","doi":"10.1016/j.amj.2024.05.020","DOIUrl":"https://doi.org/10.1016/j.amj.2024.05.020","url":null,"abstract":"<div><h3>Introduction</h3><p>The ongoing Russia-Ukraine war has significantly increased trauma related civilian injuries and deaths at the front lines and throughout Ukraine. Early assessments identified an immediate need for trauma education and training among first responders due to the rapidly rising trauma volume and strained prehospital resources. In response, an academic-non-governmental organization was formed to develop, and deliver, a live in-person prehospital training course throughout Ukraine.</p></div><div><h3>Objective</h3><p>To determine the impact of targeted needs-based training on first responder preparedness, knowledge, and confidence to manage trauma patients.</p></div><div><h3>Methods</h3><p>A new 16-hour course containing lectures, skills stations, case studies, and simulation called Prehospital Trauma Fundamentals (PHTF) was developed using needs assessments and international training standards. Course materials were translated into Ukrainian, and courses were taught with live bidirectional interpretation as required. 10 courses were taught from August-November 2022 by both non-Ukrainian and Ukrainian instructors. Pre- and post- knowledge and self-confidence assessments measured course effectiveness. Six-to-eight-week follow-up surveys were also distributed. Data were analyzed using McNemar's test for paired data and Wilcoxon matched-pairs signed-rank test. This project was determined to not require Institutional Review Board approval by the Mass General Brigham Office of Human Research Affairs.</p></div><div><h3>Results</h3><p>268 first responders were trained in Kyiv, Dnipro, Odessa, and Zaporizhzhia. Participants were predominantly female (65%), median age was 35yrs. Of 193 matched re-to post-course knowledge assessments, scores increased from 53.4%[SD15.4%] to 74.4%[SD15.6%](p&lt;0.001). Assessment scores increased for most participants (93.3%). Self-confidence surveys demonstrated improved comfort handling trauma patients (71.7%v83.3%;p&lt;0.001), preparedness to manage life-threatening conditions (46.1%v66.1%;p&lt;0.0001), and belief in an organized approach to trauma care (59.2%v90.5%;p&lt;00001). Nervousness decreased (63.1%v52.5%;p&lt;0.05) and sense of skill deficit decreased (79.0%v33.7%;p&lt;0.0001). 59 (22.0%) participants completed the follow-up survey; 100% stated the training has or will have a life-saving effect in their patient management. Most (62.7%) had already applied course skills and taught (64.4%) others course skills or information.</p></div><div><h3>Conclusion</h3><p>PHTF increased participant knowledge, preparedness, and confidence to care for trauma patients. Participants successfully applied information taught during the ongoing conflict, which suggests value in delivering targeted educational programs just before or during large-scale events. This course and lessons learned from its development and delivery can serve as a starting point for delivering first responder trauma education in other ","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 4","pages":"Pages 366-367"},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141423931","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 Simpler Method for Choosing Adult i-gel Size: An Evaluation of Real-World Prehospital Data","authors":"Tanner Smida,&nbsp;Remle P. Crowe,&nbsp;Patrick W. Merrill,&nbsp;James F. Scheidler","doi":"10.1016/j.amj.2024.05.024","DOIUrl":"https://doi.org/10.1016/j.amj.2024.05.024","url":null,"abstract":"<div><h3>Objective</h3><p>The i-gel supraglottic airway device is commonly used in the United States and worldwide for prehospital airway management. Previous research has suggested that a sex-based method of size selection (4.0 for female patients, 5.0 for male patients) is superior to a weight-based method in patients undergoing elective anesthesia. Our objective was to compare a sex-based i-gel size selection strategy to a weight-based strategy using real-world prehospital data.</p></div><div><h3>Methods</h3><p>The ESO Data Collaborative 2018-2022 dataset was used. All initial i-gel insertion attempts in patients &gt; 18 years of age were evaluated for inclusion. Insertion attempts were excluded if age, sex, weight, success, or device size was not documented. Airway attempts were classified as being consistent with a weight-based sizing method if the i-gel size was 3.0 and the patient was less than 50 kg, the i-gel size was 4.0 and the patient was 50-90 kg, or the i-gel size was 5.0 and the patient was greater than 90 kg. Airway attempts were classified as being consistent with a sex-based sizing method if the i-gel was a 4.0 and the patient was a female or if the i-gel was a 5.0 and the patient was a male. Logistic regression was used to compare the rate of insertion failure on the first attempt for the group placed in alignment with the weight-based but not sex-based method to the group placed in alignment with the sex-based but not weight-based method.</p></div><div><h3>Results</h3><p>After application of exclusion criteria, 39,867 initial i-gel insertion attempts were included. The overall rate of failure was 6.5% (2,585/39,867). Among the total number of insertion attempts, 9,637 (24.2%) were consistent with both the weight-based and sex-based sizing method, 10,738 (26.9%) were consistent with the weight- but not sex-based sizing method, 5,527 (13.9%) were consistent with the sex- but not weight-based method, and 13,965 (35.0%) were consistent with neither method. The rate of unsuccessful i-gel placement was similar when i-gel devices were placed in alignment with a sex-based size selection method in comparison to i-gel placement in alignment with a weight-based selection strategy (6.0 vs. 6.4%). Logistic regression analysis did not reveal a significant difference between groups (OR: 1.08 [0.95, 1.23]).</p></div><div><h3>Conclusion</h3><p>The use of a sex-based method of i-gel size selection may be equivalent with respect to the rate of unsuccessful i-gel placement on the first attempt in comparison to a weight-based method.</p></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 4","pages":"Page 368"},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141424578","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":"Gender-affirming Care via HRT and Difficult Anesthetization, a Critical Care Transport Consideration","authors":"Zane Z Grimm BSN, RN, PHRN,&nbsp;Chase J Canter BS, FP-C","doi":"10.1016/j.amj.2024.05.025","DOIUrl":"https://doi.org/10.1016/j.amj.2024.05.025","url":null,"abstract":"<div><h3>Background</h3><p>With gender-affirming care seeing an 11-fold, five year availability increase in some states, patients being prescribed hormone replacement therapy (HRT) have increased. Research from greater than five years ago finds that puberty suppression treatment or gender-affirming hormone therapy and anesthesia medicines have no instances of drug-drug interaction. This case study examines difficult anesthetization of a transgender female prescribed hormone replacement therapy.</p></div><div><h3>Objective</h3><p>We aim to examine the anesthesia requirements of a transgender, post cardiac arrest patient during interfacility critical care transport who is prescribed hormone replacement and steroid therapy for gender affirming care.</p></div><div><h3>Methods</h3><p>Case Study describing a transgender female and her requirement for an unusual amount of sedation and analgesia.</p></div><div><h3>Results</h3><p>The patient is a 56-year-old transgender female with a history of coronary artery disease, coronary vasospasm, ventricular tachycardia, internal defibrillator placement, hypertension and gender dysphoria who receives Progesterone and Estradiol Valerate (E2V). The patient experienced an in-hospital VT arrest, received ACLS medications, defibrillation, and intubation. ROSC was achieved and prior to CCT arrival, the patient received a total of 525mcg of fentanyl, 10mg of vecuronium, 11mg of midazolam, 1mg of Dilaudid, and a 150mcg/hr fentanyl infusion for post-intubation sedation. Following CCT arrival, the patient is conscious, obviously uncomfortable, and follows commands while still being ventilated as well as restrained to the hospital bed. IV patency is ensured. To achieve a RASS of -3/-4 and appropriate ventilator compliance, she required a total of 10mg of midazolam, 200mcg of fentanyl, and 345mg of ketamine, in less than 20 minutes. It is noted that this patient does not have a significant history of alcoholism, drug use, or any conditions that would increase metabolic demand. She has relatively unremarkable CMP, CBC, and blood gas values. The patient was successfully transported 30 minutes by ground to a cardiac ICU, requiring redosing of analgesia and initiation of an infusion of ketamine at 4mcg/kg/min. Upon moving the patient to the hospital bed at the receiving, she required additional PRN analgesia and sedation doses post-transfer of care.</p></div><div><h3>Conclusion</h3><p>With limited, dated research on the effects of anesthesia requirements of patients receiving HRT for gender-affirming care, further studies should evaluate the need for increased anesthesia requirements for patients receiving progesterone and E2V. Critical care transport providers should be aware of the possibility of difficult anesthetization within this population.</p></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 4","pages":"Page 368"},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141424560","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 a Performance Improvement Bundle to Achieve DASHH-1A Success","authors":"Diana Deimling BSN, RN, CCRN, CEN, CFRN, NRP,&nbsp;Jacob A. Miller DNP, MBA, ACNP, ENP-C, CNS, NRP, FAEN,&nbsp;Anthony Braun MHA, BSN, RN, CFRN, CEN, NRP,&nbsp;Sally Mills DNP, RN, ACNP-BC, CPNP-AC, CCRN,&nbsp;Katherine Connelly MD, NRP, FP-C,&nbsp;Joshua Lambert PhD, MS,&nbsp;William R. Hinckley MD, FAAEM, CMTE, MTSP-C","doi":"10.1016/j.amj.2024.05.017","DOIUrl":"https://doi.org/10.1016/j.amj.2024.05.017","url":null,"abstract":"<div><h3>Background</h3><p>DASHH-1A is a quality metric used across HEMS and CCT programs to evaluate the safety and effectiveness of their airway management performance. The ability to achieve DASHH-1A success is multifactorial. This quality improvement project aimed to improve our program's DASHH-1A success rate.</p></div><div><h3>Local problem</h3><p>With excellent airway practitioners on our staff, we were perplexed as to why we did not meet the GAMUT achievable benchmark of care in DASHH-1A airway management. Our objective was to determine what may be impacting our success rates, both negatively and positively, to ultimately improve our DASHH-1A success rates.</p></div><div><h3>Methods</h3><p>Four investigators each reviewed a different patient population (interfacility trauma, interfacility medical, scene trauma, scene medical) to evaluate trends in their respective cohorts which may impact our DASHH-1A success. A brief literature review of current RSI practices was also conducted. Following these studies, we implemented a performance improvement plan and compared our adult DASHH-1A success rates for the 16 month periods pre- and post-intervention. All pediatric and crash airways were excluded.</p></div><div><h3>Interventions</h3><p>We revised our RSI protocol to include a bundle of care for all RSI airway attempts, which was then reviewed monthly at department CQI meetings. In addition to prior RSI mandates, we specified parameters to initiate additional airway, ventilation, and/or hemodynamic resuscitative efforts; mandated bag-mask ventilation during the period between paralytic administration and initiation of laryngoscopy; mandated use of a real-time, call-and-response RSI checklist; and implemented a standardized documentation template to capture those interventions performed.</p></div><div><h3>Results</h3><p>Pre-intervention DASHH-1A success rate was 63% (38/60 advanced airways). This improved to 72% (39/54 advanced airways) in the post-intervention period. This resulted in an improvement of our DASHH-1A success, with an absolute difference of 8.9% and a relative increase of 14%. A notable finding revealed that we had a 92% compliance rate with the utilization of our full DASHH-1A bundle.</p></div><div><h3>Conclusions</h3><p>The implementation of a DASHH-1A bundle of care had a high degree of compliance and was shown to improve our program's overall adult DASHH-1A success rate. A limitation of our study was our small sample size, <em>n</em> = 114 total patients. Recommendations for further studies would include a multi-center pre/post study to review similar programs’ DASHH-1A airway success.</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":"141424572","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":"GAMUT Metric Implementation Improves Ventilator Documentation and Management Practices","authors":"Kellan Doberstein,&nbsp;Dr. Andrew Cathers,&nbsp;Dr. Craig Tschautscher,&nbsp;Dr. Ryan Newberry,&nbsp;Dr. Brittney Bernardoni","doi":"10.1016/j.amj.2024.05.019","DOIUrl":"https://doi.org/10.1016/j.amj.2024.05.019","url":null,"abstract":"<div><h3>Background</h3><p>It is well established that lung-protective ventilation strategies are imperative for reducing patient morbidity and mortality. Recognizing the importance of early lung-protective ventilation in the pre-hospital setting, the Ground and Air Medical qUality Transport (GAMUT) Quality Improvement Collaborative recently established a metric that aims to keep plateau pressure &lt; 30 mmHg. GAMUT develops and tracks transport-specific quality metrics used by both domestic and international critical care transport (CCT) programs. The impact of GAMUT metric implementation on documentation practices and patient care in a CCT program remains unanswered.</p></div><div><h3>Objectives</h3><p>To determine if incorporation of the GAMUT metric, plateau pressure &lt; 30 mmHg, changed the incidence of plateau pressure documentation or lung-protective ventilation.</p></div><div><h3>Methods</h3><p>This was a single center, retrospective cohort study of endotracheally intubated and mechanically ventilated adult patients transported by a university affiliated, physician/nurse-staffed CCT program between August 2021 and October 2022. Patients mechanically ventilated via an extraglottic airway and those under the age of 18 were excluded. Pre-GAMUT data was collected from August 2021 to January 2022 and post-GAMUT implementation data from May 2022 to October 2022. February 2022 to April 2022 was excluded from analysis as this was the initial education and implementation period. Data was extracted from the transport service chart by a trained data abstractor and recorded in an external database (REDCap). Statistical analysis was performed using a Pearson chi square for categorical variables and a two-sample t-test for continuous variables.</p></div><div><h3>Results</h3><p>Before implementation of the GAMUT metric, plateau pressure was documented in 11.8% of charts (n=22/187) compared to 69.4% (n=109/157) in post GAMUT charts (p &lt; 0.0125). There was a statistically significant increase in the proportion of patients ventilated with both plateau pressure &lt; 30 mmHg and driving pressure &lt; 15 mmHg post GAMUT metric implementation (p &lt; 0.0125 for both).</p></div><div><h3>Conclusions</h3><p>Our findings indicate that GAMUT metric implementation not only improved documentation of plateau pressure by nearly 6-fold, but also significantly increased the proportion of patients transported with lung-protective ventilation as evidenced by both lower plateau and driving pressures. Implementation of a GAMUT metric appears to improve both documentation practices and quality of patient care.</p></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 4","pages":"Page 366"},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141424574","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":"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}