Pub Date : 2024-11-01DOI: 10.1016/j.amj.2024.08.003
Matthew E. Anton MD , Antonia L. Altomare DO, MPH , Amanda R. Blais PharmD , Jeremy C. Patten NRP , Kalle J. Fjeld MD , Alyson M. Esteves PharmD, BCPS, BCCCP , Matthew A. Roginski MD, MPH
Objective
Deep sedation of mechanically ventilated patients is associated with poorer outcomes, including longer hospital length of stay and more ventilator days. In contrast, light sedation is associated with decreased hospital and intensive care unit length of stay, lower ventilator days, and decreased mortality. This study sought to decrease the use of unindicated deep sedation and benzodiazepine use in mechanically ventilated patients during critical care transport. Previous work identified > 90% of intubated, nonparalyzed patients were deeply sedated in this critical care transport system.
Methods
This study was conducted at a critical care transport service affiliated with a rural academic medical center. Chart review of all mechanically ventilated adults transported between January and November 2023 with no indication for deep sedation was performed. Improvement initiatives were implemented using Plan-Do-Study-Act cycles and included transport crew education, guideline revision, and enhanced performance feedback.
Results
A 25% reduction in the proportion of deeply sedated patients was achieved.
Conclusion
Deep sedation is not universally indicated in critical care transport of mechanically ventilated patients. This quality improvement initiative achieved its main aim of reducing the proportion of deeply sedated patients by 25% with the implementation of 3 Plan-Do-Study-Act cycles.
{"title":"Reducing Deep Sedation and Benzodiazepine Use in Mechanically Ventilated Patients During Critical Care Transport: A Quality Improvement Initiative","authors":"Matthew E. Anton MD , Antonia L. Altomare DO, MPH , Amanda R. Blais PharmD , Jeremy C. Patten NRP , Kalle J. Fjeld MD , Alyson M. Esteves PharmD, BCPS, BCCCP , Matthew A. Roginski MD, MPH","doi":"10.1016/j.amj.2024.08.003","DOIUrl":"10.1016/j.amj.2024.08.003","url":null,"abstract":"<div><h3>Objective</h3><div>Deep sedation of mechanically ventilated patients is associated with poorer outcomes, including longer hospital length of stay and more ventilator days. In contrast, light sedation is associated with decreased hospital and intensive care unit length of stay, lower ventilator days, and decreased mortality. This study sought to decrease the use of unindicated deep sedation and benzodiazepine use in mechanically ventilated patients during critical care transport. Previous work identified > 90% of intubated, nonparalyzed patients were deeply sedated in this critical care transport system.</div></div><div><h3>Methods</h3><div>This study was conducted at a critical care transport service affiliated with a rural academic medical center. Chart review of all mechanically ventilated adults transported between January and November 2023 with no indication for deep sedation was performed. Improvement initiatives were implemented using Plan-Do-Study-Act cycles and included transport crew education, guideline revision, and enhanced performance feedback.</div></div><div><h3>Results</h3><div>A 25% reduction in the proportion of deeply sedated patients was achieved.</div></div><div><h3>Conclusion</h3><div>Deep sedation is not universally indicated in critical care transport of mechanically ventilated patients. This quality improvement initiative achieved its main aim of reducing the proportion of deeply sedated patients by 25% with the implementation of 3 Plan-Do-Study-Act cycles.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 6","pages":"Pages 512-517"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758765","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}
Pub Date : 2024-11-01DOI: 10.1016/j.amj.2024.09.009
Çiğdem Akalın Akkök MD, PhD, Emek Köse PhD
{"title":"Anti-D Immunoglobulin May Have Effect if Given Within 10 Days","authors":"Çiğdem Akalın Akkök MD, PhD, Emek Köse PhD","doi":"10.1016/j.amj.2024.09.009","DOIUrl":"10.1016/j.amj.2024.09.009","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 6","pages":"Pages 474-475"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758992","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}
Pub Date : 2024-11-01DOI: 10.1016/j.amj.2024.09.010
David J. Dries MSE, MD, FACS, MCCM
{"title":"ABCs for HEMS","authors":"David J. Dries MSE, MD, FACS, MCCM","doi":"10.1016/j.amj.2024.09.010","DOIUrl":"10.1016/j.amj.2024.09.010","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 6","pages":"Page 478"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758994","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}
Pub Date : 2024-11-01DOI: 10.1016/j.amj.2024.09.004
Katherine M. Connelly MD, NRP, FP-C , David Hindle MD , Peter Rankin RN , Trevor Johnson RN , Andrew Cathers MD
The transport of intubated patients is a common but high-risk scenario for air medical transport crews. In the case presented, a physician-nurse HEMS crew responded for the interfacility transfer of a patient with severe angioedema who had undergone awake fiberoptic nasotracheal intubation in the referring emergency department. The endotracheal tube had been damaged, however, and could not be adequately secured for transport. To facilitate tube securement, the crew elected to convert from nasotracheal to orotracheal intubation. Recognizing the high likelihood of anatomic difficulty and to minimize the risk of airway loss, the crew performed an airway exchange by passing a bougie adjacent to the existing endotracheal tube, while using the in situ tube to provide continued ventilation. This case highlights the importance of familiarity with airway exchange procedures and presents a novel technique of extraluminal bougie-assisted endotracheal tube exchange.
{"title":"Extraluminal Bougie-Assisted Endotracheal Tube Exchange Performed by Helicopter Emergency Medical Services","authors":"Katherine M. Connelly MD, NRP, FP-C , David Hindle MD , Peter Rankin RN , Trevor Johnson RN , Andrew Cathers MD","doi":"10.1016/j.amj.2024.09.004","DOIUrl":"10.1016/j.amj.2024.09.004","url":null,"abstract":"<div><div>The transport of intubated patients is a common but high-risk scenario for air medical transport crews. In the case presented, a physician-nurse HEMS crew responded for the interfacility transfer of a patient with severe angioedema who had undergone awake fiberoptic nasotracheal intubation in the referring emergency department. The endotracheal tube had been damaged, however, and could not be adequately secured for transport. To facilitate tube securement, the crew elected to convert from nasotracheal to orotracheal intubation. Recognizing the high likelihood of anatomic difficulty and to minimize the risk of airway loss, the crew performed an airway exchange by passing a bougie adjacent to the existing endotracheal tube, while using the in situ tube to provide continued ventilation. This case highlights the importance of familiarity with airway exchange procedures and presents a novel technique of extraluminal bougie-assisted endotracheal tube exchange.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 6","pages":"Pages 572-574"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758902","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}
Pub Date : 2024-11-01DOI: 10.1016/j.amj.2024.08.005
Christopher L. Hunter MD, PhD, Linh Nguyen MD, Linda Papa MD, MSc
Objective
The aim of this study was to determine the first-pass intubation success rates of air medical providers using direct laryngoscopy, channeled blade video laryngoscopy, and nonchanneled blade video laryngoscopy.
Methods
This was a retrospective cohort study of the Orlando Health Air Care Team (ACT) airway quality registry over a 5-year period. The ACT had 3 approved approaches for endotracheal intubation: direct laryngoscopy, the King Vision (Ambu, Ballerup Denmark) channeled blade laryngoscope, or the C-MAC (Karl-Storz, Tuttlingen Germany) (nonchanneled) laryngoscope. The main outcome was the first-pass success rate. The secondary outcomes included the number of attempts, the overall success rate, and complications.
Results
Of 517 intubations, 312 were performed with direct laryngoscopy, 126 with a channeled video laryngoscope, and 79 with a nonchanneled laryngoscope. The mean number of attempts was 1.26, and the overall success rate was 93%. Use of the nonchanneled video laryngoscope had a higher first-pass success rate than direct or channeled laryngoscopy (92% vs. 76% and 78%, P = .006), required fewer attempts (1.09 [95% confidence interval (CI), 1.01-1.17] vs. 1.29 [95% CI, 1.23-1.35] and 1.28 [95% CI, 1.18-1.38], P < .001), and a higher overall success rate for intubation (99% vs. 90% and 95%, P = .018).
Conclusion
The use of a nonchanneled video laryngoscope provided higher first-pass success rates, fewer total attempts, and higher overall success rates.
{"title":"Comparing Air Medical Personnel Intubation Success Rates Using Direct, Channeled Video-Assisted, and Unchanneled Video-Assisted Laryngoscopy","authors":"Christopher L. Hunter MD, PhD, Linh Nguyen MD, Linda Papa MD, MSc","doi":"10.1016/j.amj.2024.08.005","DOIUrl":"10.1016/j.amj.2024.08.005","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to determine the first-pass intubation success rates of air medical providers using direct laryngoscopy, channeled blade video laryngoscopy, and nonchanneled blade video laryngoscopy.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study of the Orlando Health Air Care Team (ACT) airway quality registry over a 5-year period. The ACT had 3 approved approaches for endotracheal intubation: direct laryngoscopy, the King Vision (Ambu, Ballerup Denmark) channeled blade laryngoscope, or the C-MAC (Karl-Storz, Tuttlingen Germany) (nonchanneled) laryngoscope. The main outcome was the first-pass success rate. The secondary outcomes included the number of attempts, the overall success rate, and complications.</div></div><div><h3>Results</h3><div>Of 517 intubations, 312 were performed with direct laryngoscopy, 126 with a channeled video laryngoscope, and 79 with a nonchanneled laryngoscope. The mean number of attempts was 1.26, and the overall success rate was 93%. Use of the nonchanneled video laryngoscope had a higher first-pass success rate than direct or channeled laryngoscopy (92% vs. 76% and 78%, <em>P</em> = .006), required fewer attempts (1.09 [95% confidence interval (CI), 1.01-1.17] vs. 1.29 [95% CI, 1.23-1.35] and 1.28 [95% CI, 1.18-1.38], <em>P</em> < .001), and a higher overall success rate for intubation (99% vs. 90% and 95%, <em>P</em> = .018).</div></div><div><h3>Conclusion</h3><div>The use of a nonchanneled video laryngoscope provided higher first-pass success rates, fewer total attempts, and higher overall success rates.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 6","pages":"Pages 523-527"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758908","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}
Pub Date : 2024-11-01DOI: 10.1016/j.amj.2024.09.003
Mark D. Frank MD , Bastian Heuschild MD , Omar Abdelhafiz , Ute Lewitzka , Jörg Braun MD , Desiree Braun , Katja Petrowski MD
Objective
Typical reasons for calling the rescue helicopter are medical emergencies, such as heart disease, trauma, and neurologic emergencies. However, there are also a small number of patients with attempted or completed suicide. The aim of this article was a general analysis and evaluation of the specific circumstances of emergencies related to suicide or attempted suicide in the prehospital environment involving the rescue helicopter (helicopter emergency medical services) Christoph 38 of the DRF Stiftung Luftrettung gAG based in Dresden, Germany.
Methods
The data of all emergency interventions performed by the helicopter emergency medical services in Dresden, Germany, between January 1, 2008, and December 31, 2020, were analyzed by examining the DIVI rescue protocols and electronic data (MEDAT and HEMSDER (Convexis, Germany)) with regard to suicide-related variables. The time, methods and information about the reason, sociodemographic data, and results of medical treatment were recorded and retrospectively analyzed.
Results
There were a total of 17,754 emergencies during the study period. Of these, 277 cases (1.56%) were due to suicide. The average time for the emergency services to arrive at the scene of the emergency was 11.14 minutes. There were 52 patients with a completed suicide, 183 with a suicide attempt, and 42 patients with a suicide threat. Eleven were pronounced dead before or at the time of arrival of the emergency doctor. Of the 241 patients who were still alive when the emergency physician arrived, 101 were endotracheally intubated and mechanically ventilated, and 25 patients received cardiopulmonary resuscitation. In 19.57% of the patients, health problems were noted as the primary reason for attempted/completed suicide. In a further 12.68%, partnership problems or the loss of a partner were cited. The most common method used was an overdose (49.39%) followed by leaping from a great height (20%) and hanging (15.51%). Stab wounds and gunshot wounds were observed in 24% of the cases. The overall mortality rate was 18.77%. The method used, sex, and a suicide note were identified as possible influencing factors for the fatal outcome of a suicide.
Conclusion
The number of suicide victims is low compared with the total number of 17,754 deployments. However, the mortality rate for these missions is quite high at 18%. Although some factors and circumstances could be identified in this study, many backgrounds and explanations are still missing. Therefore, this study shows a general need for more research in regard to better prevention as well as improved education and training of emergency response teams.
{"title":"Air Rescue Missions for Suicide: A Retrospective Analysis of a 12-Year Period From a German Rescue Helicopter Base","authors":"Mark D. Frank MD , Bastian Heuschild MD , Omar Abdelhafiz , Ute Lewitzka , Jörg Braun MD , Desiree Braun , Katja Petrowski MD","doi":"10.1016/j.amj.2024.09.003","DOIUrl":"10.1016/j.amj.2024.09.003","url":null,"abstract":"<div><h3>Objective</h3><div>Typical reasons for calling the rescue helicopter are medical emergencies, such as heart disease, trauma, and neurologic emergencies. However, there are also a small number of patients with attempted or completed suicide. The aim of this article was a general analysis and evaluation of the specific circumstances of emergencies related to suicide or attempted suicide in the prehospital environment involving the rescue helicopter (helicopter emergency medical services) Christoph 38 of the DRF Stiftung Luftrettung gAG based in Dresden, Germany.</div></div><div><h3>Methods</h3><div>The data of all emergency interventions performed by the helicopter emergency medical services in Dresden, Germany, between January 1, 2008, and December 31, 2020, were analyzed by examining the DIVI rescue protocols and electronic data (MEDAT and HEMSDER (Convexis, Germany)) with regard to suicide-related variables. The time, methods and information about the reason, sociodemographic data, and results of medical treatment were recorded and retrospectively analyzed.</div></div><div><h3>Results</h3><div>There were a total of 17,754 emergencies during the study period. Of these, 277 cases (1.56%) were due to suicide. The average time for the emergency services to arrive at the scene of the emergency was 11.14 minutes. There were 52 patients with a completed suicide, 183 with a suicide attempt, and 42 patients with a suicide threat. Eleven were pronounced dead before or at the time of arrival of the emergency doctor. Of the 241 patients who were still alive when the emergency physician arrived, 101 were endotracheally intubated and mechanically ventilated, and 25 patients received cardiopulmonary resuscitation. In 19.57% of the patients, health problems were noted as the primary reason for attempted/completed suicide. In a further 12.68%, partnership problems or the loss of a partner were cited. The most common method used was an overdose (49.39%) followed by leaping from a great height (20%) and hanging (15.51%). Stab wounds and gunshot wounds were observed in 24% of the cases. The overall mortality rate was 18.77%. The method used, sex, and a suicide note were identified as possible influencing factors for the fatal outcome of a suicide.</div></div><div><h3>Conclusion</h3><div>The number of suicide victims is low compared with the total number of 17,754 deployments. However, the mortality rate for these missions is quite high at 18%. Although some factors and circumstances could be identified in this study, many backgrounds and explanations are still missing. Therefore, this study shows a general need for more research in regard to better prevention as well as improved education and training of emergency response teams.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 6","pages":"Pages 535-543"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758904","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}
Pub Date : 2024-11-01DOI: 10.1016/j.amj.2024.07.009
Gustavo Sanchez M.S. , Shantanu Gupta Ph.D. , Mary E. Johnson Ph.D.
Objective
Helicopter air ambulance (HAA) services are essential to air medical transport in the United States. However, HAA accidents, incidents, and fatalities have been a reason for concern for HAA operations. This article analyzes the numbers, proportions, contributing or causal factors, and defining events of HAA accidents in the United States from 2010 to 2021.
Methods
The National Transportation Safety Board final investigation reports, defining events, findings, and summary data were analyzed for 83 HAA accidents in the United States from 2010 to 2021. The 2 proportions test was used to compare the proportions of fatal HAA accidents between 2010-2015 and 2016-2021.
Results
The data show that 21/47 (45%) of HAA accidents in 2010-2015 and 6/36 (17%) in 2016-2021 were fatal, representing a significant (P < .01) reduction in the proportion of fatal accidents in 2016-2021 from 2010-2015 time period. VFR encounter IMC events accounted for 9/47 (19%) of HAA accidents in 2010-2015 and 1/36 (3%) accident in 2016-2021, representing a significant (P < .05) reduction in VFR encounter IMC accidents.
Conclusion
There was a statistically significant decrease in the proportion of fatal HAA accidents from 2010-2015 to 2016-2021, which may be attributable to the changes in the regulatory framework, training protocols, safety awareness initiatives, and technological advancements to address HAA safety.
{"title":"Analysis of Helicopter Air Ambulance Accidents in the United States From 2010 to 2021","authors":"Gustavo Sanchez M.S. , Shantanu Gupta Ph.D. , Mary E. Johnson Ph.D.","doi":"10.1016/j.amj.2024.07.009","DOIUrl":"10.1016/j.amj.2024.07.009","url":null,"abstract":"<div><h3>Objective</h3><div>Helicopter air ambulance (HAA) services are essential to air medical transport in the United States. However, HAA accidents, incidents, and fatalities have been a reason for concern for HAA operations. This article analyzes the numbers, proportions, contributing or causal factors, and defining events of HAA accidents in the United States from 2010 to 2021.</div></div><div><h3>Methods</h3><div>The National Transportation Safety Board final investigation reports, defining events, findings, and summary data were analyzed for 83 HAA accidents in the United States from 2010 to 2021. The 2 proportions test was used to compare the proportions of fatal HAA accidents between 2010-2015 and 2016-2021.</div></div><div><h3>Results</h3><div>The data show that 21/47 (45%) of HAA accidents in 2010-2015 and 6/36 (17%) in 2016-2021 were fatal, representing a significant (P < .01) reduction in the proportion of fatal accidents in 2016-2021 from 2010-2015 time period. VFR encounter IMC events accounted for 9/47 (19%) of HAA accidents in 2010-2015 and 1/36 (3%) accident in 2016-2021, representing a significant (P < .05) reduction in VFR encounter IMC accidents.</div></div><div><h3>Conclusion</h3><div>There was a statistically significant decrease in the proportion of fatal HAA accidents from 2010-2015 to 2016-2021, which may be attributable to the changes in the regulatory framework, training protocols, safety awareness initiatives, and technological advancements to address HAA safety.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 6","pages":"Pages 499-507"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758897","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}
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.
Methods
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.
Results
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.
Conclusion
No score demonstrated sufficient predictive ability for deterioration in transit to be used clinically.
{"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 , 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}
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.
Methods
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.
Results
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; P < .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%, P = .03). However, logistic analysis did not show significant differences (odds ratio = 1.007; 95% confidence interval, 0.987-1.016; P = .814).
Conclusion
Keyword methods for early HEMS requests may appear to reduce time to specialty care and suggest improvement of outcomes for patients with AAD.
目的急性主动脉夹层（AAD）是一种危及生命的疾病，需要快速的医疗干预。在日本，利用基于关键字的早期请求或地面紧急医疗服务的标准请求部署直升机紧急医疗服务。本研究评估了这些请求方法对患者结果的影响。方法采用2015年4月至2020年3月日本航空医学服务协会注册数据进行回顾性队列研究。本研究共分析了342例HEMS运送的AAD患者，不包括院外心脏骤停患者。患者分类基于是否使用关键字方法或在初始GEMS接触后要求HEMS。我们比较了两组的时间间隔、院前干预和包括脑功能类别在内的结果。结果与对照组相比，关键词方法组从知晓GEMS到接触HEMS的时间显著缩短(中位数分别为27分钟和33分钟；P & lt;措施)。从接触到离开现场的时间没有显著差异。患者特征、HEMS工作人员接触时的生命体征和HEMS工作人员提供的医疗干预没有统计学上的显著差异。从HEMS工作人员接触到医院到达，生命体征的变化包括呼吸频率和收缩压的显著下降。关键词方法组患者在脑功能分类方面的良好预后比例显著高于对照组（77.2% vs. 66.5%, P = 0.03）。然而，logistic分析未显示显著性差异(优势比= 1.007；95%置信区间为0.987 ~ 1.016；P = .814)。结论针对AAD患者早期HEMS请求的关键词方法可减少专科护理时间，改善预后。
{"title":"Keyword-Based Early Request for Helicopter Emergency Medical Services in Acute Aortic Dissection: A Registry-Based Study","authors":"Hiroaki Taniguchi MD, Hiroki Nagasawa MD, PhD, Tatsuro Sakai MD, Hiromichi Ohsaka MD, PhD, Kazuhiko Omori MD, PhD, 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> < .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}
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