Air Medical Journal最新文献

英文中文

Balancing Risks and Benefits of Snake Antivenom in Retrieval Medicine 在检索医学中平衡蛇毒血清的风险和收益。

Q3 Nursing

Air Medical Journal

Pub Date : 2026-03-01 Epub Date: 2025-11-22 DOI: 10.1016/j.amj.2025.10.015

Guy Hardwick MBBS , Peter Brendt FANZCA, FACEM

引用次数: 0

March-April 2026 Forum 2026年3月- 4月论坛

Q3 Nursing

Air Medical Journal

Pub Date : 2026-03-01 Epub Date: 2026-02-02 DOI: 10.1016/j.amj.2026.01.014

引用次数: 0

Patterns of Injuries in Danish Motorcyclists Requiring Air Ambulance Activation: A 5-Year Review 丹麦摩托车手需要空中救护车激活的伤害模式：一项5年回顾。

Q3 Nursing

Air Medical Journal

Pub Date : 2026-03-01 Epub Date: 2025-12-01 DOI: 10.1016/j.amj.2025.11.002

Ka Jun Cheng MBBS , Carsten Meilandt MSc , Leif Rognås PhD, MD

Objective

Powered 2-wheeler (PTW) riders are a highly vulnerable road-user group who frequently require helicopter emergency medical services (HEMS) for critical care and transport. This study aimed to describe the population of injured PTW riders attended by the Danish Air Ambulance and compare them with the wider Danish HEMS trauma population.

Methods

This was a retrospective population-based study of Danish HEMS missions from January 1, 2018, to December 31, 2023, including all primary missions involving a PTW patient. Data were collected from the Danish HEMS database on patient demographics, vehicle type, interventions performed, and destination. We also registered International Classification of Diseases, 10th edition, diagnoses and National Advisory Committee for Aeronautics (NACA) scores.

Results

A total of 228 patients (90% male) were included. The most common diagnosis was unspecified multiple injuries (49%), indicating polytrauma. Significant differences were noted between vehicle types: 58% of injured motorcyclists were involved in accidents with another vehicle, whereas 59% of scooter rider incidents were single vehicle. Notably, 67% of PTW patients were assigned a NACA score of ≥4, and 71% required at least 1 prehospital intervention. Most were transported to a major trauma center (MTC) (85% of motorcyclists vs. 76% of scooter riders). Compared with the general Danish HEMS trauma population, PTW patients had higher NACA scores, were more likely to be conveyed to MTCs, and more frequently required prehospital interventions.

Conclusion

PTW riders attended to by the Danish Air Ambulance represent a severely injured patient cohort who more frequently require advanced prehospital treatment and transport than the wider trauma population.

目的：动力两轮车（PTW）骑手是一个非常脆弱的道路使用者群体，他们经常需要直升机紧急医疗服务（HEMS）进行重症监护和运输。本研究的目的是描述受伤的PTW骑手参加丹麦空中救护，并比较他们与更广泛的丹麦HEMS创伤人群。方法：这是一项基于人群的回顾性研究，研究了2018年1月1日至2023年12月31日期间丹麦HEMS的任务，包括所有涉及PTW患者的主要任务。数据从丹麦HEMS数据库中收集，包括患者人口统计、车辆类型、实施的干预措施和目的地。我们还注册了国际疾病分类，第10版，诊断和国家航空咨询委员会（NACA）评分。结果：共纳入228例患者，其中90%为男性。最常见的诊断是未明确的多发损伤（49%），表明多发创伤。不同类型的车辆之间存在显著差异：58%的受伤的摩托车手涉及与另一辆车的事故，而59%的摩托车骑手事故涉及与一辆车的事故。值得注意的是，67%的PTW患者的NACA评分≥4,71%的患者需要至少1次院前干预。大多数人被送往一个主要的创伤中心（MTC）（85%的摩托车手对76%的摩托车手）。与普通丹麦HEMS创伤人群相比，PTW患者有更高的NACA评分，更有可能被转送到MTCs，更频繁地需要院前干预。结论：由丹麦空中救护人员参加的PTW乘客代表了一个严重受伤的患者群体，他们比更广泛的创伤人群更频繁地需要先进的院前治疗和运输。

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引用次数: 0

Simulation-Based Training to Promote Whole Blood Administration Protocol Among Critical Care Transport of Trauma Patients 以模拟为基础的训练促进全血给药方案在创伤病人重症监护转运中的应用。

Q3 Nursing

Air Medical Journal

Pub Date : 2026-03-01 Epub Date: 2025-11-25 DOI: 10.1016/j.amj.2025.10.013

Olivia C. Newbern DNP, CRNA , Julee Waldrop DNP, FNP, PNP, CNE, EBP-C , Michele Kuszajewski DNP, RN, CHSE , Virginia C. Simmons DNP, CRNA, CHSE-A, ANEF, FAANA, FAAN

Objective

Trauma patients often present to emergency departments with coagulopathies. Recognizing the unique challenges of caring for trauma patients and the urgent need for protocol-driven resuscitation is essential.

Methods

This project used a practice evaluation design that incorporated simulation-based learning (SBL) to educate critical care transport team (CCTT) providers on the existing whole blood administration protocol (WBAP), aiming to enhance protocol adherence and staff preparedness.

Results

Most participants (77%) successfully adhered to all critical decision points, indicating notable improvements in adherence. Participants reported increased confidence, knowledge, and preparedness following SBL, each with a mean of 2.9 and a median of 3.0, where 1 = do not agree, 2 = somewhat agree, and 3 = strongly agree. Simulation reinforced critical decision-making (mean 3.0) and procedural skills (mean 2.9), aligning with established best practices.

Conclusion

SBL improved trauma care training, reinforced critical decision-making, and strengthened procedural skills among CCTT providers. Further research is needed to assess multiple aspects of the WBAP during critical care transport missions and the long-term sustainability of educational interventions. Ongoing training, policy enhancements, and continued whole blood use in CCTT care may contribute to improved outcomes for trauma patients.

目的：创伤患者经常出现凝血功能障碍的急诊科。认识到照顾创伤患者的独特挑战和迫切需要的方案驱动的复苏是必不可少的。方法：本项目采用结合模拟学习（SBL）的实践评估设计，对危重病转运团队（CCTT）提供者进行现有全血给药协议（WBAP）的教育，旨在提高协议的依从性和工作人员的准备程度。结果：大多数参与者（77%）成功地坚持了所有关键决策点，表明依从性显着改善。参与者报告在SBL之后增加了信心，知识和准备，每个平均值为2.9，中位数为3.0，其中1 =不同意，2 =有些同意，3 =非常同意。模拟强化了关键决策（平均3.0）和程序技能（平均2.9），与已建立的最佳实践保持一致。结论：SBL改善了CCTT提供者的创伤护理培训，强化了关键决策，增强了程序技能。需要进一步的研究来评估重症监护运输任务中WBAP的多个方面和教育干预的长期可持续性。持续的培训，政策的加强，以及在CCTT护理中继续使用全血可能有助于改善创伤患者的预后。

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引用次数: 0

Air Transport Medicine From the Field 航空运输医学从外地。

Q3 Nursing

Air Medical Journal

Pub Date : 2026-03-01 Epub Date: 2026-01-28 DOI: 10.1016/j.amj.2025.12.002

Benjamin Miller MD, Jay Zhang MD, Christian Martin-Gill MD, MPH, Frank Guyette MD, MPH, Dylan Morris MD, Leonard Weiss MD, James Price MBBS, Ed B.G. Barnard PhD

引用次数: 0

General Information 一般信息

Q3 Nursing

Air Medical Journal

Pub Date : 2026-03-01 Epub Date: 2026-02-20 DOI: 10.1016/S1067-991X(26)00040-4

引用次数: 0

Postintubation Hemodynamic Collapse in Traumatically Injured Critical Care Transport Patients: A Retrospective Cohort Study 创伤性重症监护转运患者插管后血流动力学崩溃：一项回顾性队列研究。

Q3 Nursing

Air Medical Journal

Pub Date : 2026-03-01 Epub Date: 2025-11-17 DOI: 10.1016/j.amj.2025.10.007

Kalle J. Fjeld MD , Jacob M. Markwood MD , Abby L. Blake DO , Alissa M. Bates MD , Alyson M. Esteves PharmD, BCPS, BCCCP , Matthew A. Roginski MD, MPH

Background

Endotracheal intubation of trauma patients incurs risks including post-intubation hemodynamic collapse. Trauma patients are at increased risk of secondary harm related to hypotension. The aim of this study was to describe post-intubation hemodynamic collapse in traumatically injured CCT patients and investigate associations with in-hospital outcomes.

Methods

Retrospective chart review of trauma patients ≥18 years admitted to a rural level one trauma center who were transported and intubated by the hospital-based CCT service between January 2017 and June 2024. Hemodynamic collapse was defined as cardiac arrest, systolic blood pressure (SBP) <65 mmHg at least once, SBP <90 mmHg for greater than 30 minutes, new vasopressor requirement, vasopressor dose increase, or fluid bolus of >15 mL/kg to maintain SBP. The primary outcome was the incidence of hemodynamic collapse. Secondary outcomes were identification of potentially modifiable patient risk factors and in-hospital outcomes including length of stay and mortality.

Results

One hundred forty-two trauma patients were included. Thirty-five (24.6%) patients experienced hemodynamic collapse and 2 (5.7%) had cardiac arrest. When controlled for ISS, patients with pre-intubation blood administration (OR 5.89, 95% CI 1.8-19.31), pre-intubation vasopressors (OR 11.21, CI 2.02-62.25), and first systolic blood pressure <90 mmHg (OR 7.66, CI 1.18-49.74) had higher odds of hemodynamic collapse after intubation. The median shock index and injury severity scores (ISS) were also higher: 1.07 (0.71-1.38) versus 0.68 (0.53-0.84) and 36 (14-43) versus 24 (17-34), respectively (p <0.05). When controlled for ISS there was no significant difference in hospital mortality (OR 1.78, 95% CI 0.73-4.36).

Conclusion

Post-intubation hemodynamic collapse occurred in 1 in 4 patients in this cohort of traumatically injured patients. Patients with post-intubation hemodynamic collapse were more likely to have received blood, fluids, and vasopressors and they had higher ISS and in-hospital mortality. The risks and benefits of a definitive airway for these patients must be carefully weighed.

背景：创伤患者气管插管存在包括插管后血流动力学衰竭在内的风险。创伤患者与低血压相关的二次伤害风险增加。本研究的目的是描述创伤性CCT患者插管后血流动力学崩溃，并调查其与院内预后的关系。方法：回顾性分析2017年1月至2024年6月在某农村一级创伤中心接受医院CCT服务转运和插管的≥18岁的创伤患者。血流动力学塌陷定义为心脏骤停，收缩压（SBP） 15 mL/kg维持收缩压。主要终点是血流动力学衰竭的发生率。次要结局是确定潜在可改变的患者危险因素和住院结局，包括住院时间和死亡率。结果：纳入创伤患者142例。35例（24.6%）发生血流动力学衰竭，2例（5.7%）发生心脏骤停。当控制ISS时，插管前给血（OR 5.89, 95% CI 1.8-19.31）、插管前血管加压药（OR 11.21, CI 2.02-62.25）和首次收缩压的患者。结论：在这组创伤性损伤患者中，每4例患者中就有1例发生插管后血流动力学塌陷。插管后血流动力学衰竭的患者更有可能接受血液、液体和血管加压药物治疗，他们的ISS和住院死亡率更高。对于这些患者，必须仔细权衡最终气道的风险和益处。

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引用次数: 0

A Simulation-Based, Qualitative Assessment of Decision Making Among Critical Care Transport Crews 基于模拟的重症监护运输人员决策的定性评估。

Q3 Nursing

Air Medical Journal

Pub Date : 2026-03-01 Epub Date: 2025-11-24 DOI: 10.1016/j.amj.2025.10.010

Daniel Johnson DO , Heather Costigan MPH , Candace Bordner MS , Avram Flamm DO , Lauren Van Scoy MD

Objective

The breadth and complexity of care in the out-of-hospital environment are increasing. The clinical decision-making process of emergency medical services clinicians is not well understood.

Methods

This study aimed to analyze the process of critical care transport clinicians using simulated scenarios with structured debriefing. Members of a critical care transport team completed a simulation session during which they cared for a medical or trauma patient with airway management concerns. A standardized debriefing exploring their decision-making process was performed after the simulation session, recorded, and transcribed. Thematic analysis was performed to uncover themes related to the clinical decision making that took place.

Results

A total of 8 subjects (5 nurses and 3 paramedics) completed simulation sessions including 5 medical and 3 trauma scenarios. The median years of experience in critical care transport was 15. The following 3 themes emerged from the quantitative analysis: (1) participants felt that the scenarios were realistic and applicable to their daily practice, (2) participants felt that the scenarios required them to think critically, and (3) participants relied on established protocols combined with experience for their clinical decision making.

Conclusion

During the simulated care of complex patients with airway management concerns, critical care transport clinicians made complex decisions by using a combination of standing protocols, experience, and foundational knowledge.

目的：院外护理的广度和复杂性日益增加。急诊医疗服务临床医生的临床决策过程尚不清楚。方法：本研究旨在利用结构化述职的模拟情景分析重症监护转运临床医生的流程。重症监护运输小组的成员完成了一个模拟会议，在此期间，他们照顾了一位有气道管理问题的医疗或创伤患者。在模拟会议结束后，对他们的决策过程进行了标准化的汇报，并进行了记录和转录。进行主题分析以揭示与发生的临床决策相关的主题。结果：共有8名受试者（5名护士和3名护理人员）完成了5个医疗场景和3个创伤场景的模拟。重症监护运输经验的中位数为15年。从定量分析中得出以下3个主题：(1)参与者认为场景是现实的，适用于他们的日常实践；(2)参与者认为场景需要他们批判性地思考；(3)参与者依靠既定的方案结合经验进行临床决策。结论：在气道管理问题复杂患者的模拟护理中，重症监护转运临床医生通过综合使用常规方案、经验和基础知识做出复杂的决策。

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引用次数: 0

Association Between Prehospital Blood Transfusion in Helicopter Emergency Medical Services and Survival: A Retrospective Population-Based Cohort Study 直升机紧急医疗服务院前输血与生存之间的关系：一项基于人群的回顾性队列研究

Q3 Nursing

Air Medical Journal

Pub Date : 2026-03-01 Epub Date: 2025-12-09 DOI: 10.1016/j.amj.2025.11.003

Naoya Miura MD, MPH, PhD, Asuka Tsuchiya MD, MPH, PhD, Motohiro Matsumoto MD, Hiromichi Aoki MD, Seiji Morita MD, PhD

Objective

Critical hemorrhage is a life-threatening condition in which blood transfusion is an essential lifesaving intervention. Although the importance of prehospital blood transfusion is increasingly recognized, its effectiveness remains unclear, particularly in Asian health care settings. This study aimed to characterize patients receiving prehospital blood transfusion through helicopter emergency medical services (HEMS) and evaluate their association with survival outcomes in a Japanese population-based cohort.

Methods

We conducted a retrospective evaluation of data from the Japanese Society for Aeromedical Services Registry from April 2020 to March 2023. This study included adult patients transported by physician-staffed HEMS. Propensity score matching (1:4) was used to adjust for confounding factors. The primary outcome measure was patient survival until hospital discharge.

Results

Among the 24,776 patients, 71 (0.3%) received prehospital blood transfusions using type O packed red blood cells. Transfusion recipients had lower systolic blood pressures (83 mm Hg vs. 138 mm Hg; P < .001) and higher rates of external causes of injury (80.3% vs. 51.1%; P < .001) than did those who did not receive a transfusion. After propensity score matching (N = 230), prehospital transfusion was associated with improved survival (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.05–4.18). The results of the trauma subgroup analysis showed no statistically significant association (OR, 1.88; 95% CI, 0.80–4.40).

Conclusion

In Japan’s physician-staffed HEMS, prehospital blood transfusion was appropriately provided to patients with hemorrhagic shock and, after adjustment for confounding factors, was associated with improved survival. These findings provide evidence supporting the potential benefits of prehospital blood transfusion in appropriately selected patients within physician-staffed air medical systems.

目的：危重出血是一种危及生命的疾病，输血是一种必要的救生干预措施。虽然院前输血的重要性日益得到承认，但其有效性仍不清楚，特别是在亚洲卫生保健机构。本研究旨在描述通过直升机紧急医疗服务（HEMS）接受院前输血的患者的特征，并评估其与日本人群为基础的队列生存结果的关系。方法：对2020年4月至2023年3月日本航空医疗服务协会登记的数据进行回顾性评估。本研究包括由医生管理的HEMS运送的成年患者。倾向得分匹配（1:4）用于调整混杂因素。主要结局指标是患者在出院前的生存。结果：24776例患者中，71例（0.3%）患者院前输血为O型红细胞。与未接受输血的患者相比，接受输血的患者收缩压较低（83 mm Hg vs 138 mm Hg; P < 0.001），外因损伤发生率较高（80.3% vs 51.1%; P < 0.001）。经倾向评分匹配（N = 230），院前输血与生存率提高相关（优势比[OR]， 2.09； 95%可信区间[CI]， 1.05-4.18）。创伤亚组分析结果显示无统计学意义的相关性（OR, 1.88; 95% CI, 0.80-4.40）。结论：在日本由医生管理的HEMS中，院前输血对失血性休克患者是适当的，并且在调整混杂因素后，与生存率的提高有关。这些发现提供了证据，支持在配备医生的空中医疗系统中对适当选择的患者进行院前输血的潜在益处。

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引用次数: 0

Interhospital Transport Characteristics for Neonates With Congenital Diaphragmatic Hernia 新生儿先天性膈疝的院间转运特征。

Q3 Nursing

Air Medical Journal

Pub Date : 2026-03-01 Epub Date: 2026-01-28 DOI: 10.1016/j.amj.2025.12.001

Katrin C. Lichtsinn MD, MS , Daniel A. Enquobahrie MD, MPH, PhD , John Feltner MS , Aditya Goparaju , Megan M. Gray MD , Sandy Johng MD , Mihai Puia-Dumitrescu MD, MPH , Rebecca Stark MD , Rachel Umoren MBBCh, MS , Zeenia C. Billimoria MD

Objective

Congenital diaphragmatic hernia (CDH) occurs when a diaphragmatic defect develops in utero, allowing herniation of the abdominal contents into the chest cavity. As a result, many neonates with CDH are critically ill after birth owing to varying degrees of pulmonary hypoplasia, respiratory failure, pulmonary hypertension, and cardiac dysfunction. Neonates with CDH require surgical repair of the diaphragmatic defect, and those who are not born at a center with the ability to perform pediatric surgery must be transferred to one shortly after birth. Our objective was to describe transport characteristics and vital sign variability for neonates with CDH transferred after delivery.

Methods

This was a retrospective observational analysis of 51 neonates with prenatally diagnosed CDH born at a single delivery hospital between March 2020 and March 2024 and transported to a single tertiary referral neonatal intensive care unit. Descriptive statistics were used to compare groups by CDH severity.

Results

Neonates with severe CDH were transported more rapidly than those with mild or moderate CDH. During transport, more neonates with severe disease received inhaled nitric oxide, but other transport interventions were not significantly different between the groups. All neonates experienced at least 1 abnormal vital sign. A higher proportion of neonates with severe CDH had low oxygen saturation values compared with those with milder disease.

Conclusion

Vital sign abnormalities were universally common during transport, highlighting the physiologic instability of neonates with CDH. Understanding these transport variables will aid provider teams in decision making for these critically ill neonates.

目的：先天性膈疝（CDH）发生于子宫内膈缺损，导致腹部内容物疝入胸腔。因此，许多患有CDH的新生儿在出生后因不同程度的肺发育不全、呼吸衰竭、肺动脉高压和心功能障碍而病情危重。患有CDH的新生儿需要手术修复膈缺损，而那些不是出生在有能力进行儿科手术的中心的新生儿必须在出生后不久转移到一个中心。我们的目的是描述转运特征和新生儿的生命体征变异性转移的CDH分娩后。方法：回顾性观察分析了51名产前诊断为CDH的新生儿，这些新生儿于2020年3月至2024年3月在一家分娩医院出生，并被送往一家三级转诊新生儿重症监护病房。描述性统计采用CDH严重程度组间比较。结果：重度CDH患儿转运速度快于轻、中度CDH患儿。在运输过程中，吸入一氧化氮的重症新生儿较多，但其他运输干预措施组间无显著差异。所有新生儿均出现至少1项生命体征异常。重症CDH新生儿低氧饱和度的比例高于病情较轻的新生儿。结论：转运过程中生命体征异常普遍存在，突出了新生儿CDH的生理不稳定性。了解这些运输变量将有助于提供者团队为这些危重新生儿做出决策。

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