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Can the MIRACLE2 Score Be Used in the Prehospital Environment and Is It Useful? An Observational Study MIRACLE2 评分可用于院前环境吗?观察研究
Q3 Nursing Pub Date : 2024-03-01 DOI: 10.1016/j.amj.2023.11.008
Sarah Morton MBBS, FRCA, FICM , Chris Gough BMBS, FRCEM

Objective

The MIRACLE2 score has been developed for use in a primary percutaneous coronary intervention center. It is unclear if it is feasible in the helicopter emergency medical service (HEMS) setting.

Methods

The computerized system at 1 UK HEMS was interrogated between December 1, 2020, and May 1, 2022, for the components of the MIRACLE2 score (recorded contemporaneously) plus demographics and outcomes in all post–return of spontaneous circulation patients conveyed to the hospital. pH was excluded because of no point-of-care testing resulting in a modified MIRACLE2 score (maximum score of 9). Data were analyzed using the chi-square test; P < .05 was statistically significant.

Results

Three hundred thirty patients (240 males) with out-of-hospital cardiac arrests were reviewed. Ninety-two adult patients with nontraumatic out-of-hospital cardiac arrests had sustained return of spontaneous circulation and a median MIRACLE2 score of 4 (range, 0-7). Forty-seven patients died before hospital discharge; the median MIRACLE2 score was higher in those who died (4) than those who survived (1.5, P < .01); 90.3% of those with a score ≥ 5 were triaged to an emergency department rather than directly to a catheterization laboratory.

Conclusion

A modified MIRACLE2 score can be calculated in the HEMS setting. The benefit of point-of-care testing pH requires investigation. There may be a benefit in predicting outcomes in this nondifferentiated group, but additional research is required.

目的 MIRACLE2 评分是为经皮冠状动脉介入治疗中心开发的。方法 在 2020 年 12 月 1 日至 2022 年 5 月 1 日期间,对英国 1 家直升机紧急医疗服务机构的计算机系统进行了调查,以了解 MIRACLE2 评分的组成部分(实时记录)以及所有转运至医院的自发循环恢复后患者的人口统计学特征和结果。采用卡方检验对数据进行分析;P <.05具有统计学意义。结果对330名院外心脏骤停患者(240名男性)进行了复查。92名非创伤性院外心脏骤停的成年患者持续恢复了自主循环,MIRACLE2评分中位数为4(范围0-7)。47名患者在出院前死亡;死亡患者的中位 MIRACLE2 评分(4)高于存活患者(1.5,P <.01);评分≥5 的患者中有 90.3% 被分流到急诊科,而不是直接送到导管室。需要研究床旁检测 pH 值的益处。在预测未分化人群的预后方面可能有好处,但还需要进一步研究。
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引用次数: 0
Simple Yet Effective—Sterile Water Injections to Treat Labor Pain in the Transport Environment 简单而有效--在运输环境中用消毒水注射治疗分娩疼痛
Q3 Nursing Pub Date : 2024-03-01 DOI: 10.1016/j.amj.2023.12.004
Fabian Schuelke BSc, Peter Brendt FANZCA, DESA, EDIC, FACEM

Sterile water injections (SWI) is a nonpharmacologic pain relief option to treat back pain in labor. This case report describes and discusses the use of SWI in the context of an obstetric retrieval of a 29-year-old woman who was transferred by the Royal Flying Doctor Service South Eastern Section. It provides an overview of SWI, discusses the relevance for medical transport, and offers suggestions for medical transport professionals.

无菌水注射(SWI)是一种治疗分娩背痛的非药物止痛方法。本病例报告描述并讨论了在皇家飞行医生服务队东南分队转运的一名 29 岁产妇的产科抢救中使用 SWI 的情况。报告概述了 SWI,讨论了其与医疗转运的相关性,并为医疗转运专业人员提供了建议。
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引用次数: 0
Hypothermic Cardiac Arrest: A Case Report of an Unexpected Survivor Using Air Medical Transportation in Nepal 低温性心脏骤停:尼泊尔使用空中医疗运送意外生还者的病例报告
Q3 Nursing Pub Date : 2024-03-01 DOI: 10.1016/j.amj.2023.11.011
Ashim Subedi MD , Kishor Khanal MD , Ashim Regmi MD , Sagarika Panday MBBS , Rupesh Yadav MBBS , Pritina Nakarmi MBBS , Enish Shrestha MBBS , Prashanti Prasai MBBS , Ryan McHenry MBChB , Sanjaya Karki MD

This is a case of a 34-year-old man surviving hypothermic cardiac arrest with excellent neurologic recovery in Nepal. After 3 days without communication at an altitude of approximately 6,000 m, the patient was located in a crevasse and retrieved by a helicopter-supported search and rescue team. At first contact, he was reported to be breathing and shivering with appropriate pupillary response. The patient was then flown to a local teaching hospital where he was assessed on arrival and found to be in cardiac arrest with absence of spontaneous breathing and a central pulse and bilaterally fixed and dilated pupils. An electrocardiogram demonstrated asystole, and his core temperature was unrecordably low on the available device. After resuscitation and return of spontaneous circulation, the patient received a secondary helicopter transfer to a major hospital in the capital, Kathmandu, where his recovery continued. The report discusses the physiological basis of the relatively favorable outcomes observed in hypothermic cardiac arrest and highlights the operations and capability of helicopter emergency medical services in a country on the United Nations list of least developed nations.

这是在尼泊尔发生的一例 34 岁男子低体温心脏骤停存活且神经系统恢复良好的病例。在海拔约 6,000 米的地方,病人在失去联系 3 天后被发现在一个裂缝中,由直升机支持的搜救队将其救出。首次接触时,据报告他有呼吸和颤抖,瞳孔有适当的反应。病人随后被送往当地的一家教学医院,到达医院后对其进行了评估,发现他心跳停止,没有自主呼吸和中心脉搏,双侧瞳孔固定并放大。心电图显示心跳骤停,现有设备无法记录其核心体温过低。经过抢救,患者恢复了自主循环,随后由直升机转送至首都加德满都的一家大医院,并在那里继续康复。报告讨论了在低体温心脏骤停中观察到的相对有利结果的生理基础,并强调了直升机紧急医疗服务在联合国最不发达国家名单上的一个国家的运作和能力。
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引用次数: 0
March-April 2024 Forum 2024 年 3-4 月论坛
Q3 Nursing Pub Date : 2024-03-01 DOI: 10.1016/j.amj.2024.01.008
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引用次数: 0
Applications of Artificial Intelligence in Helicopter Emergency Medical Services: A Scoping Review 人工智能在直升机紧急医疗服务中的应用:范围审查
Q3 Nursing Pub Date : 2024-03-01 DOI: 10.1016/j.amj.2023.11.012
Jennifer Hsueh MD , Christie Fritz MD , Caroline E. Thomas , Andrew P. Reimer PhD , Andrew T. Reisner MD , David Schoenfeld MD , Adrian Haimovich MD , Stephen H. Thomas MD

Objective

Recent systematic reviews of acute care medicine applications of artificial intelligence (AI) have focused on hospital and general prehospital uses. The purpose of this scoping review was to identify and describe the literature on AI use with a focus on applications in helicopter emergency medical services (HEMS).

Methods

A literature search was performed with specific inclusion and exclusion criteria. Articles were grouped by characteristics such as publication year and general subject matter with categoric and temporal trend analyses.

Results

We identified 21 records focused on the use of AI in HEMS. These applications included both clinical and triage uses and nonclinical uses. The earliest study appeared in 2006, but over one third of the identified studies have been published in 2021 or later. The passage of time has seen an increased likelihood of HEMS AI studies focusing on nonclinical issues; for each year, the likelihood of a nonclinical focus had an odds ratio of 1.3.

Conclusion

This scoping review provides overview and hypothesis-generating information regarding AI applications specific to HEMS. HEMS AI may be ultimately deployed in nonclinical arenas as much as or more than for clinical decision support. Future studies will inform future decisions as to how AI may improve HEMS systems design, asset deployment, and clinical care.

目的近期对人工智能(AI)在急诊医学中应用的系统性综述主要集中在医院和普通院前应用方面。本范围综述的目的是识别和描述有关人工智能应用的文献,重点是直升机紧急医疗服务(HEMS)中的应用。根据发表年份和一般主题等特征对文章进行分组,并进行分类和时间趋势分析。这些应用包括临床和分流用途以及非临床用途。最早的研究发表于 2006 年,但超过三分之一的研究发表于 2021 年或之后。随着时间的推移,HEMS 人工智能研究关注非临床问题的可能性越来越大;每过一年,关注非临床问题的可能性的几率比为 1.3。HEMS 人工智能最终在非临床领域的应用可能与临床决策支持一样多,甚至更多。未来的研究将为人工智能如何改进 HEMS 系统设计、资产部署和临床护理提供决策依据。
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引用次数: 0
Use of Fixed Wing Modified Scene Air Ambulance Responses for Injured Patients in Northern Ontario: A Pilot Study 在安大略省北部对受伤病人使用固定翼改装现场空中救护:试点研究
Q3 Nursing Pub Date : 2024-03-01 DOI: 10.1016/j.amj.2023.12.008
Nicole Willis MClSc , Karla Gagnon , Kealin Wong MD , Melissa McGowan MHK , Brodie Nolan MD, MSc

Objective

Timely access to a lead trauma hospital (LTH) saves lives; however, the vast geography of Northern Ontario creates a barrier to equitable access to an LTH. Paramedics in Ontario follow the field trauma triage standard (FTTS) to identify which patients should be directly brought to an LTH. A pilot project was launched using a fixed wing modified scene response (MSR) to transport patients from Northern Ontario who met the FTTS directly to an LTH. This study aimed to 1) explore the impact of the fixed wing MSR pilot program on the time to LTH arrival for injured patients in Northern Ontario compared with the traditional interfacility transfer (IFT) process and 2) determine the frequency and specific FTTS criteria that were fulfilled.

Methods

This was a retrospective cohort study of injured patients in Northern Ontario who were emergently transported to an LTH by the provincial air ambulance service between January 2016 and October 2021. Electronic patient care records were manually reviewed, and patient cases were grouped by their sending and receiving facilities to evaluate time differences between MSR and IFT.

Results

For same-distance transports, the average time from injury to trauma center arrival was reduced with MSR (292.8 minutes) compared with IFT (507.8 minutes), with a mean difference of 130.3 minutes. All MSR cases and 90% of IFT cases met at least 1 FTTS criterion.

Conclusion

Fixed wing MSR improves access to timely definitive care for injured patients in Northern Ontario, and all patients transported in this pilot project met the trauma bypass criteria.

目标及时前往创伤急救医院(LTH)可以挽救生命;然而,安大略省北部广阔的地理位置给公平前往创伤急救医院造成了障碍。安大略省的辅助医务人员遵循现场创伤分流标准(FTTS),以确定哪些病人应直接送往重症监护医院。安大略省启动了一个试点项目,使用固定翼改装现场响应(MSR)将安大略省北部符合现场创伤分流标准的病人直接送往长住区。本研究旨在:1)与传统的设施间转运(IFT)流程相比,探索固定翼MSR试点项目对安大略省北部受伤患者到达长距离医疗救护站时间的影响;2)确定满足FTTS标准的频率和具体标准。方法这是一项回顾性队列研究,研究对象是2016年1月至2021年10月期间由省级空中救护服务紧急送往长距离医疗救护站的安大略省北部受伤患者。研究人员对患者的电子护理记录进行了人工审核,并根据患者的发送和接收设施对患者病例进行了分组,以评估MSR和IFT之间的时间差异。结果对于相同距离的转运,MSR(292.8分钟)与IFT(507.8分钟)相比,从受伤到到达创伤中心的平均时间缩短了,平均差异为130.3分钟。所有 MSR 病例和 90% 的 IFT 病例均符合至少一项 FTTS 标准。
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引用次数: 0
There Is No Evidence to Support the Use of Video Laryngoscopes Without a Stylet in the Prehospital Setting 没有证据支持在院前环境中使用不带插针的视频喉镜
Q3 Nursing Pub Date : 2024-03-01 DOI: 10.1016/j.amj.2023.09.006
Avram Flamm DO, EMT-P, FACEP, FAEMS, Olivia Waldron BS
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引用次数: 0
Validation of Air Medical Prehospital Triage Score in Determining Resource Utilization at Level 1 Trauma Centers 验证空中医疗院前分诊评分以确定一级创伤中心的资源利用情况
Q3 Nursing Pub Date : 2024-03-01 DOI: 10.1016/j.amj.2023.10.001
CPT Tyler Webb MD , Josh Burton MSN, RN , M. Chance Spalding DO, PhD , Howard A. Werman MD

Objective

Overtriage (ie, delivering less severely injured patients via helicopter) is costly, raises safety concerns, and reduces efficiency of the trauma system. The Air Medical Prehospital Triage (AMPT) scoring system was developed to determine which trauma patients would gain a survival benefit by air transport. The objective of this study was to evaluate the AMPT scoring system as a method of reducing trauma overtriage when helicopter emergency medical services were used.

Methods

A retrospective study of all scene trauma transports delivered by helicopter to 1 of 2 level 1 trauma centers was evaluated for 1) hospital stay less than 1 day and 2) failure to meet 1 of the following criteria for resource utilization: intensive care unit admission, an operative procedure within the first 24 hours, the need for blood products, Injury Severity Score ≥ 16, or death during hospitalization. Helicopter emergency medical services personnel recorded specific criteria from the Centers for Disease Control and Prevention (CDC) field trauma triage guidelines and AMPT that were met by transported trauma patients.

Results

There were 244 patients in the study population. Eighty-one (33.2%) patients were discharged within 24 hours; 11 (13.5%) of these patients were positive using AMPT scoring, whereas 44 (54.3%) patients met 1 of the CDC criteria. Similarly, 141 (57.8%) patients failed to meet 1 of the level 1 resource criteria; 19 (13.5%) met the AMPT criteria for air medical transport, whereas 84 (59.6%) met 1 of the CDC criteria. Undertriage was 63.5% for AMPT and 20.2% for CDC based on resource utilization criteria.

Conclusion

The AMPT score reduced the number of patients who were inappropriately transported to a trauma center. However, this appeared to be at the expense of undertriage. Future studies should focus on developing a refined air medical–specific triage tool that has both low overtriage rates as well as lower undertriage rates.

目标空中转运(即通过直升机运送伤势较轻的患者)成本高昂,引起安全问题,并降低创伤系统的效率。空中医疗院前分诊(AMPT)评分系统的开发是为了确定哪些创伤患者可以通过空中转运获得生存。本研究的目的是评估 AMPT 评分系统作为使用直升机急救医疗服务时减少创伤过度转运的一种方法。方法对所有由直升机运送到 2 个一级创伤中心中的 1 个中心的现场创伤转运进行回顾性研究,评估 1) 住院时间少于 1 天;2) 未达到以下资源利用标准之一:入住重症监护室、在最初 24 小时内进行手术、需要血制品、损伤严重程度评分≥ 16 或在住院期间死亡。直升机紧急医疗服务人员记录了符合疾病控制和预防中心(CDC)现场创伤分诊指南和 AMPT 的具体标准的转运创伤患者。81名(33.2%)患者在24小时内出院;其中11名(13.5%)患者的AMPT评分呈阳性,44名(54.3%)患者符合疾病预防控制中心的一项标准。同样,141 名(57.8%)患者未达到 1 级资源标准中的 1 项;19 名(13.5%)患者达到了空中医疗转运的 AMPT 标准,而 84 名(59.6%)患者达到了 CDC 标准中的 1 项。根据资源利用标准,AMPT 的低分率为 63.5%,CDC 的低分率为 20.2%。然而,这似乎是以减少转运为代价的。未来的研究应侧重于开发一种既能降低过度转运率又能降低过度转运率的改进型空中医疗专用分诊工具。
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引用次数: 0
Vibratory Impact of 3 Different Ambulance Suspension Systems on the Simulated Neonate and Health Care Provider During Normal Driving Conditions 正常驾驶条件下 3 种不同救护车悬挂系统对模拟新生儿和医护人员的振动影响
Q3 Nursing Pub Date : 2024-03-01 DOI: 10.1016/j.amj.2023.11.006
Trevor Pier MS , Justin S. Misuraca MS, RRT-NPS, RRT-ACCS, C-NPT , Maria J. Mandt MD

Objective

Patients and health care providers experience varying degrees of vibration during interfacility ground transport. The impact of vibration on term and preterm neonates may result in physiologic instability and increased risk of intracranial hemorrhage, whereas the impact on health care providers has been shown to include an increase in perceived and physiologic stress levels and may contribute to chronic back and neck pain. This study aimed to evaluate 3 common ambulance suspension systems and the corresponding vibratory impact produced during typical interfacility driving conditions on adult caregiver and neonatal patient mannequins.

Methods

Type 3 ambulances with air, liquid, and traditional suspensions were evaluated using various driving tests to simulate typical road conditions. Vibrations were measured using triaxial accelerometers placed on the chassis, upon the head of a seated caregiver mannequin in the ambulance bench seat, and the head of a neonatal mannequin supine and secured in an isolette. Data analysis included the average vibration frequency, root mean square values, and maximum vibration amplitudes.

Results

The results showed that the supine neonatal mannequin experienced the highest vibration frequency and amplitude in the vertical (x) direction, whereas the adult caregiver mannequin experienced higher vibration frequencies in both parallel (y) and lateral (z) directions and the highest vibration amplitude in the y direction. The liquid suspension system consistently demonstrated the lowest vibration levels in all driving conditions and directions, whereas traditional suspension had the highest values.

Conclusion

This study provides important insights into the vibrations incurred by simulated neonatal patients and health care providers during ambulance transport. The directional vibration frequency and amplitude differ between a neonatal mannequin and an adult mannequin when placed in typical positions with typical restraints during varied ambulance driving conditions. In all directional movements and driving conditions, a liquid suspension system decreases vibration frequency and amplitude more than air or traditional systems. The live patient and caregiver impact of these results should be further investigated.

目标在医院间地面转运过程中,患者和医疗服务提供者会经历不同程度的振动。振动对足月儿和早产儿的影响可能会导致生理不稳定和颅内出血风险增加,而对医护人员的影响已被证明包括感知和生理压力水平的增加,并可能导致慢性背部和颈部疼痛。本研究旨在评估 3 种常见的救护车悬挂系统以及在典型的机构间驾驶条件下对成人护理人员和新生儿患者人体模型产生的相应振动影响。使用放置在底盘上的三轴加速度计、救护车长椅上坐着的护理人员人体模型的头部以及仰卧并固定在等压床上的新生儿人体模型的头部测量振动。数据分析包括平均振动频率、均方根值和最大振动振幅。结果表明,仰卧的新生儿人体模型在垂直(x)方向的振动频率和振幅最大,而成年护理人员人体模型在平行(y)和横向(z)方向的振动频率较高,在 y 方向的振动振幅最大。液体悬挂系统在所有行驶条件和方向上的振动水平始终最低,而传统悬挂系统的振动值最高。在不同的救护车驾驶条件下,将新生儿人体模型和成人人体模型放置在典型位置并使用典型约束装置时,其方向振动频率和振幅均有所不同。在所有方向的运动和驾驶条件下,液体悬挂系统比空气悬挂系统或传统系统更能降低振动频率和振幅。应进一步研究这些结果对病人和护理人员的影响。
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引用次数: 0
General Information 一般信息
Q3 Nursing Pub Date : 2024-03-01 DOI: 10.1016/S1067-991X(24)00028-2
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引用次数: 0
期刊
Air Medical Journal
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