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Comparing Air Medical Personnel Intubation Success Rates Using Direct, Channeled Video-Assisted, and Unchanneled Video-Assisted Laryngoscopy 比较空气医务人员使用直接、通道视频辅助和非通道视频辅助喉镜插管的成功率
Q3 Nursing Pub Date : 2024-11-01 DOI: 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.
目的探讨空气医务人员使用直接喉镜、通道式叶片视频喉镜和非通道式叶片视频喉镜进行首次插管的成功率。方法:本研究是对奥兰多健康空气护理小组(ACT)气道质量注册表进行的为期5年的回顾性队列研究。ACT有3种批准的气管插管入路:直接喉镜,King Vision (Ambu, Ballerup Denmark)通道刀片喉镜,或C-MAC (Karl-Storz, Tuttlingen Germany)(非通道)喉镜。主要的结果是一次通过率。次要结果包括手术次数、总成功率和并发症。结果517例插管中,直接喉镜312例,通道视频喉镜126例,非通道喉镜79例。平均尝试次数为1.26次,总成功率为93%。使用非通道视频喉镜比直接喉镜或通道喉镜有更高的一次通过成功率(92%比76%和78%,P = 0.006),需要更少的尝试(1.09[95%置信区间(CI), 1.01-1.17]比1.29 [95% CI, 1.23-1.35]和1.28 [95% CI, 1.18-1.38], P <;.001),插管总成功率更高(99% vs. 90%和95%,P = .018)。结论使用无通道视频喉镜具有较高的一次通过率、较少的总尝试次数和较高的总成功率。
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引用次数: 0
Air Rescue Missions for Suicide: A Retrospective Analysis of a 12-Year Period From a German Rescue Helicopter Base 自杀的空中救援任务:对德国救援直升机基地12年的回顾分析
Q3 Nursing Pub Date : 2024-11-01 DOI: 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.
呼叫救援直升机的典型原因是医疗紧急情况,如心脏病、创伤和神经系统紧急情况。然而,也有少数患者企图或已经自杀。本文的目的是对医院前环境中涉及救援直升机(直升机紧急医疗服务)的与自杀或自杀未遂有关的紧急情况的具体情况进行一般分析和评估。方法对2008年1月1日至2020年12月31日期间德国德累斯顿直升机紧急医疗服务部门实施的所有紧急干预的数据进行分析,通过查阅DIVI救援方案和电子数据(MEDAT和HEMSDER (Convexis,德国))对自杀相关变量进行分析。记录时间、方法、原因、社会人口统计资料、治疗结果等信息,并进行回顾性分析。结果研究期间共发生突发事件17754起。其中,自杀死亡277例(1.56%)。紧急服务人员到达事故现场的平均时间为11.14分钟。有52名患者已经自杀,183名患者有自杀企图,42名患者有自杀威胁。其中11人在急救医生到达之前或到达时被宣布死亡。当急诊医生到达时,241名患者仍然活着,101名患者接受了气管内插管和机械通气,25名患者接受了心肺复苏。在19.57%的患者中,健康问题被认为是企图/完成自杀的主要原因。还有12.68%的人提到了合伙人问题或失去合伙人。自杀方式最多的是过量(49.39%),其次是跳高(20%)和上吊(15.51%)。24%的病例有刀伤和枪伤。总死亡率为18.77%。使用的方法、性别和遗书被确定为可能影响自杀致命结果的因素。结论与部署总数17754人相比,自杀人数较少。然而,这些特派团的死亡率相当高,达18%。虽然在这项研究中可以确定一些因素和情况,但许多背景和解释仍然缺失。因此,这项研究表明,普遍需要在更好的预防以及改进应急反应小组的教育和培训方面进行更多的研究。
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引用次数: 0
Analysis of Helicopter Air Ambulance Accidents in the United States From 2010 to 2021 2010 - 2021年美国直升机空中救护事故分析
Q3 Nursing Pub Date : 2024-11-01 DOI: 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.
目的直升机空中救护(HAA)服务对美国的空中医疗运输至关重要。然而,HAA事故、事故和死亡一直是HAA运营关注的原因。本文分析了2010年至2021年美国HAA事故的数量、比例、促成因素或因果因素以及定义事件。方法分析美国国家运输安全委员会的最终调查报告、定义事件、调查结果和汇总数据,分析2010年至2021年美国83起HAA事故。采用2比例检验比较2010-2015年和2016-2021年致命HAA事故的比例。结果数据显示,2010-2015年HAA事故中有21/47(45%)死亡,2016-2021年有6/36(17%)死亡,死亡率显著(P <;.01)与2010-2015年期间相比,2016-2021年期间致命事故的比例有所下降。VFR遭遇IMC事件占2010-2015年HAA事故的9/47(19%)和2016-2021年事故的1/36(3%),代表了显著的(P <;.05)降低VFR遭遇IMC事故。结论从2010-2015年到2016-2021年,HAA致命事故的比例有统计学意义上的下降,这可能是由于监管框架、培训协议、安全意识举措和技术进步的变化,以解决HAA安全问题。
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引用次数: 0
Trauma Scores Show Limited Utility for Predicting In-Flight Deterioration in Air Medical Patients 创伤评分在预测空中医疗病人飞行中病情恶化方面效用有限
Q3 Nursing Pub Date : 2024-11-01 DOI: 10.1016/j.amj.2024.09.002
Benjamin Powell BSc, PGDipHSM, MBBS, GCertTM, MPH, DipPHRM, FACEM , Susanna Cramb PhD

Objective

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.
目的本研究的目的是确定Triage修订创伤评分(TRTS)、格拉斯哥昏迷评分/年龄/收缩压(GAP)评分和休克指数(SI)在预测飞行中低血压和空中医疗创伤患者重症监护干预需求方面的应用。方法对昆士兰州3582例空气创伤病例进行回顾性分析。计算每位患者的初始TRTS、GAP评分和SI,并确定飞行中最低平均动脉压和收缩压。还记录了飞行中重症监护干预措施的制度,包括液体复苏、血管加压剂和外科手术。然后使用受试者工作特征曲线检查TRTS、GAP评分和SI预测飞行中低血压的效用。结果3种方法的预测价值均较低,其中GAP评分对飞行干预的预测效果略好于TRTS和SI。GAP评分曲线下的受试者工作特征面积为0.76,而TRTS和SI评分曲线下的受试者工作特征面积为0.74。结论没有一种评分能充分预测转运过程中病情恶化的情况,可用于临床。
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引用次数: 0
Keyword-Based Early Request for Helicopter Emergency Medical Services in Acute Aortic Dissection: A Registry-Based Study 基于关键词的急性主动脉夹层直升机紧急医疗服务早期请求:一项基于登记的研究
Q3 Nursing Pub Date : 2024-11-01 DOI: 10.1016/j.amj.2024.09.006
Hiroaki Taniguchi MD, Hiroki Nagasawa MD, PhD, Tatsuro Sakai MD, Hiromichi Ohsaka MD, PhD, Kazuhiko Omori MD, PhD, Youichi Yanagawa MD, PhD

Objective

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,&nbsp;Hiroki Nagasawa MD, PhD,&nbsp;Tatsuro Sakai MD,&nbsp;Hiromichi Ohsaka MD, PhD,&nbsp;Kazuhiko Omori MD, PhD,&nbsp;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> &lt; .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}
引用次数: 0
Articles That May Change Your Practice: Whole Blood for Traumatic Hemorrhagic Shock 文章可能改变你的做法:全血治疗创伤性失血性休克
Q3 Nursing Pub Date : 2024-11-01 DOI: 10.1016/j.amj.2024.07.010
Russell D. MacDonald MD, MPH, FCFP, FRCPC, DRCPSC, Blake A. Forte MD, MHS, MS, Michael D. Stocker MD, MPH, Aaron J. Lacy MD, FAWN
{"title":"Articles That May Change Your Practice: Whole Blood for Traumatic Hemorrhagic Shock","authors":"Russell D. MacDonald MD, MPH, FCFP, FRCPC, DRCPSC,&nbsp;Blake A. Forte MD, MHS, MS,&nbsp;Michael D. Stocker MD, MPH,&nbsp;Aaron J. Lacy MD, FAWN","doi":"10.1016/j.amj.2024.07.010","DOIUrl":"10.1016/j.amj.2024.07.010","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 6","pages":"Pages 479-480"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758995","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}
引用次数: 0
The RACE Scale for Large Vessel Stroke Diversion to a Comprehensive Stroke Center by Helicopter Air Ambulance: A Retrospective Cohort Study 直升机空中救护将大血管卒中转移到综合卒中中心的RACE量表:一项回顾性队列研究
Q3 Nursing Pub Date : 2024-11-01 DOI: 10.1016/j.amj.2024.07.011
William Krebs DO, RDMS, EMT-P , Melina Alexander DO , Alisha Fujita DO , Quinci Copeland MD , Nancy Buderer MS , Osama Zaidat MD , Eugene Lin MD

Objective

Acute ischemic stroke caused by large vessel occlusion (LVO) occurs frequently and benefits from endovascular therapies available at comprehensive stroke centers (CSCs). Prehospital stroke severity tools have been devised to detect LVO. The goal of this study was to assess the value of the Rapid Arterial Occlusion Evaluation (RACE) score in helicopter air ambulance (HAA) activation.

Methods

A retrospective assessment of RACE scales > 4 performed by prehospital providers was used in order to activate HAAs. Descriptive statistics were obtained for patients transported, with the primary goal of determining the positive predictive values of the RACE scale for LVO occlusions. The secondary outcomes assessed if patients without LVO had other conditions requiring a CSC.

Results

Data from 136 subjects were analyzed; 53 (39.0%) were true LVO cases as defined by computed tomographic imaging, computed tomography angiographic imaging, or magnetic resonance imaging. Mechanical thrombectomy occurred in 30 cases (22.1%), with 63 (46.4%) requiring a neurologic intervention. There were 83 (61%) false positives (no LVO on imaging). Of these false positives, 28 (20.6%) were non-LVO strokes, 22 (16.1%) were intracranial hemorrhages, and 8 (5.9%) had neurologic conditions requiring CSC care.

Conclusion

A RACE scale > 4 is an effective triage tool that delivers potential thrombectomy candidates to CSCs. When there is a false positive, the majority of patients require CSC care and benefit from direct transport from the scene.
目的:大血管闭塞(LVO)引起的急性缺血性脑卒中发生频繁,并受益于综合卒中中心(CSCs)提供的血管内治疗。院前卒中严重程度工具已被设计用于检测LVO。本研究的目的是评估快速动脉闭塞评估(RACE)评分在直升机空中救护(HAA)激活中的价值。方法回顾性评价RACE量表;采用院前提供者进行的4例以激活HAAs。对运送的患者进行描述性统计,主要目的是确定RACE量表对左心室闭塞的阳性预测值。次要结果评估如果没有LVO的患者有其他需要CSC的情况。结果共分析136例受试者的资料;53例(39.0%)通过计算机断层成像、计算机断层血管成像或磁共振成像诊断为真正的LVO病例。机械取栓30例(22.1%),其中63例(46.4%)需要神经系统干预。83例(61%)假阳性(影像学无LVO)。在这些假阳性中,28例(20.6%)为非lvo卒中,22例(16.1%)为颅内出血,8例(5.9%)为需要CSC护理的神经系统疾病。结论RACE量表;4是一种有效的分诊工具,可为csc提供潜在的血栓切除候选物。当出现假阳性时,大多数患者需要CSC护理,并从现场直接运输中受益。
{"title":"The RACE Scale for Large Vessel Stroke Diversion to a Comprehensive Stroke Center by Helicopter Air Ambulance: A Retrospective Cohort Study","authors":"William Krebs DO, RDMS, EMT-P ,&nbsp;Melina Alexander DO ,&nbsp;Alisha Fujita DO ,&nbsp;Quinci Copeland MD ,&nbsp;Nancy Buderer MS ,&nbsp;Osama Zaidat MD ,&nbsp;Eugene Lin MD","doi":"10.1016/j.amj.2024.07.011","DOIUrl":"10.1016/j.amj.2024.07.011","url":null,"abstract":"<div><h3>Objective</h3><div>Acute ischemic stroke caused by large vessel occlusion (LVO) occurs frequently and benefits from endovascular therapies available at comprehensive stroke centers (CSCs). Prehospital stroke severity tools have been devised to detect LVO. The goal of this study was to assess the value of the Rapid Arterial Occlusion Evaluation (RACE) score in helicopter air ambulance (HAA) activation.</div></div><div><h3>Methods</h3><div>A retrospective assessment of RACE scales &gt; 4 performed by prehospital providers was used in order to activate HAAs. Descriptive statistics were obtained for patients transported, with the primary goal of determining the positive predictive values of the RACE scale for LVO occlusions. The secondary outcomes assessed if patients without LVO had other conditions requiring a CSC.</div></div><div><h3>Results</h3><div>Data from 136 subjects were analyzed; 53 (39.0%) were true LVO cases as defined by computed tomographic imaging, computed tomography angiographic imaging, or magnetic resonance imaging. Mechanical thrombectomy occurred in 30 cases (22.1%), with 63 (46.4%) requiring a neurologic intervention. There were 83 (61%) false positives (no LVO on imaging). Of these false positives, 28 (20.6%) were non-LVO strokes, 22 (16.1%) were intracranial hemorrhages, and 8 (5.9%) had neurologic conditions requiring CSC care.</div></div><div><h3>Conclusion</h3><div>A RACE scale &gt; 4 is an effective triage tool that delivers potential thrombectomy candidates to CSCs. When there is a false positive, the majority of patients require CSC care and benefit from direct transport from the scene.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 6","pages":"Pages 508-511"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758898","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}
引用次数: 0
Air Transport Medicine: From the Field 航空运输医学:来自现场
Q3 Nursing Pub Date : 2024-11-01 DOI: 10.1016/j.amj.2024.09.008
Prof. Marius Rehn MD, PhD, Marit Bekkevold MD, Per Bredmose MD, PhD, Tone Solvik Olsen MD, Jostein Hagemo MD, PhD, James Price MB, BS, Ed B.G. Barnard PhD
{"title":"Air Transport Medicine: From the Field","authors":"Prof. Marius Rehn MD, PhD,&nbsp;Marit Bekkevold MD,&nbsp;Per Bredmose MD, PhD,&nbsp;Tone Solvik Olsen MD,&nbsp;Jostein Hagemo MD, PhD,&nbsp;James Price MB, BS,&nbsp;Ed B.G. Barnard PhD","doi":"10.1016/j.amj.2024.09.008","DOIUrl":"10.1016/j.amj.2024.09.008","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 6","pages":"Pages 476-477"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758993","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}
引用次数: 0
Determining What Proportion of Helicopter Emergency Medical Services–Transported Patients Are Urban Versus Rurally Based: A Retrospective 36-Year Geospatial Analysis of a Critical Care Helicopter Emergency Medical Services Organization's Patient Transports 确定直升机紧急医疗服务运送的病人中城市与农村的比例:对一家危重护理直升机紧急医疗服务组织病人运送的36年回顾性地理空间分析
Q3 Nursing Pub Date : 2024-11-01 DOI: 10.1016/j.amj.2024.10.004
Domhnall O'Dochartaigh MSc , Elizabeth Schrekinger BSc , Glenda Farnden , Jon Gogan BPE (Kin) , Darren Hudson MD, FRCPC

Objective

There is an increased mortality rate of patients residing in rural compared with urban communities. Helicopter emergency medical services (HEMS) decrease both the time to hospital arrival and trauma mortality in patients originating from rural areas. An unreported number of urban residents are served by HEMS. Our objective was to quantify the fraction of urban residents who live in the adjoining city of a HEMS base and are transferred by helicopter while they are in rural areas.

Methods

This was a retrospective analysis of HEMS charts between 1985 and 2022. Records were assessed for patients’ city and postal code. A secondary database was searched to assess mission location.

Results

Thirty-five thousand nine hundred seventy-one cases were analyzed; 3,871 (10.76%) cases involved patients residing within the urban area of an open HEMS base, and 32,100 (89.24%) did not. This contrasts with 2.04% of all missions conducted in urban areas. Cases flown with patients from outside of the 3 provinces were as follows: British Columbia (1,233/21,941; 5.3% of Alberta cases), international (988/35,971; 2.7% of total cases), Ontario (177/4,691; 3.6% of Manitoba cases), and other provinces combined (158/3,5971; 0.4% of total cases).

Conclusion

We highlight the impact of HEMS, where it serves both rural residents and all people who work in, travel through, visit, or recreate across the areas that our HEMS supports.
目的与城市社区相比,农村社区患者的死亡率有所上升。直升机紧急医疗服务减少了来自农村地区的病人到达医院的时间和创伤死亡率。接受医疗急救服务的城市居民数量不详。我们的目标是量化居住在卫生紧急医疗服务基地邻近城市的城市居民的比例,当他们在农村地区时,由直升机转移。方法回顾性分析1985 ~ 2022年的HEMS图表。评估了患者所在城市和邮政编码的记录。搜索了二级数据库以评估特派团地点。结果共分析病例35000 971例;3871例(10.76%)患者居住在开放HEMS基地的市区,32100例(89.24%)患者居住在非市区。这与在城市地区执行的所有特派团的2.04%形成对比。与患者一起从3个省以外飞来的病例如下:不列颠哥伦比亚省(1,233/21,941);艾伯塔省5.3%的病例),国际(988/35,971;占总病例的2.7%),安大略省(177/4,691;占马尼托巴省病例的3.6%),其他省份合计(158/3,5971;占总病例的0.4%)。结论:我们强调医疗卫生服务的影响,它既服务于农村居民,也服务于所有在医疗卫生服务支持的地区工作、旅行、访问或娱乐的人。
{"title":"Determining What Proportion of Helicopter Emergency Medical Services–Transported Patients Are Urban Versus Rurally Based: A Retrospective 36-Year Geospatial Analysis of a Critical Care Helicopter Emergency Medical Services Organization's Patient Transports","authors":"Domhnall O'Dochartaigh MSc ,&nbsp;Elizabeth Schrekinger BSc ,&nbsp;Glenda Farnden ,&nbsp;Jon Gogan BPE (Kin) ,&nbsp;Darren Hudson MD, FRCPC","doi":"10.1016/j.amj.2024.10.004","DOIUrl":"10.1016/j.amj.2024.10.004","url":null,"abstract":"<div><h3>Objective</h3><div>There is an increased mortality rate of patients residing in rural compared with urban communities. Helicopter emergency medical services (HEMS) decrease both the time to hospital arrival and trauma mortality in patients originating from rural areas. An unreported number of urban residents are served by HEMS. Our objective was to quantify the fraction of urban residents who live in the adjoining city of a HEMS base and are transferred by helicopter while they are in rural areas.</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of HEMS charts between 1985 and 2022. Records were assessed for patients’ city and postal code. A secondary database was searched to assess mission location.</div></div><div><h3>Results</h3><div>Thirty-five thousand nine hundred seventy-one cases were analyzed; 3,871 (10.76%) cases involved patients residing within the urban area of an open HEMS base, and 32,100 (89.24%) did not. This contrasts with 2.04% of all missions conducted in urban areas. Cases flown with patients from outside of the 3 provinces were as follows: British Columbia (1,233/21,941; 5.3% of Alberta cases), international (988/35,971; 2.7% of total cases), Ontario (177/4,691; 3.6% of Manitoba cases), and other provinces combined (158/3,5971; 0.4% of total cases).</div></div><div><h3>Conclusion</h3><div>We highlight the impact of HEMS, where it serves both rural residents and all people who work in, travel through, visit, or recreate across the areas that our HEMS supports.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 6","pages":"Pages 575-577"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758899","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}
引用次数: 0
Evaluation of Isopropyl Alcohol Aromatherapy in Treating Nausea in Helicopter Emergency Medical Services Patients 异丙醇芳香疗法治疗直升机急诊病人恶心的疗效评价
Q3 Nursing Pub Date : 2024-11-01 DOI: 10.1016/j.amj.2024.08.004
David Koenig DO , Kevin P. Young FP-C , Robert Treat PhD , J. Marc Liu MD, MPH, FAEMS , Timothy Lenz MD, MPH, EMT-P, FAEMS, FACEP

Objective

Isopropyl alcohol (IPA) aromatherapy provides rapid relief of nausea at minimal cost, is universally available, and has no known significant adverse effects. These attributes make it ideal for the prehospital setting. However, there is no published research on the use of IPA in critical care transport (CCT). The objective of this study was to investigate if CCT patients experience improvement of nausea with IPA aromatherapy.

Methods

A retrospective chart review was performed over a 2-year period on adult patients served by a Midwest CCT system that provides both air and ground transport. Data were obtained 1 year before and 1 year after a protocol change in which the first-line antiemetic was changed from intravenous ondansetron (prechange) to inhaled IPA (postchange). The IPA was administered by placing a pad under the patient's nares as they inhaled. The proportion of nausea improvement was compared between the prechange and postchange periods.

Results

Two hundred seventeen records were included. In helicopter emergency medical services, 33 of 50 (66.0%) patients reported improvement with ondansetron, and 13 of 21 (61.9%) reported improvement with IPA (P = .742). Patients transported by ground emergency medical services showed improvement in 65 of 73 (89.0%) cases for ondansetron and 40 of 73 (54.8%) for IPA (P < .001).

Conclusion

There was no difference in the proportion of nausea improvement between ondansetron and IPA in helicopter emergency medical services patients. In ground emergency medical services patients, more patients had nausea improvement with ondansetron compared with IPA. This study suggests IPA may be a faster, more efficacious alternative for nausea relief in CCT patients.
目的异丙醇(IPA)芳香疗法能以最低的成本快速缓解恶心,是普遍可用的,并且没有已知的显著不良反应。这些属性使其成为院前设置的理想选择。然而,在重症监护运输(CCT)中使用IPA的研究尚未发表。本研究的目的是调查CCT患者是否通过IPA芳香疗法改善恶心症状。方法对中西部地区提供空中和地面运输的CCT系统服务的成人患者进行了为期2年的回顾性图表回顾。数据是在方案改变前1年和改变后1年获得的,其中一线止吐剂从静脉注射昂丹司琼(改变前)改为吸入IPA(改变后)。IPA是通过在患者吸入时在他们的鼻子下放置一个垫子来管理的。比较改变前后恶心症状改善的比例。结果共纳入病历217份。在直升机紧急医疗服务中,50例患者中有33例(66.0%)报告昂丹司琼改善,21例患者中有13例(61.9%)报告IPA改善(P = .742)。地面紧急医疗服务运送的患者中,使用昂丹司琼的73例中有65例(89.0%)得到改善,使用IPA的73例中有40例(54.8%)得到改善。措施)。结论直升机紧急医疗服务患者使用昂丹司琼与IPA后恶心症状改善比例无显著差异。在地面紧急医疗服务患者中,与IPA相比,使用昂丹司琼改善恶心症状的患者更多。本研究提示IPA可能是缓解CCT患者恶心的更快、更有效的替代方案。
{"title":"Evaluation of Isopropyl Alcohol Aromatherapy in Treating Nausea in Helicopter Emergency Medical Services Patients","authors":"David Koenig DO ,&nbsp;Kevin P. Young FP-C ,&nbsp;Robert Treat PhD ,&nbsp;J. Marc Liu MD, MPH, FAEMS ,&nbsp;Timothy Lenz MD, MPH, EMT-P, FAEMS, FACEP","doi":"10.1016/j.amj.2024.08.004","DOIUrl":"10.1016/j.amj.2024.08.004","url":null,"abstract":"<div><h3>Objective</h3><div>Isopropyl alcohol (IPA) aromatherapy provides rapid relief of nausea at minimal cost, is universally available, and has no known significant adverse effects. These attributes make it ideal for the prehospital setting. However, there is no published research on the use of IPA in critical care transport (CCT). The objective of this study was to investigate if CCT patients experience improvement of nausea with IPA aromatherapy.</div></div><div><h3>Methods</h3><div>A retrospective chart review was performed over a 2-year period on adult patients served by a Midwest CCT system that provides both air and ground transport. Data were obtained 1 year before and 1 year after a protocol change in which the first-line antiemetic was changed from intravenous ondansetron (prechange) to inhaled IPA (postchange). The IPA was administered by placing a pad under the patient's nares as they inhaled. The proportion of nausea improvement was compared between the prechange and postchange periods.</div></div><div><h3>Results</h3><div>Two hundred seventeen records were included. In helicopter emergency medical services, 33 of 50 (66.0%) patients reported improvement with ondansetron, and 13 of 21 (61.9%) reported improvement with IPA (<em>P</em> = .742). Patients transported by ground emergency medical services showed improvement in 65 of 73 (89.0%) cases for ondansetron and 40 of 73 (54.8%) for IPA (<em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>There was no difference in the proportion of nausea improvement between ondansetron and IPA in helicopter emergency medical services patients. In ground emergency medical services patients, more patients had nausea improvement with ondansetron compared with IPA. This study suggests IPA may be a faster, more efficacious alternative for nausea relief in CCT patients.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 6","pages":"Pages 518-522"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758913","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}
引用次数: 0
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Air Medical Journal
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