Pub Date : 2025-08-29DOI: 10.1016/j.amj.2025.07.005
Jacob N. Qurashi MD, MPH, CFRN, C-NPT , Jennifer Shelby BS, RN , Aleta Kay Martin BSRC, RRT-NPS, CHSOS, CHSE , Archana V. Dhar MD, FAAP
Objective
Cardiopulmonary resuscitation (CPR) during interfacility neonatal and pediatric transport is a rare phenomenon (0.33% and 0.18%, respectively). The ability to maintain high-quality manual CPR in a moving vehicle with limited personnel and equipment impacts its effectiveness. There are limited data about neonatal and pediatric transport teams training staff on resuscitation during transport. This study evaluated the feasibility of in situ, simulation-based CPR training for a tertiary hospital’s pediatric-neonatal transport team to better replicate real-world constraints.
Methods
Critical care teams—each comprising a nurse, respiratory therapist, and paramedic—completed an in situ simulation aboard a moving ambulance. Generally, 18 participants formed 6 teams, managing a hypoxia-induced bradycardia scenario requiring CPR. Operational metrics, teamwork, and resource management were evaluated. Post-simulation, participants completed a deidentified survey.
Results
The mean participant age was 41.7 (standard deviation [SD] = 8.29) years with 8.9 (SD = 6.19) years of transport experience; 27% had not previously performed CPR during transport. Median time for bag-valve-mask initiation was 0.47 (SD = 0.41) minutes, CPR start was 0.62 (SD = 0.65) minutes, epinephrine administration was 1.25 (SD = 1.61) minutes, and contact with medical command was 1.40 (SD = 0.76) minutes. Post-simulation, 89% preferred in situ training over traditional simulation. Confidence improvements in prehospital care, logistics, and team resource management were negatively correlated with years of transport experience (P < .05).
Conclusion
In situ simulation enhances training fidelity, improves provider confidence, and may be especially valuable for onboarding new transport team members, supporting safer patient care during transport.
{"title":"Implementing In Situ Simulation of High-Risk/Low-Volume Emergency Situations for Pediatric Transport Teams","authors":"Jacob N. Qurashi MD, MPH, CFRN, C-NPT , Jennifer Shelby BS, RN , Aleta Kay Martin BSRC, RRT-NPS, CHSOS, CHSE , Archana V. Dhar MD, FAAP","doi":"10.1016/j.amj.2025.07.005","DOIUrl":"10.1016/j.amj.2025.07.005","url":null,"abstract":"<div><h3>Objective</h3><div>Cardiopulmonary resuscitation (CPR) during interfacility neonatal and pediatric transport is a rare phenomenon (0.33% and 0.18%, respectively). The ability to maintain high-quality manual CPR in a moving vehicle with limited personnel and equipment impacts its effectiveness. There are limited data about neonatal and pediatric transport teams training staff on resuscitation during transport. This study evaluated the feasibility of in situ, simulation-based CPR training for a tertiary hospital’s pediatric-neonatal transport team to better replicate real-world constraints.</div></div><div><h3>Methods</h3><div>Critical care teams—each comprising a nurse, respiratory therapist, and paramedic—completed an in situ simulation aboard a moving ambulance. Generally, 18 participants formed 6 teams, managing a hypoxia-induced bradycardia scenario requiring CPR. Operational metrics, teamwork, and resource management were evaluated. Post-simulation, participants completed a deidentified survey.</div></div><div><h3>Results</h3><div>The mean participant age was 41.7 (standard deviation [SD] = 8.29) years with 8.9 (SD = 6.19) years of transport experience; 27% had not previously performed CPR during transport. Median time for bag-valve-mask initiation was 0.47 (SD = 0.41) minutes, CPR start was 0.62 (SD = 0.65) minutes, epinephrine administration was 1.25 (SD = 1.61) minutes, and contact with medical command was 1.40 (SD = 0.76) minutes. Post-simulation, 89% preferred in situ training over traditional simulation. Confidence improvements in prehospital care, logistics, and team resource management were negatively correlated with years of transport experience (<em>P</em> < .05).</div></div><div><h3>Conclusion</h3><div>In situ simulation enhances training fidelity, improves provider confidence, and may be especially valuable for onboarding new transport team members, supporting safer patient care during transport.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 6","pages":"Pages 488-491"},"PeriodicalIF":0.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145371290","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 : 2025-08-27DOI: 10.1016/j.amj.2025.07.009
Catherine M. Kuza MD, FASA, FCCM , Andrea H. Denton MILS , Stephanie Streit MD , Joseph Rossano MD, MS, FAAP, FACC , Sarita Chung MD , Joshua M. Tobin MD, MSc
Objective
The management of blood resuscitation in hemorrhagic shock in trauma patients is evolving. Prehospital whole blood (WB) re-emerged into practice to correct coagulopathy, replace blood loss, and improve survival. This scoping review evaluated the use of prehospital WB in adult trauma patients with hemorrhagic shock.
Methods
We performed a literature search using PubMed, Embase, and CINAHL, including studies published between January 2015 and March 2024.
Results
A total of 10 studies (n = 9,621) were reviewed. Studies included 2 case series, 1 prospective randomized controlled trial, and 7 observational studies. Eight studies evaluated civilian patient populations (1 non-trauma, 7 trauma) and 2 were military (1 trauma, 1 mixed trauma/non-trauma).
Conclusion
Prehospital WB programs are feasible and relatively safe. They may be beneficial in trauma and other populations; however, the reviewed studies are poor in quality and suboptimal in study design. Thus, definitive recommendations cannot be made. Additional studies are required.
{"title":"Prehospital Whole Blood in Trauma—A Scoping Review","authors":"Catherine M. Kuza MD, FASA, FCCM , Andrea H. Denton MILS , Stephanie Streit MD , Joseph Rossano MD, MS, FAAP, FACC , Sarita Chung MD , Joshua M. Tobin MD, MSc","doi":"10.1016/j.amj.2025.07.009","DOIUrl":"10.1016/j.amj.2025.07.009","url":null,"abstract":"<div><h3>Objective</h3><div>The management of blood resuscitation in hemorrhagic shock in trauma patients is evolving. Prehospital whole blood (WB) re-emerged into practice to correct coagulopathy, replace blood loss, and improve survival. This scoping review evaluated the use of prehospital WB in adult trauma patients with hemorrhagic shock.</div></div><div><h3>Methods</h3><div>We performed a literature search using PubMed, Embase, and CINAHL, including studies published between January 2015 and March 2024.</div></div><div><h3>Results</h3><div>A total of 10 studies (n = 9,621) were reviewed. Studies included 2 case series, 1 prospective randomized controlled trial, and 7 observational studies. Eight studies evaluated civilian patient populations (1 non-trauma, 7 trauma) and 2 were military (1 trauma, 1 mixed trauma/non-trauma).</div></div><div><h3>Conclusion</h3><div>Prehospital WB programs are feasible and relatively safe. They may be beneficial in trauma and other populations; however, the reviewed studies are poor in quality and suboptimal in study design. Thus, definitive recommendations cannot be made. Additional studies are required.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 6","pages":"Pages 530-538"},"PeriodicalIF":0.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145371298","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 : 2025-08-27DOI: 10.1016/j.amj.2025.07.007
Laurence J. Lewandowski-Barrett MBBS , Chris King MBBCHIR
Regional anesthesia has become an established and effective form of in-hospital pain relief, offering significant benefits than systemic analgesia. Its application in the prehospital setting remains limited and underused. The prehospital environment poses many different challenges compared with in-hospital care, and, therefore, practice cannot necessarily be directly translated. This review explores the current prehospital applications of regional anesthesia, perceived advantages, and indications. It evaluates contraindications and complications, in particular the risk of masking compartment syndrome and iatrogenic nerve injury in the traumatically injured patient, and the implications for prolongation of scene time. Finally, it addresses some of the practical, logistical, safety, and training considerations for implementation.
{"title":"Considerations for Regional Anaesthesia in the Prehospital Environment","authors":"Laurence J. Lewandowski-Barrett MBBS , Chris King MBBCHIR","doi":"10.1016/j.amj.2025.07.007","DOIUrl":"10.1016/j.amj.2025.07.007","url":null,"abstract":"<div><div>Regional anesthesia has become an established and effective form of in-hospital pain relief, offering significant benefits than systemic analgesia. Its application in the prehospital setting remains limited and underused. The prehospital environment poses many different challenges compared with in-hospital care, and, therefore, practice cannot necessarily be directly translated. This review explores the current prehospital applications of regional anesthesia, perceived advantages, and indications. It evaluates contraindications and complications, in particular the risk of masking compartment syndrome and iatrogenic nerve injury in the traumatically injured patient, and the implications for prolongation of scene time. Finally, it addresses some of the practical, logistical, safety, and training considerations for implementation.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 6","pages":"Pages 525-529"},"PeriodicalIF":0.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145371375","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 : 2025-08-26DOI: 10.1016/j.amj.2025.06.013
Elisa Willoch , Christian Tappert MD, PhD , Andreas Krüger MD, PhD , Helge Haugland MD, PhD
Objective
In Norway, physician-staffed helicopter emergency medical services (HEMS) provide critical care for patients needing advanced prehospital treatment. To measure the quality of care, 15 quality indicators (QIs) are monitored, including the occurrence of “debriefing,” a discussion aimed at promoting communication, team learning, and safety. At Trondheim HEMS, the “debriefing” quality indicator has been identified as underperforming compared with other Nordic HEMS bases, suggesting missed opportunities for communication and learning. Given that human error is a major factor in adverse events both in medicine and aviation, enhancing debriefing practices may be crucial for improving quality and safety. The objective of this study was to assess the impact of two interventions on debriefing rates.
Methods
In this prospective quality improvement study at Trondheim HEMS, HEMS crews recorded debriefing occurrences in a QI database. The primary measure was the debriefing rate per shift, analyzed using statistical process control. Before the interventions, baseline data were collected in a 2-month period. The first intervention involved placing reminder posters in high-traffic areas. The second intervention provided feedback through a continuously displayed chart of debriefing performance, allowing crews to compare their rates to overall trends. Each intervention lasted 2 months, followed by washout periods where interventions were removed to evaluate sustained effects.
Results
The first intervention had no significant improvement in debriefing rates. Notable variation between physicians was observed during the first intervention and washout period. The second intervention stabilized the process and increased the average debriefing rate from 58% in the baseline period to 71% during the intervention. This continued during the following washout period.
Conclusion
Prominent variation in performance between physicians indicates a lack of framework for debriefing to occur. The increased debriefing rate is still not ideal. Further approaches are needed to improve debriefing practices in the service.
{"title":"Debriefing in Physician-Staffed Helicopter Emergency Medical Services: A Quality Improvement Study","authors":"Elisa Willoch , Christian Tappert MD, PhD , Andreas Krüger MD, PhD , Helge Haugland MD, PhD","doi":"10.1016/j.amj.2025.06.013","DOIUrl":"10.1016/j.amj.2025.06.013","url":null,"abstract":"<div><h3>Objective</h3><div>In Norway, physician-staffed helicopter emergency medical services (HEMS) provide critical care for patients needing advanced prehospital treatment. To measure the quality of care, 15 quality indicators (QIs) are monitored, including the occurrence of “debriefing,” a discussion aimed at promoting communication, team learning, and safety. At Trondheim HEMS, the “debriefing” quality indicator has been identified as underperforming compared with other Nordic HEMS bases, suggesting missed opportunities for communication and learning. Given that human error is a major factor in adverse events both in medicine and aviation, enhancing debriefing practices may be crucial for improving quality and safety. The objective of this study was to assess the impact of two interventions on debriefing rates.</div></div><div><h3>Methods</h3><div>In this prospective quality improvement study at Trondheim HEMS, HEMS crews recorded debriefing occurrences in a QI database. The primary measure was the debriefing rate per shift, analyzed using statistical process control. Before the interventions, baseline data were collected in a 2-month period. The first intervention involved placing reminder posters in high-traffic areas. The second intervention provided feedback through a continuously displayed chart of debriefing performance, allowing crews to compare their rates to overall trends. Each intervention lasted 2 months, followed by washout periods where interventions were removed to evaluate sustained effects.</div></div><div><h3>Results</h3><div>The first intervention had no significant improvement in debriefing rates. Notable variation between physicians was observed during the first intervention and washout period. The second intervention stabilized the process and increased the average debriefing rate from 58% in the baseline period to 71% during the intervention. This continued during the following washout period.</div></div><div><h3>Conclusion</h3><div>Prominent variation in performance between physicians indicates a lack of framework for debriefing to occur. The increased debriefing rate is still not ideal. Further approaches are needed to improve debriefing practices in the service.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 6","pages":"Pages 459-464"},"PeriodicalIF":0.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145371374","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 : 2025-08-25DOI: 10.1016/j.amj.2025.07.003
Tejinder Singh Lakhwani PhD, Yerasani Sinjana PhD
This case study evaluates the strategic growth, operational challenges, and decision-making complexities faced by Aeromed International Rescue Services Pvt. Ltd., India's leading air ambulance provider. Established in 2013 by Dr. Amod Jaiswal, Aeromed has expanded from a single-charter operation to conducting >300 missions annually, serving patients across India and neighboring countries. The case opens with a real-time scenario involving an extracorporeal membrane oxygenation (ECMO)-supported emergency transfer from Guwahati to Chennai, framing Aeromed’s commitment to its core value: “Critical Care. Anywhere. Anytime.” The narrative traces Aeromed’s evolution from initial market entry, expansion into tier 2 and tier 3 cities, technological innovations such as ECMO and neonatal air transport, and resilience during the coronavirus disease 2019 pandemic. At the center of the case is a strategic dilemma in 2024, where Aeromed must choose 1 of the following 3 growth paths: invest in artificial intelligence-driven triage and dispatch platforms, deepen regional access through private helipad infrastructure, or scale nationally and internationally through a licensing/franchise model. Through analytical frameworks such as SWOT, SALT, and PESTLE and exhibits including cost analyses and service data, learners are encouraged to critically evaluate Aeromed’s mission, scalability, and financial sustainability.
本案例研究评估了印度领先的空中救护提供商Aeromed International Rescue Services Pvt. Ltd.所面临的战略增长、运营挑战和决策复杂性。由Amod Jaiswal博士于2013年创立的Aeromed已经从单一包机业务扩展到每年执行300次任务,为印度和邻国的患者提供服务。该案例以一个实时场景开场,涉及由体外膜氧合(ECMO)支持的从古瓦哈蒂到金奈的紧急转移,这体现了Aeromed对其核心价值的承诺:“重症监护”。任何地方。任何时候都可以。”叙述了航空公司从最初的市场进入,扩展到二三线城市,ECMO和新生儿航空运输等技术创新,以及2019年冠状病毒病大流行期间的应变能力的演变。案例的核心是2024年的战略困境,Aeromed必须在以下三种增长路径中选择一种:投资人工智能驱动的分类和调度平台,通过私人直升机停机坪基础设施深化区域准入,或通过许可/特许经营模式在国内和国际上扩张。通过SWOT、SALT和PESTLE等分析框架以及包括成本分析和服务数据在内的展品,鼓励学习者批判性地评估Aeromed的使命、可扩展性和财务可持续性。
{"title":"Aeromed: Navigating India’s Skyways to Save Lives","authors":"Tejinder Singh Lakhwani PhD, Yerasani Sinjana PhD","doi":"10.1016/j.amj.2025.07.003","DOIUrl":"10.1016/j.amj.2025.07.003","url":null,"abstract":"<div><div>This case study evaluates the strategic growth, operational challenges, and decision-making complexities faced by Aeromed International Rescue Services Pvt. Ltd., India's leading air ambulance provider. Established in 2013 by Dr. Amod Jaiswal, Aeromed has expanded from a single-charter operation to conducting >300 missions annually, serving patients across India and neighboring countries. The case opens with a real-time scenario involving an extracorporeal membrane oxygenation (ECMO)-supported emergency transfer from Guwahati to Chennai, framing Aeromed’s commitment to its core value: “Critical Care. Anywhere. Anytime.” The narrative traces Aeromed’s evolution from initial market entry, expansion into tier 2 and tier 3 cities, technological innovations such as ECMO and neonatal air transport, and resilience during the coronavirus disease 2019 pandemic. At the center of the case is a strategic dilemma in 2024, where Aeromed must choose 1 of the following 3 growth paths: invest in artificial intelligence-driven triage and dispatch platforms, deepen regional access through private helipad infrastructure, or scale nationally and internationally through a licensing/franchise model. Through analytical frameworks such as SWOT, SALT, and PESTLE and exhibits including cost analyses and service data, learners are encouraged to critically evaluate Aeromed’s mission, scalability, and financial sustainability.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 6","pages":"Pages 452-456"},"PeriodicalIF":0.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145371229","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 : 2025-08-21DOI: 10.1016/j.amj.2025.06.011
Karen R. Bourdon RN, BSN , Chase J. Canter BS, FP-C
Background
Performing and interpreting point of care laboratory testing is an advanced skill that requires additional training outside of a critical care transport providers primary education. Providers must be knowledgeable and confident in their ability to perform all clinical tasks to exude competence. Limited evaluations of self-efficacy and perceived confidence exist in the CCT, point-of-care testing realm.
Objective
This study aims to evaluate perceived confidence in clinical decision making of providers utilizing point-of-care testing (POCT) in the CCT setting.
Methods
A cross-sectional survey was administered to providers of a CLIA licensed critical care transport team. The survey was of electronic format, queried demographics and subjective concepts using a psychometric response scale. The survey was anonymous and voluntary. Both critical care nurses/paramedics of this CLIA licensed agency, who operate under an EM, FAEMS medical director, who is the certified laboratory director, were eligible to participate in the survey. Providers not employed at the agency prior to receiving CLIA licensure were excluded.
Results
Survey participants included critical care nurses (70%) and critical care paramedics (30%), all whom (n=10) self-identified as board certified through BCEN or IBSC. Experience in critical care transport varied finding 0-3 years (40%), 4-7 years (30%), and 10+ years (30%). All survey participants agreed or strongly agreed with concepts regarding POCT and its positive effect on patient safety and quality of care with recent laboratory results. Likewise, all participants agreed or strongly agreed their clinical acumen increased as did their confidence interpreting laboratory results because of required quarterly education. Participants found the availability of POCT increased their confidence in clinical decision making as well as made clinical decision making easier. 30% of providers attested to questioning the appropriateness of the care they provided prior to having POCT availability with 50% answering neutral and 20% disagreeing to that statement.
Conclusion
This survey highlights the positive impact of POCT on CCT providers confidence in clinical decision making. The results demonstrate that POCT enhances clinical acumen and fosters greater confidence among providers when interpreting laboratory results, while improving patient safety and care quality. The findings suggest that ongoing education and access to POCT contributes to the providers sense of subjective competence, making clinical decisions more streamlined. However, a portion of providers expressed uncertainty in the appropriateness of care before the availability of POCT, indicating areas for further investigation into the impact of POCT on patient safety and clinical outcomes. This survey underscores the importance of continued tra
{"title":"Point of Care Laboratory Testing and its Effect on Confidence in Clinical Decision Making","authors":"Karen R. Bourdon RN, BSN , Chase J. Canter BS, FP-C","doi":"10.1016/j.amj.2025.06.011","DOIUrl":"10.1016/j.amj.2025.06.011","url":null,"abstract":"<div><h3>Background</h3><div>Performing and interpreting point of care laboratory testing is an advanced skill that requires additional training outside of a critical care transport providers primary education. Providers must be knowledgeable and confident in their ability to perform all clinical tasks to exude competence. Limited evaluations of self-efficacy and perceived confidence exist in the CCT, point-of-care testing realm.</div></div><div><h3>Objective</h3><div>This study aims to evaluate perceived confidence in clinical decision making of providers utilizing point-of-care testing (POCT) in the CCT setting.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was administered to providers of a CLIA licensed critical care transport team. The survey was of electronic format, queried demographics and subjective concepts using a psychometric response scale. The survey was anonymous and voluntary. Both critical care nurses/paramedics of this CLIA licensed agency, who operate under an EM, FAEMS medical director, who is the certified laboratory director, were eligible to participate in the survey. Providers not employed at the agency prior to receiving CLIA licensure were excluded.</div></div><div><h3>Results</h3><div>Survey participants included critical care nurses (70%) and critical care paramedics (30%), all whom (n=10) self-identified as board certified through BCEN or IBSC. Experience in critical care transport varied finding 0-3 years (40%), 4-7 years (30%), and 10+ years (30%). All survey participants agreed or strongly agreed with concepts regarding POCT and its positive effect on patient safety and quality of care with recent laboratory results. Likewise, all participants agreed or strongly agreed their clinical acumen increased as did their confidence interpreting laboratory results because of required quarterly education. Participants found the availability of POCT increased their confidence in clinical decision making as well as made clinical decision making easier. 30% of providers attested to questioning the appropriateness of the care they provided prior to having POCT availability with 50% answering neutral and 20% disagreeing to that statement.</div></div><div><h3>Conclusion</h3><div>This survey highlights the positive impact of POCT on CCT providers confidence in clinical decision making. The results demonstrate that POCT enhances clinical acumen and fosters greater confidence among providers when interpreting laboratory results, while improving patient safety and care quality. The findings suggest that ongoing education and access to POCT contributes to the providers sense of subjective competence, making clinical decisions more streamlined. However, a portion of providers expressed uncertainty in the appropriateness of care before the availability of POCT, indicating areas for further investigation into the impact of POCT on patient safety and clinical outcomes. This survey underscores the importance of continued tra","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Page 436"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886009","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 : 2025-08-21DOI: 10.1016/j.amj.2025.06.012
Zane Z. Grimm RN, BSN, CFRN , Nolan R. Suchora RN, BSN, CFRN
Background
With the expansion of critical care ground transportation call volumes will increase. The increase in volume as a trend in healthcare is shifted towards daylight shift workers compared to their counterparts. Having the added aspect of transport distance in interfacility transportation adds an increased workload with increasing distances.
Objective
We aim to examine the relationship between distance traveled and patient volume to determine the correlation in workload between night shift workers and day shift workers in the interfacility critical care transport setting. The value of this information may be utilized to determine appropriate staffing levels and/or the need for crew downtime.
Methods
Utilizing quantitative data including call volume and Total transport mileage from a critical care transport service.
Results
A total of 1293 patients were treated and transported 78,838.78 miles via critical care ground ambulance. Day shift workers transported 701 or 54% of the total patients. These patients were transported a total of 41,427.06 miles averaging 59.09 miles per patient. Night shift workers transported 592 patients or 46% of the total patients. These patients were transported a total of 36,298.42 miles averaging 61.31 miles per patient. Dayshift workers averaged 1.92 transports per shift compared to the 1.62 transports per shift of the night shift workers. The night shift workers, however, averaged 37.8 miles per shift compared to the 30.7 miles of day shift workers.
Conclusion
Night shift workers in critical care ground transportation travel more miles with a lesser volume compared to their counterparts in the daytime who transport a higher quantity with lesser mileage, resulting in equal workloads.
{"title":"Comparing Workloads of Night Shift and Day Shift Workers in Critical Care Ground Transport","authors":"Zane Z. Grimm RN, BSN, CFRN , Nolan R. Suchora RN, BSN, CFRN","doi":"10.1016/j.amj.2025.06.012","DOIUrl":"10.1016/j.amj.2025.06.012","url":null,"abstract":"<div><h3>Background</h3><div>With the expansion of critical care ground transportation call volumes will increase. The increase in volume as a trend in healthcare is shifted towards daylight shift workers compared to their counterparts. Having the added aspect of transport distance in interfacility transportation adds an increased workload with increasing distances.</div></div><div><h3>Objective</h3><div>We aim to examine the relationship between distance traveled and patient volume to determine the correlation in workload between night shift workers and day shift workers in the interfacility critical care transport setting. The value of this information may be utilized to determine appropriate staffing levels and/or the need for crew downtime.</div></div><div><h3>Methods</h3><div>Utilizing quantitative data including call volume and Total transport mileage from a critical care transport service.</div></div><div><h3>Results</h3><div>A total of 1293 patients were treated and transported 78,838.78 miles via critical care ground ambulance. Day shift workers transported 701 or 54% of the total patients. These patients were transported a total of 41,427.06 miles averaging 59.09 miles per patient. Night shift workers transported 592 patients or 46% of the total patients. These patients were transported a total of 36,298.42 miles averaging 61.31 miles per patient. Dayshift workers averaged 1.92 transports per shift compared to the 1.62 transports per shift of the night shift workers. The night shift workers, however, averaged 37.8 miles per shift compared to the 30.7 miles of day shift workers.</div></div><div><h3>Conclusion</h3><div>Night shift workers in critical care ground transportation travel more miles with a lesser volume compared to their counterparts in the daytime who transport a higher quantity with lesser mileage, resulting in equal workloads.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Page 436"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886010","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 : 2025-08-21DOI: 10.1016/j.amj.2025.06.010
Jesse Conterato , Ryan K. Newbury , Andrew D. Cathers , Craig F. Tschautscher , Brittney Bernardoni
Objective
Intubation of critically ill patients is a high stakes procedure. Across the healthcare industry, procedural checklists have been recognized as a successful tool for improving patient safety and outcomes. While intubation checklists may improve patient outcomes and reduce complications, the content comprising a checklist is not standardized and varies widely. This novel approach to intubation checklist development embeds quality improvement Plan-Do-Study-Act (PDSA) cycles within healthcare team-based intubation simulations to efficiently elicit feedback and garner buy-in from relevant stakeholders.
Methods
Plan: A multidisciplinary group of critical care transport (CCT) providers drafted the initial intubation checklist using a modified Delphi process reviewing checklists from external CCT transport programs.
Do
This draft checklist was then trialed in two simulation-based educational sessions for CCT providers at a single institution. During each session, four groups of CCT providers rotated through an intubation workshop. During each workshop, providers utilized the intubation checklist in three brief simulated intubation scenarios of escalating complexity.
Study
After each intubation scenario, the participants provided semi-structured feedback regarding content and use of the checklist.
Act
Between intubation workshops, this feedback informed serial modifications to the checklist. This iterative process of refining, trialing, and soliciting feedback repeated over eight cycles.
Results
Feedback from providers addressed multiple components of the checklist, including both its functionality and clinical implications. Changes were made to simplify wording in order to improve clarity and length of the checklist. Participant feedback also informed resequencing of checklist items to produce a more natural flow within clinical scenarios. The visual characteristics of the checklist, including color and font, were modified to improve visual tracking and flow. The clinical and operational implications of including certain checklist items were discussed, including the use of specific equipment and medications.
Conclusion
Integrating quality improvement processes into educational simulation facilitated efficient intubation checklist development. Utilizing PDSA cycles embedded within simulation, rapid iterative adjustments were made over two 3 hour sessions based on end-user feedback from CCT providers. Additionally, soliciting provider feedback promoted team engagement and buy-in for future implementation of this intubation checklist in patient care.
{"title":"Simulation-Based Rapid Plan-Do-Study Act Cycles for Airway Management Checklist Development and Quality Improvement","authors":"Jesse Conterato , Ryan K. Newbury , Andrew D. Cathers , Craig F. Tschautscher , Brittney Bernardoni","doi":"10.1016/j.amj.2025.06.010","DOIUrl":"10.1016/j.amj.2025.06.010","url":null,"abstract":"<div><h3>Objective</h3><div>Intubation of critically ill patients is a high stakes procedure. Across the healthcare industry, procedural checklists have been recognized as a successful tool for improving patient safety and outcomes. While intubation checklists may improve patient outcomes and reduce complications, the content comprising a checklist is not standardized and varies widely. This novel approach to intubation checklist development embeds quality improvement Plan-Do-Study-Act (PDSA) cycles within healthcare team-based intubation simulations to efficiently elicit feedback and garner buy-in from relevant stakeholders.</div></div><div><h3>Methods</h3><div>Plan: A multidisciplinary group of critical care transport (CCT) providers drafted the initial intubation checklist using a modified Delphi process reviewing checklists from external CCT transport programs.</div></div><div><h3>Do</h3><div>This draft checklist was then trialed in two simulation-based educational sessions for CCT providers at a single institution. During each session, four groups of CCT providers rotated through an intubation workshop. During each workshop, providers utilized the intubation checklist in three brief simulated intubation scenarios of escalating complexity.</div></div><div><h3>Study</h3><div>After each intubation scenario, the participants provided semi-structured feedback regarding content and use of the checklist.</div></div><div><h3>Act</h3><div>Between intubation workshops, this feedback informed serial modifications to the checklist. This iterative process of refining, trialing, and soliciting feedback repeated over eight cycles.</div></div><div><h3>Results</h3><div>Feedback from providers addressed multiple components of the checklist, including both its functionality and clinical implications. Changes were made to simplify wording in order to improve clarity and length of the checklist. Participant feedback also informed resequencing of checklist items to produce a more natural flow within clinical scenarios. The visual characteristics of the checklist, including color and font, were modified to improve visual tracking and flow. The clinical and operational implications of including certain checklist items were discussed, including the use of specific equipment and medications.</div></div><div><h3>Conclusion</h3><div>Integrating quality improvement processes into educational simulation facilitated efficient intubation checklist development. Utilizing PDSA cycles embedded within simulation, rapid iterative adjustments were made over two 3 hour sessions based on end-user feedback from CCT providers. Additionally, soliciting provider feedback promoted team engagement and buy-in for future implementation of this intubation checklist in patient care.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Pages 435-436"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886008","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 : 2025-08-21DOI: 10.1016/j.amj.2025.06.005
Abby L. Blake DO , Kalle J. Fjeld MD , Pietra Oelke , Matthew A. Roginski MD, MPH , Patricia R. Atchinson DO
Objective
Describe first pass endotracheal intubation failures as well as associated patient and procedural factors in a rural critical care transport service.
Methods
Retrospective chart review of patients ≥18 years intubated by a mixed rotor wing and ground critical care transport service (nurse-paramedic teams) between January 2017 and June 2024. Direct and video laryngoscopy was available during the study period. The primary outcome was incidence of first pass failure. One intubation attempt was defined as the insertion of the laryngoscopy past the lips. First pass failure was defined as failure to place an endotracheal tube through the vocal cords on the first intubation attempt. Secondary outcomes included reason for failure as well as association of patient and procedural factors with failure.
Results
There were 389 intubations performed with 53 (13.6%) first pass failures. The most common reasons for failure were hypoxia (7, 13.2%), contamination (22, 41.5%), and anatomy (32, 60.4%). Multiple reasons for failure were cited in 15 first pass intubation attempts (28.3%). There was an association between first pass failure and predicted difficult airway OR 2.66 (95% CI 1.47-4.80). There was no association between operator type and first pass success rate. There was no association of first pass failure with bougie use, direct laryngoscopy, location of intubation, or pre-intubation hypoxia.
Conclusion
First pass failure occurred in approximately one in eight intubations. This descriptive analysis of intubation failure provides a starting point for further quality improvement work. Future work should incorporate systematic review of intubations with objective data (i.e. video-recorded laryngoscopy) and the use of an airway failure taxonomy to describe performance errors and allow for iterative quality improvement in a learning healthcare system.
目的探讨农村危重病转运服务中首次气管插管失败及相关的患者和程序因素。方法回顾性分析2017年1月至2024年6月期间由混合旋翼和地面重症监护运输服务(护理-护理团队)插管的≥18岁患者。研究期间可进行直接喉镜检查和视频喉镜检查。主要观察指标为首次通过失败的发生率。一次插管尝试被定义为喉镜穿过嘴唇插入。第一次插管失败被定义为在第一次插管尝试时未能将气管内插管通过声带。次要结局包括失败的原因以及患者和手术因素与失败的关系。结果共行插管389例,首次插管失败53例(13.6%)。最常见的失败原因是缺氧(7.13.2%)、污染(22.41.5%)和解剖(32.60.4%)。首次插管失败的15例(28.3%)有多种原因。首次通过失败与预测气道困难OR之间存在关联,OR为2.66 (95% CI 1.47-4.80)。操作者类型与首次通过成功率之间没有关联。首次通过失败与布基使用、直接喉镜检查、插管位置或插管前缺氧没有关联。结论首次插管失败发生率约为1 / 8。这种对插管失败的描述性分析为进一步的质量改进工作提供了一个起点。未来的工作应结合客观数据(如视频记录喉镜)插管的系统回顾,并使用气道衰竭分类法来描述性能错误,并允许在学习医疗保健系统中迭代改进质量。
{"title":"Description of Critical Care Transport First Pass Endotracheal Intubation Failures","authors":"Abby L. Blake DO , Kalle J. Fjeld MD , Pietra Oelke , Matthew A. Roginski MD, MPH , Patricia R. Atchinson DO","doi":"10.1016/j.amj.2025.06.005","DOIUrl":"10.1016/j.amj.2025.06.005","url":null,"abstract":"<div><h3>Objective</h3><div>Describe first pass endotracheal intubation failures as well as associated patient and procedural factors in a rural critical care transport service.</div></div><div><h3>Methods</h3><div>Retrospective chart review of patients ≥18 years intubated by a mixed rotor wing and ground critical care transport service (nurse-paramedic teams) between January 2017 and June 2024. Direct and video laryngoscopy was available during the study period. The primary outcome was incidence of first pass failure. One intubation attempt was defined as the insertion of the laryngoscopy past the lips. First pass failure was defined as failure to place an endotracheal tube through the vocal cords on the first intubation attempt. Secondary outcomes included reason for failure as well as association of patient and procedural factors with failure.</div></div><div><h3>Results</h3><div>There were 389 intubations performed with 53 (13.6%) first pass failures. The most common reasons for failure were hypoxia (7, 13.2%), contamination (22, 41.5%), and anatomy (32, 60.4%). Multiple reasons for failure were cited in 15 first pass intubation attempts (28.3%). There was an association between first pass failure and predicted difficult airway OR 2.66 (95% CI 1.47-4.80). There was no association between operator type and first pass success rate. There was no association of first pass failure with bougie use, direct laryngoscopy, location of intubation, or pre-intubation hypoxia.</div></div><div><h3>Conclusion</h3><div>First pass failure occurred in approximately one in eight intubations. This descriptive analysis of intubation failure provides a starting point for further quality improvement work. Future work should incorporate systematic review of intubations with objective data (i.e. video-recorded laryngoscopy) and the use of an airway failure taxonomy to describe performance errors and allow for iterative quality improvement in a learning healthcare system.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Page 433"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886003","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}