Air Medical Journal最新文献

Objective

Pediatric-neonatal transport research projects are presented at the American Academy of Pediatrics (AAP) Section on Transport Medicine (SOTM) scientific abstract program annually. Journal publication increases the impact of these projects. Our objectives were to determine the publication rate of transport abstracts and to identify factors predictive of publication success.

Methods

We reviewed all AAP SOTM abstracts accepted for presentation from 2011 to 2020 and assessed presentation format (oral/platform vs. poster), authors’ professional degree (physician vs. nonphysician), and first author's trainee status. We searched PubMed, Ovid, and ResearchGate for publications by abstract title and authors and then compared published versus unpublished abstracts. Categorical variables were expressed as proportions and compared using the chi-square test or the Fisher exact test, whereas continuous variables were summarized using medians and interquartile ranges (IQRs) and compared using the Student t-test or the Kruskal-Wallis test as appropriate. A linear probability model was performed.

Results

Of 194 presented abstracts, 67 (34.5%) were published. The publication rate was significantly higher for oral/platform versus poster abstracts (P < .01), if the abstract was an oral/platform (probability increase by 19.5%, P < .01), and if the first author was a trainee (probability increase by 25.6%, p < 0.05). The constant was estimated as 24.9% probability of publication. Hence, if the first author was a physician, a trainee, and had an oral/platform presentation, there was an 85.8% chance of being published. The median (IQR) time to publication was 2 years (IQR: 2-4 years), with articles published the longest having the most citations. Articles were published in 27 different journals, with nearly half (33/67, 49.3%) being published in 3 journals.

Conclusion

AAP SOTM abstracts have a 34.5% publication rate over the past 10 years, which is consistent with other medical specialties. Oral abstracts, physician first authors, and trainee first authors had a significantly higher success rate. Special emphasis should be placed nationally on supporting nonphysician transport professionals to publish their work.

Objective

The coronavirus disease 2019 (COVID-19) pandemic has proven to be a significant hardship for the entire world. Health care systems and their workers have been stretched to their limits. Research regarding whether this increased strain has affected patient safety has not been sufficient, especially in emergency medical services. The aim of this study was to determine if there has been an increased rate of adverse events in ground and helicopter emergency medical services since the onset of the COVID-19 pandemic.

Methods

A 2-year retrospective review was performed at a Midwest regional critical care transport service. The rate of adverse events for 1-year periods before and after March 13, 2020, was the primary outcome. All adverse events that generated a quality improvement incident report form (QIRF) were included, except those generated for non–clinical-related incidents. Additionally, a smaller time frame between May 1st and August 31st of both years was included containing all flagged adverse events from peer reviewers; not all of these generated a QIRF.

Results

In the time period between March 13, 2019, and March 12, 2020, 5 of 3,154 (0.16%) calls generated a QIRF versus 21 of 3,185 (0.66%) calls between March 13, 2020, and March 12, 2021. There was a significant relationship showing an adverse event was more likely to happen after the onset of COVID-19 compared with before (χ²₁ [N = 6,339] = 8.643, P ≤ .001). Additionally, from May 1st to August 31st, the total adverse event rates were 16.86% (143/848 calls) and 24.46% (387/1,582 calls) for 2019 and 2020, respectively. Similarly, statistical significance existed for adverse events occurring after onset of the pandemic versus before (χ²₁ [N = 2,430] = 18.253, P ≤ .001).

Conclusion

A higher rate of adverse events for the year after the onset of COVID-19 existed. Additional studies looking at the causes of adverse events and patient outcomes should be undertaken to further understand this increase.

Objective

This study aimed to describe the type and frequency of enteral and parenteral fluids and medications used during the transport of neonates by a regional pediatric critical care transport team.

Methods

We performed a retrospective analysis of neonates transported by a regional neonatal transport team affiliated with a level IV neonatal intensive care unit within a large care network between 2020 and 2021. Demographic and clinical data were collected from the electronic medical record. Standard frequency tabulation and summary statistics were used to report demographics, transport characteristics, and fluid and medication use; results were then stratified by preterm (37 weeks) and term births.

Results

In the 628 included transports, more term than preterm infants received at least 1 fluid or medication (53% vs. 43%, respectively). The most commonly administered medications were antibiotics (ampicillin and gentamicin), prostaglandin, and opiates (morphine sulfate and fentanyl). In addition, term infants received more analgesic medications, antimicrobials, and prostaglandin, whereas preterm infants received total parenteral nutrition more often. There were over 38 different medications provided on the transports studied.

Conclusion

This study of a single transport team revealed that a wide variety of medications and fluids were used in the transport of neonates, with term infants receiving more medications than preterm infants. These data could be used by transport teams in making or updating their standardized medication lists or in creating simulations.

Objective

The i-gel supraglottic airway device (Intersurgical, Berkshire, UK) is commonly used in the United States and worldwide for prehospital airway management. Previous research has suggested that a sex-based method of size selection (4.0 for female patients and 5.0 for male patients) is superior to a weight-based method in patients undergoing elective anesthesia. Our objective was to compare a sex-based i-gel size selection strategy with a weight-based strategy using real-world prehospital data.

Methods

The ESO Data Collaborative 2018 to 2022 dataset was used. All initial i-gel insertion attempts in patients > 18 years of age were evaluated for inclusion. Insertion attempts were excluded if age, sex, weight, success, or device size was not documented. Logistic regression was used to compare the rate of insertion failure on the first attempt for the group placed in alignment with the weight-based but not sex-based method with the group placed in alignment with the sex-based but not weight-based method.

Results

After the application of the exclusion criteria, 39,867 initial i-gel insertion attempts were included. The overall rate of failure was 6.5% (2,585/39,867). The rate of unsuccessful i-gel placement was similar when i-gel devices were placed in alignment with a sex-based size selection method in comparison to i-gel placement in alignment with a weight-based selection strategy (6.0% vs. 6.4%). Logistic regression analysis did not reveal a significant difference between groups (odds ratio: 1.08; 95% confidence interval: 0.95-1.23).

Conclusion

The use of a sex-based method of i-gel size selection may be equivalent with respect to the rate of unsuccessful i-gel placement on the first attempt in comparison to a weight-based method.

Objective

The objective of this study was to use the National Emergency Medical Services Information System (NEMSIS) dataset to generate national air medical transport statistics.

Methods

Retrospective review of the 2021 NEMSIS dataset to identify all air medical transfers, both fixed- and rotor-wing. Transfers where then subcategorized into interfacility and scene responses. Frequencies for each category were generated and reported.

Results

A total of 317,267 air medical transfers were completed in 2021. These included 19,421 (6 %) with missing incident location code data. Of the 297,706 transfers with valid location codes, 208,689 (70%) were interfacility transfers, and 89,016 (30%) were scene responses.

Conclusion

These preliminary results are consistent with other national estimates and achieve representation of all states and territories. Future work will include longitudinal analysis of NEMSIS datasets and direct survey of transport programs to establish long-term reliability.

Point-of-care ultrasound (POCUS) has been shown to be a valuable tool in the management of acutely ill patients in the prehospital setting. POCUS not only has utility from a diagnostic perspective but also has been shown to reduce the rate of complications from otherwise traditionally “blind” procedures, such as pericardiocentesis. This case report highlights the utility of POCUS in the prehospital setting to guide emergent pericardiocentesis to treat cardiac tamponade. The applicability of various approaches to ultrasound-guided pericardiocentesis is also discussed.