Air Medical Journal最新文献

{"title":"Common Mental Health Symptoms in Personnel Working in Helicopter Emergency Medical Services: A Systematic Review","authors":"Karina Damsgaard MSc ,&nbsp;Pernille Melander-Nyboe MSc ,&nbsp;Jesper Pihl-Thingvad MSc, PhD ,&nbsp;Jacob Steinmetz MD, PhD ,&nbsp;Tine Bennedsen Gehrt MSc, PhD","doi":"10.1016/j.amj.2025.06.019","DOIUrl":"10.1016/j.amj.2025.06.019","url":null,"abstract":"<div><h3>Background</h3><div>Helicopter emergency medical service (HEMS) personnel regularly respond to severe and life-threatening situations, often involving critically ill or injured patients. Yet limited research exists on their mental health outcomes compared with ground-based emergency medical services (EMS). This systematic review synthesizes empirical evidence on mental health symptoms among HEMS personnel, focusing on prevalence rates and key psychological outcomes.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, PsycINFO, and Scopus identified original, quantitative studies in English or Scandinavian languages. Studies were included if they reported on at least 1 mental health outcome of interest in HEMS personnel. Study quality was rated using criteria adapted from the National Institute of Health’s Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.</div></div><div><h3>Results</h3><div>From 987 identified articles, 33 full texts were screened, and 9 studies were included, comprising 1 longitudinal and 8 cross-sectional designs. Six studies were rated as being fair quality, 2 as good, and 1 as poor. Outcomes evaluated included depression (5 studies), stress (5 studies), post-traumatic stress disorder/symptoms (PTSD; 3 studies), burnout (3 studies), anxiety (2 studies), secondary traumatic stress (1 study), and compassion fatigue (1 study). Across all studies, HEMS personnel reported low prevalence rates for mental health symptoms. However, burnout and depression were more frequently highlighted as concerns than PTSD.</div></div><div><h3>Conclusion</h3><div>Despite regular exposure to traumatic stressors, HEMS personnel report low levels of stress, PTSD, anxiety, and secondary traumatic stress, whereas burnout and depression had slightly higher levels, suggesting the need for targeted preventive interventions and support mechanisms within HEMS environments<em>.</em></div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Pages 420-428"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886047","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}

{"title":"Prehospital Triage of Pediatric Emergencies Treated by Helicopter Emergency Medical Services: A Population-Based Cohort Study","authors":"Emma Atsuko Tsuchiya BSc ,&nbsp;Oscar Rosenkrantz MD ,&nbsp;Troels Martin Hansen MD ,&nbsp;Jens Aage Kølsen Petersen MD, PhD ,&nbsp;Jacob Steinmetz MD, PhD","doi":"10.1016/j.amj.2025.05.008","DOIUrl":"10.1016/j.amj.2025.05.008","url":null,"abstract":"<div><h3>Objective</h3><div>Helicopter emergency medical services (HEMS) play a crucial role in emergency medical services across many countries. Although some patients are discharged at the scene, most are transported to tertiary or local hospital emergency departments (EDs), with critically ill pediatric patients usually triaged to tertiary EDs. We evaluated whether critically ill pediatric patients treated by HEMS were primarily triaged to the highest level of care by comparing mortality between those admitted to tertiary versus local EDs.</div></div><div><h3>Methods</h3><div>We conducted a cohort study of patients aged &lt;18 years clinically evaluated by a Danish HEMS crew during 2019-2024. The primary outcome was 30-day mortality. Secondary outcomes were National Advisory Committee for Aeronautics scores, International Classification of Diseases, 10th Revision, diagnoses, and prehospital interventions. Fisher’s exact test was used for categorical comparisons.</div></div><div><h3>Results</h3><div>Of 1,104 pediatric missions, 836 patients were included. The 30-day mortality was higher in tertiary ED patients with 32 patients (5.4%) compared with 1 patient (0.4%) in the local ED group (<em>P</em> &lt; .001). More tertiary ED patients had critical National Advisory Committee for Aeronautics scores (42.4% vs. 10.4%, <em>P</em> &lt; .001). Injuries and Poisoning was the most common International Classification of Diseases, 10th Revision, category in the tertiary ED group, whereas Factors Influencing Health Status was the most frequent in the local ED group. Prehospital interventions were more common in the tertiary ED group (35.6% vs. 10.4%, <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>The 30-day mortality was higher in patients transported to tertiary EDs, indicating that HEMS crews generally triaged the most critically ill pediatric patients to the highest level of care.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Pages 365-371"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885997","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}

{"title":"Flight-Crew Administration Speeds Time to Tranexamic Acid: FAST TXA Study","authors":"Christie L. Fritz MD ,&nbsp;David W. Schoenfeld MD, MPH ,&nbsp;Matthew J. Bivens MD ,&nbsp;Kathie Dunn RN, MSN ,&nbsp;Jacqueline C. Stocking PhD, MBA, MSN, NEA-BC, CMTE, CEN, CFRN, FP-C, CCP-C, RN, NRP, FAASTN ,&nbsp;Lincoln Zernicke MD ,&nbsp;Caroline E. Thomas ,&nbsp;Edward Racht MD ,&nbsp;Carlo L. Rosen MD ,&nbsp;Stephen H. Thomas MD, MPH","doi":"10.1016/j.amj.2025.06.001","DOIUrl":"10.1016/j.amj.2025.06.001","url":null,"abstract":"<div><h3>Objective</h3><div>Tranexamic acid (TXA) is a standard therapy for the early treatment of life-threatening traumatic hemorrhage. Multiple studies suggest a benefit to earlier TXA, and meta-analysis calculates that each 15-minute time savings achieved by prehospital TXA improves mortality 10%. In trauma patients for whom helicopter emergency medical services (HEMS) initiated prehospital TXA, this study’s primary aim was to calculate the minutes’ time savings achieved compared with hypothetical TXA initiation at trauma centers. A secondary study aim was to evaluate whether there was geographic variation in the degree to which HEMS-initiated TXA expedited the initiation of the TXA.</div></div><div><h3>Methods</h3><div><span>Four years of data (2021-2024) were queried using the medical records database of a nationwide </span>HEMS organization. Eligible cases were injured patients who received TXA initiated by HEMS flight crews in the prehospital setting. Variables assessed included patient age, sex, transport year, state/US Census Bureau region, time of TXA initiation, and time of hospital arrival.</div></div><div><h3>Results</h3><div>The study assessed 7,188 prehospital HEMS TXA initiations and found that flight-crew commencement of TXA therapy saved a median of 22 minutes overall and 25 minutes for pediatric patients. In all 4 regions of the United States, HEMS initiation of TXA saved at least 15 minutes; inter-regional variation in the degree to which HEMS initiation of TXA saved time was largely explained by variations in overall prehospital time.</div></div><div><h3>Conclusion</h3><div>In the study dataset, HEMS was associated with significantly faster time to TXA, and despite regional variation in the degree of time savings, HEMS initiation of TXA saved at least 15 minutes in all 4 major US regions. Application of the metric of 10% survival increment per 15-minute expedited TXA initiation resulted in an estimate of mortality improvement of 14.7% overall and 16.7% for pediatric patients.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Pages 379-385"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885999","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}

{"title":"Analgesia and Sedation Related to the Use of Long-Acting Neuromuscular Blockers: A Narrative Review","authors":"Vahé Ender NRP,&nbsp;Michael Frakes APRN, NRP,&nbsp;Jason Cohen DO,&nbsp;Susan R. Wilcox MD","doi":"10.1016/j.amj.2025.05.003","DOIUrl":"10.1016/j.amj.2025.05.003","url":null,"abstract":"<div><div>Rapid sequence intubation<span><span> is a standard procedure in critical care transport (CCT). Owing to its numerous benefits and clinical uses, rocuronium<span> has become the first-line neuromuscular blocking agent in rapid sequence </span></span>intubation<span>, supplanting succinylcholine<span> in many transport services. The deferred resumption of muscle activity with rocuronium may delay administering analgesia or sedation after intubation, resulting in awareness while paralyzed. We undertook a narrative review to evaluate this hazard in the existing literature. Numerous studies have revealed that 10% to 50% of intubated emergency department (ED) patients receive no sedation. Several retrospective reviews of intubated ED and transport patients found that the mean time to sedation or analgesia was longer for those receiving rocuronium than succinylcholine. Patients intubated with rocuronium in transport are more likely to receive neither analgesia nor sedation. Another study of a CCT program assesses data from 264 intubations, using a before and after model to analyze time to sedation after a formulary change from succinylcholine to rocuronium. Guidelines and prompts have not been successful at improving analgosedation systems. EDs have used pharmacists with success to improve post-intubation analgesia and sedation practices, but this is not feasible for transport. Although rocuronium has numerous benefits over succinylcholine for CCT systems, the existing literature demonstrates an ongoing risk of delays in sedation after intubation with rocuronium, with some patients not receiving any analgesia or sedation at all. Guidelines and prompts have not been successful, and ED solutions are impractical for the transport environment. Transport systems must remain vigilant for proper sedation after rocuronium administration.</span></span></span></div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Pages 416-419"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886046","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}

{"title":"Determinants and Prediction of Transport Ventilators’ Oxygen Consumption","authors":"Eloïse De Beaufort XX ,&nbsp;Alice Hutin MD, PhD ,&nbsp;Arnaud Lesimple PhD ,&nbsp;Lionel Lamhaut MD, PhD ,&nbsp;Jean-Christophe Richard MD, PhD ,&nbsp;Guillaume Carteaux MD, PhD","doi":"10.1016/j.amj.2025.05.010","DOIUrl":"10.1016/j.amj.2025.05.010","url":null,"abstract":"<div><div>This study investigates the determinants of oxygen consumption in transport ventilators, a critical factor for patient safety, especially during long-distance transfers and in resource-limited settings. A bench study was conducted on 4 ventilators to measure oxygen consumption under various ventilation settings. The main factor influencing oxygen consumption was the bias flow, a specific flow not contributing to patient ventilation. A formula incorporating bias flow was assessed to estimate oxygen consumption. The accuracy of this formula was then compared with clinical data assessed during a long-distance air medical evacuation with mechanically ventilated patients. The high heterogeneity of oxygen consumption observed between the ventilators was mainly explained by the different levels of bias flow. The clinical experience revealed that including this parameter in the prediction may permit to improve oxygen consumption accuracy.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Pages 429-431"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886048","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}

{"title":"Gaslini Neonatal Emergency Transport Service. Celebrating 30 Years of Activity, 1995-2025","authors":"Carlo Bellini MD, PhD ,&nbsp;Luca A. Ramenghi MD, PhD ,&nbsp;Giovanni Serra MD","doi":"10.1016/j.amj.2025.05.006","DOIUrl":"10.1016/j.amj.2025.05.006","url":null,"abstract":"<div><div><span>On February 1, 2025, the Neonatal Emergency Transport Service (NETS) at Gaslini Hospital in Genoa, Italy, marked an extraordinary milestone: 30 years of dedicated service. Since its establishment, NETS Gaslini has been a beacon of hope, providing rapid responses and transporting &gt; 8,000 critically ill </span>newborns. Each transport represents a unique story of urgency, swift action, and compassionate care. This article honors NETS Gaslini’s remarkable journey, tracing its origins and evolution and celebrating the countless lives it has touched. Through heartfelt anecdotes and pivotal moments, we celebrate 3 decades of unwavering commitment to saving the most fragile lives.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Pages 338-346"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885125","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}

{"title":"Simulation-Based Rapid Plan-Do-Study Act Cycles for Airway Management Checklist Development and Quality Improvement","authors":"Jesse Conterato ,&nbsp;Ryan K. Newbury ,&nbsp;Andrew D. Cathers ,&nbsp;Craig F. Tschautscher ,&nbsp;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":"2025-09-01","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}

{"title":"Something Old and Something New: Measles, Candida auris, and Infection Prevention in the Prehospital Setting","authors":"Stephen Y. Liang MD, MPHS,&nbsp;Erika M. Robertson MD, SM, EMT-P,&nbsp;James L. Li MD, MEd, FAEMS,&nbsp;Aaron J. Lacy MD, MHPE, FACEP","doi":"10.1016/j.amj.2025.06.024","DOIUrl":"10.1016/j.amj.2025.06.024","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Pages 333-335"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885123","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}

{"title":"Association Between Intraosseous Access Establishment and Prehospital Vasopressor Administration in Patients With Out-of-Hospital Cardiac Arrest in Helicopter Emergency Medical Services: Analysis of the Japanese Society for Aeromedical Services Registry","authors":"Hidemasa Kudo MD ,&nbsp;Hiroyuki Ohbe PhD ,&nbsp;Daisuke Kudo PhD ,&nbsp;Tetsuya Sato PhD ,&nbsp;Shigeki Kushimoto PhD","doi":"10.1016/j.amj.2025.06.016","DOIUrl":"10.1016/j.amj.2025.06.016","url":null,"abstract":"<div><h3>Objective</h3><div>The establishment of intraosseous (IO) access in patients with out-of-hospital cardiac arrest (OHCA) enables reliable vasopressor administration. However, no studies have examined the association between IO access and vasopressor administration in a nationwide prehospital setting. We aimed to examine the association between IO access and vasopressor administration in patients with OHCA using a nationwide database.</div></div><div><h3>Methods</h3><div>This retrospective cohort study used data from the Japanese Society for Aeromedical Services Registry (JSAS-R) between April 2020 and March 2023. The primary outcome was vasopressor administration before hospital arrival. Secondary outcomes included in-hospital mortality, length of hospital stay, doctor contact-to-hospital arrival time, and return of spontaneous circulation (ROSC) on hospital arrival. The association between IO access establishment and clinical outcomes was examined using multivariate logistic regression with multiple imputation.</div></div><div><h3>Results</h3><div>Among 3,264 patients with OHCA, 321 (9.8%) received IO access (IO group), while the remaining 2,943 (90.2%) who did not receive IO access formed the control group. Prehospital vasopressor administration was significantly more frequent in the IO group than in the control group (82.9% vs. 70.6%; <em>p</em> &lt; 0.001; odds ratio [OR]: 1.77; 95% confidence interval [CI]: 1.28–2.46). However, the IO group showed a significant decrease in ROSC on hospital arrival (OR, 0.64; 95% CI: 0.45–0.91). No significant intergroup differences were observed in other secondary outcomes.</div></div><div><h3>Conclusion</h3><div>IO access was associated with increased prehospital vasopressor administration, suggesting higher success rates of IO vascular access among patients with OHCA in the helicopter emergency medical service setting.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Pages 399-403"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885835","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}

{"title":"Air Transport Medicine: From the Field","authors":"Tim Harris BM, BS, FRCEM, FFICM, FACEM,&nbsp;Neel Bhanderi BM, BS, FACEM, FRCEM,&nbsp;Dan Harris BM, BS, FACEM,&nbsp;Chris Smith BM, BS, FCICM,&nbsp;Ryan Breslin MB, BChir, FANZCA,&nbsp;James Moran BM, BS, FRCEM, FACEM,&nbsp;Le Nguyen MBBS, M Med (Crit Care),&nbsp;James Price MBBS,&nbsp;Ed Barnard PhD","doi":"10.1016/j.amj.2025.07.002","DOIUrl":"10.1016/j.amj.2025.07.002","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Pages 330-332"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886026","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}