Air Medical Journal最新文献

{"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":"2025-06-29","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":"Corrigendum to: Articles that may change your practice: Reviewing Intraosseous Versus Intravenous First Approach to Access in Out-of-Hospital Cardiac Arrest Data From Randomized Controlled Trials, Air Med J. 2025 May-Jun;44(3):174-176.","authors":"Blaise Loughman MD, EMT-P,&nbsp;Fatou Ndaw MD,&nbsp;Aaron J. Lacy MD, MHPE, FACEP,&nbsp;James L. Li MD, M.Ed, FAEMS","doi":"10.1016/j.amj.2025.06.020","DOIUrl":"10.1016/j.amj.2025.06.020","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Page 432"},"PeriodicalIF":0.0,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885512","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":"The Potential of Flight Simulation to Support Pilot Training for Mountain Helicopter Emergency Medical Services","authors":"Neale A. Watson PhD,&nbsp;Nicholas Fernandez PhD,&nbsp;Ieuan Owen PhD,&nbsp;Mark D. White PhD","doi":"10.1016/j.amj.2025.06.002","DOIUrl":"10.1016/j.amj.2025.06.002","url":null,"abstract":"<div><h3>Objective</h3><div>To demonstrate how piloted flight simulation can be used to replicate rescue helicopter missions in mountainous terrain. To meet this objective, a piloted flight simulation environment has been created in which a helicopter pilot can “fly” over a mountain terrain and through realistic turbulent air flow.</div></div><div><h3>Methods</h3><div>A solid model, 550 metres across, of a mountainous island has been created and which contains topographic features such as a bowl, pinnacle, ridge, canyon, and cliff. The air flow over this terrain has been computed for a 20-knot wind and integrated with a helicopter flight model representative of a UH-60 Black Hawk. Using a full-motion flight simulator, two test pilots explored the island and conducted a stable hover flight test up the face of the cliff.</div></div><div><h3>Results</h3><div>The simulation demonstrates great promise and was judged by the test pilots to be an impressive first attempt at developing a search and rescue “training landscape.” The flight test results revealed how the pilots found it difficult to maintain a stable hover when exposed to the turbulent shear layer at the top of the cliff, consistent with their real-world experience.</div></div><div><h3>Conclusion</h3><div>The exploratory study was considered to be successful, meriting further research and development to increase the range of wind conditions and to explore the other topographic features in the terrain.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Pages 386-389"},"PeriodicalIF":0.0,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886000","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":"Transport-Related Risk Factors for Intraventricular Hemorrhage in Preterm Neonates: An Exploratory Analysis","authors":"Colleen Butler MSN, RN, C-NPT, NPD-BC ,&nbsp;Julianne Olshannikov MSc, RRT-NPS, C-NPT ,&nbsp;Jennifer Watts MSc, RRT-NPS, C-NPT, FAARC ,&nbsp;Rachelle J. Lancaster PhD, RN ,&nbsp;Mamta Jaiswal MBBS, PhD ,&nbsp;Joseph Chase BS, MPH","doi":"10.1016/j.amj.2025.05.009","DOIUrl":"10.1016/j.amj.2025.05.009","url":null,"abstract":"<div><div>Preterm neonates face unique risks during ground transport due to environmental factors<span><span> and the urgent need for critical interventions. Neuroprotection<span> during transport is essential to safeguard this vulnerable population from developing intraventricular hemorrhage (IVH). Despite efforts to optimize </span></span>neonatal transport practices, specific transport-related factors contributing to IVH remain poorly understood.</span></div></div><div><h3>Objectives</h3><div>The study aims to identify transport-related factors contributing to IVH, including 1) the association between critical ground transport (miles loaded, time, infant securement) and clinical factors of IVH (hypotension, intubation<span>, etc.) and 2) the impact of maternal and fetal factors on IVH development, including maternal infection, pre-delivery medication administration, Apgar score<span>, respiratory support changes, and hypoxic events.</span></span></div></div><div><h3>Method</h3><div><span>A retrospective design was used, gathering data from the electronic health records of 2 transport teams in the Midwest. </span>Logistic regression models were used to identify transport and maternal variables associated with IVH development.</div></div><div><h3>Results</h3><div>Among the 79 neonates included in this study, 25 (31.6%) developed IVH. Data indicate a higher incidence of IVH in male neonates (<em>P</em> = .02). Furthermore, maintaining the patient in a midline position was associated with IVH status (<em>P</em> = .03). However, no association was found between critical ground transport and IVH rates. Maternal infection was associated with IVH (<em>B</em> = 1.82, standard error = 0.833, odds ratio = 6.17, 95% confidence interval: 1.30-37.5, <em>P</em> = .0288).</div></div><div><h3>Conclusion</h3><div>Findings underscore the need to optimize ground transport practices, particularly for male neonates, highlighting midline positioning and maternal infections as modifiable factors in IVH prevention.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Pages 372-378"},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885998","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":"General Information","authors":"","doi":"10.1016/S1067-991X(25)00177-4","DOIUrl":"10.1016/S1067-991X(25)00177-4","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 4","pages":"Page 232"},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144470125","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":"Analysis of Disease-Specific Outcomes According to Time of Doctor Helicopter Dispatch Request","authors":"Youichi Yanagawa MD, PhD,&nbsp;Noriko Tanaka MD,&nbsp;Chihiro Maekawa MD,&nbsp;Yoshihiro Nagatake MD,&nbsp;Ayaka Tashiro MD,&nbsp;Masashi Kato MD,&nbsp;Raiki Tokutsu MD,&nbsp;Soichiro Ota MD, PhD,&nbsp;Hiromichi Ohsaka MD, PhD,&nbsp;Hiroki Nagasawa MD, PhD,&nbsp;Kazuhiko Omori MD, PhD","doi":"10.1016/j.amj.2025.05.004","DOIUrl":"10.1016/j.amj.2025.05.004","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate whether the keyword method—requesting the dispatch of a doctor helicopter (DH) based on information obtained from the emergency call before emergency medical technicians make contact with patients—is useful for other disease category, using data from the Japan DH Registry (JDHR).</div></div><div><h3>Methods</h3><div>Patients (<em>N</em> = 41,592) enrolled in JDHR were included in the study. The following data were collected for each subject: time from emergency call to DH staff-patient contact, DH request method (keyword or not), gender, age, vital signs at the time of emergency medical technician contact, medical intervention details, disease category details which were determined by the JDHR classification, hospitalization duration, and 1-month outcome. The subjects were dichotomized into the following 2 groups in each disease category: a keyword group and a control group.</div></div><div><h3>Results</h3><div><span>The study revealed significant disparities of the backgrounds between the 2 groups in each disease category. The keyword group had statistically significant earlier patient contact, respectively, in each disease category, compared with the control group. Concerning the overall performance category in 1 month, the keyword group exhibited low values (favorable function) of cerebral infarction, </span>intracerebral hemorrhage<span><span>, other endogenous diseases, and trauma category compared with the control group. The keyword group exhibited a statistically significant shorter hospital stay in other endogenous diseases, trauma, and non-trauma cases of exogenous diseases. </span>Multivariate analysis<span> revealed that the keyword method was not selected as an independent factor related to survival, except in the intracerebral hemorrhage category.</span></span></div></div><div><h3>Conclusion</h3><div>In our study, early DH involvement dispatch and rapid transport by keyword methods were associated with better outcomes or shorter hospital stay, regardless of heterogeneity in patient characteristics and disease types. However, the keyword-based dispatch system itself did not seem to improve outcomes independent of patient-specific factors and disease severity.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Pages 354-359"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885996","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":"2025-06-19","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":"Care of the Agitated Patient Who Presents a Threat to Safe Transport in Critical Care Transport Medicine: A Consensus Statement","authors":"Jennifer DeMarco MD ,&nbsp;Brian Shields MD ,&nbsp;William Hinckley MD ,&nbsp;Craig Bates MD ,&nbsp;Mike Jasumback MD ,&nbsp;Craig Tschautscher MD, MS ,&nbsp;Ben Lawner MD ,&nbsp;Adam L. Gottula MD","doi":"10.1016/j.amj.2025.05.005","DOIUrl":"10.1016/j.amj.2025.05.005","url":null,"abstract":"<div><h3>Objective</h3><div>Critical care transport medicine (CCTM) often encounters agitated patients who pose immediate threats to safe transport. The Air Medical Physicians Association recognized this unique risk and brought together experts to draft consensus statements and best practices for managing such patients.</div></div><div><h3>Methods</h3><div>The Air Medical Physician Symposium “Lite” was held on November 4, 2024, in Salt Lake City, Utah. Participants included international CCTM professionals. Attendees completed a survey on best practices, knowledge gaps, barriers to translation, and research priorities related to in-flight sedation and agitation protocols. The survey results informed lectures and panel discussions, followed by electronic audience voting to rank priority items.</div></div><div><h3>Results</h3><div>The analysis reveals standardized sedation protocols, training for in-flight staff, implementing a sedation checklist, monitoring sedation levels, and using non-pharmacologic techniques as best practices for caring for agitated patients who present a threat to safe transport. Knowledge gaps, barriers to translation, and research priorities were also identified and described.</div></div><div><h3>Conclusion</h3><div>This consensus statement identifies critical areas for improving patient safety and operational protocols in CCTM. Addressing the outlined best practices, knowledge gaps, and research priorities is essential to advance CCTM and ensure safe patient transport.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Pages 360-364"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885995","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":"2025-06-13","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":"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":"2025-06-13","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}