Pub Date : 2025-06-11DOI: 10.1016/j.amj.2025.03.008
Hannah M. Baumgartner PhD , Justin Durham PhD , Peter T. Hu PhD
Helicopter air ambulance (HAA) operations are subject to unique risks due to their time-sensitive and safety critical nature. The Civil Aerospace Medical Institute completed analyses of the National Transportation Safety Board’s (NTSB) Case Analysis and Reporting Online aviation accident and serious incident database and the National Aeronautics and Space Administration’s Aviation Safety Reporting System data in a 10-year span. In total, 102 Aviation Safety Reporting System reports, 53 final NTSB accident reports, and 3 final NTSB incident reports involving HAA from 2013 to 2023 that occurred within the United States were coded for human factors and organizational risk factors. The analyses identified several human factor risks affecting HAA pilots related to situation awareness, judgment and decision making, adherence to procedures, and experience and training. Furthermore, organizational issues influencing HAA operations, such as communication, safety culture, and those involving operator policy and procedure, were identified. These human factors and organizational safety findings suggest potential areas for safety interventions or mitigations in HAA operations.
{"title":"Human Factors in Helicopter Air Ambulance Accidents, Incidents, and Safety Reports","authors":"Hannah M. Baumgartner PhD , Justin Durham PhD , Peter T. Hu PhD","doi":"10.1016/j.amj.2025.03.008","DOIUrl":"10.1016/j.amj.2025.03.008","url":null,"abstract":"<div><div>Helicopter air ambulance (HAA) operations are subject to unique risks due to their time-sensitive and safety critical nature. The Civil Aerospace Medical Institute completed analyses of the National Transportation Safety Board’s (NTSB) Case Analysis and Reporting Online aviation accident and serious incident database and the National Aeronautics and Space Administration’s Aviation Safety Reporting System data in a 10-year span. In total, 102 Aviation Safety Reporting System reports, 53 final NTSB accident reports, and 3 final NTSB incident reports involving HAA from 2013 to 2023 that occurred within the United States were coded for human factors and organizational risk factors. The analyses identified several human factor risks affecting HAA pilots related to situation awareness, judgment and decision making, adherence to procedures, and experience and training. Furthermore, organizational issues influencing HAA operations, such as communication, safety culture, and those involving operator policy and procedure, were identified. These human factors and organizational safety findings suggest potential areas for safety interventions or mitigations in HAA operations.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Pages 347-353"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885994","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 : 2025-06-01DOI: 10.1016/j.amj.2025.04.002
Nicholas J. Larson BA, NREMT , Frederick B. Rogers MD, MS, MA, FACS , Benoit Blondeau MD, MBA, FACS , David J. Dries MD, MSE, FACS, MCCM
Obstetrical care in the United States is in crisis. As timely access to obstetric care becomes increasingly less common in the United States, the role of an emergency medical services clinician in the care of a pregnant trauma patient has become increasingly important, particularly in rural or austere environments with extended times to arrival at a trauma center with capacity to provide definitive obstetrical care. In this review, we provide considerations for the primary management of pregnant trauma patients in a prehospital setting by reviewing the essentials of immediate care by organ system, with particular emphasis on airway support and medication considerations in pregnancy.
{"title":"Prehospital Management of the Pregnant Trauma Patient","authors":"Nicholas J. Larson BA, NREMT , Frederick B. Rogers MD, MS, MA, FACS , Benoit Blondeau MD, MBA, FACS , David J. Dries MD, MSE, FACS, MCCM","doi":"10.1016/j.amj.2025.04.002","DOIUrl":"10.1016/j.amj.2025.04.002","url":null,"abstract":"<div><div>Obstetrical care in the United States is in crisis. As timely access to obstetric care becomes increasingly less common in the United States, the role of an emergency medical services clinician in the care of a pregnant trauma patient has become increasingly important, particularly in rural or austere environments with extended times to arrival at a trauma center with capacity to provide definitive obstetrical care. In this review, we provide considerations for the primary management of pregnant trauma patients in a prehospital setting by reviewing the essentials of immediate care by organ system, with particular emphasis on airway support and medication considerations in pregnancy.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 4","pages":"Pages 236-241"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144470128","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 : 2025-05-30DOI: 10.1016/j.amj.2025.05.001
Shantanu Gupta PhD, Gustavo Sanchez MS, Mary E. Johnson PhD
{"title":"Completing the Picture: Reaffirming the Methodology, Results, and Limitations of the HAA Accident Analysis Article","authors":"Shantanu Gupta PhD, Gustavo Sanchez MS, Mary E. Johnson PhD","doi":"10.1016/j.amj.2025.05.001","DOIUrl":"10.1016/j.amj.2025.05.001","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 4","pages":"Pages 234-235"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144470127","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 : 2025-05-22DOI: 10.1016/j.amj.2025.04.007
Katherine Stuart MD, Mackenzie Johnson MD, Aaron J. Lacy MD, MHPE, FACEP, James L. Li MD, MEd, FAEMS
{"title":"Articles That May Change Your Practice: Utilization of Non-Invasive Positive Pressure Ventilation in the Prehospital Setting","authors":"Katherine Stuart MD, Mackenzie Johnson MD, Aaron J. Lacy MD, MHPE, FACEP, James L. Li MD, MEd, FAEMS","doi":"10.1016/j.amj.2025.04.007","DOIUrl":"10.1016/j.amj.2025.04.007","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 4","pages":"Pages 259-261"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144470131","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 : 2025-05-20DOI: 10.1016/j.amj.2025.04.008
Frances M. Russell MD , Michael Supples MD , Omkar Tamhankar BS , Oliver Hobson BS , Jenna Pallansch MD , Pamela Soriano MD , Patrick Finnegan MD , Mark Liao MD
Objective
Previous studies have revealed that paramedics can learn how to perform lung ultrasound (LUS) to identify pulmonary edema and acute heart failure, but studies evaluating subsequent clinical application are lacking. We set out to evaluate how the implementation of a LUS training program affected paramedic behavior (Kirkpatrick’s methodology level 3).
Methods
This was a prospective observational cohort study on paramedics from a single agency. Paramedics completed 1 hour of training including a pre- and post-intervention survey and test, 30 minutes of didactics, 30 minutes of hands-on scanning, and an independent objective structured clinical evaluation. They, then, completed a ride-along with a physician trained in LUS. For the next 15 months, paramedics independently performed and interpreted clinically indicated LUS examinations on patients being transported for shortness of breath. The number of LUS performed, accuracy of interpretation, image quality, and change in management based on LUS findings were analyzed.
Results
Of 26 paramedics, 22 (85%) completed 109 LUS in 15 months, with a median of 2 LUS performed per paramedic (range 1-18). Sensitivity and specificity of paramedic-performed LUS for pulmonary edema were 73.8% (confidence interval 0.58-0.85) and 91.0% (confidence interval 0.81-0.96), respectively. Of the 31 true positives, 20 patients (64.5%) were treated with nitroglycerin, furosemide, or positive pressure ventilation, whereas 11 patients were not treated despite a positive LUS result. Median image quality was 4 (range 1-5) on a 5-point scale.
Conclusion
Implementation of a LUS training program led to most paramedics using LUS in the clinical setting and obtaining high-quality images. Specificity of paramedic-performed LUS was high when compared with hospital diagnosis. Prehospital heart failure treatment based on LUS findings was moderate.
{"title":"Evaluating the Impact That a Lung Ultrasound Training Program to Detect Acute Heart Failure Has on Paramedic Behavior","authors":"Frances M. Russell MD , Michael Supples MD , Omkar Tamhankar BS , Oliver Hobson BS , Jenna Pallansch MD , Pamela Soriano MD , Patrick Finnegan MD , Mark Liao MD","doi":"10.1016/j.amj.2025.04.008","DOIUrl":"10.1016/j.amj.2025.04.008","url":null,"abstract":"<div><h3>Objective</h3><div>Previous studies have revealed that paramedics can learn how to perform lung ultrasound (LUS) to identify pulmonary edema and acute heart failure, but studies evaluating subsequent clinical application are lacking. We set out to evaluate how the implementation of a LUS training program affected paramedic behavior (Kirkpatrick’s methodology level 3).</div></div><div><h3>Methods</h3><div>This was a prospective observational cohort study on paramedics from a single agency. Paramedics completed 1 hour of training including a pre- and post-intervention survey and test, 30 minutes of didactics, 30 minutes of hands-on scanning, and an independent objective structured clinical evaluation. They, then, completed a ride-along with a physician trained in LUS. For the next 15 months, paramedics independently performed and interpreted clinically indicated LUS examinations on patients being transported for shortness of breath. The number of LUS performed, accuracy of interpretation, image quality, and change in management based on LUS findings were analyzed.</div></div><div><h3>Results</h3><div>Of 26 paramedics, 22 (85%) completed 109 LUS in 15 months, with a median of 2 LUS performed per paramedic (range 1-18). Sensitivity and specificity of paramedic-performed LUS for pulmonary edema were 73.8% (confidence interval 0.58-0.85) and 91.0% (confidence interval 0.81-0.96), respectively. Of the 31 true positives, 20 patients (64.5%) were treated with nitroglycerin, furosemide, or positive pressure ventilation, whereas 11 patients were not treated despite a positive LUS result. Median image quality was 4 (range 1-5) on a 5-point scale.</div></div><div><h3>Conclusion</h3><div>Implementation of a LUS training program led to most paramedics using LUS in the clinical setting and obtaining high-quality images. Specificity of paramedic-performed LUS was high when compared with hospital diagnosis. Prehospital heart failure treatment based on LUS findings was moderate.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 4","pages":"Pages 314-317"},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144470231","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 : 2025-05-20DOI: 10.1016/j.amj.2025.04.005
Christie L. Fritz MD, MS , Caroline E. Thomas BS , Michael Skaggs MD, MS , Lincoln Zernicke MD , Michael Patrick McCartin MD , Ira J. Blumen MD , James Price MBBS , Owen Hibberd MBBS , David W. Schoenfeld MD, MPH , Stephen H. Thomas MD, MPH
Objective
This scoping review is an annual update of helicopter emergency medical services (HEMS) outcomes literature added to the HEMS outcomes assessment research database (HOARD). HOARD is maintained by the critical care transport collaborative outcomes research effort (CCT CORE) and is updated each year with the previous calendar year’s studies assessing whether HEMS use alters patient-centered outcomes.
Methods
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review (PRISMA-ScR) guidelines, we used multiple reviewers of records retrieved from multiple medical and gray literature sources: Medline (PubMed), EMBASE, Scopus, CINAHL, and Google Scholar. Eligible for review was HEMS vs. ground EMS outcomes studies either published or appearing in preprint databases during calendar year 2024. HOARD excludes case reports and review articles (unless they provide a new calculation of effect estimate). We assessed articles for subject matter (trauma vs non-trauma), journal impact factor (JIF), and geographic region of the study’s correspondence author. Categorical analyses comparing 2024 studies with HOARD studies from 2023 were executed with Pearson’s chi-square or Fisher’s exact test, and we also calculated risk ratio with its 95% confidence interval. Non-normal JIF data were described using median and interquartile range and analyzed using rank sum testing. Nonparametric trend testing evaluated the last decade’s evidence using Cochrane-Armitage (dichotomous) or Cuzick (JIF) testing.
Results
Of an initial records of N = 5,179 (74 of which were reviewed as full text), we identified 21 studies for addition to HOARD. Longitudinal analysis revealed a significant (P < .001) annual trend toward increasing proportions of studies focusing on non-trauma; 2024 was the first time in a decade that the more than half of the year’s outcomes studies focused on non-trauma. There was no indication of trend involving the proportion of studies emanating from the USA (P = .821) or from the combined countries of USA and Europe (P = .566). The 2024 JIF had a median of 2.11 and interquartile range of 1.25 to 2.60. There was no suggestion (P = .919) of longitudinal JIF trend in the past decade.
Conclusion
This scoping review provides information on 21 HEMS outcomes studies new to the evidence base in 2024. The HOARD database, freely available, has been updated with these studies.
{"title":"Recent Outcomes Research in Helicopter Emergency Medical Services: A Scoping Review of Publication-Year 2024 Additions to the Helicopter Outcomes Assessment Research Database","authors":"Christie L. Fritz MD, MS , Caroline E. Thomas BS , Michael Skaggs MD, MS , Lincoln Zernicke MD , Michael Patrick McCartin MD , Ira J. Blumen MD , James Price MBBS , Owen Hibberd MBBS , David W. Schoenfeld MD, MPH , Stephen H. Thomas MD, MPH","doi":"10.1016/j.amj.2025.04.005","DOIUrl":"10.1016/j.amj.2025.04.005","url":null,"abstract":"<div><h3>Objective</h3><div>This scoping review is an annual update of helicopter emergency medical services (HEMS) outcomes literature added to the HEMS outcomes assessment research database (HOARD). HOARD is maintained by the critical care transport collaborative outcomes research effort (CCT CORE) and is updated each year with the previous calendar year’s studies assessing whether HEMS use alters patient-centered outcomes.</div></div><div><h3>Methods</h3><div>Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review (PRISMA-ScR) guidelines, we used multiple reviewers of records retrieved from multiple medical and gray literature sources: Medline (PubMed), EMBASE, Scopus, CINAHL, and Google Scholar. Eligible for review was HEMS vs. ground EMS outcomes studies either published or appearing in preprint databases during calendar year 2024. HOARD excludes case reports and review articles (unless they provide a new calculation of effect estimate). We assessed articles for subject matter (trauma vs non-trauma), journal impact factor (JIF), and geographic region of the study’s correspondence author. Categorical analyses comparing 2024 studies with HOARD studies from 2023 were executed with Pearson’s chi-square or Fisher’s exact test, and we also calculated risk ratio with its 95% confidence interval. Non-normal JIF data were described using median and interquartile range and analyzed using rank sum testing. Nonparametric trend testing evaluated the last decade’s evidence using Cochrane-Armitage (dichotomous) or Cuzick (JIF) testing.</div></div><div><h3>Results</h3><div>Of an initial records of <em>N</em> = 5,179 (74 of which were reviewed as full text), we identified 21 studies for addition to HOARD. Longitudinal analysis revealed a significant (<em>P</em> < .001) annual trend toward increasing proportions of studies focusing on non-trauma; 2024 was the first time in a decade that the more than half of the year’s outcomes studies focused on non-trauma. There was no indication of trend involving the proportion of studies emanating from the USA (<em>P</em> = .821) or from the combined countries of USA and Europe (<em>P</em> = .566). The 2024 JIF had a median of 2.11 and interquartile range of 1.25 to 2.60. There was no suggestion (<em>P</em> = .919) of longitudinal JIF trend in the past decade.</div></div><div><h3>Conclusion</h3><div>This scoping review provides information on 21 HEMS outcomes studies new to the evidence base in 2024. The HOARD database, freely available, has been updated with these studies.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 4","pages":"Pages 306-313"},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144470232","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 : 2025-05-17DOI: 10.1016/j.amj.2025.04.004
Joseph Hill MSN, APRN, FNP-C, CFRN, CMTE , Jeremy Norman MBA, NRP, FP-C , M. David Gothard MS , Michelle M. McLean MD , Deanne Krajkowski BS CTRS , Bethany Figg Ded.T, MBA, MLIS, C-TAGME, AHIP , Jeff Marr FP-C
Objective
Stress-induced hyperglycemia is a well-established risk factor for mortality in critically ill trauma patients. Limited research exists on prehospital diagnostic tools for predicting hemorrhagic shock and mortality in this population.
Methods
A retrospective study involving 435 adult and pediatric trauma patients transported by air ambulance in 13 years aimed to assess the predictive value of prehospital point-of-care glucose (POCG), shock index (SI), Glasgow Coma Scale (GCS), fluid administration, and reverse SI multiplied by GCS (rSIG) for 24-hour and 30-day mortalities.
Results
Univariate analyses revealed that an elevated SI and lower GCS were associated with increased mortality, whereas POCG and crystalloid fluid administration were not significant predictors. Multivariate analysis confirmed SI and GCS as independent predictors of 30-day mortality. The rSIG emerged as the strongest predictor, with an Area Under the Receiver Operating Characteristic curve (AUROC) of 0.872. POCG alone did not demonstrate statistical significance in predicting mortality.
Conclusion
Prehospital SI and GCS are valuable predictors of mortality, with rSIG offering the highest predictive accuracy. Despite limitations, this study suggests the potential impact of prehospital markers on trauma-related outcomes, emphasizing the need for further research validation.
{"title":"Predictive Value of Prehospital Point-of-Care Glucose Measurement and Shock Indices in Traumatically Injured Patients: A Retrospective Study","authors":"Joseph Hill MSN, APRN, FNP-C, CFRN, CMTE , Jeremy Norman MBA, NRP, FP-C , M. David Gothard MS , Michelle M. McLean MD , Deanne Krajkowski BS CTRS , Bethany Figg Ded.T, MBA, MLIS, C-TAGME, AHIP , Jeff Marr FP-C","doi":"10.1016/j.amj.2025.04.004","DOIUrl":"10.1016/j.amj.2025.04.004","url":null,"abstract":"<div><h3>Objective</h3><div>Stress-induced hyperglycemia is a well-established risk factor for mortality in critically ill trauma patients. Limited research exists on prehospital diagnostic tools for predicting hemorrhagic shock and mortality in this population.</div></div><div><h3>Methods</h3><div>A retrospective study involving 435 adult and pediatric trauma patients transported by air ambulance in 13 years aimed to assess the predictive value of prehospital point-of-care glucose (POCG), shock index (SI), Glasgow Coma Scale (GCS), fluid administration, and reverse SI multiplied by GCS (rSIG) for 24-hour and 30-day mortalities.</div></div><div><h3>Results</h3><div>Univariate analyses revealed that an elevated SI and lower GCS were associated with increased mortality, whereas POCG and crystalloid fluid administration were not significant predictors. Multivariate analysis confirmed SI and GCS as independent predictors of 30-day mortality. The rSIG emerged as the strongest predictor, with an Area Under the Receiver Operating Characteristic curve (AUROC) of 0.872. POCG alone did not demonstrate statistical significance in predicting mortality.</div></div><div><h3>Conclusion</h3><div>Prehospital SI and GCS are valuable predictors of mortality, with rSIG offering the highest predictive accuracy. Despite limitations, this study suggests the potential impact of prehospital markers on trauma-related outcomes, emphasizing the need for further research validation.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 4","pages":"Pages 302-305"},"PeriodicalIF":0.0,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144470005","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号