Air Medical Journal最新文献

英文中文

The Estimated Cost-Effectiveness of Physician-Staffed Helicopter Emergency Medical Services Compared to Ground-Based Emergency Medical Services in Finland 芬兰配备医生的直升机紧急医疗服务与地面紧急医疗服务相比的成本效益估算

Q3 Nursing

Air Medical Journal

Pub Date : 2024-05-01 DOI: 10.1016/j.amj.2023.12.006

Axel Ackermann MBBS , Jukka Pappinen PhD , Jouni Nurmi MD, PhD , Hilla Nordquist PhD , Paulus Torkki PhD

Objective

Because the unit cost of helicopter emergency medical services (HEMS) is higher than traditional ground-based emergency medical services (EMS), it is important to further investigate the impact of HEMS. The aim of this study was to evaluate the cost-effectiveness of physician-staffed HEMS compared with ground-based EMS in Finland under current practices.

Methods

The incremental cost-effectiveness ratio was evaluated using the differences in outcomes and costs between HEMS and ground-based EMS. The estimated mortality within 30 days and quality-adjusted life years (QALYs) were used to measure health benefits. Quality of life was estimated according to the EuroQoL scale, and a 1-way sensitivity analysis was conducted on the QALY indexes ranging from 0.6 to 0.8. Survival rates were calculated according to the national HEMS database, and the cost structure was estimated at 48 million euros based on financial statements.

Results

HEMS prevented the 30-day mortality of 68.1 patients annually, with an incremental cost-effectiveness ratio of €43,688 to €56,918/QALY. Fixed costs accounted for 93% of HEMS expenses because of 24/7 operations, making the capacity utilization rate a major determinant of total costs.

Conclusion

HEMS intervention is cost-effective compared with ground-based EMS and is acceptable from a societal willingness-to-pay perspective. These findings contribute valuable insights for health care management decision making and highlight the need for future research for service optimization.

目的由于直升机紧急医疗服务 (HEMS) 的单位成本高于传统的地面紧急医疗服务 (EMS)，因此进一步调查 HEMS 的影响非常重要。本研究的目的是评估在芬兰，在目前的做法下，由医生参与的直升机急救服务与地面急救服务相比的成本效益。方法利用直升机急救服务与地面急救服务在结果和成本上的差异评估增量成本效益比。30 天内的估计死亡率和质量调整生命年 (QALY) 用于衡量健康效益。生活质量根据欧洲生活质量量表进行估算，并对 0.6 至 0.8 的 QALY 指数进行了单向敏感性分析。根据国家 HEMS 数据库计算了存活率，并根据财务报表估算出成本结构为 4800 万欧元。结果 HEMS 每年可避免 68.1 名患者在 30 天内死亡，增量成本效益比为 43688 欧元至 56918 欧元/QALY。由于全天候运行，固定成本占急救服务费用的 93%，因此容量利用率是决定总成本的主要因素。结论与地面急救服务相比，急救服务干预具有成本效益，从社会支付意愿的角度来看是可以接受的。这些发现为医疗保健管理决策提供了宝贵的见解，并强调了未来优化服务研究的必要性。

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引用次数: 0

Editors Note: By the Numbers 重症监护更新

Q3 Nursing

Air Medical Journal

Pub Date : 2024-05-01 DOI: 10.1016/j.amj.2024.03.013

David J. Dries MSE, MD

引用次数: 0

May/June 2024 Forum 2024 年 5 月/6 月论坛

Q3 Nursing

Air Medical Journal

Pub Date : 2024-05-01 DOI: 10.1016/j.amj.2024.03.008

引用次数: 0

Caring for Patients Without Providing Patient Care: The Role of the Pilot Outside of the Cockpit 不为病人提供护理而为病人提供护理：飞行员在驾驶舱外的角色

Q3 Nursing

Air Medical Journal

Pub Date : 2024-05-01 DOI: 10.1016/j.amj.2024.03.007

Eugene Reynolds BA

引用次数: 0

Fate of Pediatric Transport Medicine Abstracts 2011 to 2020: What Predicts Publication Success? 2011年至2020年儿科转运医学摘要的命运：如何预测出版成功？

Q3 Nursing

Air Medical Journal

Pub Date : 2024-05-01 DOI: 10.1016/j.amj.2023.11.014

Ranna A. Rozenfeld MD, FAAP, FCCM , Corina Noje MD

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.

目标每年在美国儿科学会 (AAP) 运输医学分会 (SOTM) 的科学摘要计划中介绍儿科-新生儿运输研究项目。在期刊上发表论文可以提高这些项目的影响力。我们的目标是确定转运摘要的发表率，并找出预测发表成功的因素。方法我们回顾了 2011 年至 2020 年所有被接受发表的 AAP SOTM 摘要，并评估了发表形式（口头/平台与海报）、作者的专业程度（医生与非医生）以及第一作者的受训者身份。我们按摘要标题和作者在 PubMed、Ovid 和 ResearchGate 上搜索了相关出版物，然后比较了已发表和未发表的摘要。分类变量用比例表示，并使用卡方检验或费雪精确检验进行比较；连续变量用中位数和四分位数间距（IQR）表示，并酌情使用学生 t 检验或 Kruskal-Wallis 检验进行比较。结果在提交的 194 篇摘要中，有 67 篇（34.5%）发表。口头/平台摘要的发表率明显高于海报摘要（P <.01），如果摘要是口头/平台摘要（概率增加 19.5%，P <.01），如果第一作者是实习生（概率增加 25.6%，P <0.05）。常数估计为 24.9% 的发表概率。因此，如果第一作者是一名医生、一名实习生，并做过口头/平台发言，那么发表的概率为 85.8%。文章发表时间的中位数（IQR）为 2 年（IQR：2-4 年），发表时间最长的文章被引用的次数最多。文章发表在 27 种不同的期刊上，其中近一半（33/67，49.3%）发表在 3 种期刊上。口头摘要、医生第一作者和实习生第一作者的成功率明显更高。应在全国范围内特别重视支持非医师运输专业人员发表论文。

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引用次数: 0

The Effect of Coronavirus Disease 2019 on Adverse Events in Health Care: A Retrospective Study in Ground and Helicopter Emergency Medical Services 2019 年冠状病毒疾病对医疗服务不良事件的影响：地面和直升机紧急医疗服务的回顾性研究

Q3 Nursing

Air Medical Journal

Pub Date : 2024-05-01 DOI: 10.1016/j.amj.2023.11.015

Blake Miller MS (Medical Student), Timothy J. Lenz MD, MPH, EMT-P, FAEMS, FACEP

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.

目标 2019 年冠状病毒病（COVID-19）大流行已证明给全世界带来了巨大的困难。医疗保健系统及其工作人员的工作量已达到极限。有关这种压力的增加是否会影响患者安全的研究还不够充分，特别是在紧急医疗服务方面。本研究旨在确定自 COVID-19 大流行以来，地面和直升机紧急医疗服务中的不良事件发生率是否有所上升。主要结果是 2020 年 3 月 13 日之前和之后 1 年的不良事件发生率。所有产生质量改进事件报告表（QIRF）的不良事件都包括在内，但非临床相关事件除外。此外，在这两年的 5 月 1 日至 8 月 31 日之间的较小时间范围内，还包括同行评审员标记的所有不良事件；但并非所有这些事件都生成了 QIRF。结果在 2019 年 3 月 13 日至 2020 年 3 月 12 日期间，3154 次呼叫中有 5 次（0.16%）生成了 QIRF，而在 2020 年 3 月 13 日至 2021 年 3 月 12 日期间，3185 次呼叫中有 21 次（0.66%）生成了 QIRF。有显著关系显示，COVID-19 开始后发生不良事件的几率高于 COVID-19 开始前（χ21 [N = 6,339] = 8.643，P ≤ .001）。此外，从 5 月 1 日至 8 月 31 日，2019 年和 2020 年的不良事件总发生率分别为 16.86%（143/848 次呼叫）和 24.46%（387/1,582 次呼叫）。同样，大流行开始后发生的不良事件与大流行开始前发生的不良事件相比具有统计学意义（χ21 [N = 2,430] = 18.253，P ≤ .001）。为进一步了解不良事件增加的原因和患者预后，应开展更多研究。

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引用次数: 0

Prehospital Blood Transfusion in Helicopter Emergency Medical Services: An Italian Survey 直升机紧急医疗服务中的院前输血：意大利调查。

Q3 Nursing

Air Medical Journal

Pub Date : 2024-05-01 DOI: 10.1016/j.amj.2024.02.002

Olivia Bradley BEH, Biswadev Mitra MBBS, PhD, Ben Meadley BAppSci, PhD, Toby St Clair MSpecPara(AR), David Anderson MBChB

引用次数: 0

A Description of Medications and Intravenous Fluids Used During Neonatal Transport by a Regional Pediatric Critical Care Team 地区儿科重症监护团队在新生儿转运过程中使用的药物和静脉输液说明

Q3 Nursing

Air Medical Journal

Pub Date : 2024-05-01 DOI: 10.1016/j.amj.2023.12.009

Devin McKissic MD , Taylor Riley MPH , Zeenia Billimoria MBBS , Rossella Mastroianni MD , Annabelle Kotler , Ashima Bhatti MPharm , John Feltner MS , Chris Baker RN, BSN , Rachel A. Umoren MD , Megan M. Gray MD

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.

本研究旨在描述一个地区性儿科重症监护转运团队在转运新生儿过程中使用的肠内和肠外液体及药物的类型和频率。从电子病历中收集了人口统计学和临床数据。采用标准频数表和汇总统计来报告人口统计学、转运特征、输液和用药情况；然后按早产儿（37 周）和足月儿对结果进行分层。结果在纳入的 628 次转运中，接受至少一种输液或用药的足月儿多于早产儿（分别为 53% 和 43%）。最常使用的药物是抗生素（氨苄西林和庆大霉素）、前列腺素和阿片类药物（硫酸吗啡和芬太尼）。此外，足月儿接受的镇痛药物、抗菌药物和前列腺素较多，而早产儿接受全肠外营养的次数较多。结论这项针对一个转运团队的研究显示，在转运新生儿的过程中使用了多种药物和液体，其中足月儿比早产儿接受的药物更多。这些数据可供转运团队在制定或更新其标准药物清单或创建模拟时使用。

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引用次数: 0

Of HEMS and Blood: A Reply to Facchetti et al 关于紧急医疗服务和血液：答复 Facchetti 等人

Q3 Nursing

Air Medical Journal

Pub Date : 2024-05-01 DOI: 10.1016/j.amj.2024.03.001

Luca Carenzo MD, Lorenzo Gamberini MD, Marco Tartaglione MD

引用次数: 0

A Simpler Method for Choosing Adult i-gel Size: An Evaluation of Real-World Prehospital Data 选择成人 i-gel 尺寸的更简便方法：真实院前数据评估

Q3 Nursing

Air Medical Journal

Pub Date : 2024-05-01 DOI: 10.1016/j.amj.2024.03.011

Tanner Smida BS , Remle P. Crowe PhD , Patrick W. Merrill NRP , James F. Scheidler MD

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.

目的i-gel 声门上气道装置（Intersurgical，英国伯克郡）在美国和世界各地普遍用于院前气道管理。以前的研究表明，在接受选择性麻醉的患者中，基于性别的尺寸选择方法（女性患者为 4.0，男性患者为 5.0）优于基于体重的方法。我们的目的是利用真实的院前数据，比较基于性别的 i-gel 尺寸选择策略和基于体重的策略。对所有首次尝试插入 i-gel 的 18 岁及以上患者进行评估以纳入数据集。如果没有记录年龄、性别、体重、成功率或装置尺寸，则排除插入尝试。采用 Logistic 回归法比较了根据体重但不根据性别的方法对准插入组和根据性别但不根据体重的方法对准插入组的首次插入失败率。总失败率为 6.5%（2,585/39,867）。当 i-gel 装置与基于性别的尺寸选择方法相一致时，与 i-gel 装置与基于体重的选择策略相一致时的失败率相似（6.0% vs. 6.4%）。Logistic 回归分析显示，组间差异不显著（几率比：1.08；95% 置信区间：0.95-1.23）。

{"title":"A Simpler Method for Choosing Adult i-gel Size: An Evaluation of Real-World Prehospital Data","authors":"Tanner Smida BS , Remle P. Crowe PhD , Patrick W. Merrill NRP , James F. Scheidler MD","doi":"10.1016/j.amj.2024.03.011","DOIUrl":"10.1016/j.amj.2024.03.011","url":null,"abstract":"<div><h3>Objective</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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).</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"43 3","pages":"Pages 259-261"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140771506","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}

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