Pub Date : 2025-05-13DOI: 10.1016/j.amj.2025.04.003
Carmen Rodriguez Perez MD, PhD , Carlo Bellini MD, PhD , Maurizio Gente MD , Diego Minghetti MD , Elisa Cavalleri MD , Francesca Catani MD , Francesco Maria Risso MD, PhD
Objective
Emergency neonatal transport is well established in many Western countries, with comprehensive frameworks and guidelines for the management of neonatal respiratory distress. The aim of this survey was to provide valuable insights into the ventilators currently used during neonatal transport in Italy. We hope that the results of this survey will help guide and inform future improvements in the quality of care provided during neonatal transport for newborns with respiratory distress.
Methods
Survey period: January 2025 (1-31). A simple questionnaire with 3 key questions was sent by e-mail to the directors of the 55 currently active Italian neonatal emergency transport services (NETS). The questions were as follows: Which ventilator model(s) are used? How many ventilators are mounted on each transport incubator in use? How many transport incubators are currently in use in your NETS?
The last 2 questions have an additional query: Is it possible for your NETS to transport twins simultaneously, and if so, what is the current ventilation strategy?
Results
The survey, conducted among 55 Italian NETS, provides the following breakdown of the main results. Total ventilators used: 115; Hamilton T1: 61 of 115 (most used); Fabian without High Frequency Ventilation (HFV): 24 of 115; Stephan F 120: 18 of 115; Crossvent-2i+: 6 of 115; Leoni Plus with HFV: 2 of 115; MVP-10: 2 of 115; Bronchotron F00038-1: 1 of 115; pNeuton mini NEO: 1 of 115.
Conclusion
This survey has revealed that there is great variability in Italy regarding the ventilators used in neonatal transport.
{"title":"Ventilators Currently Used in Emergency Neonatal Transport: Italian National Survey, Year 2025","authors":"Carmen Rodriguez Perez MD, PhD , Carlo Bellini MD, PhD , Maurizio Gente MD , Diego Minghetti MD , Elisa Cavalleri MD , Francesca Catani MD , Francesco Maria Risso MD, PhD","doi":"10.1016/j.amj.2025.04.003","DOIUrl":"10.1016/j.amj.2025.04.003","url":null,"abstract":"<div><h3>Objective</h3><div>Emergency neonatal transport is well established in many Western countries, with comprehensive frameworks and guidelines for the management of neonatal respiratory distress. The aim of this survey was to provide valuable insights into the ventilators currently used during neonatal transport in Italy. We hope that the results of this survey will help guide and inform future improvements in the quality of care provided during neonatal transport for newborns with respiratory distress.</div></div><div><h3>Methods</h3><div>Survey period: January 2025 (1-31). A simple questionnaire with 3 key questions was sent by e-mail to the directors of the 55 currently active Italian neonatal emergency transport services (NETS). The questions were as follows: Which ventilator model(s) are used? How many ventilators are mounted on each transport incubator in use? How many transport incubators are currently in use in your NETS?</div><div>The last 2 questions have an additional query: Is it possible for your NETS to transport twins simultaneously, and if so, what is the current ventilation strategy?</div></div><div><h3>Results</h3><div>The survey, conducted among 55 Italian NETS, provides the following breakdown of the main results. Total ventilators used: 115; Hamilton T1: 61 of 115 (most used); Fabian without High Frequency Ventilation (HFV): 24 of 115; Stephan F 120: 18 of 115; Crossvent-2i+: 6 of 115; Leoni Plus with HFV: 2 of 115; MVP-10: 2 of 115; Bronchotron F00038-1: 1 of 115; pNeuton mini NEO: 1 of 115.</div></div><div><h3>Conclusion</h3><div>This survey has revealed that there is great variability in Italy regarding the ventilators used in neonatal transport.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 4","pages":"Pages 291-301"},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144470152","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 : 2025-05-03DOI: 10.1016/j.amj.2025.03.006
Nicholas H. George MD , Matthew McCauley MD , Ryan Newberry DO, MPH , Nikole Neidlinger MD , Tikiri Bandara BS , Jeffery Ethington MPS, BS, EMT , Matthew J. Stampfl MD , Brittney Bernardoni MD , Trevor Johnson RN, MSN, CFRN , Andrew Cathers MD
Objective
Organ transplantation is an operationally complex process. Centralized recovery centers (CRCs) address multiple logistical issues while decreasing costs and increasing organ transplanted per donor (OTPD). This paradigm is predicated on the safe and effective transport of neurologically deceased donors from index facilities. Although the merits of CRCs are well studied, these transport processes have not been well assessed. We set out to evaluate the safety, feasibility, and efficacy of transporting brain-dead organ donors through air and ground critical care transport.
Methods
We completed a comprehensive review of our processes and retrospective chart review of all donor transports from index hospitals to the local CRC in an 18-month period. Clinical and transport data were both electronically and manually abstracted from 2 existing databases.
Results
Crews transported 74 donors (32 by air, 42 by ground) resulting in 257 organs transplanted (OTPD3.67). Median operating room time was 237 (interquartile range 205-292) minutes. Donors required a median of 2 (interquartile range 0-3) infusions and a mean norepinephrine equivalent of 0.02 µg/kg/min (standard deviation 0.06). One patient (1.4%) required blood products, 6 (8.1%) developed new hypotension, and 4 (5.4%) had new hypoxemia. There were no cardiac arrests in transport.
Conclusion
Through a thoughtful collaboration between a busy organ procurement organization and well-established regional air and ground critical care transport service, in 18 months our system moved 74 donors from index hospitals to a new CRC for organ procurement. Our experience highlights the feasibility, safety, and efficacy of this cost-effective partnership.
{"title":"Facilitation of a Centralized Recovery Center Through Air and Ground Critical Care Transport","authors":"Nicholas H. George MD , Matthew McCauley MD , Ryan Newberry DO, MPH , Nikole Neidlinger MD , Tikiri Bandara BS , Jeffery Ethington MPS, BS, EMT , Matthew J. Stampfl MD , Brittney Bernardoni MD , Trevor Johnson RN, MSN, CFRN , Andrew Cathers MD","doi":"10.1016/j.amj.2025.03.006","DOIUrl":"10.1016/j.amj.2025.03.006","url":null,"abstract":"<div><h3>Objective</h3><div>Organ transplantation is an operationally complex process. Centralized recovery centers (CRCs) address multiple logistical issues while decreasing costs and increasing organ transplanted per donor (OTPD). This paradigm is predicated on the safe and effective transport of neurologically deceased donors from index facilities. Although the merits of CRCs are well studied, these transport processes have not been well assessed. We set out to evaluate the safety, feasibility, and efficacy of transporting brain-dead organ donors through air and ground critical care transport.</div></div><div><h3>Methods</h3><div>We completed a comprehensive review of our processes and retrospective chart review of all donor transports from index hospitals to the local CRC in an 18-month period. Clinical and transport data were both electronically and manually abstracted from 2 existing databases.</div></div><div><h3>Results</h3><div>Crews transported 74 donors (32 by air, 42 by ground) resulting in 257 organs transplanted (OTPD3.67). Median operating room time was 237 (interquartile range 205-292) minutes. Donors required a median of 2 (interquartile range 0-3) infusions and a mean norepinephrine equivalent of 0.02 µg/kg/min (standard deviation 0.06). One patient (1.4%) required blood products, 6 (8.1%) developed new hypotension, and 4 (5.4%) had new hypoxemia. There were no cardiac arrests in transport.</div></div><div><h3>Conclusion</h3><div>Through a thoughtful collaboration between a busy organ procurement organization and well-established regional air and ground critical care transport service, in 18 months our system moved 74 donors from index hospitals to a new CRC for organ procurement. Our experience highlights the feasibility, safety, and efficacy of this cost-effective partnership.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 4","pages":"Pages 282-285"},"PeriodicalIF":0.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144470150","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 : 2025-05-01DOI: 10.1016/j.amj.2025.02.005
Giuseppe Stirparo MD , Elena Maria Ticozzi MD , Sarah Cataldi MD , Rodolfo Bonora , Andrea Pagliosa , Angelo Giupponi MD , Serena Ruberti MD , Annalisa Bodina MD , Gabriele Perotti MD , Fabrizio Ernesto Pregliasco MD , Carlo Signorelli PhD , Giuseppe Ristagno PhD
Objective
Stroke is a time-sensitive condition in which timely intervention is crucial for optimal outcomes. Advances in stroke management, including extended time windows for thrombolysis and mechanical thrombectomy, highlight the need for efficient patient centralization. This study explores the newly adopted stroke algorithm for patient centralization in Lombardy, Italy, and evaluates the potential for helicopter emergency medical services (HEMS) to improve access to timely care.
Methods
Data regarding stroke rescue missions were retrieved from SAS-AREU database. Geospatial maps were created using QGIS (Open Source Geospatial Foundation (OSGeo), Chicago, IL) 3.30, with travel times calculated using Google Maps data. Population density was retrieved from Geoportal Lombardia. Area with road travel time to a Hub hospital >60 minutes were identified as potential HEMS priority settings.
Results
In 2024, 11,822 patients rescued by the Regional Agency for Emergency and Urgency were given the “stroke code.” HEMS was used in 214 cases, covering a median distance of 49.3 km with a median rescue time of 77 minutes. The study identified areas with road travel times exceeding 60 minutes, highlighting northern Lombardy's mountainous regions and areas with low population density as high priority areas for HEMS intervention. The analysis also revealed an unexpected advantage for air transport in some plain areas, despite viable road access.
Conclusion
Geospatial mapping is a valuable tool for identifying areas where HEMS can reduce response times. The integration of HEMS into stroke care algorithms enhances timely interventions, ensuring that patients are centralized within recommended time windows, improving outcomes, and addressing geographic and infrastructural challenges.
目的：卒中是一种时间敏感的疾病，及时干预对获得最佳结果至关重要。脑卒中管理的进步，包括延长溶栓和机械取栓的时间窗口，强调了有效的患者集中治疗的必要性。本研究探讨了意大利伦巴第新采用的卒中患者集中算法，并评估了直升机紧急医疗服务（HEMS）改善及时护理的潜力。方法从SAS-AREU数据库中检索脑卒中抢救任务数据。地理空间地图使用QGIS (Open Source Geospatial Foundation (OSGeo), Chicago， IL) 3.30创建，旅行时间使用谷歌maps数据计算。人口密度检索自伦巴第地质门户。到中心医院的公路旅行时间为60分钟的地区被确定为潜在的HEMS优先设置。结果2024年，11822例经地区急救机构抢救的患者获得了“脑卒中代码”。采用HEMS救治214例，平均救治距离49.3 km，平均抢救时间77分钟。该研究确定了道路旅行时间超过60分钟的地区，重点指出伦巴第北部山区和人口密度低的地区是医疗急救系统干预的高优先区域。分析还显示，在一些平原地区，尽管有可行的公路通道，但航空运输具有意想不到的优势。结论地理空间制图是确定HEMS可减少响应时间的有效工具。将HEMS整合到卒中护理算法中可以提高干预的及时性，确保患者在推荐的时间窗口内集中，改善结果，并解决地理和基础设施方面的挑战。
{"title":"Helicopter Emergency Medical Services as a Tool for Prehospital Emergency Rescue in Northern Italy","authors":"Giuseppe Stirparo MD , Elena Maria Ticozzi MD , Sarah Cataldi MD , Rodolfo Bonora , Andrea Pagliosa , Angelo Giupponi MD , Serena Ruberti MD , Annalisa Bodina MD , Gabriele Perotti MD , Fabrizio Ernesto Pregliasco MD , Carlo Signorelli PhD , Giuseppe Ristagno PhD","doi":"10.1016/j.amj.2025.02.005","DOIUrl":"10.1016/j.amj.2025.02.005","url":null,"abstract":"<div><h3>Objective</h3><div>Stroke is a time-sensitive condition in which timely intervention is crucial for optimal outcomes. Advances in stroke management, including extended time windows for thrombolysis and mechanical thrombectomy, highlight the need for efficient patient centralization. This study explores the newly adopted stroke algorithm for patient centralization in Lombardy, Italy, and evaluates the potential for helicopter emergency medical services (HEMS) to improve access to timely care.</div></div><div><h3>Methods</h3><div>Data regarding stroke rescue missions were retrieved from SAS-AREU database. Geospatial maps were created using QGIS (Open Source Geospatial Foundation (OSGeo), Chicago, IL) 3.30, with travel times calculated using Google Maps data. Population density was retrieved from Geoportal Lombardia. Area with road travel time to a Hub hospital >60 minutes were identified as potential HEMS priority settings.</div></div><div><h3>Results</h3><div>In 2024, 11,822 patients rescued by the Regional Agency for Emergency and Urgency were given the “stroke code.” HEMS was used in 214 cases, covering a median distance of 49.3 km with a median rescue time of 77 minutes. The study identified areas with road travel times exceeding 60 minutes, highlighting northern Lombardy's mountainous regions and areas with low population density as high priority areas for HEMS intervention. The analysis also revealed an unexpected advantage for air transport in some plain areas, despite viable road access.</div></div><div><h3>Conclusion</h3><div>Geospatial mapping is a valuable tool for identifying areas where HEMS can reduce response times. The integration of HEMS into stroke care algorithms enhances timely interventions, ensuring that patients are centralized within recommended time windows, improving outcomes, and addressing geographic and infrastructural challenges.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 3","pages":"Pages 189-194"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131144","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}
Helicopter Emergency Medical Services (HEMS) play a vital role in transporting time-sensitive patients, including pregnant women at risk of imminent childbirth, from remote locations to appropriate medical facilities. However, the potential for in-flight delivery presents unique challenges for emergency medical teams. We present a case report from Gonabad University of Medical Sciences documenting the only recorded instance of in-flight childbirth during a five-year period of HEMS operations. The case involved a 38-year-old multiparous woman (G6P5) transported from a remote village located 110 kilometers from the nearest appropriate medical facility. Despite activation time delays exceeding standard benchmarks, the medical team successfully managed the delivery in the confined space of a BK-117 helicopter. The mother maintained stable vital signs throughout transport, and both mother and infant were safely transferred to the receiving facility. The total mission duration was 62 minutes, with specific challenges noted in activation time and restricted cabin space for delivery management. This case highlights critical areas for HEMS protocol improvement, including the need for standardized dispatch criteria for obstetric emergencies, consideration of midwife inclusion in flight teams, and strategies to reduce activation times. The experience provides valuable insights for enhancing emergency medical services in similar scenarios.
{"title":"Investigating Helicopter Emergency Medical Services Challenges in Transporting Pregnant Mothers: A Case Report","authors":"Mohammad Hossein Esmaeilzadeh MSc , Fatemeh Shaghaghi PhD , Morteza Rostamian PhD , Maryam Mostafapour MSc","doi":"10.1016/j.amj.2025.03.007","DOIUrl":"10.1016/j.amj.2025.03.007","url":null,"abstract":"<div><div>Helicopter Emergency Medical Services (HEMS) play a vital role in transporting time-sensitive patients, including pregnant women at risk of imminent childbirth, from remote locations to appropriate medical facilities. However, the potential for in-flight delivery presents unique challenges for emergency medical teams. We present a case report from Gonabad University of Medical Sciences documenting the only recorded instance of in-flight childbirth during a five-year period of HEMS operations. The case involved a 38-year-old multiparous woman (G6P5) transported from a remote village located 110 kilometers from the nearest appropriate medical facility. Despite activation time delays exceeding standard benchmarks, the medical team successfully managed the delivery in the confined space of a BK-117 helicopter. The mother maintained stable vital signs throughout transport, and both mother and infant were safely transferred to the receiving facility. The total mission duration was 62 minutes, with specific challenges noted in activation time and restricted cabin space for delivery management. This case highlights critical areas for HEMS protocol improvement, including the need for standardized dispatch criteria for obstetric emergencies, consideration of midwife inclusion in flight teams, and strategies to reduce activation times. The experience provides valuable insights for enhancing emergency medical services in similar scenarios.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 4","pages":"Pages 318-322"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144470311","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 : 2025-05-01DOI: 10.1016/j.amj.2025.01.007
Lauren M. Maloney MD, NRP, FP-C, NCEE, FACEP, FAEMS , Devin A. McKissic MD , Ingrid M. Anderson MD , Daniel J. Scherzer MD , Kamal Abulebda MD , Erin Montgomery RN , Christopher Kennedy MD , Snimarjot Kaur MBBS , Mark Adler MD , Grace M. Arteaga MD , Marc A. Auerbach MD, MSc , Stephen J. Gleich MD , Erin W. Hulfish MD , Brian M. Jackson MD , Jeffrey Luk MD , Riad Lutfi MD , Maria J. Mandt MD , Arushi Manga MD , Anna E. McCormick DO , Ranna A. Rozenfeld MD , Rachel Umoren MBBCh, MS
Objective
Pediatric critical care transport (PCCT) teams are expected to manage a wide spectrum of pediatric high-acuity conditions. PCCT program leaders may have unique insights into transport team training, including opportunities, experiences, and barriers. The purpose of this study was to understand how PCCT program leaders perceived the role of simulation in PCCT team education.
Methods
PCCT medical directors or administrators from 12 ImPACTS (Improving Pediatric Acute Care Through Simulation) sites were recruited to participate in a 30-minute interview with trained facilitators. A semistructured 7-question interview guide on the barriers, supports, and opportunities presented by transport simulations was used. Interviews were digitally recorded, and transcripts were organized using Dedoose qualitative software. A grounded theory approach was used to identify themes.
Results
A total of 11 interviews were conducted with 5 PCCT medical directors (45%) and 6 administrators/clinical managers (54%) from 11 participating ImPACTS health facilities. Themes on participant experience with simulation, simulation feeling real, value of simulation, planning simulations, and logistical challenges were identified.
Conclusion
In general, although PCCT program leaders acknowledge logistical difficulties with planning simulations, they feel that transport simulations, particularly conducted in situ in a transport vehicle, are a helpful educational tool for PCCT teams.
{"title":"Perspectives on Simulation-Based Pediatric Critical Care Transport Team Education: Qualitative Analysis of Interviews With Transport Program Leaders in the ImPACTS Transport Simulation Study","authors":"Lauren M. Maloney MD, NRP, FP-C, NCEE, FACEP, FAEMS , Devin A. McKissic MD , Ingrid M. Anderson MD , Daniel J. Scherzer MD , Kamal Abulebda MD , Erin Montgomery RN , Christopher Kennedy MD , Snimarjot Kaur MBBS , Mark Adler MD , Grace M. Arteaga MD , Marc A. Auerbach MD, MSc , Stephen J. Gleich MD , Erin W. Hulfish MD , Brian M. Jackson MD , Jeffrey Luk MD , Riad Lutfi MD , Maria J. Mandt MD , Arushi Manga MD , Anna E. McCormick DO , Ranna A. Rozenfeld MD , Rachel Umoren MBBCh, MS","doi":"10.1016/j.amj.2025.01.007","DOIUrl":"10.1016/j.amj.2025.01.007","url":null,"abstract":"<div><h3>Objective</h3><div>Pediatric critical care transport (PCCT) teams are expected to manage a wide spectrum of pediatric high-acuity conditions. PCCT program leaders may have unique insights into transport team training, including opportunities, experiences, and barriers. The purpose of this study was to understand how PCCT program leaders perceived the role of simulation in PCCT team education.</div></div><div><h3>Methods</h3><div>PCCT medical directors or administrators from 12 ImPACTS (Improving Pediatric Acute Care Through Simulation) sites were recruited to participate in a 30-minute interview with trained facilitators. A semistructured 7-question interview guide on the barriers, supports, and opportunities presented by transport simulations was used. Interviews were digitally recorded, and transcripts were organized using Dedoose qualitative software. A grounded theory approach was used to identify themes.</div></div><div><h3>Results</h3><div>A total of 11 interviews were conducted with 5 PCCT medical directors (45%) and 6 administrators/clinical managers (54%) from 11 participating ImPACTS health facilities. Themes on participant experience with simulation, simulation feeling real, value of simulation, planning simulations, and logistical challenges were identified.</div></div><div><h3>Conclusion</h3><div>In general, although PCCT program leaders acknowledge logistical difficulties with planning simulations, they feel that transport simulations, particularly conducted in situ in a transport vehicle, are a helpful educational tool for PCCT teams.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 3","pages":"Pages 179-183"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131142","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 : 2025-05-01DOI: 10.1016/j.amj.2025.02.002
Yalcin Golcuk MD , Lütfi Mert Güler MSc
Helicopter emergency medical services (HEMS) are pivotal in delivering rapid medical intervention to critically ill or injured patients. Since its establishment in Turkey in 2008, the HEMS network has expanded to 13 air ambulances, enhancing health care accessibility in geographically challenging areas. However, the inaugural fatal HEMS accident on December 22, 2024, exposed significant operational vulnerabilities. This report meticulously evaluates the incident, focusing on contributory factors such as adverse weather conditions, human errors, and operational hazards. Drawing from international data and best practices, we propose evidence-based recommendations to bolster the safety and efficacy of HEMS operations in Turkey.
{"title":"The First Fatal Helicopter Emergency Medical Services Crash in Turkey: Weather, Human Factors, and Lessons Learned","authors":"Yalcin Golcuk MD , Lütfi Mert Güler MSc","doi":"10.1016/j.amj.2025.02.002","DOIUrl":"10.1016/j.amj.2025.02.002","url":null,"abstract":"<div><div>Helicopter emergency medical services (HEMS) are pivotal in delivering rapid medical intervention to critically ill or injured patients. Since its establishment in Turkey in 2008, the HEMS network has expanded to 13 air ambulances, enhancing health care accessibility in geographically challenging areas. However, the inaugural fatal HEMS accident on December 22, 2024, exposed significant operational vulnerabilities. This report meticulously evaluates the incident, focusing on contributory factors such as adverse weather conditions, human errors, and operational hazards. Drawing from international data and best practices, we propose evidence-based recommendations to bolster the safety and efficacy of HEMS operations in Turkey.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 3","pages":"Pages 223-224"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131055","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 : 2025-05-01DOI: 10.1016/j.amj.2025.01.005
Dillon Afenir BA , Taylor L. Sawyer DO, MEd, MBA , Rachel A. Umoren MBBCh, MS , John Feltner MS , Annabelle Kotler , Brian W. Bresnahan PhD
Objective
Interfacility transports from lower-level health care facilities to specialized centers support regionalization of care and improve morbidity and mortality rates. We assessed the published literature related to neonatal transport costs and characterized the clinical and economic complexities of risk-based decision-making to inform health policy options.
Methods
We conducted a targeted scoping review of published ground and air transport literature reporting on cost-related outcomes with a focus on neonatal studies. We converted estimates to 2020 US dollars. We summarized methods, findings, and limitations of existing studies. From the perspectives of various stakeholders involved in complex transfer and transportation decisions, we provided simplified estimates of stakeholder cost scenarios and graphical representations of basic microeconomic concepts associated with transport.
Results
Eight cost-related neonatal transport studies were identified from different countries. The average estimated cost of ground transport was approximately $5,043 and $18,000 for air transport. Most cost-related studies used the perspective of the referring or accepting hospital, but not both. There were no randomized or experimental intervention studies. The literature suggests that the greatest portion of the costs incurred for transfers was for interhospital transports. Our simplified estimates illustrate trade-offs among distinct stakeholders for transport decisions.
Conclusion
Interfacility transport decisions involve time-sensitive and complex processes affecting multiple stakeholders, with many variables beyond cost. Few studies report cost outcomes for neonatal transports, with identified studies varying by country-level health care systems, populations analyzed, study designs, and cost estimation methods. Improving the transport decision-making process may reduce patient risk and transport cost. Other strategies include expanding telehealth programs, improving communication among medical providers, strengthening specialist capacity at referring hospitals, and tailoring risk-based planning before delivery.
{"title":"Assessing the Complexity of Economic Scenarios and Decision-Making Processes for Interfacility Neonatal Transport: Cost-Related Literature, Multistakeholder Perspectives, and Options for Improvement","authors":"Dillon Afenir BA , Taylor L. Sawyer DO, MEd, MBA , Rachel A. Umoren MBBCh, MS , John Feltner MS , Annabelle Kotler , Brian W. Bresnahan PhD","doi":"10.1016/j.amj.2025.01.005","DOIUrl":"10.1016/j.amj.2025.01.005","url":null,"abstract":"<div><h3>Objective</h3><div>Interfacility transports from lower-level health care facilities to specialized centers support regionalization of care and improve morbidity and mortality rates. We assessed the published literature related to neonatal transport costs and characterized the clinical and economic complexities of risk-based decision-making to inform health policy options.</div></div><div><h3>Methods</h3><div>We conducted a targeted scoping review of published ground and air transport literature reporting on cost-related outcomes with a focus on neonatal studies. We converted estimates to 2020 US dollars. We summarized methods, findings, and limitations of existing studies. From the perspectives of various stakeholders involved in complex transfer and transportation decisions, we provided simplified estimates of stakeholder cost scenarios and graphical representations of basic microeconomic concepts associated with transport.</div></div><div><h3>Results</h3><div>Eight cost-related neonatal transport studies were identified from different countries. The average estimated cost of ground transport was approximately $5,043 and $18,000 for air transport. Most cost-related studies used the perspective of the referring or accepting hospital, but not both. There were no randomized or experimental intervention studies. The literature suggests that the greatest portion of the costs incurred for transfers was for interhospital transports. Our simplified estimates illustrate trade-offs among distinct stakeholders for transport decisions.</div></div><div><h3>Conclusion</h3><div>Interfacility transport decisions involve time-sensitive and complex processes affecting multiple stakeholders, with many variables beyond cost. Few studies report cost outcomes for neonatal transports, with identified studies varying by country-level health care systems, populations analyzed, study designs, and cost estimation methods. Improving the transport decision-making process may reduce patient risk and transport cost. Other strategies include expanding telehealth programs, improving communication among medical providers, strengthening specialist capacity at referring hospitals, and tailoring risk-based planning before delivery.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 3","pages":"Pages 209-216"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131053","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 : 2025-05-01DOI: 10.1016/j.amj.2025.03.009
Hannah L. Lindsay B.Paramed (Hons) , Matthew J. Humar GradDipEmergHlth , David J. Anderson MBChB, FCICM , Benjamin N. Meadley PhD
Objective
Oxygen desaturation is a complication of prehospital rapid sequence intubation before air medical transport. Preoxygenation with a self-inflating resuscitator (ie, bag-valve-mask [BVM]) device and a reservoir bag at 15 L/min oxygen flow (BVM15) is effective at extending safe apnea time. The impact of a lightweight, oxygen-sparing bag refill valve (RV) connector on preoxygenation efficacy is unclear. The objective of this study was to compare preoxygenation with a BVM with a RV connector (BVM + RV) with a BVM with a reservoir bag at 15 L/min oxygen flow (BVM15). The primary outcome was percentage of end-tidal oxygen concentration (EtO2) at 60 and 180 seconds. Secondary outcomes included EtO2 at 60 and 180 seconds when nasal cannula at 15 L/min oxygen flow (NC) was added to these preoxygenation methods (BVM + RV + NC and BVM15 + NC).
Method
Healthy volunteers were recruited and randomly allocated to receive 3 minutes of preoxygenation using each of the 4 methods (BVM + RV, BVM15, BVM + RV + NC, BVM15 + NC).
Results
This pilot study found no significant difference in the EtO2 levels at 60 and 180 seconds between the BVM plus RV and BVM15. However, the addition of NC to the BVM15 setup significantly improved the rate of EtO2 rise.
Conclusion
Preoxygenation using either a BVM plus RV or BVM15 achieves adequate EtO2 in healthy volunteers. The addition of NC further enhances rise in EtO2 levels. Although more research is needed, the RV may be an alternative device to facilitate preoxygenation in air medical services.
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Pub Date : 2025-05-01DOI: 10.1016/j.amj.2025.02.008
Blaise Loughman MD, EMT-P, Fatou Ndaw MD, Aaron J. Lacy MD, MHPE, FACEP, James L. Li MD, MEd, FAEMS
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