Pub Date : 2025-09-01Epub Date: 2025-07-10DOI: 10.1016/j.amj.2025.06.015
Matthew R. Shaw MPH, FP-C, CCP-C , Joseph Liu DO , Nicholas Segel DO , Michael Hudson MD , Iv Godzdanker MD , Zachary Lyman EdD, FP-C , Tricia Miedema MD , Holly Tallman MD , Joshua B. Gaither MD
Objective
Debate exists on how to best immobilize the cervical spine in the prehospital setting. Rigid cervical collars have been considered the standard of care for both the prevention and care of patients with suspected cervical spinal cord injury (c-SCI). Recently, soft c-collars have begun replacing rigid collars as they are better tolerated by patients. The aim of this study was to compare the safety of these 2 devices by evaluating the prevalence of c-SCI in patients immobilized with a rigid c-collar with those in a soft c-collar.
Methods
A retrospective review of data collected for the purpose of quality improvement was conducted. All cases with possible c-SCI were included. Cases with missing hospital International Classification of Disease code or documentation of emergency medical service neurologic examination were excluded. The primary outcome was c-SCI diagnosis at hospital discharge. A secondary outcome was the prevalence of c-SCI among those at high risk for c-SCI. Descriptive and chi-square analyses were completed to compare the cohorts.
Results
Of 882 patients with possible c-SCI, 267 were placed in a rigid collar and 615 in soft collars. Respectively, of those in the rigid and soft collar groups, the median age was 36 (interquartile range 24.5-53) years and 39 (interquartile range 24-58) years, and 54% (134) versus 64% (313) were male. Incidence of c-SCI was 0.8% in the rigid c-collar versus 1.5% in the soft collar group (P = .460). Among those cases with neurologic deficit noted by emergency medical services, there was no difference in incidence of c-SCI in the rigid (2/29, 6.9%) versus the soft (5/87, 5.7%) collar groups (P = .833).
Conclusion
In this limited retrospective review, no statistically significant difference in the rates of c-SCI was observed between patients who were immobilized using a rigid versus soft c-collar. Additional investigation is needed to determine whether rigid and soft c-collars provide equal protection.
{"title":"Association Between Collar Type and Incidence of Cervical Spinal Cord Injury in Trauma Patients","authors":"Matthew R. Shaw MPH, FP-C, CCP-C , Joseph Liu DO , Nicholas Segel DO , Michael Hudson MD , Iv Godzdanker MD , Zachary Lyman EdD, FP-C , Tricia Miedema MD , Holly Tallman MD , Joshua B. Gaither MD","doi":"10.1016/j.amj.2025.06.015","DOIUrl":"10.1016/j.amj.2025.06.015","url":null,"abstract":"<div><h3>Objective</h3><div><span><span>Debate exists on how to best immobilize the cervical spine in the prehospital setting. Rigid </span>cervical collars<span> have been considered the standard of care for both the prevention and care of patients with suspected </span></span>cervical spinal cord injury (c-SCI). Recently, soft c-collars have begun replacing rigid collars as they are better tolerated by patients. The aim of this study was to compare the safety of these 2 devices by evaluating the prevalence of c-SCI in patients immobilized with a rigid c-collar with those in a soft c-collar.</div></div><div><h3>Methods</h3><div><span><span>A retrospective review of data collected for the purpose of quality improvement was conducted. All cases with possible c-SCI were included. Cases with missing hospital </span>International Classification of Disease code or documentation of emergency medical service </span>neurologic examination<span> were excluded. The primary outcome was c-SCI diagnosis at hospital discharge. A secondary outcome was the prevalence of c-SCI among those at high risk for c-SCI. Descriptive and chi-square analyses were completed to compare the cohorts.</span></div></div><div><h3>Results</h3><div>Of 882 patients with possible c-SCI, 267 were placed in a rigid collar and 615 in soft collars. Respectively, of those in the rigid and soft collar groups, the median age was 36 (interquartile range 24.5-53) years and 39 (interquartile range 24-58) years, and 54% (134) versus 64% (313) were male. Incidence of c-SCI was 0.8% in the rigid c-collar versus 1.5% in the soft collar group (<em>P</em> = .460). Among those cases with neurologic deficit noted by emergency medical services, there was no difference in incidence of c-SCI in the rigid (2/29, 6.9%) versus the soft (5/87, 5.7%) collar groups (<em>P</em> = .833).</div></div><div><h3>Conclusion</h3><div>In this limited retrospective review, no statistically significant difference in the rates of c-SCI was observed between patients who were immobilized using a rigid versus soft c-collar. Additional investigation is needed to determine whether rigid and soft c-collars provide equal protection.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Pages 394-398"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886002","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 : 2025-09-01Epub Date: 2025-08-21DOI: 10.1016/j.amj.2025.06.007
Vasisht Srinivasan MD, FACEP , Courtney Gomez MD , Jane Hall PhD , Kyle Danielson MPH, MN, ARNP , Abhijit Lele MBBS, MD, MSCR, FNCS , Richard Utarnachitt MD , Andrew Latimer MD , Bryce Robinson MD
Background and Purpose
Many patients with traumatic brain injury (TBI) require aeromedical transport to trauma centers for specialized care. However, the effects of flight on TBI patients have not been previously studied. We examined how altitude influences outcomes in adult TBI patients who required helicopter transport to the regional trauma center.
Methods
State trauma registry and aeromedical transport records were retrospectively reviewed to identify TBI patients flown to the regional level I trauma center over a five-year period (2017 – 2022). Multivariable logistic regression was performed to evaluate associations between the coprimary exposures (altitude and flight duration) and coprimary outcomes (in-hospital mortality and percentage of patients discharged to home versus skilled nursing facilities) while adjusting for patient characteristics and injury severity. Secondary analyses examined interactions between hypotension and altitude.
Results
1,010 flights and 1,007 patients were identified (age: 53.6 ± 21.5 years; sex: 30.7% women; race: 90.1% white) with mean flight duration of 22.8 ± 11 mins and median altitude of 2200 ± 1300 ft. Hypoxemia (SpO2 < 94%) was observed in 29.5% of transports, and hypotension (SBP < 110 mmHg) in 34.9%. In-hospital all-cause mortality was 17.4% (N=175) and 54% (N=544) were discharged home. The main analyses showed increased mortality and discharge to SNF versus home associated with flights above 6,000 ft for all comers (adjusted OR=4.3, 95% CI: 1.1–16.5; aOR=3.2; 95% CI: 1.1–9.6, respectively). Secondary analyses suggested concomitant hypotension was associated with poorer outcomes at all higher altitudes starting at 1,500-3,000 ft, compared to flights below 1,500 ft (adjusted OR=4.4, 95% CI: 2.3–8.6; aOR=2.7; 95% CI: 1.6–4.5, respectively).
Conclusion
Transport altitude may affect mortality in TBI and compound the deleterious effects of hypotension. Further study is needed for better understanding of the effects of hypobaric transport and the implications for acute brain injury.
{"title":"The Effect of Transport Altitude on Outcomes in Traumatic Brain Injury: The HEIGHT-TBI Study","authors":"Vasisht Srinivasan MD, FACEP , Courtney Gomez MD , Jane Hall PhD , Kyle Danielson MPH, MN, ARNP , Abhijit Lele MBBS, MD, MSCR, FNCS , Richard Utarnachitt MD , Andrew Latimer MD , Bryce Robinson MD","doi":"10.1016/j.amj.2025.06.007","DOIUrl":"10.1016/j.amj.2025.06.007","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Many patients with traumatic brain injury (TBI) require aeromedical transport to trauma centers for specialized care. However, the effects of flight on TBI patients have not been previously studied. We examined how altitude influences outcomes in adult TBI patients who required helicopter transport to the regional trauma center.</div></div><div><h3>Methods</h3><div>State trauma registry and aeromedical transport records were retrospectively reviewed to identify TBI patients flown to the regional level I trauma center over a five-year period (2017 – 2022). Multivariable logistic regression was performed to evaluate associations between the coprimary exposures (altitude and flight duration) and coprimary outcomes (in-hospital mortality and percentage of patients discharged to home versus skilled nursing facilities) while adjusting for patient characteristics and injury severity. Secondary analyses examined interactions between hypotension and altitude.</div></div><div><h3>Results</h3><div><strong>1,010 flights and 1,007 patients were identified (age: 53.6 ± 21.5 years; sex: 30.7%</strong> women; race: 90.1% white) with mean flight duration of 22.8 ± 11 mins and median altitude of 2200 ± 1300 ft. Hypoxemia (SpO2 < 94%) was observed in 29.5% of transports, and hypotension (SBP < 110 mmHg) in 34.9%. In-hospital all-cause mortality was 17.4% (N=175) and 54% (N=544) were discharged home. The main analyses showed increased mortality and discharge to SNF versus home associated with flights above 6,000 ft for all comers (adjusted OR=4.3, 95% CI: 1.1–16.5; aOR=3.2; 95% CI: 1.1–9.6, respectively). Secondary analyses suggested concomitant hypotension was associated with poorer outcomes at all higher altitudes starting at 1,500-3,000 ft, compared to flights below 1,500 ft (adjusted OR=4.4, 95% CI: 2.3–8.6; aOR=2.7; 95% CI: 1.6–4.5, respectively).</div></div><div><h3>Conclusion</h3><div>Transport altitude may affect mortality in TBI and compound the deleterious effects of hypotension. Further study is needed for better understanding of the effects of hypobaric transport and the implications for acute brain injury.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Page 434"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886005","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 : 2025-09-01Epub Date: 2025-08-21DOI: 10.1016/j.amj.2025.06.009
Mikaela Hagberg MHA, BSN, RN, CEN, CFRN , Matthew Plourde MS, BSN, RN, CCRN, CFRN , Kyle Danielson MPH, MN, RN, CFRN, CMTE , David Gallagher MBA, MHA, BSN, RN, CPHQ , Michael J. Lauria MD, NRP, FP-C , Richard Utarnachitt MD
Introduction
Emergency Medical Services (EMS) first integrated into the stroke notification system in the mid-90s by using 911 telephone triggers to respond to strokes as an acute emergency. EMS systems have different performance metrics compared to hospitals that define success and quality in caring for stroke patients. Examples of these metrics are documentation of a stroke scale, pre-arrival notification, and determining a blood glucose level. Primary Stroke Centers (PSC) were developed in 2004, and Comprehensive Stroke Centers (CSC) developed in 2012. To become a PSC or CSC, the American Heart Association/American Stroke Association and The Joint Commission have defined eligibility requirements and quality metrics to measure success and quality care. Despite established quality metrics for stroke centers, no clear recommendations or guidelines exist for quality metrics and comprehensive quality stroke care within the air medical industry.
Methods
A literature review was completed in PubMed with articles from 2012-2022 and included all countries, military, combat, and natural disasters. Retrieved articles surrounding stroke quality metrics focused on ground transport or in-hospital care. There are no published metrics that define quality stroke care in the inter-hospital setting for air medical providers. We completed a retrospective data analysis of stroke patient transfers from January 1, 2019 – June 2, 2023, excluding pediatric patients and ground transports. Metrics from pre-hospital and in-hospital care areas included blood glucose, last known well, FAST, LAMS, and bedside times.
Results
A sample size (n=2041) transported patients with hemorrhagic and ischemic strokes were evaluated. The volume of patients was equivocal year over year, and quarter over quarter. Bedside times were consistent; scene calls (10 mins) and interfacility transports (20 mins). Glucose documentation was compliant at 98.24%. FAST documentation was lacking at 45.56%, and LAMS documentation at 38.18%, revealing opportunities for education and quality improvement. Our KPIs address operational, educational, clinical and regulatory requirements allowing us to shift our focus to critical care metrics that promote better patient outcomes.
Conclusion
While some of the quality metrics from the pre-hospital and in-hospital areas can be applied to the inter-hospital space, they don’t take account for the unique HEMS environment. More research is required to establish formal recommendations that consider the complexities of the air medical transport. Our analysis reveals that documentation of pre-hospital quality metrics such as FAST and LAMS was less frequent. Until better evidenced based quality metrics are established, air medical programs should consider extrapolating pre-hospital and in-hospital metrics and tracking compliance.
{"title":"The Quality Encompassing Stroke Team (QuEST) Project: Defining Stroke Quality Care within the Inter-Hospital Setting for Air Medical Providers","authors":"Mikaela Hagberg MHA, BSN, RN, CEN, CFRN , Matthew Plourde MS, BSN, RN, CCRN, CFRN , Kyle Danielson MPH, MN, RN, CFRN, CMTE , David Gallagher MBA, MHA, BSN, RN, CPHQ , Michael J. Lauria MD, NRP, FP-C , Richard Utarnachitt MD","doi":"10.1016/j.amj.2025.06.009","DOIUrl":"10.1016/j.amj.2025.06.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Emergency Medical Services (EMS) first integrated into the stroke notification system in the mid-90s by using 911 telephone triggers to respond to strokes as an acute emergency. EMS systems have different performance metrics compared to hospitals that define success and quality in caring for stroke patients. Examples of these metrics are documentation of a stroke scale, pre-arrival notification, and determining a blood glucose level. Primary Stroke Centers (PSC) were developed in 2004, and Comprehensive Stroke Centers (CSC) developed in 2012. To become a PSC or CSC, the American Heart Association/American Stroke Association and The Joint Commission have defined eligibility requirements and quality metrics to measure success and quality care. Despite established quality metrics for stroke centers, no clear recommendations or guidelines exist for quality metrics and comprehensive quality stroke care within the air medical industry.</div></div><div><h3>Methods</h3><div>A literature review was completed in PubMed with articles from 2012-2022 and included all countries, military, combat, and natural disasters. Retrieved articles surrounding stroke quality metrics focused on ground transport or in-hospital care. There are no published metrics that define quality stroke care in the inter-hospital setting for air medical providers. We completed a retrospective data analysis of stroke patient transfers from January 1, 2019 – June 2, 2023, excluding pediatric patients and ground transports. Metrics from pre-hospital and in-hospital care areas included blood glucose, last known well, FAST, LAMS, and bedside times.</div></div><div><h3>Results</h3><div>A sample size (n=2041) transported patients with hemorrhagic and ischemic strokes were evaluated. The volume of patients was equivocal year over year, and quarter over quarter. Bedside times were consistent; scene calls (10 mins) and interfacility transports (20 mins). Glucose documentation was compliant at 98.24%. FAST documentation was lacking at 45.56%, and LAMS documentation at 38.18%, revealing opportunities for education and quality improvement. Our KPIs address operational, educational, clinical and regulatory requirements allowing us to shift our focus to critical care metrics that promote better patient outcomes.</div></div><div><h3>Conclusion</h3><div>While some of the quality metrics from the pre-hospital and in-hospital areas can be applied to the inter-hospital space, they don’t take account for the unique HEMS environment. More research is required to establish formal recommendations that consider the complexities of the air medical transport. Our analysis reveals that documentation of pre-hospital quality metrics such as FAST and LAMS was less frequent. Until better evidenced based quality metrics are established, air medical programs should consider extrapolating pre-hospital and in-hospital metrics and tracking compliance.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Page 435"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886007","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 : 2025-07-01Epub 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":"2025-07-01","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}
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":"2025-07-01","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 : 2025-07-01Epub 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":"2025-07-01","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 : 2025-07-01Epub Date: 2025-04-17DOI: 10.1016/j.amj.2025.03.005
Justin C. Wang BA , Gina McKernan PhD , Dylan Morris MD , Ravi Patel MS , Chase Zikmund MS , John Lovett MSN , Francis X. Guyette MD , Michael L. Boninger MD
Objective
The health care industry accounts for 8.5% of US greenhouse gas emissions, with helicopter air ambulances (HAAs) contributing significantly. This study investigates the extent to which interfacility helicopter transfer interval affects patient outcomes, an essential consideration when optimizing flight paths.
Methods
We retrospectively analyzed adult HAA data from a large mid-Atlantic transport provider. Transport interval was defined as the time from dispatch to arrival at the receiving hospital. Patient diagnoses were categorized as cardiac, medical, neurological, surgical, and trauma. Discharge dispositions were grouped as home, hospice/morgue, and facility. Logistic regression analyzed discharge disposition as the dependent variable with transport interval and diagnostic category as independent variables.
Results
Analysis of 2,626 interfacility transfers revealed a significant logistic regression model (χ² = 202.67, df = 10, P < .001), explaining 4% to 8% of discharge variability. Although transport interval was a predictor (χ² = 45.32, df = 2, P < .001), the odds ratios (0.995 and 0.991) indicated negligible impact on outcomes.
Conclusion
The weak association between transport interval and discharge outcomes suggests that small variations in interfacility transport interval could be allowed for when optimizing helicopter flight routes for efficiency. Optimization could reduce fuel consumption without negatively affecting patient outcomes.
医疗保健行业占美国温室气体排放量的8.5%，其中直升机空中救护车（HAAs）贡献显著。本研究调查了设施间直升机转移间隔对患者预后的影响程度，这是优化飞行路径时的一个重要考虑因素。方法回顾性分析来自大西洋中部一家大型运输公司的成人HAA数据。运输间隔定义为从派遣到到达接收医院的时间。患者诊断分为心脏、内科、神经、外科和创伤。出院处置分为家庭、临终关怀/停尸房和设施。Logistic回归分析以排放处置为因变量，以输送间隔和诊断类别为自变量。结果2626例设施间转移分析显示logistic回归模型显著(χ²= 202.67,df = 10, P <；.001)，解释了4%至8%的放电变异性。虽然运输间隔是一个预测因子(χ²= 45.32,df = 2, P <；0.001)，比值比（0.995和0.991）表明对结果的影响可以忽略不计。结论运输间隔与排放结果之间的弱关联表明，在优化直升机飞行路线时，可以允许设施间运输间隔的微小变化，以提高效率。优化可以减少燃料消耗，而不会对患者的治疗结果产生负面影响。
{"title":"Evaluating the Impact of Helicopter Transport Interval in Patient Discharge Disposition for Interfacility Transfers With an Eye Toward Sustainability","authors":"Justin C. Wang BA , Gina McKernan PhD , Dylan Morris MD , Ravi Patel MS , Chase Zikmund MS , John Lovett MSN , Francis X. Guyette MD , Michael L. Boninger MD","doi":"10.1016/j.amj.2025.03.005","DOIUrl":"10.1016/j.amj.2025.03.005","url":null,"abstract":"<div><h3>Objective</h3><div>The health care industry accounts for 8.5% of US greenhouse gas emissions, with helicopter air ambulances (HAAs) contributing significantly. This study investigates the extent to which interfacility helicopter transfer interval affects patient outcomes, an essential consideration when optimizing flight paths.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed adult HAA data from a large mid-Atlantic transport provider. Transport interval was defined as the time from dispatch to arrival at the receiving hospital. Patient diagnoses were categorized as cardiac, medical, neurological, surgical, and trauma. Discharge dispositions were grouped as home, hospice/morgue, and facility. Logistic regression analyzed discharge disposition as the dependent variable with transport interval and diagnostic category as independent variables.</div></div><div><h3>Results</h3><div>Analysis of 2,626 interfacility transfers revealed a significant logistic regression model (χ² = 202.67, df = 10, <em>P</em> < .001), explaining 4% to 8% of discharge variability. Although transport interval was a predictor (χ² = 45.32, df = 2, <em>P</em> < .001), the odds ratios (0.995 and 0.991) indicated negligible impact on outcomes.</div></div><div><h3>Conclusion</h3><div>The weak association between transport interval and discharge outcomes suggests that small variations in interfacility transport interval could be allowed for when optimizing helicopter flight routes for efficiency. Optimization could reduce fuel consumption without negatively affecting patient outcomes.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 4","pages":"Pages 278-281"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144470134","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 : 2025-07-01Epub 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":"2025-07-01","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 : 2025-07-01Epub 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.
{"title":"Optimizing Preoxygenation for Prehospital Emergency Anesthesia and Air Medical Transport: A Comparative Study of Bag Refill Valve and Reservoir Bag","authors":"Hannah L. Lindsay B.Paramed (Hons) , Matthew J. Humar GradDipEmergHlth , David J. Anderson MBChB, FCICM , Benjamin N. Meadley PhD","doi":"10.1016/j.amj.2025.03.009","DOIUrl":"10.1016/j.amj.2025.03.009","url":null,"abstract":"<div><h3>Objective</h3><div>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 (EtO<sub>2</sub>) at 60 and 180 seconds. Secondary outcomes included EtO<sub>2</sub> 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).</div></div><div><h3>Method</h3><div>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).</div></div><div><h3>Results</h3><div>This pilot study found no significant difference in the EtO<sub>2</sub> 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 EtO<sub>2</sub> rise.</div></div><div><h3>Conclusion</h3><div>Preoxygenation using either a BVM plus RV or BVM15 achieves adequate EtO<sub>2</sub> in healthy volunteers. The addition of NC further enhances rise in EtO<sub>2</sub> levels. Although more research is needed, the RV may be an alternative device to facilitate preoxygenation in air medical services.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 4","pages":"Pages 286-290"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144470151","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 : 2025-07-01Epub Date: 2025-04-07DOI: 10.1016/j.amj.2025.03.003
Justin Hunter PhD, NRP, FP-C
{"title":"Key Data Missing From Helicopter Air Ambulance Analysis","authors":"Justin Hunter PhD, NRP, FP-C","doi":"10.1016/j.amj.2025.03.003","DOIUrl":"10.1016/j.amj.2025.03.003","url":null,"abstract":"","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 4","pages":"Page 233"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144470126","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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