Aeromedical Transport Research Articles

Aeromedical helicopter transport of prisoners: The Mexico City experience

Helicopter medical transport of prisoner patients has unique logistical and medical challenges, as well as potential risks to healthcare providers. Prisoners have specific requirements for safe transport, and it is of paramount importance to know the variables related to transport related mortality since most prisoners that need air evacuation are critically ill. Because we understand that there is a potentially dangerous nature of transport of this population, and because of the unique nature of them, we aimed to provide a detailed insight on predictors of outcome in prisoners who were injured as a result of trauma and that needed to be transported via air medical transport in Mexico City. A retrospective chart analysis was conducted using data from the Mexico City Police Helicopter Emergency Medical Service (HEMS) for air medical transport of felons that occurred between January 1, 2000 and December 31, 2013. Subject demographics, injury, procedures performed, transport time, Glasgow Coma Scale (GCS), and mortality were collected. Exploratory data analysis, Chi-square, and T-test were performed. Statistical significance was assumed to be p≤0.05 for two-sided hypothesis. Fifty-three patients were included in this study. Forty-two were men and 11 were women. Median age of the patients was 30±8years. Total transport time was 23±5min. Gunshot wounds accounted for 39.6% of patients, stabbing wounds 28.3%, head trauma 7.5%, motor vehicle accidents 5.7%, blunt trauma (i.e., fist assaults) 5.6%, falls 5.7%, motorcycle accidents 3.8%, and prisoner-motor vehicle collisions 3.8%. Median heart rate was 114±41 beats per minute (BPM), median systolic blood pressure (SBP) was 103±14mmHg, median diastolic blood pressure (DBP) was 70±12mmHg, and median GCS was 10±5. Mortality rate was 16.9% (n=9). The variables that were statistically significant, and therefore related to mortality were: heart rate>130bpm (p<0.001), SBP <95mmHg (p=0.039), GCS <7 (p=0.040), age>42years (range, 17-47years) p<0.001, and need for cardiopulmonary resuscitation (CPR) (p<0.001). As dangerous and challenging as it may seem, air medical transport of prisoners by a police crew physician, may be safe and reliable, since no complications or safety events were observed.

Military Nursing in "Operation Return to Brazil": aeromedical evacuation in the coronavirus pandemic.

to describe the experience of military nursing in "Operation Return to Brazil" in an aeromedical evacuation. this is an experience report of the nursing staff in the Aeromedical Evacuation of potentially-contaminated Brazilians who were in Wuhan, China, after the outbreak of the new coronavirus. the report was constructed from nursing care performed in three stages: pre-flight, screening, and flight. Pre-flight care would include aircraft configuration and material prediction. In screening, the staff was concerned with being properly attired. In the health assessment of returnees, in-flight, attention was focused on Personal Protective Equipment handling to minimize the risk of contamination by prolonged contact with potentially-contaminated passengers. Final considerations: nursing was committed to planning all the actions of this mission, which was one of the longest, strenuous and unprecedented in the history of aeromedical transport in Brazil.

Characteristics of aeromedical transport, both interhospital and directly from the scene of the incident, in patients with acute myocardial infarction or acute trauma between 2011-2016 in Poland: A case-control study.

Patients with acute myocardial infarction (AMI) or acute trauma (AT) are transported by air to save time. Helicopter Emergency Medical Service (HEMS) provides both flights to and from the emergency scene, as well as interhospital transport (interHtransport). The objective of this study was to compare aeromedical transport and HEMS missions of AMI and AT patients regarding safety, medical procedures and the length of flights. This is a case-control study analyzing the medical history records of AMI and AT patients transported between hospitals and from the scene identified using ICD-10 codes. Research of customary data (age, sex and general health status measured with Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS)) was performed. There were 48,555 flights in the years 2011-2016, of which 7,645 (15.7%) were interhospital (19% AMI and 12% AT). Out of these, 40,910 (84.3%) HEMS missions were to patients on the scene (10% AMI and 13% AT). No fatalities were noted. The AMI GCS score was higher than in AT patients: 15.0 vs 14.0, respectively. The medical procedures during transport of AMI patients between hospitals and from the scene were the following: cardiopulmonary resuscitation (CPR): 6 vs 73 cases (p < 0.001); oxygen therapy: 41.1% vs 50.2%, respectively. The median distance was 59.4 km vs 52.1 km (p < 0.001), while median flight time was 45.0 min vs 38.0 min (p < 0.001), respectively. Regarding AT patients, the procedures performed (during interhospital and from the scene transport) were the following: CPR: 5 vs 244 cases (p < 0.001); intubation: 10.7% vs 17.3% (p < 0.001); sedation: 50.1% vs 24.3% (p < 0.001); oxygen therapy: 17.6% vs 36.6% (p < 0.001); spinal board: 17.1% vs 66% (p < 0.001); cervical collar: 15.9% vs 63.4% (p < 0.001), respectively. Interhospital transport and HEMS mission median flight distance was 135.9 km vs 56.3 km (p < 0.001), while median flight time was 66.0 min vs 45.0 min (p < 0.001), respectively. Aeromedical transport is safe and very rarely requires resuscitation during the flight. The long distances of flights and time required can reflect the scarcity of trauma centers (TCs) compared to cardiovascular wards. The location of hemodynamic centers in Poland is optimal.

Using Epidemiology, Pediatric Medical Director and Peer Review to Inform Quality Improvement and Education in a Regional Adult and Pediatric Trauma Based Flight Program

Background/Aim: Pediatric patients account for only 7 % of ground EMS transports and aeromedical transports are rare with limited research and data. When helicopter transport occurs it is commonly provided by neonatal-pediatric teams focusing on interfaciltiy transports and limited scene flights. Project target population includes transports of children 0-≤ 18 years from a critical care air transport service of three rotor wing aircraft bases including scene, interfaciltiy, trauma and medical. Each base has a primary service area within overlapping 150 nautical-mile radius covering 15,000 square-miles …

Abstract 2: Cardiac Arrest During Aeromedical Transport: A 5-year Retrospective Case Review

Objectives Air emergency medical services (AEMS) are regularly employed in many parts of the world to transport severely ill or injured patients rapidly to definitive care. Out-of-hospital cardiac arrest (OHCA) is a potentially catastrophic event that may occur among a subset of the most severely ill patients that are encountered. This study describes the pre-arrest characteristics, treatments applied, and short-term outcomes of patients with OHCA treated by AEMS. Methods All adult patients who experienced OHCA at a single, academic aeromedical transport service between 2013–2017 were included in this retrospective analysis. All cases during which an adult patient suffered cardiac arrest occurring from the time of AEMS arrival at the scene or sending facility to hand off at the receiving facility were included. Data including standard Utstein variables, treatments, and short-term outcome were extracted by the authors. Univariate descriptive statistics were computed using SPSS ver. 25. Results During the 5-year period, 92 cases of adult OHCA were identified among 16,779 transports. The median age of patients experiencing OHCA was 64.5 years [55.3, 63.3]. Among patients transported, the average transport time was 75.4 minutes [63.4, 87.3]. 60 OHCA cases (65.2%) were of medical etiology and 32 (34.8%) were traumatic. Scene calls were the origin for 51.1% of calls; the rest were interfacility transfers. 36/92 patients (39.1%) had multiple cardiac arrests under AEMS care, and OHCA occurred for the first time most often before take-off: 39.1% at the initial scene, 29.3% in transit or loading to aircraft, and in flight 31.5% of the time. 17.4% of the cohort had an initial shockable rhythm and 42.4% achieved return of spontaneous circulation (ROSC) by arrival at the destination facility; an additional 5.4% achieved ROSC and were not transported. Conclusions In this cohort, OHCA occurred in 92 adult patients over 5 years, with approximately two thirds medical and one third traumatic in nature. Initial rhythm was rarely shockable, but sustained ROSC was achieved in almost half the patients. Almost 4 in 10 patients had multiple cardiac arrests under AEMS care, and initial arrest was most likely to occur prior to air transport as opposed to in flight. A high proportion of patients achieving ROSC is possible, even with relatively low rates of shockable initial rhythm. This study suggests that while cardiac arrest in flight is rare, medical teams must be prepared to handle both medical and traumatic arrests as well as multiple arrests during the course of air transport.

A review of CBRN topics related to military and civilian patient exposure and decontamination.

Chemical and biological (CB) warfare have long been practiced, and although these types of warfare are not acceptable in modern times, this does not prevent them from occurring. This makes it important for societies to be able to appropriately respond to these events, including the best way to decontaminate victims to keep them and emergency responders safe. Decontamination methods such as chemical, physical, wet, and dry methods are discussed, as well as their downsides. Secondary contamination, which played a significant role in the Tokyo sarin attacks, has long been noted by anecdotal evidence, although it has been little studied. Biological agents cause more problems after infection has taken place, and thus preventing the spread of infection is the largest concern. There are many differences between military and civilian populations, and the response to mass casualty attacks differs accordingly. There are several emerging technologies that can make this process easier on all parties, such as bioscavengers, antitoxins, and color changing bleach for visualization. A reliable way to quantify decontamination is also needed, which would allow for better care of victims both in normal hospital situations, as well as during aeromedical transport. In addition, several gaps were identified, such as the lack of scientific basis for 90 percent reduction during decontamination, a way to quantify decontamination, and the lack of studies on toxic industrial chemicals and secondary contamination.

THE SYSTEM OF CARE FOR INJURED CHILDREN IN THE STATE OF COLORADO AND THE ROCKY MOUNTAIN REGION OF THE WESTERN UNITED STATES

This article describes the different levels of trauma center designation in the United States and focuses on the pediatric trauma centers in the state of Colorado. These urban centers serve a large geographic area that is characterized by rugged mountains, wide open plains and rapidly changing weather patterns. Critical care ground and aeromedical transport are utilized for severely injured children and the quality of care, from initial management in the feld until discharge from the hospital, is critically evaluated by a robust trauma performance improvement (PI) program. The PI program uses audit flters, data analytics and bench-marking to continuously evaluate the network of care to optimize outcomes.

Safety and Flight Considerations for Mechanical Circulatory Support Devices During Air Medical Transport and Evacuation: A Systematic Narrative Review of the Literature

ObjectiveThe air medical transportation industry has seen a steady rise in the use of mechanical circulatory support devices (eg, intra-aortic balloon pumps, ventricular assist devices, and extracorporeal membrane oxygenation) during transport missions, either for definitive management or repatriation. As these complex devices become more common, the industry will have to adapt to support their use in their clientele. The goal of this narrative review was to assess our current experiences regarding mechanical circulatory support devices in air medical transportation and to identify important factors to ensure successful transport. MethodsWe conducted a systematic search on MEDLINE and Embase using the following search terms: aeromedical transportation, air transportation, intra-aortic balloon pump, ventricular assist device, and extracorporeal membrane oxygenation. Results were cross-referenced to identify articles addressing both air medical transport and mechanical circulatory support devices. ResultsAfter a systematic review of the available literature, 49 articles addressing mechanical support devices transported by rotary wing and fixed wing aircraft were reviewed. In summary, our review encompassed 811 total aerial transports (152 by balloon pumps, 12 by ventricular assist devices, and 647 by extracorporeal membrane oxygenation). We found air medical transportation with these devices carried out in the public, private, or military sectors, to be safe, with low rates of serious adverse events. Dedicated training sessions focused on device troubleshooting and problem-solving during transport, optimal medical crew composition, predeparture logistical preparations, and on-demand specialist consultation can improve mission success. ConclusionWe report that air medical transportation of patients supported by mechanical circulatory support devices is safe. Complications can be mitigated by training and addressed either during the predeparture or in-transportation phase.

Lifesaving interventions in blackout conditions using night vision technology: Come to the dark side.

During military combat operations and civilian night-time aeromedical transport, medical providers are frequently required to perform lifesaving interventions (LSIs) in low-light environments. Because definitive surgical care is often delayed until a white light environment is permissible, we sought to determine if night optical device (NOD) technology could enable surgical capabilities in blackout conditions. Using a crossover design, six surgeons performed 11 different procedures on six swine, three in normal light conditions (LC) and 3 in blackout conditions (BC) using two-chamber NODs after familiarization with the procedures in both conditions on manikins. Successful completion and procedural times were compared between groups. Blackout conditions were confirmed with ambient light reading of 0.2 lux during BC versus 3962.9 lux for LC (p < 0.001). There were no significant differences in success rates for any procedure. There were no differences in operative times between BC and LC for extremity tourniquet placement, femoral artery cut-down and clamping, resuscitative thoracotomy, or percutaneous resuscitative endovascular balloon occlusion of the aorta placement. The following procedures took significantly longer in BC vs. LC: Focused Assessment with Sonography for Trauma examination (98 seconds vs. 62 seconds), peripheral IV placement (140 seconds vs. 35 seconds), intraosseous access (51 seconds vs. 26 seconds), jugular vein cut-down and access (237 seconds vs. 104 seconds), laparotomy and packing (71 seconds vs. 51 seconds), stapled splenectomy (137 seconds vs. 74 seconds), resuscitative endovascular balloon occlusion of the aorta placement via cutdown (1,008 seconds vs. 338 seconds), and cricothyroidotomy (177 seconds vs. 109 seconds) (all p < 0.05). Lifesaving interventions can be safely and effectively performed in blackout conditions using NODs, although increased difficulty with select procedure types was identified. Focused training and technological improvements to currently available devices are needed. Basic science.

Experience of physician and nurse specialists in Sweden undertaking long distance aeromedical transportation of critically ill patients: A qualitative study

IntroductionTransportation of critically ill patients, intra- or inter-hospital, always involves risks when resources are limited. With aeromedical transports, additional risk factors are incurred. The physiological effects of altitude, when both pressure and density decline, can lead to hypobaric hypoxia and gases trapped in body cavities will expand and cause stress on biological tissue. AimThe aim of this study was to explore the experiences of nurse and physician specialists in Sweden undertaking long distance aeromedical transport of critically ill patients, with a flight time of more than two hours. MethodA qualitative approach with a descriptive design. Thirteen recorded semi-structured interviews with physician and nurse specialists were analyzed using inductive qualitative content analysis. ResultsOne overall theme emerged, To be one step ahead to ensure patient safety in the air; with three categories 1) With the patient in focus, 2) To be part of a team and concerned about patient safety and 3) To be in need of recovery. ConclusionThis study demonstrates the challenges with long distance aeromedical transport of critically ill patients. The healthcare personnel make decisions and actions to be one step ahead to ensure patient safety. This isolated work is improved with experience, education, training and good communication skills.

Air Force Nursing Executive leadership impact on health care 2004–2008

Recorded history allows us to recognize our past and can contribute to the present and future nursing practice. The purpose of this study is to examine the impact of the United States Air Force Nursing Executive leadership on military health care transformation, through Major General (Retired) Melissa A. Rank's personal stories and experiences. This study explores the development and impact of Air Force nursing in its historical, social, and global context between the years of 2004–2008. The oral history method was used to explore and record the professional life experiences of a great military nurse leader. The United States Air Force Nurse Corps has contributed to global healthcare via humanitarian medical support, medical disaster relief, aeromedical patient transport, development of best practices, advances in technology, education programs, and transformation in deployed medical care during times of war, peace, and natural disasters.

253 Aeromedical Transport Predictors for Pediatric Trauma in North Carolina

253 Aeromedical Transport Predictors for Pediatric Trauma in North Carolina

Prehospital Tranexamic Acid Administration During Aeromedical Transport After Injury

BackgroundTranexamic acid (TXA) has been shown to reduce mortality in the treatment of traumatic hemorrhage. This effect seems most profound when given early after injury. We hypothesized that extending a protocol for TXA administration into the prehospital aeromedical setting would improve outcomes while maintaining a similar safety profile to TXA dosed in the emergency department (ED). Materials and methodsWe identified all trauma patients who received TXA during prehospital aeromedical transport or in the ED at our urban level I trauma center over an 18-mo period. These patients had been selected prospectively for TXA administration using a protocol that selected adult trauma patients with high-risk mechanism and concern for severe hemorrhage to receive TXA. Patient demographics, vital signs, lab values including thromboelastography, blood administration, mortality, and complications were reviewed retrospectively and analyzed. ResultsOne hundred sixteen patients were identified (62 prehospital versus 54 ED). Prehospital TXA patients were more likely to have sustained blunt injury (76% prehospital versus 46% ED, P = 0.002). There were no differences between groups in injury severity score or initial vital signs. There were no differences in complication rates or mortality. Patients receiving TXA had higher rates of venous thromboembolic events (8.1% in prehospital and 18.5% in ED) than the overall trauma population (2.1%, P < 0.001). ConclusionsPrehospital administration of TXA during aeromedical transport did not improve survival compared with ED administration. Treatment with TXA was associated with increased risk of venous thromboembolic events. Prehospital TXA protocols should be refined to identify patients with severe hemorrhagic shock or traumatic brain injury.

P116: A randomized cross-over trial of conventional bimanual versus single elbow (Koch) chest compression quality in a height-restricted aeromedical helicopter

Introduction: Aeromedical helicopters and fixed wing aircraft are used across Canada to transfer patients to definitive care. Given height limitation in aeromedical transport, CPR performance can be affected. An adapted manual compression technique has been proposed by H. Koch (pron. Cook) that uses the elbow to compress the sternum rather than the conventional hand. This preliminary study evaluated the quality of Koch compressions versus conventional bimanual compressions. Methods: Paramedics (5), registered nurses (3) and a physician (1) were recruited. Each participant performed a 2 minute cycle of each technique, were randomized to determine which technique was performed first, and rested 5 minutes between compression cycles. A Resusci Anne SkillReporter manikin atop a stretcher in a BK117 helicopter was used. The compressors performed without feedback or prompting. Outcomes include compression rate, depth, recoil, and fatigue. Results: The mean conventional compression rate was (bpm) 118 +/− 13 versus 111 +/− 10 in the Koch scenario (p=0.02) (target 100 to 120). Mean conventional compression depth (mm) was 44 +/− 9 versus 49 +/− 7 in the Koch scenario (p=0.01) (target 50 to 60). The mean percentage of compressions with complete release in the conventional scenario was 86 +/− 20 versus 84 +/− 22 in the Koch scenario (p=0.9) (target 100%). Using a Modified Borg Scale of 1 to 10, mean provider fatigue after conventional CPR was 7 (+/− 1.6) versus 3 (+/− 1.2) using Koch technique (p&lt;0.001). On average, Koch technique improved the percentage of compressions at target rate by 26%, the percentage at correct depth by 9%, overall compression quality score by 13% and were more less fatiguing. Conclusion: Using an elbow in a height-restricted environment improved compression depth and reduced provider fatigue. From our limited data, Koch compressions appear to improve compression quality. Further study and external validation are required.

Aeromedical Transport Operations Using Helicopters during the 2016 Kumamoto Earthquake in Japan.

More than 6,000 people died in the Great Hanshin (Kobe) Earthquake in 1995, and it was later reported that there were around 500 preventable trauma deaths. In response, the Japanese government developed the helicopter emergency medical service in 2001, known in Japan as the "Doctor-Heli" (DH), which had 46 DHs and 2 private medical helicopters as of April 2016. DHs transport physicians and nurses to provide pre-hospital medical care at the scene of medical emergencies. Following lessons learned in the Great East Japan Earthquake in 2011, a research group in the Ministry of Health, Labour and Welfare developed a command and control system for the DH fleet as well as the Disaster Relief Aircraft Management System Network (D-NET), which uses a satellite communications network to monitor the location of the fleet and weather in real-time during disasters. During the Kumamoto Earthquake disaster in April 2016, 75 patients were transported by 13 DHs and 1 private medical helicopter in the first 5 days. When medical demand for the DHs exceeded supply, 5 patients, 8 patients, and 1 patient were transported by Self-Defense Force, Fire Department, and Coast Guard helicopters, respectively. Of the 89 patients who were transported, 30 (34%) had trauma, 3 (3%) had pulmonary embolisms caused by sleeping in vehicles, and 17 (19%) were pregnant women or newborns. This was the first time that the command and control system for aeromedical transport and D-NET, established after the Great East Japan Earthquake in 2011, were operated in an actual large-scale disaster. Aeromedical transport by DHs and helicopters belonging to several other organizations was accomplished smoothly because the commanders of the involved organizations could communicate directly with each other in person within the Aviation Coordination Section of the prefectural government office. However, ongoing challenges in the detailed operating methods for aeromedical transport were highlighted and include improving shared knowledge and training across the organizational framework. These are particularly important issues to address given the Nankai Trough and Tokyo inland earthquakes that are predicted for the near future in Japan.

Resuscitative Endovascular Balloon Occlusion of the Aorta: A Bridge to Flight Survival.

Trauma endures as the leading cause of death worldwide, and most deaths occur in the first 24 hours after initial injury as a result of hemorrhage. Historically, about 90% of battlefield deaths occur before the injured person arrives at a theater hospital, and most are due to noncompressible hemorrhage of the torso. Resuscitative endovascular balloon occlusion of the aorta is an evolving technique to quickly place a balloon into the thoracic or abdominal aorta to efficiently block blood flow to distal circulation. Maneuvers, such as resuscitative endovascular balloon occlusion of the aorta, to control endovascular hemorrhage offer a potential intervention to control noncompressible hemorrhage. This technique can be performed percutaneously or open in prehospital environments to restore hemodynamic functions and serve as a survival bridge until the patient is delivered to a treatment facility for definitive surgical hemostasis. This article describes the indications, complications, and application of resuscitative endovascular balloon occlusion of the aorta to military and civilian aeromedical transport.

Abstract WP371: Safe and Rapid Interfacility Transport of Drip and Ship Patients

Background and Issues: Stroke care delivery continues to undergo dynamic changes as evolving treatment extends the critical reperfusion time window. Stroke centers have responded by improving approaches to rapidly transport patients receiving alteplase or who have been identified as endovascular eligible. Limited literature exists discussing interfacility transport during ischemic stroke reperfusion. Purpose: We describe the outcomes of a quality assurance (QA) process of auditing interfacility transfers to ensure adherence to protocol when transporting drip and ship patients. This approach has been recognized as a best practice during CSC certification. Methods: As the number of interfacility transfers increased, the stroke team met with the aeromedical and critical care ground transport team to develop ongoing QA processes for the care of patients during transport. Competencies and education for crew and ongoing quality metrics were established. Revisions were made to stroke transport protocols to more closely align with the American Stroke Association guidelines. Retrospective chart review of protocol adherence and complications was completed monthly with feedback provided to the transport teams. Results: Since 2015 this CSC admitted 2911 stroke patients with 860 neuro transfers by 4 helicopters and 2 ground critical care transport teams. Retrospective analysis of 116 drip and ship transport charts was completed. There were no life-threatening complications or major neurological deterioration in our sample. One airway event resolved with intubation in transit. Common protocol deviations involved timing of vital signs and neuro checks and titration of vasoactive medications. Conclusion: Logistics of interfacility transport continues to evolve as more patients are referred to CSC’s for advanced interventions. Access to highly-trained transport teams provides rapid and safe passage during reperfusion. Crew education and ongoing QA encourages continual performance improvement, improves communication and reinforces protocol adherence. Dissemination of best practices is critical as limited specialized neurovascular services will continue to require interfacility patient movement to access advanced stroke resources.

Aeromedical Transport in Children: A Descriptive Analysis of 96 Cases.

Pediatric aeromedical transport (AT) is highly challenging. We aim to describe a series of 96 cases of children requiring medical transport in terms of the indication, modalities, and related adverse events. In this single-center retrospective study, we included air-transported patients less than 18 years old. During the study period, 96 patients, with median age of 120 months (range, 0-204), were air transported. The reason for AT was repatriation to the home country from another hospital in 65 (67.7%), whereas for 31 (32.3%) patients, it was for transport from a hospital to another for a special procedure. The main diagnosis was trauma surgery (n = 38; 39.5%). Fifteen (15.6%) patients were mechanically ventilated. No patient sustained serious adverse events during the flight. Patients were transported by an air ambulance or by a scheduled aircraft in 55.2% and 44.8%, respectively. The median flight distance was 822 km (range, 277-9878), and most of the ATs were intra-European (n = 41; 42.7%). This study describes an international experience in providing AT services for pediatric clinical cases. Among pediatric patients, the younger ones constitute a specific population, and most of them require mechanical ventilation. Therefore, the transport of these patients seems to be more appropriate in a dedicated air ambulance.

Aeromedical Transport of Pediatric Patients Less Than Three Months of Age

Aeromedical Transport of Pediatric Patients Less Than Three Months of Age

LO24: Is prehospital care supported by evidence-based guidelines? An environmental scan and quality appraisal using AGREE II

Introduction: The Institute of Medicine (IOM) has recommended that high-quality, evidence-based guidelines be developed for emergency medical services (EMS). The National Association of EMS Physicians (NAEMSP) has outlined a strategy that will see this task fulfilled, consisting of multiple working groups focused on all aspects of guideline development and implementation. A first step, and our objective, was a cataloguing and appraisal of the current guidelines targeting EMS providers. Methods: A systematic search of the literature was conducted in MEDLINE (1175), EMBASE (519), PubMed (14), Trip (416), and guidelines.gov (64) through May 1, 2016. Two independent reviewers screened titles for relevance to prehospital care, and then abstracts for essential guideline features, including a systematic review, a grading system, and an association between level of evidence and strength of recommendation. All disagreements were moderated by a third party. Citations meeting inclusion criteria were appraised with the AGREE II tool, which looks at six different domains of guideline quality, containing a total of 23 items rated from 1 to 7. Each guideline was appraised by three separate reviewers, and composite scores were calculated by averaging the scaled domain totals. Results: After primary (kappa 97%) and secondary (kappa 93%) screening, 49 guidelines were retained for full review. Only three guidelines obtained a score of &amp;gt;90%, the topics of which included aeromedical transport, analgesia in trauma, and resuscitation of avalanche victims. Only two guidelines scored between 80% and 90%, the topics of which included stroke and pediatric seizure management. One guideline, splinting in an austere environment, scored between 70% and 80%. Nine guidelines scored between 60% and 70%, the topics of which included ischemic stroke, cardiovascular life support, hemorrhage control, intubation, triage, hypothermia, and fibrinolytic use. Of the remaining guidelines, 14 scored between 50% and 60%, and 20 obtained a score of &amp;lt;50%. Conclusion: There are few high-quality, evidence-based guidelines in EMS. Of those that are published, the majority fail to meet established quality measures. Although a lack of randomized controlled trials (RCTs) conducted in the prehospital field continues to limit guideline development, suboptimal methodology is also commonplace within the existing literature.