Association Of Air Medical Services Research Articles

A Survey of the Operational Environment and Regulations of Hospital Owned Helipads at Level I Trauma Centers

<h3>Introduction</h3> The Association of Air Medical Services (AAMS) estimates that 400,000 patients per year are transported by rotor wing aircraft. Despite the frequent utilization of air medical transport, little is known about the operational environment and regulations of hospital owned helipads. We sought to understand the environment and regulations of hospital helipads, hypothesizing that the majority of these facilities have strict rules regarding who may use their facilities and how aircraft approach and depart. <h3>Methods</h3> We developed a 23-item survey to explore the operational environment and regulations surrounding the use of helipads at level I trauma centers in the United States. Flight crew members and administration, as well as hospital administrators, were invited to complete a multiple choice and free text survey hosted by a secure online data collection tool. The survey was publicized through relevant professional organizations, social media, and individual invitation. Descriptive statistics were calculated. <h3>Results</h3> We received 138 responses and analyzed survey data for 87 adult and pediatric level I trauma centers representing 34 states after excluding surveys that did not name a specific center, level II trauma centers, and duplicates for a facility already enrolled. The mean (SD) number of helipads controlled by a center is 2 (1) with the majority (84%) being rooftop helipads. 17/87 (20%) of facilities require a formal agreement with a transport program prior to use of their helipad. Of that group, 8/17 (47%) indicate pre-specified consequences for violation of the agreement and 7/8 (88%) of those consequences include loss of landing privileges. A minority of facilities (9%) require CAMTS accreditation as a prerequisite for helipad use, and the most common restrictions in place are specific approach paths (67%), specific departure paths (64%) and aircraft type and weight restrictions (64%). 74/87 (85%) of facilities require 10-15 minute notification prior to arrival, while only 13/87 (15%) require notification prior to departure. <h3>Conclusion</h3> There is significant variation in the operational environment and regulations surrounding the use of hospital owned helipads at level I trauma centers, with a minority requiring formal agreement for use of the helipad or specifying repercussions for violation of the agreement.

Challenges and Resources for New Critical Care Transport Crewmembers: A Descriptive Exploratory Study

ObjectiveThe purpose of this study was to identify the challenges new crewmembers experience in the critical care transport (CCT) environment and to determine the most valuable resources when acclimating to the transport environment. To date, no study has focused on the unique challenges nor the resources most effective in CCT training. MethodsThis descriptive exploratory study was conducted with a convenience survey sent to the 3 largest professional CCT organizations: the Association of Air Medical Services, the Air and Surface Transport Nurses Association, and the Association of Critical Care Transport. ResultsThe study survey responses revealed that more education and training are needed. Novice crewmembers identified areas in safety, communication, environment, and crew resource management as particularly challenging. Responses also validate the need for more simulation training, especially for CCT of low-volume/high-risk patient populations. ConclusionResults of this survey provide valuable insight for improving training effectiveness of health care professionals transitioning to the CCT environment. More information regarding best practice on the frequency and timing of CCT simulation training should be collected, particularly for simulations completed in the transport environment.

Frequency of Manuscript Publication Following Presentation of EMS Abstracts at National Meetings

Specialized knowledge and a scientific body of literature are the foundation of the recognition of Emergency Medical Services (EMS) as a subspecialty within emergency medicine (EM). Emergency Medical Services research often is presented at national meetings and published in abstract form, but full publication occurs less frequently. Problem The primary goal of the study was to determine the rate at which EMS-related research presented at selected conferences went on to manuscript publication. A secondary goal was the determination of the time to manuscript publication. A cross-sectional study of published abstracts from the 2003-2005 national meetings of the American College of Emergency Physicians (ACEP), Society for Academic Emergency Medicine (SAEM), National Association of EMS Physicians (NAEMSP), Association of Air Medical Services (AAMS), and the National Association of EMS Educators (NAEMSE) was conducted to identify EMS-related abstracts. PubMed (National Center for Biotechnology Information, Bethesda, Maryland USA) was searched using abstract title keywords and authors' names to determine if the study had been published in a PubMed-indexed journal in the time since presentation and abstract publication. Abstracts for the five conferences were reviewed for 2003-2005. Six hundred and thirty-five EMS-related abstracts met the inclusion criteria. The total number of EMS abstracts presented and the percent subsequently published as a manuscript were: SAEM 135, 53.3%; ACEP 128, 48.4%; NAEMSP 282, 42.9%; AAMS 66, 33.3%; and NAEMSE 24, 16.7%. The overall rate of publication was 44.3%. The average time to publication was 22.2 months (SD = 16.5 months, range = 0-94 months). Less than half of EMS abstracts go on to manuscript publication. This may represent missed opportunities for the growth of EMS as a subspecialty.

2013 Air Medical Transport Conference

248 It’s that time of year again! The 2013 Air Medical Transport Conference (AMTC) is headed to Virginia Beach, Virginia, from Monday, October 21, to Wednesday, October 23. As AMTC attendees have come to expect, the 2013 event is jam-packed with innovative and informative education sessions, as well as access to the most advanced products and services available to emergency medical transport providers on the tradeshow floor! AMTC hosts more than 2500 attendees from all over the world for this superb annual gathering of the minds. The conference is specifically designed to educate, inform, cultivate friendships, and supply the latest information on the newest techniques and innovative approaches to emergency medical transport from the experts in your field. Education topics will cover a variety of disciplines, including core clinical, specialty clinical, management, patient safety, aviation safety, research, communications, and global perspectives. In addition to education sessions, the AMTC tradeshow features over 140 companies displaying products and services directly applicable to air and critical care ground medicine. If you are interested in the air or ground medical transport field, you need to head for the Beach! The conference is organized by the Association of Air Medical Services with cooperation from the Air & Surface Transport Nurses Association, the Air Medical Physician Association, the International Association of Flight and Critical Care Paramedics, the National Association of Air Medical Communication Specialists, and the National EMS Pilots Association. Most events will be held at the Virginia Beach Convention Center. The AMTC hotels are right on the water and in close proximity to a variety of dining and shopping options, as well as top-notch entertainment. Finish up each busy day by wiggling your toes in the sand or dipping your feet into the ocean waves. For full details on the conference and regular updates, visit www.aams.org, click on Education and Meetings, and then select AMTC 2013. We’ll see you at the Beach!

Air Ambulance Medical Transport Advertising and Marketing

The National Association of EMS Physicians (NAEMSP), the American College of Emergency Physicians (ACEP), the Air Medical Physician Association (AMPA), the Association of Air Medical Services (AAMS), and the National Association of State EMS Officials (NASEMSO) believe that patient care and outcomes are optimized by using air medical transport services that are licensed air ambulance providers with robust physician medical director oversight and ongoing quality assessment and review. Only air ambulance medical transport services with these credentials should advertise/market themselves as air ambulance services.

Memories and Milestones

On July 13, 2010, the Commission on Accreditation of Medical Transport Systems (CAMTS) celebrated its 20th anniversary. We will officially mark this milestone with past and present board members, site surveyors, and accredited programs during the Air Medical Transport Conference (AMTC) in October. The Association of Air Medical Services (AAMS) is celebrating its 30th year. AMTC will be quite exciting, with old friends and acquaintances revisiting memories and milestones from the past.

Air Medical Transport Personnel Experiences with and Opinions about Research

Introduction This study examined air medical transport (AMT) personnel's experiences with and opinions about prehospital and AMT research. Methods A Web-based questionnaire was sent to eight randomly selected AMT programs from each of six Association of Air Medical Services (AAMS) regions. Responders were defined by university association (UA) and AMT professional role. Results Forty-eight of 54 (89%) contacted programs and 536 of 1,282 (42%) individuals responded. Non-UA responders (74%) had significantly more work experience in emergency medical services (EMS) (13.5 ± 8.5 vs. 10.8 ± 8.3 years, P = .002) and AMT (8.3 ± 6.3 vs. 6.8 ± 5.7 years, P = .008), whereas UA responders (26%) had more research training (51% vs. 37%, P = .006), experience (79% vs. 59%, P < .001), and grants (7% vs. 2%, P = .006). By AMT role, administrators had the most work experience, and physicians had the most research experience. Research productivity of responders was low, with only 9% having presented and 10% having published research; and UA made no difference in productivity. A majority of responders advocated research: EMS (66%) and AMT (68%), program (53%). Willingness to participate in research was high for both EMS research (87%) and AMT research (92%). Conclusions Although AMT personnel were strong advocates of and willing to participate in research, few had research knowledge. For AMT personnel, disparity exists between advocating for and producing research.

Emergency airway management in critically injured patients: A survey of U.S. aero-medical transport programs

Objective Pre-hospital airway management represents the intervention most likely to impact outcomes in critically injured patients. As such, airway management issues dominate quality improvement (QI) reviews of aero-medical programs. The purpose of this study was to evaluate current practice patterns of airway management in trauma among U.S. aero-medical service (AMS) programs. Methods The Association of Air Medical Services (AAMS) Resource Guide from 2005 to 2006 was utilized to identify the e-mail addresses of all directors of U.S. aero-medical transport programs. Program directors from 182 U.S. aero-medical programs were asked to participate in an anonymous, web-based survey of emergency airway management protocols and practices. Non-responders to the initial request were contacted a second time by e-mail. Results 89 programs responded. 98.9% have rapid sequence intubation (RSI) protocols. 90% use succinylcholine, 70% use long-acting neuromuscular blockers (NMB) within their RSI protocol. 77% have protocols for mandatory in-flight sedation but only 13% have similar protocols for maintenance paralytics. 60% administer long-acting NMB immediately after RSI, 13% after confirmation of neurological activity. Given clinical scenarios, however, 97% administer long-acting NMB to patients with scene and in-flight Glasgow Coma Scale (GCS) of 3, even for brief transport times. Conclusions The majority of AMS programs have well defined RSI and in-flight sedation protocols, while protocols for in-flight NMB are uncommon. Despite this, nearly all programs administer long-acting NMB following RSI, irrespective of GCS or flight time. Given the impact of in-flight NMB on initial assessment, early intervention, and injury severity scoring, a critical appraisal of current AMS airway management practices appears warranted.

Quantifying the Value of AMPA Membership Services

Introduction The purpose of this study was to quantify the value of current and future Air Medical Physician Association (AMPA) membership services. Methods Three-hundred-ninety-eight AMPA members were contacted by e-mail to participate in ranking AMPA membership services by a perceived numeric value (10 = highest to 1 = lowest), using a web-based survey. Results One-hundred-eighteen AMPA members completed the survey. The percentage of respondents having attended the conference and their AMPA-related Conference ranked-value scores were as follows: Air Medical Transport Conference (AMTC), 43%, 9.6 ± 1.9; AirMed International Conference, 9%, 7.8 ± 4.2; AMTC Pre-conference, 65%, 7.6 ± 2.5; Critical Care Transport Medicine Conference (CCTMC), 47%, 6.6 ± 2.6; CCTMC Pre-conference, 37%, 6.6 ± 2.6; the Association of Air Medical Services (AAMS) Mid-Year Conference, 6%, 6.4 ± 4.9; and General Membership meeting, 63%, 5.6 ± 2.4. Current AMPA Benefit/Service ranked-value scores were as follows: textbook, 8.4 ± 1.8; voice for physicians, 8.0 ± 2.3; position papers, 7.9 ± 1.8; Air Medical Journal subscription, 7.8 ± 2.1; networking with others, 7.7 ± 2.4; newsletter, 7.3 ± 1.9; means to enhance professional credibility, 7.1 ± 2.5; web site, 7.0 ± 2.1; voice on Commission on Accreditation of Medical Transport Systems (CAMTS), 7.0 ± 2.7; continuing medical education (CME) credits, 6.6 ± 3.0; conference discounts, 6.4 ± 2.9; and curriculum vitae builder, 4.9 ± 2.9. Future AMPA Benefits/Services ranked-value scores were as follows: evidence-based guidelines, 8.6 ± 1.7; transport database, 7.7 ± 2.1; malpractice repository, 7.6 ± 2.2; DVD lectures, 7.4 ± 2.0; medical director certification, 7.2 ± 2.9; lobbying, 7.1 ± 2.4; photo library, 6.4 ± 2.3; salary and benefits surveys, 6.4 ± 2.6; speaker's bureau, 6.2 ± 2.4; and consulting service list, 6.2 ± 2.4. Conclusion This AMPA survey was useful in prioritizing membership services.

What risk managers should know about air medical patient transport: From the association of air medical services

The use of air medical services (AMS) has become an essential component of the healthcare system. Appropriately used air medical critical care transport can save lives and reduce the cost of healthcare. It does so by minimizing the time the critically ill and injured spend out of a hospital, by bringing more medical capabilities to the patient than are normally provided by ground emergency medical services, and by helping get the patient to the appropriate specialty care quickly. Risk managers should be aware of the everyday decisions made in critical care transport to ensure the most appropriate utilization of resources to benefit the patient.

Joint Position Statement of the National Association of EMS Physicians, the American College of Emergency Physicians andthe Association of Air Medical Services (Draft 9-13-06 for possible ACEP/AAMS approval) Approved by NAEMSP Board, August 23, 2006

Joint Position Statement of the National Association of EMS Physicians, the American College of Emergency Physicians andthe Association of Air Medical Services (Draft 9-13-06 for possible ACEP/AAMS approval) Approved by NAEMSP Board, August 23, 2006

AMTC 2004 Cincinnati

AMTC 2004 Cincinnati

CAMTS sets the standard

In October 2004, the Commission on Accreditation of Medical Transport Systems (CAMTS) will publish the 6th edition of its accreditation standards. Revisions for the next edition begin almost immediately because we strive to publish standards that are concurrent with actual practice. Patient care and safety remain the two highest priorities. In developing new standards and revising current guidelines, the challenge is to raise the bar with each new edition, while keeping standards clear and meaningful with enough flexibility to address the unique variances of medical transport. Looking back at previous editions of CAMTS standards is like reviewing the changes we have experienced in the medical transport profession. When accreditation standards were first developed in 1991, we incorporated guidelines already developed by organizations such as the Association of Air Medical Services, the Helicopter Association International, Air & Surface Transport Nurses Association, and the National EMS Pilots Association. We held public forums to include input from individual professionals directly involved in medical transport. We wrote the first standards with great emphasis on the rotor-wing, hospital-based program because this is where the greatest challenges were in terms of safety and where most of the input originated. Since 1995, we have expanded the rotor-wing and fixed-wing sections to more appropriately address the independent medical transport systems that are not affiliated with hospitals and to address maintenance issues not previously included. By 1997, CAMTS changed its name to include standards and a process for ground critical care transport teams. These ground services, especially the pediatric and neonatal teams, wanted to demonstrate their level of quality and be eligible to apply for accreditation. In 2000, we also included ground advance life support (ALS)/basic life support (BLS) standards to meet the needs of expanding programs that wanted to have their entire transport service accredited by one body and through one site visit. Many air medical services were expanding into ground transport at all levels of care, so these standards were developed, and now ground ALS/BLS services can be included in the accreditation application if associated with an air or ground critical care service. In 2002, in an effort to de-emphasize titles (registered nurse and physician) as the only way to define critical care team members, we added an alternative means for programs to apply as a critical care team. Paramedic teams can apply as a critical care team if they demonstrate this level of care through mission profile, patient acuity, clinical experience, and educational requirements. Most importantly, outcome studies must show appropriate care is provided and a comprehensive performance improvement process must exist to review the critical care transports. As we move forward to the 2004 edition of standards, we will include a section for medical escort services and programs that provide medical escorts on commercial airlines or ground vehicles. We also will list criteria for human patient simulators that are appropriate in meeting the standards for initial and ongoing training. We have posted the first draft of revisions for the 6th edition on the Web site (www.camts.org). We value all suggestions and have included a comment section with the revisions. Your input will go directly to the accreditation standards committee and be considered for the second draft, which will be presented to the board of directors for approval at the July meeting.

Maryland State Police Aviation Division. A model emergency medical system for our nation.

This collective review has the following purposes. First we will describe each of the components of the Maryland State Police Aviation Division. We will then provide detailed information about the Atlas and Database of Air Medical Services (ADAMS) compiled by the center for transportation and injury research (Buffalo, New York) in alliance with the Association of Air Medical Services (Alexandria, Virginia) that provides a unique opportunity for each state to evaluate the comprehensive nature of their air medical services. The concept "the golden hour" has been molded into the world's premier public service aviation unit, which has proudly served the citizens of Maryland for over 24 years. This effort was initially made possible through a cooperative effort between the Maryland State Police Aviation Division and Dr. R Adams Cowley at the University of Maryland Hospital as a public service to the citizens of the state. This arrangement added a unique, economical, and life-saving component to the regionalized Emergency Medical Services and Critical Care system coordinated by the Maryland Institute for Emergency Medical Services Systems (MIESS). The Maryland State Police Aviation Division has four components: (1) aircraft, (2) state troopers, (3) system communications (SYSCOM) center, and (4) level I adult and pediatric trauma centers, as well as a regional burn center. ADAMS is a compilation of information of Air Medical Services in the United States to respond to traumas and other emergencies. Specifically, ADAMS provides descriptive and geographic information on Air Medical Service base locations, communication centers, rotor wing (RW) assets, and the major hospitals and transports that receive scene transports. The database includes all types of provider organizations including nonprofit, commercial, and public service (fire, police) air medical service providers, as well as several military units that routinely provide transport in remote areas. ADAMS provides national and statewide maps indicating air transport systems, trauma centers, and geographic population density. To provide a greater perspective on emergency medical care in individual states using the carefully tabulated ADAMS data, we compared the air emergency medical systems in Maryland to those of Oregon. Regardless of population density, Maryland provides air medical transport throughout the entire state, with the exception of only three small geographic areas. Maryland's 15 helicopter bases provide quick access for the seriously injured patient to either a Level I or pediatric trauma center within the "golden hour." In contrast, the air medical transportation system in Oregon is restricted to only three small geographic regions, making it an invitation to death for many seriously injured patients. It should be a federal mandate that the injured patient should gain access either by air transport or ambulance service to a Level I trauma center within that "golden hour." This federal legislation should include new criteria to initiate the dispatch of a helicopter to the scene of an accident or injury.

Safety above all: An Air Medical Safety Advisory Council update

In April 2000, the Federal Aviation Administration came to the air medical community, through the Association of Air Medical Services (AAMS), and asked what we were going to do about rising EMS accident rates in recent years. AAMS responded by organizing a summit meeting of key players from the industry, including program directors, professional organizations, hospitals, pilots, and crewmembers interested in participating.

A national survey of air medical infectious disease control practices

Introduction: Caring for an infectious patient in the air medical environment presents a special challenge to all air crew members (ACMs) involved. The purpose of this study was to survey the infectious disease control practices of air medical programs (AMPs) that are members of the Association of Air Medical Services. Methods: A structured telephone survey was designed to gather data. Using one interviewer (an undergraduate student) with no knowledge of the study's goal minimized experimental bias. AMPs from 151 geographically selected areas were called between June and August 1996. Only the programs' chief flight nurses (CFNs) were targeted as respondents. Results: The response rate was 91% (138 of 151). Although no program refused to participate, 13 CFNs were unavailable to be interviewed. Mission profile was 32% scene and 68% interhospital with an annual average, of 950 patient transports per program. Transport type was 61% rotor-wing aircraft, 17% fixed-wing, and 22% both. Flight physicals for ACMs were required by 57% of the AMPs. Pre-employment screenings for rubella, tuberculosis (TB), and varicella were noted. Interestingly, 17% of the AMPs reported pre-employment HIV testing. Immunization was mandated by 57% of AMPs, including hepatitis B virus, measles, rubella, and tetanus. Nine percent of the respondents refused to accept a transport with specific contagious conditions, primarily TB. A formal decontamination policy was in effect at 88% of the AMPs, and OSHA approved filter masks were available at 70%. Pathogen exposure reporting was required by 97%. Conclusion: A current, comprehensive infection control program, continuing education, and 100% compliance with standard precautions will help reduce the possibility of accidental exposures. These strategies to reduce transmission also can be extended during training sessions to the prehospital and hospital personnel with whom the air medical program serves.

The use of chemical restraint in helicopter transport

Introduction: Helicopter transport of the combative patient is a major safety hazard facing air medical teams. Although physical restraints alone are helpful, the addition of chemical restraint (CR) often is necessary to control these patients while in flight. Methods: A survey was conducted to determine the current practices of using nonparalyzing CR in air medical transport programs nationwide. The survey consisted of 24 questions on the use of CR during transport. Each U.S. program belonging to the Association of Air Medical Services was contacted by telephone, and a flight nurse or paramedic provided answers based on personal experience and statistics compiled by his or her individual program. Results: Of the 100 programs responding, benzodiazepines were used most commonly to control agitation with 51% using midazolam. Patients with a head injury required CR more frequently than any other condition (73%). Crews flying larger aircraft reported less need for CR. A physician order was required by only 30% of the programs, but delays infrequently endangered the patient (2%). Only 7% of the responding programs had a patient whose condition deteriorated because of CR. Conclusion: CR is necessary in air medical transport. Most programs use short-acting benzodiazepines. Crews in smaller aircraft use CR more frequently, and head injury is the most common condition requiring such restraint.

Assessment of U.S. helicopter emergency medical services' planning and preparedness for disaster response

Introduction: Helicopter emergency medical services (HEMS) roles in disaster response vary significantly from routine operation, and as reported in the literature, such responses have not been without difficulty. We identified nine criteria (written policy, triage and incident command training, disaster drill participation, ground and air communications plan, critical incident stress management, annual review, policy sharing) that may significantly affect an air medical program's disaster preparedness, response, and recovery. Of these criteria, a written policy is considered of primary importance. Methods: A written survey was developed and mailed in July 1995 to 187 U.S. rotor-wing members of the Association of Air Medical Services. The survey was designed to identify the programs that had a written policy and fulfilled the guideline criteria, had a written policy and partially fulfilled the criteria, or did not have a written policy. Results: Surveys were returned from 104 (56%) programs. Of the 103 qualifying respondents, 16 (16%) meet the criteria, 55 (53%) partially met the criteria, and 32 (31%) did not have written policies. Conclusion: Most U.S. HEMS programs have not fully addressed disaster preparedness, response, and recovery. HEMS disaster response guidelines should be established, and these criteria should be incorporated.

Trauma triage: Do AAMS transport guidelines do it effectively?

Purpose: Appropriateness of helicopter transport for trauma patient transfer is under closer scrutiny with the development of regionalized trauma systems and managed care. This study was conducted to determine the effectiveness of the 14 Association of Air Medical Services (AAMS) guidelines in triaging trauma patients. Methods: The application of the trauma transport guidelines for 511 patients flown to our trauma center with hospital stays of fewer than 3 days were analyzed to ensure high sensitivity to overtriage. Injury severity score (ISS), revised trauma score (RTS), Glasgow coma scale (GCS), and mortality rates associated with each of the guidelines were analyzed. Results: Each guideline was associated with mortality greater than or equal to 20%, except motor vehicle, falls, amputation, and degloving. All guidelines had significant ISS (> 14), RTS (< 10), and GCS (< 12), except falls (ISS—6.7, RTS—11, GCS—13.3) and amputations (ISS—6.3, RTS—11, GCS—13.5). Degloving, motor vehicle, spinal cord, airway, and extrication also had a significantly higher RTS (> 12). Conclusion: The AAMS transport guidelines for trauma patients accurately predict the potential for serious or life-threatening injury, with the exception of falls and amputations. The rapid access to highly skilled reimplantation teams required by patients with amputations justifies helicopter transport. However, falls greater than 20 feet do not appear to identify potential for life-threatening injury.

Quality Assurance and Continuous Quality Improvement within air transport programs

Introduction: In June of 1993, the Association of Air Medical Services (AAMS) Quality Management Committee surveyed 240 air medical programs regarding their Quality Assurance and Continuous Quality Improvement activities. Methods: The survey tool consisted of questions related to Quality Assurance/Continuous Quality Improvement program structure and specific Quality Assurance indicators contained in the AAMS/NFNA Quality Assurance Resource Document. Comparisons were made among fixed-wing, rotor-wing, and combined programs, for use of the Quality Assurance Resource Document, for availability of computers and for hospital-based versus profit or public service programs. Results: Returned surveys totaled 148 for a 62% return rate, with most of the respondents being single hospital based programs. Ninety-three percent of those surveyed have a Quality Assurance program in place to monitor indicators, whereas 63% have also begun to include the Continuous Quality Improvement team process. Only 50% of respondents use computers in their Quality Assurance/Continuous Quality Improvement activities. Conclusion: Significant differences among groups were found for several Quality Assurance indicators.