Aeromedical Research Articles

A Retrospective Geospatial Simulation Study of Helicopter Emergency Medical Services’ Potential Time Benefit Over Ground Ambulance Transport in Northern South Africa

ObjectiveOne of the most important benefits of helicopter emergency medical services (HEMS) is a time benefit, either through expedited access to the casualty or a reduction in the transport time to definitive care. However, HEMS utilization does not come without risk to the public and crew or at an insignificant cost. Cost is an essential consideration for health policy decisions, especially in low- to middle-income countries, such as South Africa. The aim of this study was to determine whether there is a time benefit of HEMS dispatch in South Africa compared with simulated driving time. A secondary aim was to determine the distance from the incident site to the hospital at which a time benefit can be guaranteed. MethodsA retrospective study was undertaken by comparing the prehospital times of patients who underwent HEMS transportation with simulated ground emergency medical services (GEMS) transportation times. Handwritten patient records of actual flights were reviewed and analyzed. The actual flight times recorded were used to calculate the helicopter transport time, activation to scene time, scene time, and scene to hospital time. Times were assigned based on a nonsimultaneous dispatch model, as is used in South Africa. For each helicopter mission, Google Maps (Google Inc, Mountain View, CA) was used to simulate the fastest ground route from the same location of the incident to the same receiving hospital corrected for typical traffic trends. The actual HEMS and simulated GEMS times were compared using the paired t-test. Linear regression analysis was performed to determine a minimum driving distance at which HEMS provides a time benefit. ResultsA total of 118 HEMS transports were analyzed, the majority of which were trauma related (n = 115, 97%). HEMS transport resulted in a mean time deficit of −15 minutes (95% confidence interval, −18 to −11; P < .05) compared with simulated GEMS drive times. After regression, HEMS transport provides a time benefit at a driving distance greater than 119 km. ConclusionThe current study demonstrated that there was rarely a time benefit for actual primary emergency responses when HEMS was used compared with simulated driving time of GEMS transport. Using a nonsimultaneous dispatch model, a time benefit only occurs when the driving distance from the incident site to the hospital is greater than 119 km. There is an urgent need to critically evaluate HEMS utilization in the South African context.

119 항공구급 서비스 개선방안에 관한 연구

Following the tourist falling accident in the Grand Canyon of the United States, the need for medical services for overseas Koreans is on the rise. In this study, I tried to suggest an improvement plan for the 119 Air Ambulance Service, which is an unmet emergency service need, because overseas Koreans must receive the same emergency service as domestic citizens. According to a literature review, air ambulance services have been universalized worldwide when considering goal setting, strategy setting, organizational structure, and geographical conditions step-by-step. Fixedwing aircraft, the core equipment of air ambulance services, may incur high costs; therefore, it is necessary to consider the uncertainty of the initial business, and to utilize Incheon International Airport in consideration of the regional conditions of an international airport for overseas dispatches in relation to the operation of the organization. As operating personnel, an Air Ambulance Transfer Team Leader, Air Ambulance Medical Team Leader (specialist), and EMS Provider are required, starting with the central 119 EMS Captain, and it is recommended to have advanced life support (ALS)-level professional equipment capable of transporting critical patients.

Analysis of Air Rescue for Offshore Wind Energy: A Retrospective Analysis of Structural and Process Quality for the Years 2014 to 2017

In order to achieve the emission targets required by the German Federal Environment Agency (Umweltbundesamt), the offshore wind industry has become 1 of the central building blocks of the so-called “energy turnaround.” After the first offshore wind farm (OWF), Alpha Ventus, started operation in 2010, the number of OWFs in the North Sea and Baltic Sea has grown steadily. Because of the ongoing growth of the industry, the number of workers on-site has more than quadrupled in recent years. Although the majority of OWFs are located in the exclusive economic zone up to 130 km from the mainland, the same legal provisions of the Occupational Health and Safety Act (Arbeitsschutzgesetz) apply here as on the mainland. This means that the operators of the wind farms are legally obligated to maintain a seamless rescue chain. Because of the distance to the mainland, rescue helicopters are the means of choice to ensure prompt emergency preclinical care and, if necessary, rapid evacuation. The company Northern HeliCopter GmbH, part of the DRF Luftrettung since 2019, offers as part of WINDEACare rescue helicopters stationed at 3 locations on the North Sea and Baltic Sea to its contract partners an emergency medical staffed air rescue service, which is operational 24 hours a day, 365 days a year. This article is the first to provide a detailed overview of a new field in prehospital emergency care on the high seas and, to this end, has recorded all offshore missions performed from 2014 through 2017 with evaluation of related medical and aeronautical data.

Which Method of Transportation Is Associated With Better Outcomes for Patients With Firearm Injuries to the Head and Neck?

In firearm injuries (FI), rapid transportation is important for survival. Information regarding different methods of transportation for head and neck FI is limited. The purpose of the study was to measure the association between method of transportation and the need for tracheostomy and/or intensive care unit (ICU). This retrospective cross-sectional study reviewed patients in Trauma Registry at Grady Memorial Hospital (GMH) in Atlanta, Georgia, from January 2016 to June 2021. Patients ≥18years old who sustained FI to the head and neck and were transported via ground emergency medical services (GEMS) or helicopter emergency medical services (HEMS) were included. Patients who arrived at the hospital by foot, private vehicle, or transported from a different hospital were excluded. The primary predictor variable was method of transportation (GEMS: ambulance transportation to GMH vs HEMS: helicopter transportation to GMH helipad). The primary outcome variables were tracheostomy (yes/no) and ICU admission (yes/no). Patient, injury, and hospital-related covariates were collected. Univariate analysis, χ2 test for categorical variables, and independent t test for continuous variables were calculated. Statistical significance was P<.05. Of total, 609 patients met the inclusion criteria. There were 560 patients (483 males) with a mean age of 33.6years old (range, 18 to 90) transported by GEMS. There were 49 patients (40 males) with a mean age of 44years old (range, 18 to 82) transported by HEMS. Patients transported by HEMS were statistically more likely to have longer transportation time in minutes [13.2 (range, 5 to 132) versus 24.2 (range, 9 to 46), P= <.001], lower Glasgow Coma Scale score [9.9 (range, 3 to 15) versus 6.3 (range, 3 to 15); P= <.001], higher Injury Severity Score [19.3 (range, 3.7 to 98) versus 24.2 (range, 10.3 to 98); P=.007], require transfusion [195 (34.8%); versus 26 (53.1%); P=.013], tracheostomy [46(8.2%) versus 13 (26.5%); P= <.001], and/or admitted to ICU [169, 30.2% versus 24 (49%); P=.007]. HEMS was positively associated with more tracheostomy and/or ICU admission. Additionally, patients transported by HEMS experienced longer transportation time and severe injuries. HEMS triage criteria specific for FI to the head and neck should be developed.

Treating Specialty Patients on the Western Frontier

The Kite Flight specialty transport program provides neonatal, pediatric, and obstetric transports across West Texas and Eastern New Mexico. Supplementing local ground and air medical services in the region, Kite Flight has grown services by over 500% in under 3 years. Providing enhanced services to the patients in the region, through provider education and transport, our goal is to improve outcomes for our vulnerable patient populations.

Use of a Rapid Rhino in haemorrhage control for penetrating neck injury presenting in traumatic cardiac arrest

Background Penetrating neck injuries present as serious, life-threatening events which require advanced expeditious management if the patient is to survive without significant morbidity and mortality. In-hospital paradigms for high-volume centres include the use of Foley catheter balloon tamponade to temporarily or definitively control haemorrhage from carotid sheath structures, although these techniques are less commonly deployed in the field. Case report We highlight the case of a 25-year-old male who presented to the ambulance service with three self-inflicted neck wounds – one to each of the zones of the neck. The zone 2 wound had transected the internal jugular vein and also the ipsilateral vertebral artery, causing severe haemorrhage leading to hypovolaemic cardiac arrest in a remote farmhouse location. He was treated with a modified tamponade technique, employing the use of a Rapid Rhino 900™ epistaxis catheter, secured with sutures into the zone 2 wound prior to inflation. This resulted in complete haemostasis, which allowed the patient to be volume resuscitated, anaesthetised and flown by air ambulance to the regional trauma centre. His injuries were treated and his recovery was interrupted only by a transient Horner's syndrome. Discussion This report showcases the first time this modification of a well-known in-hospital technique was deployed, which proved life-saving in this case and could be of use to others. We discuss the importance of catheter tamponade techniques as opposed to direct packing, in particular for those who need to be transported either within, between or to the hospital. This is in contradistinction to other authors advocating direct packing as the mainstay of treatment.

Impact of Point-of-Care Ultrasound on Prehospital Decision Making by HEMS Physicians in Critically Ill and Injured Patients: A Prospective Cohort Study.

Several studies have shown the additional benefit of point-of-care ultrasound (POCUS) by prehospital Emergency Medical Services (EMS). Since organization of EMS may vary significantly across countries, the value of POCUS likely depends on the prehospital system in which it is used. In order to be able to optimally implement POCUS and develop a tailored training curriculum, it is important to know how often POCUS is currently used, for which indications it is used, and how it affects decision making. The aims of this study were: (1) to determine the percentage of patients in whom POCUS was used by Dutch Helicopter Emergency Medical Services (HEMS) crews; (2) to determine how often POCUS findings led to changes in on-scene management; and (3) what these changes were. Patients who received prehospital care from December 1, 2020 through March 31, 2021 by a single HEMS crew were included in this prospective cohort study. Clinical data and specific data on POCUS examination, findings, and therapeutic consequences were collected and analyzed. During the study period, on-scene HEMS care was provided to 612 patients, of which 211 (34.5%) patients underwent POCUS. Of these, 209 (34.2%) patients with a median age of 45 years were included. There were 131 (62.7%) trauma patients, and 70 (33.7%) of the included patients underwent cardiopulmonary resuscitation (CPR). The median reported time of POCUS examination was three (P25-P75 2-5) minutes. Median prolongation of on-scene time was zero (P25-P75 0-1) minutes. In 85 (40.7%) patients, POCUS examination had therapeutic consequence: POCUS was found to impact treatment decisions in 34 (26.0%) trauma patients and 51 (65.4%) non-trauma patients. In patients with cardiac arrest, POCUS was most often used to aid decision making with regard to terminating or continuing resuscitation (28 patients; 13.4%). During the study period, POCUS examination was used in 34.5% of all prehospital HEMS patients and had a therapeutic consequence in 40.7% of patients. In trauma patients, POCUS seems to be most effective for patient triage and evaluation of treatment effectiveness. Moreover, POCUS can be of significant value in patients undergoing CPR. A tailored HEMS POCUS training curriculum should include ultrasound techniques for trauma and cardiac arrest.

Initial Training Evolution for the Helicopter Air Ambulance Professional

Training of the helicopter air ambulance medical professional has evolved over time with greater knowledge, experience, and innovations in pre- and intrahospital care. This article is a discussion of the training evolution of a historical, award-winning air medical program in the Southwest Virginia footprint.

Air Medical Transport for Acute Ischemic Stroke Patients: A Retrospective Cohort Study of National Trends Over an 8-Year Period

ObjectiveOptimal management of ischemic stroke is time dependent. An understanding of patterns of air medical transport may identify disparities that could affect patient care. MethodsIn this 8-year (2007-2014) observational, retrospective, cohort study, we abstracted a 20% national sample of Medicare data from patients ≥ 66 years of age hospitalized with a primary diagnosis of acute ischemic stroke who presented to the emergency department by ambulance (air or ground). ResultsAmong 149,751 hospitalized stroke patients who arrived by ambulance, the mean age was 81.6 years (standard deviation = 8.0 years), 62.1% were female (n = 93,007), and 86.3% were White (n = 129,268). Of these, 5,534 patients (3.7%) used any form of air ambulance. Air ambulance use (2007: 2.5%, 2014: 4.9%; P < .001) and arrival at certified stroke centers (2007: 40.3%, 2014: 63.2%; P < .001) increased over time. Air ambulance use was less likely among older patients (76-85 years and >85 years vs. 66-75 years; odds ratio [OR] = 0.68; 95% confidence interval [CI], 0.64-0.72 and OR = 0.34; 95% CI, 0.32-0.37, respectively) and all racial minorities except American Natives (OR = 2.07; 95% CI, 1.57-2.73) and more likely among sicker patients (Charlson Comorbidity Index ≥ 2 vs. 1, OR = 1.23; 95% CI, 1.09-1.38) and rural residents (OR = 1.34; 95% CI, 1.09-1.64). After adjustment for covariates, air ambulance use was associated with higher odds of thrombolysis (adjusted OR = 2.57; 95% CI, 2.38-2.79). ConclusionAir ambulance use is independently associated with increased thrombolysis use for stroke, but disparities exist in both air ambulance and thrombolysis use. Further research into underlying causes for these disparities would be beneficial for systems and public health-based interventions for improving outcomes for ischemic stroke.

Prehospital management in trauma patients and the increasing number of helicopter EMS transportations : An epidemiological study of the TraumaRegister DGU®

To compare the prehospital treatment modalities and intervention regimens for major trauma patients with comparable injury patterns between Austria and Germany. This analysis is based on data retrieved from the TraumaRegister DGU®. Data included severely injured trauma patients with an injury severity score (ISS) ≥ 16, an age ≥ 16 years, and who were primarily admitted to an Austrian (n = 4186) or German (n = 41,484) levelI trauma center (TC) from 2008 to 2017. Investigated endpoints included prehospital times and interventions performed until final hospital admission. The cumulative time for transportation from the site of the accident to the hospital did not significantly differ between the countries (62 min in Austria, 65 min in Germany). Overall, 53% of all trauma patients in Austria were transported to the hospital with ahelicopter compared to 37% in Germany (p < 0.001). The rate of intubation was 48% in both countries, the number of chest tubes placed (5.7% Germany, 4.9% Austria), and the frequency of administered catecholamines (13.4% Germany, 12.3% Austria) were comparable (Φ = 0.00). Hemodynamic instability (systolic blood pressure, BP ≤ 90 mmHg) upon arrival in the TC was higher in Austria (20.6% vs. 14.7% in Germany; p < 0.001). Amedian of 500 mL of fluid was administered in Austria, whereas in Germany 1000 mL was infused (p < 0.001). Patient demographics did not reveal arelationship (Φ = 0.00) between both countries, and the majority of patients sustained ablunt trauma (96%). The observed ASA score of 3-4 was 16.8% in Germany versus 11.9% in Austria. Significantly more helicopter EMS transportations (HEMS) were carried out in Austria. The authors suggest implementing international guidelines to explicitly use the HEMS system for trauma patients only a)for the rescue/care of people who have had an accident or are in life-threatening situations, b)for the transport of emergency patients with ISS > 16, c)for transportation of rescue or recovery personnel to hard to reach regions or, d)for the transport of medicinal products, especially blood products, organ transplants or medical devices.

Prehospital anaesthesia by a helicopter emergency medicine service: a review

Background: The Northern Ireland (NI) Ambulance Service launched its helicopter emergency medical service (HEMS) in 2017. Aims: This paper reviews the first 200 cases of prehospital emergency anaesthesia (PHEA). Methods: A retrospective review of the NI HEMS intubation database between 29 July 2017 and 28 February 2021 was conducted. Findings: PHEA was delivered as rapid sequence intubation (RSI). There was a 100% RSI success rate. The mean 999 call to RSI time was 65.9 minutes (median=61 minutes), with 14.6% of procedures carried out within the National Institute for Health and Care Excellence target of 45 minutes or less. The first pass oral intubation rate was 89.3%. There was a significant difference in the number of male compared to female patients (men=145; women=55; P≤0.0001). Conclusion: PHEA delivery by the HEMS since it was set up has been successful provided in a safe, robust manner. Reducing the 999 call to RSI time in line with the National Institute for Health and Care Excellence target was identified as an area for development.

GA-LNS Optimization for Helicopter Rescue Dispatch

Aviation emergency rescue has become one of the most effective means for natural disaster relief due to its flexible and timely characteristics. A reasonable emergency dispatch plan can guarantee the effective implementation of all the rescue measures. Most of previous studies in this area focused on the scheduling and routing but ignored the impact of the specific rescue process, for example the fuel consumption of various helicopters. In this paper, a multi-helicopter-multi-trip Aviation Rescue Routing Problem (ARRP) is analysed which covers the whole rescue process. In addition, a time-domain procedural simulation model is built which can consider different helicopters, refueling or not, various resource locations, multiple disaster sites and other operation factors. Based on that, a Genetic Algorithm (GA) hybridized Large Neighborhood Search (LNS) algorithm (GA-LNS) is proposed for optimization. In ARRP, single search algorithm may lead to the local optimum due to complexity. In contrast, the distance greedy strategy and the load ratio strategy are combined in GA-LNS which can fix the local optimum problem. More specifically, based on the helicopter-tagged-task-sequenced chromosome, the single-point crossover operator is used in GA and then, the worst removal strategy and the first/last insertion strategy are adopted in LNS. Finally, the numerical experiments are exercised to verify the effectiveness of the proposed GA-LNS algorithm which is compared with three traditional basic heuristic algorithms and a stateof-the-art memetic algorithm.

Survival Benefit of Helicopter Scene Response for Patients with an Injury Severity Score of at Least Nine: A Systematic Review and Meta-Analysis

Background and Aim Helicopter EMS (HEMS) is a well-established mode of rapid transportation for patients with need for time-sensitive interventions, especially in patients with significant traumatic injuries. Traditionally in the setting of trauma, HEMS is often considered appropriate when used for patients with “severe” injury as defined by Injury Severity Score (ISS) >15. This may be overly conservative, and patients with a lower ISS may benefit from HEMS-associated speed or care quality. Our objective was to perform a meta-analysis of trauma HEMS transports to evaluate for possible mortality benefit in injured cases defined by an ISS score >8, lower than the customary ISS cutoff of >15. Methods A broad search of the literature was performed including PubMed, EMBASE, SCOPUS, Cochrane Central Register of Controlled Trials, and Google Scholar from the years 1970 to 2022. The gray literature and reference lists of included publications were also examined. We included studies with the outcome of mortality in HEMS vs control in trauma transports from scene of injury for patients (adult or pediatric) with ISS > 8. Results Nine eligible studies were used in the final analysis: six in the primary analysis and three in sensitivity analysis due to patient overlap. All studies reported statistically significant survival benefit in HEMS compared to control group. The minimum survival odds ratio (OR) benefit observed was OR 1.15 (95% CI 1.06–1.25) and maximum was OR 2.04 (95% CI 1.18–3.57). Risk of bias tool (ROBINS-I) application yielded moderate to low risk of bias, mainly due to the observational nature of the studies included. Conclusions There was a statistically significant survival benefit in patients with ISS > 8 when HEMS was used over traditional ground ambulance transportation, although novel and more inclusive trauma triage criteria may be more appropriate in the future to guide HEMS utilization decision-making. Restricting HEMS to trauma patients with ISS >15 likely misses survival benefit that could be afforded to the subset of trauma patients with serious injury.

5G Key Technologies for Helicopter Aviation Medical Rescue.

Rapid global population growth and urbanization have heightened the demand for emergency medical rescue, with helicopter medical rescue emerging as an effective solution. The advent of 5G communication technology, characterized by large bandwidth, low latency, and high reliability, offers substantial promise in enhancing the efficiency and quality of helicopter rescue operations. However, the full integration of 5G technology into helicopter emergency medical services is still in its nascent stages and requires further development. In this viewpoint, we present our experience from the Shenzhen University General Hospital of the application of 5G low-altitude network communication technology, body area network disease sensing technology, and 5G air-ground collaborative rapid diagnosis and treatment technology in aeromedical rescue. We consider that the 5G air-to-ground collaborative rapid diagnosis and treatment technology enables high-quality remote consultation, enhancing emergency medical rescue and providing strong support for future rescue operations.

Air Medical Blood Transfusion as a Trigger of Massive Transfusion Protocol

Air medical services can improve access to blood products at the point of injury. Studies have shown that early activation of mass transfusion protocols (MTPs) can improve the survival of trauma patients by up to 25%. There are several scoring systems to guide early activation, but the use of a single criterion has been elusive. Our study sought to determine if air medical administration of blood products was a risk factor for massive transfusion activation and utilization of prehospital vital signs for calculation of the shock index. In our retrospective study, we evaluated adult trauma patients transfused by helicopter emergency medical services (HEMS) and as a control all patients in our institution receiving the MTP. Our study found HEMS blood transfusion was not a reliable trigger for MTP, although the sample size may have limited our findings. We found that HEMS care resulted in an overall reduction in the volume of transfusion and an improvement in hemodynamic parameters upon trauma center arrival. HEMS transfusion and a higher rate of tranexamic acid administration may have contributed to these findings. Of note, the assessment of blood consumption score and shock index were nonspecific in the study populations.

A dynamic task assignment model for aviation emergency rescue based on multi-agent reinforcement learning

China's natural disaster situation presents a complex and severe scenario, resulting in substantial human and material losses as a result of large-scale emergencies. Recognizing the significance of aviation emergency rescue, the state provides strong support for its development. However, China's current aviation emergency rescue system is still under construction and encounters various challenges; one such challenge is to match the dynamically changing multi-point rescue demands with the limited availability of aircraft dispatch. We propose a dynamic task assignment model and a trainable model framework for aviation emergency rescue based on multi-agent reinforcement learning. Combined with a targeted design, the scheduling matching problem is transformed into a stochastic game process from the rescue location perspective. Subsequently, an optimized strategy model with high robustness can be obtained by solving the training framework. Comparative experiments demonstrate that the proposed model is able to achieve higher assignment benefits by considering the dynamic nature of rescue demands and the limited availability of rescue helicopter crews. Additionally, the model is able to achieve higher task assignment rates and average time satisfaction by assigning tasks in a more efficient and timely manner. The results suggest that the proposed dynamic task assignment model is a promising approach for improving the efficiency of aviation emergency rescue.

Leadership in the multiteam system of prehospital medicine.

Emergency Medicine AustralasiaEarly View Trainee Focus Leadership in the multiteam system of prehospital medicine Natalie Kay PGDipClinEd, MBChB, Corresponding Author Natalie Kay PGDipClinEd, MBChB Emergency Medicine Specialist, Prehospital and Retrieval Medicine Doctor [email protected] Te Whatu Ora Counties Manukau, Middlemore Hospital, Auckland, New Zealand Northern Rescue Helicopter Ltd, Auckland, New Zealand Correspondence: Dr Natalie Kay, Northern Rescue Helicopter Ltd, 440 Harvard Lane, Ardmore, Auckland 2582, New Zealand. Email: [email protected]Search for more papers by this author Natalie Kay PGDipClinEd, MBChB, Corresponding Author Natalie Kay PGDipClinEd, MBChB Emergency Medicine Specialist, Prehospital and Retrieval Medicine Doctor [email protected] Te Whatu Ora Counties Manukau, Middlemore Hospital, Auckland, New Zealand Northern Rescue Helicopter Ltd, Auckland, New Zealand Correspondence: Dr Natalie Kay, Northern Rescue Helicopter Ltd, 440 Harvard Lane, Ardmore, Auckland 2582, New Zealand. Email: [email protected]Search for more papers by this author First published: 21 June 2023 https://doi.org/10.1111/1742-6723.14265Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References 1Hearns S (ed). Reducing the pressure from frazzle to flow. In: Peak Performance Under Pressure, 1st edn. Bridgwater: Class Professional Publishing, 2019; 233– 47. 2Lauria MJ, Gallo IA, Rush S, Brooks J, Spiegel R, Weingart S. Psychological skills to improve emergency care providers' performance under stress. Ann. Emerg. Med. 2017; 70: 884– 90. 3 New Zealand Government. Coordinated Incident Management System (CIMS), 3rd edn. Wellington: Officials' Committee for Domestic and External Security Coordination, Department of the Prime Minister and Cabinet, 2019. 4Stoate JM. Together or apart: modelling the inter-agency workings of emergency response multiteam systems (PhD thesis). Leeds: Leeds University Business School, 2015. 5 Fire and Emergency New Zealand. What We Do and Why We Do It. Wellington: Fire and Emergency New Zealand, 2023. [Cited Apr 2023.] Available from URL: https://fireandemergency.nz/about-us/what-we-do/ 6 Fire and Emergency New Zealand. Annual Report 2022. Wellington: Fire and Emergency New Zealand, 2023. [Cited Jun 2023.] Available from URL: https://www.fireandemergency.nz/assets/Documents/FENZ_Annual_Report_2022.pdf 7Hylander J, Saveman B, Bjornstig U, Gyllencreutz L. Prehospital management provided by medical on-scene commanders in tunnel incidents in Oslo, Norway – an interview study. Scand. J. Trauma Resusc. Emerg. Med. 2019; 27: 78. 8Calland V, Williams P. Scene safety and assessment. In: T Nutbeam, M Boylan, eds. ABC of Prehospital Emergency Medicine. Chichester: Wiley, 2013; 13. 9Low A, Hulme J. ABC of Transfer and Retrieval Medicine, 1st edn. Chichester: Wiley, 2015. 10Salas E, Granados DD, Klein C et al. Does team training improve team performance? A meta-analysis. Hum. Factors 2008; 50: 903– 33. 11Carson JB, Tesluk PE, Marrone JA. Shared leadership in teams: an investigation of antecedent conditions and performance. Acad. Manag. J. 2007; 50: 1217– 34. 12Diviney R. Why Dynamic Subordination Is Required for High-Functioning Teams. [Updated 2 Aug 2022; cited 28 May 2023.] Available from URL: https://theattributes.com/blog/why-dynamic-subordination-is-required-for-high-performing-teams Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Operation Remote Immunity: exploring the impact of a service-learning elective in remote Indigenous communities

BackgroundThe novel coronavirus, COVID-19, emerged in December 2019. Shortly after, vaccines against the virus were distributed in Canada for public use, but the remoteness of many northern Indigenous communities in Ontario posed a challenge for vaccine distribution and dissemination. The Ministry of Health partnered with the Northern Ontario School of Medicine University (NOSMU) and the air ambulance service, Ornge, to assist in delivering the vaccination doses to 31 fly-in communities in the Nishnawbe Aski Nation and Moosonee, all within Ontario. These deployments were considered “service-learning electives” for Undergraduate and Postgraduate medical learners from NOSMU who joined the operation in two-week deployments. NOSMU is renowned for its social accountability mandate and gives its medical learners opportunities to participate in service-learning to enhance their medical skills and cultural sensitivity. The purpose of this study is to examine the relationship between social accountability and medical learners’ experiences during a service-learning elective in northern Indigenous communities in Ontario during the COVID-19 pandemic.MethodsData were collected through a planned post-placement activity completed by eighteen Undergraduate and Postgraduate medical learners, who participated in the vaccine deployment. The activity consisted of a 500-word reflective response passage. Thematic analysis was used to identify, analyze, and report the themes within the collected data.ResultsTwo themes were identified by the authors, which formed a concise overview of the collected data: (1) confronting the realities of working in Indigenous communities; and (2) service-learning as a path to social accountability.ConclusionsThese vaccine deployments were an opportunity for medical learners to engage in service-learning and engage with Indigenous communities in Northern Ontario. Service-learning is an exceptional method which provides an opportunity to expand knowledge on the social determinants of health, social justice, and social accountability. The medical learners in this study reiterated the idea that learning medicine through a service-learning model leads to a greater depth of knowledge on Indigenous health and culture, and enhances medical knowledge compared to classroom learning.

Associations Between Hourly Ambient Particulate Matter Air Pollution and Ambulance Emergency Calls: Time-Stratified Case-Crossover Study.

Associations between short-term exposure to ambient particulate matter (PM) air pollutants and mortality or hospital admissions have been well-documented in previous studies. Less is known about the associations of hourly exposure to PM air pollutants with ambulance emergency calls (AECs) for all causes and specific causes by conducting a case-crossover study. In addition, different patterns of AECs may be attributed to different seasons and daytime or nighttime periods. In this study, we quantified the risk of all-cause and cause-specific AECs associated with hourly PM air pollutants between January 1, 2013, and December 31, 2019, in Shenzhen, China. We also examined whether the observed associations of PM air pollutants with AECs for all causes differed across strata defined by sex, age, season, and the time of day. We used ambulance emergency dispatch data and environmental data between January 1, 2013, and December 31, 2019, from the Shenzhen Ambulance Emergency Centre and the National Environmental Monitor Station to conduct a time-stratified case-crossover study to estimate the associations of air pollutants (ie, PM with an aerodynamic diameter less than 2.5 µm [PM2.5] or 10 µm [PM10]) with all-cause and cause-specific AECs. We generated a well-established, distributed lag nonlinear model for nonlinear concentration response and nonlinear lag-response functions. We used conditional logistic regression to estimate odds ratios with 95% CIs, adjusted for public holidays, season, the time of day, the day of the week, hourly temperature, and hourly humidity, to examine the association of all-cause and cause-specific AECs with hourly air pollutant concentrations. A total of 3,022,164 patients were identified during the study period in Shenzhen. Each IQR increase in PM2.5 (24.0 µg/m3) and PM10 (34.0 µg/m3) concentrations over 24 hours was associated with an increased risk of AECs (PM2.5: all-cause, 1.8%, 95% CI 0.8%-2.4%; PM10: all-cause, 2.0%, 95% CI 1.1%-2.9%). We observed a stronger association of all-cause AECs with PM2.5 and PM10 in the daytime than in the nighttime (PM2.5: daytime, 1.7%, 95% CI 0.5%-3.0%; nighttime, 1.4%, 95% CI 0.3%-2.6%; PM10: daytime, 2.1%, 95% CI 0.9%-3.4%; nighttime, 1.7%, 95% CI 0.6%-2.8%) and in the older group than in the younger group (PM2.5: 18-64 years, 1.4%, 95% CI 0.6%-2.1%; ≥65 years, 1.6%, 95% CI 0.6%-2.6%; PM10: 18-64 years, 1.8%, 95% CI 0.9%-2.6%; ≥65 years, 2.0%, 95% CI 1.1%-3.0%). The risk of all-cause AECs increased consistently with increasing concentrations of PM air pollutants, showing a nearly linear relationship with no apparent thresholds. PM air pollution increase was associated with a higher risk of all-cause AECs and cardiovascular diseases-, respiratory diseases-, and reproductive illnesses-related AECs. The results of this study may be valuable to air pollution attributable to the distribution of emergency resources and consistent air pollution control.

REBOA in Bleeding and Cardiac Arrest in Pre-Hospital Care by Helicopter Emergency Medical Service: The RIBCAP-HEMS Project

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) plays an important role in the most severe trauma and medical patients with cardiac arrest. Its use in pre-hospital emergency medicine in Germany does not yet regularly occur, and the vast majority of rapid response vehicles are not equipped with REBOA devices. In this article we will describe the introduction of REBOA for bleeding patients, as well as an adjunct for refractory out-of-hospital cardiac arrest (OHCA), in a German helicopter emergency medical service (HEMS).Methods: The DRF-Luftrettung HEMS base in Halle (Saale) Germany has incorporated REBOA in pre-hospital emergency medicine and will accompany this introduction with a feasibility study. We will describe the implementation of REBOA and the results of the training course. The training consists of theoretical and practical issues within different case scenarios. This was carried out before introducing REBOA into pre-hospital emergency medicine. Using a pre- and post-course exam and a self-assessment questionnaire the theoretical and practical knowledge and the performance of the critical care teams were determined.Results: The results of the pre-course exam in comparison with the post-course exam improved from 82% to 96%. Based on the self-assessment questionnaires, all participants felt a relevant improvement of their theoretical and practical knowledge. All physicians successfully performed REBOA under ongoing cardiopulmonary resuscitation in manikin simulators.Conclusions: The results from the training course indicate that there was a significant improvement of the theoretical and practical knowledge, as well as the performance of REBOA. The on-going feasibility study will show if it is worth introducing REBOA in a civilian HEMS for the patients in extremis.