Helicopter Emergency Medical Services Setting Research Articles

Can the MIRACLE2 Score Be Used in the Prehospital Environment and Is It Useful? An Observational Study

ObjectiveThe MIRACLE2 score has been developed for use in a primary percutaneous coronary intervention center. It is unclear if it is feasible in the helicopter emergency medical service (HEMS) setting. MethodsThe computerized system at 1 UK HEMS was interrogated between December 1, 2020, and May 1, 2022, for the components of the MIRACLE2 score (recorded contemporaneously) plus demographics and outcomes in all post–return of spontaneous circulation patients conveyed to the hospital. pH was excluded because of no point-of-care testing resulting in a modified MIRACLE2 score (maximum score of 9). Data were analyzed using the chi-square test; P < .05 was statistically significant. ResultsThree hundred thirty patients (240 males) with out-of-hospital cardiac arrests were reviewed. Ninety-two adult patients with nontraumatic out-of-hospital cardiac arrests had sustained return of spontaneous circulation and a median MIRACLE2 score of 4 (range, 0-7). Forty-seven patients died before hospital discharge; the median MIRACLE2 score was higher in those who died (4) than those who survived (1.5, P < .01); 90.3% of those with a score ≥ 5 were triaged to an emergency department rather than directly to a catheterization laboratory. ConclusionA modified MIRACLE2 score can be calculated in the HEMS setting. The benefit of point-of-care testing pH requires investigation. There may be a benefit in predicting outcomes in this nondifferentiated group, but additional research is required.

Wellbeing of Helicopter Emergency Medical Services Personnel in a Challenging Work Context: A Qualitative Study

Background Helicopter emergency medical services (HEMS) personnel provide on-scene trauma care to patients with high mortality risk. Work in the HEMS setting is characterized by frequent exposure to critical incidents and other stressors. The aim of this study was to further our understanding of the factors underlying HEMS personnel wellbeing to inform organizations regarding workplace interventions that can be implemented to support employees. Method We conducted 16 semi-structured interviews with HEMS personnel from a university hospital in The Netherlands. Interview topics included work context, personal characteristics, coping, work engagement, and psychosocial support. To analyze the data, we used a generic qualitative research approach inspired by grounded theory, including open, axial, and selective coding. Results The analysis revealed ten categories that provide insight into factors underlying the wellbeing of HEMS personnel and their work context: team and collaboration, coping, procedures, informal peer support, organizational support and follow-up care, drives and motivations, attitudes, other stressors, potentially traumatic events, and emotional impact. Various factors are important to their wellbeing, such as working together with colleagues and social support. Participants reported that HEMS work can have an emotional impact on wellbeing, yet they use multiple strategies to cope with various stressors. The perceived need for organizational support and follow-up care is low among participants. Conclusion This study identifies factors and strategies that support the wellbeing of HEMS personnel. It also provides insight into the HEMS work culture and help-seeking behavior in this population. Findings from this study may benefit employers by shedding much-needed light on factors that HEMS personnel feel affect wellbeing.

Comparison of Hyperangulated Versus Standard Geometry Video Laryngoscopy in a Simulated Helicopter Emergency Medical Service Setting: A Randomized Crossover Trial

Comparison of Hyperangulated Versus Standard Geometry Video Laryngoscopy in a Simulated Helicopter Emergency Medical Service Setting: A Randomized Crossover Trial

Factors That Contribute to Provider Decision Between Direct and Video Laryngoscopy in a Helicopter Emergency Medical Services System: A Survey

ObjectiveIn caring for critically ill patients in the prehospital setting, rapid, definitive airway management is a high-risk, crucial procedure. All helicopter emergency medical services (HEMS) providers must proficiently and safely perform this procedure. Little information is available about the preference and efficacy of video laryngoscopy (VL) compared with direct laryngoscopy (DL). Additionally, there is a paucity of research investigating which method of intubation is more successful in the HEMS setting. The objective of this study was to delineate factors that contribute to provider decision regarding the method of orotracheal intubation and compare the frequency of use for each method. MethodsAn anonymous online survey was distributed to all providers in a single HEMS program. The survey results were deidentified and blinded to the researchers. ResultsThe survey was sent to 40 HEMS providers; 29 responded, and 119 total intubations were reported. Method familiarity and patient condition were the most commonly cited reasons for choosing both DL and VL for intubation. DL accounted for 15 intubation attempts, whereas 104 attempts were completed by VL. ConclusionFor both laryngoscopy techniques, the top reasons cited for selecting an intubation technique were being comfortable with that technique and patient presentation. Further investigation with chart review would help confirm the reported data.

Thinking Out of the (Big) Box: A Wearable Near-Infrared Spectroscopy Monitor for the Helicopter Emergency Medical Service

ObjectiveIn prehospital helicopter emergency medical service (HEMS) settings, the medical team has limited monitoring options, usually restricted to systemic variables. Regional tissue oxygenation (rO2) can be assessed by near-infrared spectroscopy (NIRS), but clinical NIRS monitors are unpractical (“big boxes” and additional cables) in HEMS. As an alternative, we identified a wearable, athlete training NIRS device (Moxy; Idiag, Fehraltorf, Switzerland) and hypothesized that it would be applicable in our HEMS setting. MethodsThis feasibility study was performed at the Dutch HEMS Lifeliner 1. The Moxy sensor was tested in-flight and on ground. We tested various anatomic measurement spots, and multiple conditions and interventions were imposed to track rO2. ResultsThe rO2 measurements with the wearable Moxy NIRS device are both feasible and practical in an HEMS setting. Multiple conditions and interventions were tested successfully (eg, tourniquet placement [rO2↓], muscle compression [rO2↓], reperfusion [rO2↑], oxygen administration [rO2↑], hyperemia [rO2↑], and venous congestion [rO2↓]). ConclusionOur results suggest that rO2 measurements with the wearable Moxy NIRS device are both feasible and practical in HEMS, and Moxy allows the tracking of simulated pathophysiologic effects on rO2. Future studies will have to verify our preliminary data and elucidate if and how wearable NIRS monitoring may support treatment in HEMS and improve patient outcome.

Portable Blood (Gas) Analyzer in a Helicopter Emergency Medical Service

IntroductionIn prehospital helicopter emergency medical services (HEMS), the medical team frequently manages critical patients with only limited, noninvasive monitoring options on-site and during HEMS transport. To gain deeper insight into the patient's pathology and to track prehospital treatment effects, a point-of-care blood (gas) analyzer appears desirable also in HEMS. Thus, we hypothesized that prehospital blood (gas) analysis is feasible in the HEMS setting. MethodsA prehospital evaluation of a portable blood (gas) analyzer (i-Stat 1; Abbott, Chicago, IL) with appropriate laboratory cartridges was performed within the Dutch HEMS Lifeliner 1, serving a region of ∼4.5 million inhabitants. Venous blood (gas) measurements were performed in our HEMS collective in both trauma and nontrauma cases. ResultsThe HEMS team identified benefits (eg, portability and speed) and limitations (eg, a narrow operational temperature range) regarding the tested blood (gas) analyzer. Regarding the actual blood (gas) results, the team collected results without major abnormalities but also cases identifying major pathologies, including several cases of marked acidosis, refractory hypoglycemia, or severe anemia. ConclusionIn conclusion, portable blood (gas) analysis proved feasible in an HEMS operation but with relevant limitations. Future studies will have to show how these limitations can be overcome and how the implementation of portable blood (gas) analyzers may support improved patient outcome.

Direct vs. Video Laryngoscopy in a Helicopter Emergency Medical Service (HEMS) Setting: A Retrospective Comparison

Introduction In the prehospital setting, when caring for critically ill patients, the ability to quickly and effectively secure a definitive airway can be a matter of life of death. As such, all helicopter emergency medical service (HEMS) providers must be able to safely perform this procedure with speed and efficacy. Video laryngoscopy (VL) was invented and introduced as an improved technique for performing orotracheal intubation, and its use has become widespread amongst pre-hospital and HEMS organizations. Despite this, little information is available regarding the efficacy of VL when compared to standard direct laryngoscopy (DL) in this pre-hospital setting. As such, there is sparse evidence to guide the HEMS provider's decision on which to use when attempting to secure the airway of a critically ill patient. Provider preference often comes into play in this situation. In a preliminary survey, Nolen and Pokorney found that while the majority of Wisconsin Flight For Life (FFL) HEMS providers choose VL, variation does exist between providers in regards to VL vs DL preference. Self-reported success rates by providers suggested 100% first pass success with DL and 87.5 success with VL. This survey relied on provider recall, and further review of records is required to evaluate the accuracy of these reports. Currently, there is no protocol regarding which laryngoscopy modality to employ in the HEMS setting. This research aims to improving the quality of care received by patients who require orotracheal intubation by HEMS providers. To do this, we investigate whether the use of VL or DL increases successful orotracheal intubations by HEMS providers. We hypothesized that the first pass and overall success would be greater with VL and the overall complications would be less with VL when compared to DL. Methods A retrospective chart review was performed of all intubated patients transported by HEMS providers from January 2015 to July 2017. Inclusion Criteria Adult patients transported by HEMS providers that required orotracheal intubation and underwent at least one attempt at orotracheal intubation. Results When comparing the survey results, we found similar rates of DL vs VL attempts (15/21 vs 104/120). First pass success rates were overestimated for both modalities (100%/90.5% vs 87.5%/84.8%). First Pass Success Rate No statistically significant difference was found in 1st pass success rate. The top reported reason for failed DL attempts was inability to pass tube, while the top reported reason for failed VL attempts include blood/secretions on camera, followed by inability to pass tube. Overall Success Rate No statistically significant difference was found between the two modalities. However, there was notably no difference between 1st pass and overall success rate in the DL group, while the overall success improved over fist pass in the VL group. While not statistically significant, this trend results from more attempts and alterations by those performing VL prior to resorting to a rescue airway. The most common alteration made was change in VL blade, followed by changing from VL to DL. Complications DL and VL groups had nearly identical complication rates. In both groups, the primary complication was hypoxia, so BVM ventilation was utilized. There was one cardiac arrest in the DL group. Influencing Factors Overwhelmingly, the method of intubation favored by HEMS providers is video laryngoscopy (VL). In the survey by Pokorney and Nolan, provider preference was the most common reason for choosing a modality. Of the patient characteristics observed, no significant differences were found. Initial GCS showed near statistical significance, with lower initial GCS trending to VL. Perhaps VL is more utilized when indication for intubation is apparent immediately upon arrival on scene. Unresponsiveness as reason for intubation, however, did not vary significantly. Respiratory failure alone demonstrated a statistically significant difference with proportionally more VL intubations in these patients. No definition for what constitutes respiratory failure was present in the charts and the reason for this variance between modality used is unknown. Conclusion In the data reviewed, no significant differences were found in first pass or overall success rates for direct and video laryngoscopy. Additionally no significant difference was observed in the complication rates and no factors were found that influenced the decision to perform DL vs VL.

Intubation Performance of Advanced Airway Devices in a Helicopter Emergency Medical Service Setting

ObjectiveThis study attempts to determine if newer indirect laryngoscopes or intubating devices are superior to a standard laryngoscope for intubation success among helicopter emergency medical service (HEMS) personnel. MethodsFlight nurses and paramedics intubated standardized mannequins with a normal airway, a trauma airway, and a difficult airway using a standard laryngoscope, a gum elastic bougie, the Airtraq laryngoscope (King System Corp, Noblesville, IN), the Glidescope Ranger laryngoscope (Verathon Inc, Bothell, WA), and the S.A.L.T. device (Microtek Medical, Inc, Lehmberg, IN) in grounded helicopters wearing helmets and flight gear. Participant demographics, time to glottic view, the modified Cormack-Lehane score, total intubation time, number of attempts, and overall successful intubation were recorded for each type of airway. ResultsTwo-hundred thirty-six subjects were initially enrolled across 107 bases in 15 states, and 177 completed the study. First-attempt success rates did not vary by device for the normal airway (P = .203), but the Airtraq laryngoscope and the S.A.L.T. device were highest in the difficult airway (82.0% and 85.0%, respectively; P < .0001). The time to first-attempt success in the difficult airway was lowest for the S.A.L.T. device and the Airtraq laryngoscope (mean = 9.72 seconds and 19.70 seconds, respectively; P < .0001). ConclusionUsing HEMS providers, the Airtraq laryngoscope and the S.A.L.T. device showed the fastest and highest intubation success on the first attempt in difficult simulated HEMS airway scenarios.

32 Effectiveness of Two Rescue Airway Devices for Difficult Intubations in a Helicopter Emergency Medical Service Setting

32 Effectiveness of Two Rescue Airway Devices for Difficult Intubations in a Helicopter Emergency Medical Service Setting

Feasibility of Bedside Thoracic Ultrasound in the Helicopter Emergency Medical Services Setting

IntroductionBedside thoracic ultrasound has been shown to be a valuable diagnostic tool in the emergency department. The purpose of this study was to evaluate the feasibility of bedside thoracic ultrasound in the prehospital HEMS setting. SettingAir ambulance helicopters during patient transportation. MethodsThis was a prospective pilot study. 71 consecutive, nonpregnant patients over 18 years old were enrolled. While in flight, providers completed limited bedside thoracic ultrasounds with the patient supine and recorded their interpretation of the presence or absence of the ultrasonographic sliding lung sign on a closed data-set instrument. Results41 (58%) of the eligible patients had a recorded thoracic ultrasound acquired in flight. The level of agreement in image interpretation between the flight crew and expert reviewer was substantial (Kappa 0.67, CI 0.44-0.90). The reviewer rated 54% of all images as “good” in quality. The most common reason cited for not completing the ultrasound was lack of enough provider time or space limitations within the aircraft cabin. ConclusionThe results of this study suggest that, with limited training, bedside thoracic ultrasound image acquisition and interpretation for the sliding lung sign in the HEMS setting is feasible.

246 Comprehensive Comparison of Intubation Performance Using Direct, Indirect Laryngoscopy and Airway Adjunct Devices, In a Simulated Helicopter Emergency Medical Services Setting

246 Comprehensive Comparison of Intubation Performance Using Direct, Indirect Laryngoscopy and Airway Adjunct Devices, In a Simulated Helicopter Emergency Medical Services Setting

Prehospital Glidescope video laryngoscopy for difficult airway management in a helicopter rescue program with anaesthetists

The objective of this study was to analyze the prehospital use of a Glidescope video laryngoscope (GSVL) due to anticipated and unexpected difficult airway in a helicopter emergency medical service setting in which emergency physicians (EP) are experienced anesthetists. Retrospective observational study and survey of the experiences of EP were conducted for more than a 3-year period (July 2007-August 2010). In 1675 missions, 152 tracheal intubations (TI) were performed. GSVL was used in 23 cases (15%). A total of 17 patients presented with multiple traumas, including nine with cervical spine immobilization, three with burns, and three with nontraumatic diagnoses. Eight patients experienced previously failed TI with conventional laryngoscopy (five by nonhelicopter emergency medical service EP). In two patients, the EP required two attempts with GSVL to obtain a successful TI. Since the introduction of the GSVL, no other backup airway device was necessary. GSVL may be a valuable support instrument in the prehospital management of difficult airways in emergency patients.