Aeromedical Research Articles

Kitesurfing and snowkiting injuries in Norway: a retrospective study

BackgroundKiteboarding (kitesurfing on water and snowkiting) is a fairly new sport and is defined as a high-risk sport. The injury rate has been reported to be between 6 and 9 per 1000 h. The aim of the study was to identify and describe kiteboarding-related injuries in Norway over a five-year period.MethodsWe used “snowball sampling” to identify kiteboarding accidents in a retrospective study. In addition, we conducted structural searches in the National Air Ambulance Service and Search and Rescue Helicopter patient record databases. All included informants were interviewed. Descriptive methods were used to characterise the sample.ResultsTwenty-nine kiteboarders were included, with a total of 33 injuries. One half of the injuries to head, face and neck were cerebral concussions (n = 12). The most common type of injury was bone fractures (n = 28), followed by soft tissue injuries (n = 24). Most injuries were of moderate severity (51%) and falling from less than 5 m was the most common mechanism of injury. Operator error and lack of experience were the most frequently reported causes of accidents (82%).ConclusionsSerious injuries occured during kiteboarding. The majority of kiteboarders reported operator error or lack of experience as the cause of their accident. Prior to kiteboarding, a course highlighting the importance in using helmet for snowkiting and both helmet and life vest in kitesurfing, should be mandatory.

Evaluation of the Success of Simulation of the Unmanned Aerial Vehicle Precision Landing Provided by a Newly Designed System for Precision Landing in a Mountainous Area

Unmanned aerial vehicle technology is the most advanced and helpful in almost every area of interest in human work. These devices become autonomous and can fulfil a variety of tasks, from simple imaging and obtaining data to search and rescue operations. The most challenging environment for search and rescue operations is the mountainous area. This article is devoted to the theoretical description and simulation tests of a prototype method of landing the light and the medium-weight UAVs used as supplementary devices for SAR (search and rescue) and HEMS (helicopter emergency medical service) in hard-to-reach mountainous terrains. The autonomous flight of a UAV in mountainous terrain has many specifics, and it is usually performed according to predetermined map points (pins) uploaded directly into the control software of the UAV. It is necessary to characterise each point flown on the chosen flight route line in advance and therefore to know its exact geographical coordinates (longitude, latitude and height of the point above the terrain), and the control system of UAV must react to the change in the weather and other conditions in real time. Usually, it is difficult to make this forecast with sufficient time in advance, mainly when UAVs are used as supplementary devices for the needs of HEMS or MRS (mountain rescue service). The most challenging phase is the final approach and landing of the UAV, especially if a loss of GNSS (global navigation satellite system) signal occurs, like in the determined area of the Little Cold Valley in the Slovak High Tatras—which is infamous for the widespread loss of GNSS signals or communication/controlling connection between the UAV and the pilot-operator at the operational station. To solve the loss of guidance, a new method for guiding and controlling the UAV in its final approach and landing in a determined area is tested. An alternative landing navigation system for UAVs in a specific mountainous environment—the authors’ designed frequency Doppler landing system (FDLS)—is briefly described but thoroughly tested with the help of artificial intelligence. An estimation of dynamic stability is used based on the time recording of the current position of the UAV, with the help of a frequency-modulated or amplitude-modulated signal based on the author’s prototype of a precision landing system designed for mountainous terrain. This solution could overcome the problems of GNSS signal loss. The presented research primarily evaluates the success of the simulation flights for the supplementary UAV. The success of navigating the UAV to land in the mountainous environment at an exact landing point using the navigation signals from the FDLS was evaluated at more than 95%.

Temporary Standard Operating Procedure Design about Medical Evacuation Helicopter from Pertamina Mandalika International Circuit to General Hospital of West Nusa Tenggara Province

This research was conducted based on the discovery of a hazard that arose due to the flight path of the medical evacuation helicopter from the Pertamina Mandalika International Circuit to the General Hospital of West Nusa Tenggara Province. This research was conducted at Lombok Branch Office of Indonesian Air Navigation Service Provider, AirNav Indonesia, from September to December 2022. It was carried out using qualitative research methodology which is observation. The data and facts was processed using descriptive analysis. Based on the analysis of the data obtained, author concluded that a temporary standard operating procedure regarding medical evacuation helicopter is required and the author has come up with one.

Current evidence on the use of pocus in the diagnosis of pneumothorax in emergency rooms: a systematic review

Introduction: Point of Care Ultrasound (POCUS) is currently recognized as useful and, in some cases, mandatory, such as during invasive procedures. Its bedside application includes differential diagnosis and therapeutic management of complex clinical conditions during hemodynamic instability. The emergence of portable devices with superior image quality and their applicability in emergency rooms and intensive care units has demonstrated high diagnostic effectiveness. Objective: It was to highlight the use of POCUS in the diagnosis of pneumothorax in emergency rooms, through a systematic review of meta-analytic articles, systematic reviews, and observational studies from the last 11 years (2012 to 2023). Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from October to December 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 127 articles were found, 43 articles were evaluated in full and 31 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 22 studies with a high risk of bias and 26 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=61.5%<50%. It was concluded that the POCUS method is operator-dependent and has greater sensitivity (78 to 90%) and specificity greater than 98% in chest radiography. However, when performed correctly by trained professionals, following protocols, it proved to be useful for identifying and treating pneumothorax. POCUS is a portable, fast, and low-cost bedside examination that does not involve ionizing radiation, in addition to identifying a precise location for performing thoracentesis in cases of pneumothorax, which assists clinical physicians in urgent and emergency rooms, as well as in external environments such as rescue helicopters. There is a consensus among the authors researched that, to obtain clinical evidence on the use of POCUS in the diagnosis of pneumothorax, more randomized controlled studies are necessary, which reinforce the use of this versatile equipment in different urgent and emergency scenarios

Severity-Driven Trends in Mortality in a Large Regionalized Critical Care Transport Service

ObjectiveThe epidemiology accompanying helicopter emergency medical services (HEMS) transport has evolved as agencies have matured and become integrated into regionalized health systems, as evidenced primarily by nationwide systems in Europe. System-level congruence between Europe and the United States, where HEMS is geographically fragmentary, is unclear. In this study, we provide a temporal, epidemiologic characterization of the largest standardized private, nonprofit HEMS system in the United States, STAT MedEvac. MethodsWe obtained comprehensive timing, procedure, and vital signs data from STAT MedEvac prehospital electronic patient care records for all adult patients transported to UPMC Health System hospitals in the period of January 2012 through October 2021. We linked these data with hospital electronic health records available through June 2018 to establish length of stay and vital status at discharge. ResultsWe studied 90,960 transports and matched 62.8% (n = 57,128) to the electronic health record. The average patient age was 58.6 years ( 19 years), and most were male (57.9%). The majority of cases were interfacility transports (77.6%), and the most common general medical category was nontrauma (72.7%). Sixty-one percent of all patients received a prehospital intervention. Overall, hospital mortality was 15%, and the average hospital length of stay (LOS) was 8.8 days ( 10.0 days). Observed trends over time included increases in nontrauma transports, level of severity, and in-hospital mortality. In multivariable models, case severity and medical category correlated with the outcomes of mortality and LOS. ConclusionIn the largest standardized nonprofit HEMS system in the United States, patient mortality and hospital LOS increased over time, whereas the proportion of trauma patients and scene runs decreased.

The Effect of Coronavirus Disease 2019 on Adverse Events in Health Care: A Retrospective Study in Ground and Helicopter Emergency Medical Services

ObjectiveThe coronavirus disease 2019 (COVID-19) pandemic has proven to be a significant hardship for the entire world. Health care systems and their workers have been stretched to their limits. Research regarding whether this increased strain has affected patient safety has not been sufficient, especially in emergency medical services. The aim of this study was to determine if there has been an increased rate of adverse events in ground and helicopter emergency medical services since the onset of the COVID-19 pandemic. MethodsA 2-year retrospective review was performed at a Midwest regional critical care transport service. The rate of adverse events for 1-year periods before and after March 13, 2020, was the primary outcome. All adverse events that generated a quality improvement incident report form (QIRF) were included, except those generated for non–clinical-related incidents. Additionally, a smaller time frame between May 1st and August 31st of both years was included containing all flagged adverse events from peer reviewers; not all of these generated a QIRF. ResultsIn the time period between March 13, 2019, and March 12, 2020, 5 of 3,154 (0.16%) calls generated a QIRF versus 21 of 3,185 (0.66%) calls between March 13, 2020, and March 12, 2021. There was a significant relationship showing an adverse event was more likely to happen after the onset of COVID-19 compared with before (χ21 [N = 6,339] = 8.643, P ≤ .001). Additionally, from May 1st to August 31st, the total adverse event rates were 16.86% (143/848 calls) and 24.46% (387/1,582 calls) for 2019 and 2020, respectively. Similarly, statistical significance existed for adverse events occurring after onset of the pandemic versus before (χ21 [N = 2,430] = 18.253, P ≤ .001). ConclusionA higher rate of adverse events for the year after the onset of COVID-19 existed. Additional studies looking at the causes of adverse events and patient outcomes should be undertaken to further understand this increase.

The Estimated Cost-Effectiveness of Physician-Staffed Helicopter Emergency Medical Services Compared to Ground-Based Emergency Medical Services in Finland

ObjectiveBecause the unit cost of helicopter emergency medical services (HEMS) is higher than traditional ground-based emergency medical services (EMS), it is important to further investigate the impact of HEMS. The aim of this study was to evaluate the cost-effectiveness of physician-staffed HEMS compared with ground-based EMS in Finland under current practices. MethodsThe incremental cost-effectiveness ratio was evaluated using the differences in outcomes and costs between HEMS and ground-based EMS. The estimated mortality within 30 days and quality-adjusted life years (QALYs) were used to measure health benefits. Quality of life was estimated according to the EuroQoL scale, and a 1-way sensitivity analysis was conducted on the QALY indexes ranging from 0.6 to 0.8. Survival rates were calculated according to the national HEMS database, and the cost structure was estimated at 48 million euros based on financial statements. ResultsHEMS prevented the 30-day mortality of 68.1 patients annually, with an incremental cost-effectiveness ratio of €43,688 to €56,918/QALY. Fixed costs accounted for 93% of HEMS expenses because of 24/7 operations, making the capacity utilization rate a major determinant of total costs. ConclusionHEMS intervention is cost-effective compared with ground-based EMS and is acceptable from a societal willingness-to-pay perspective. These findings contribute valuable insights for health care management decision making and highlight the need for future research for service optimization.

Prehospital Patient and Family Aftercare Service in Helicopter Emergency Medical Services: A Patient's Perspective

Over the past decade the medical profession has witnessed patient and family aftercare becoming increasingly rooted within a patient-centric approach. Furthermore, there has been strong consensus within the Helicopter Emergency Medical Service (HEMS) sector for a Patient and Family Aftercare Service (PFAS) at Air Ambulance Charity Kent Surrey Sussex to further support an individual's experience from their core primary retrieval, through to the rehabilitation experience. This patient narrative highlights key interconnections between HEMS and an aftercare team that are important to the patient experience. Firstly, the clinical team provide prompt and expert medical intervention, which is crucial in managing critical injury and illness at the scene of an injury. Secondly, the narrative explores the emotional support provided by the healthcare professionals. Thirdly, the role of the support network, comprising of family, friends, and the wider community is discussed as integral for both physical and emotional rehabilitation post-incident. Furthermore, the narrative highlights that ongoing engagement from PFAS is important to continued rehabilitation and enhanced quality of life.

Air Ambulance Services Program in Saudi Arabia: A National Healthcare Transformation Plan in Vision 2030

Air Ambulance Services Program in Saudi Arabia: A National Healthcare Transformation Plan in Vision 2030

Pattern of hospital admissions and costs associated with acute rheumatic fever and rheumatic heart disease in Australia, 2012-2017.

ObjectiveThis study aims to describe the pattern and trends in acute rheumatic fever (ARF)/rheumatic heart disease (RHD)-related hospitalisations and costs for Australians aged <65 years.MethodsThis retrospective linked data study measured trends in hospitalisations and costs for ARF, RHD and complications of ARF/RHD in Northern Territory, South Australia, Western Australia, Queensland and New South Wales between 1 July 2012 and 30 June 2017. Persons with ARF/RHD were identified from RHD registers and/or hospital records.ResultsOver the 5-year study period, 791 children, aged <16years (86.3% Indigenous), and 2761 adults, aged 16-64years (44.8% Indigenous), were hospitalised for ARF, RHD or associated complications. On average there were 296 paediatric admissions per year, increasing 6.1% annually (95% CI: 2.4-9.6%, P=0.001) and 1442 adult admissions per year, increasing 1.7% annually (95% CI: 0.1-3.4%, P=0.03). Total 5-year costs were AU$130.6m (AU$17.6m paediatric, AU$113.0m adult). Paediatric costs were mostly for ARF-related admissions whereas adult costs mostly involved valvular surgery. Emergency admissions and air ambulance transfers were common, particularly for non-metropolitan residents.ConclusionsSuccessful ARF/RHD prevention would deliver significant hospital cost savings. Investment in primary and specialist health care in regional areas may reduce emergency admissions and regional transfers, further reducing hospital burden.

Epilepsy and driving; Impact on the patient and the society

Background &#x0D; Road traffic accidents are a leading cause of morbidity and mortality in Sri Lanka. Although it is a statutory requirement to declare epilepsy before applying for a driving license, the regulations are not well defined.&#x0D; Parallel to the developing transportation infrastructure and the increasing need of driving skills for independence, the impact of epilepsy on driving has become a topic of utmost importance.&#x0D; Methods&#x0D; This is a descriptive observational study. All patients followed up at the National epilepsy center at National hospital of Sri Lanka, who fulfill the international league against epilepsy (ILAE) operational definition of epilepsy were recruited for the study for a period of three months starting from November 2022 to March 2023.&#x0D; Results &#x0D; The study evaluated 142 participants, the majority of whom were males (98%). Only 68 (47.9%) of them were seizure free for more than 2 years. Most of them were on at least two anti-seizure medications. MRI evidence of a lesion was present on 36 (25.4%) participants. 41 (28.9%) of them have faced road traffic accidents as the driver of the vehicle and some have experienced up to 4 road traffic accidents. Out of the 55 road traffic accidents reported by the participants, 13 were due to either development of seizure or aura.&#x0D; Conclusion &#x0D; The advances in transport medicine in many countries have enabled the medically disabled to drive with less restrictive solutions while ensuring road safety. This study highlights the need for formal guidelines on driving with epilepsy, considering the individual medical, financial, and social requirements.

Fate of Pediatric Transport Medicine Abstracts 2011 to 2020: What Predicts Publication Success?

ObjectivePediatric-neonatal transport research projects are presented at the American Academy of Pediatrics (AAP) Section on Transport Medicine (SOTM) scientific abstract program annually. Journal publication increases the impact of these projects. Our objectives were to determine the publication rate of transport abstracts and to identify factors predictive of publication success. MethodsWe reviewed all AAP SOTM abstracts accepted for presentation from 2011 to 2020 and assessed presentation format (oral/platform vs. poster), authors’ professional degree (physician vs. nonphysician), and first author's trainee status. We searched PubMed, Ovid, and ResearchGate for publications by abstract title and authors and then compared published versus unpublished abstracts. Categorical variables were expressed as proportions and compared using the chi-square test or the Fisher exact test, whereas continuous variables were summarized using medians and interquartile ranges (IQRs) and compared using the Student t-test or the Kruskal-Wallis test as appropriate. A linear probability model was performed. ResultsOf 194 presented abstracts, 67 (34.5%) were published. The publication rate was significantly higher for oral/platform versus poster abstracts (P < .01), if the abstract was an oral/platform (probability increase by 19.5%, P < .01), and if the first author was a trainee (probability increase by 25.6%, p < 0.05). The constant was estimated as 24.9% probability of publication. Hence, if the first author was a physician, a trainee, and had an oral/platform presentation, there was an 85.8% chance of being published. The median (IQR) time to publication was 2 years (IQR: 2-4 years), with articles published the longest having the most citations. Articles were published in 27 different journals, with nearly half (33/67, 49.3%) being published in 3 journals. ConclusionAAP SOTM abstracts have a 34.5% publication rate over the past 10 years, which is consistent with other medical specialties. Oral abstracts, physician first authors, and trainee first authors had a significantly higher success rate. Special emphasis should be placed nationally on supporting nonphysician transport professionals to publish their work.

Development by “simple consensus” of a tool to assist the activation of the helicopter at SAMU 14

The main objective of this work was to develop a tool to assist the activation of a helicopter emergency medical service (HEMS) for the SAMU 14. We opted for a methodology based on "guidelines of good professional practice." Simple consensus was used. A multidisciplinary working group (pilots, medical regulation assistants, doctors) was created. Subgroup meetings (pilots, medical regulation assistants, doctors) developed subparts of the tool. The assembly of the tool's subparts was reviewed by the working group and then by an independent reading group. This work enabled the consensual creation of a tool to support the use of the helicopter emergency medical service (HEMS) for the SAMU 14. It is composed of maps, a protocol, and a written procedure of activation. This methodology by "simple consensus" allowed the development of a tool rationalizing the activation of the helicopter emergency medical service (HEMS) for the SAMU 14. It was the first work of this type within the SAMU 14. This simple and transposable methodology could be used in other emergency centers or for other multidisciplinary protocols.

Favourable neurological outcome following paediatric out-of-hospital cardiac arrest: a retrospective observational study

BackgroundOut-of-hospital cardiac arrest (OHCA) in children is rare and can potentially result in severe neurological impairment. Our study aimed to identify characteristics of and factors associated with favourable neurological outcome following the resuscitation of children by the Swiss helicopter emergency medical service.Materials and methodsThis retrospective observational study screened the Swiss Air-Ambulance electronic database from 01-01-2011 to 31-12-2021. We included all primary missions for patients ≤ 16 years with OHCA. The primary outcome was favourable neurological outcome after 30 days (cerebral performance categories (CPC) 1 and 2). Multivariable linear regression identified potential factors associated with favourable outcome (odd ratio – OR).ResultsHaving screened 110,331 missions, we identified 296 children with OHCA, which we included in the analysis. Patients were 5.0 [1.0; 12.0] years old and 61.5% (n = 182) male. More than two-thirds had a non-traumatic OHCA (67.2%, n = 199), while 32.8% (n = 97) had a traumatic OHCA. Thirty days after the event, 24.0% (n = 71) of patients were alive, 18.9% (n = 56) with a favourable neurological outcome (CPC 1 n = 46, CPC 2 n = 10). Bystander cardiopulmonary resuscitation (OR 10.34; 95%CI 2.29–51.42; p = 0.002) and non-traumatic aetiology (OR 11.07 2.38–51.42; p = 0.002) were the factors most strongly associated with favourable outcome. Factors associated with an unfavourable neurological outcome were initial asystole (OR 0.12; 95%CI 0.04–0.39; p < 0.001), administration of adrenaline (OR 0.14; 95%CI 0.05–0.39; p < 0.001) and ongoing chest compression at HEMS arrival (OR 0.17; 95%CI 0.04–0.65; p = 0.010).ConclusionIn this study, 18.9% of paediatric OHCA patients survived with a favourable neurologic outcome 30 days after treatment by the Swiss helicopter emergency medical service. Immediate bystander cardiopulmonary resuscitation and non-traumatic OHCA aetiology were the factors most strongly associated with a favourable neurological outcome. These results underline the importance of effective bystander and first-responder rescue as the foundation for subsequent professional treatment of children in cardiac arrest.

Critical hypertension in trauma patients following prehospital emergency anaesthesia: a multi-centre retrospective observational study

BackgroundCritical hypertension in major trauma patients is associated with increased mortality. Prehospital emergency anaesthesia (PHEA) is performed for 10% of the most seriously injured patients. Optimising oxygenation, ventilation, and cerebral perfusion, whilst avoiding extreme haemodynamic fluctuations are the cornerstones of reducing secondary brain injury. The aim of this study was to report the differential determinants of post-PHEA critical hypertension in a large regional dataset of trauma patients across three Helicopter Emergency Medical Service (HEMS) organisations.MethodsA multi-centre retrospective observational study of consecutive adult trauma patients undergoing PHEA across three HEMS in the United Kingdom; 2015–2022. Critical hypertension was defined as a new systolic blood pressure (SBP) > 180mmHg within 10 min of induction of anaesthesia, or > 10% increase if the baseline SBP was > 180mmHg prior to induction. Purposeful logistical regression was used to explore variables associated with post-PHEA critical hypertension in a multivariable model. Data are reported as number (percentage), and odds ratio (OR) with 95% confidence interval (95%CI).Results30,744 patients were attended by HEMS during the study period; 2161 received PHEA and 1355 patients were included in the final analysis. 161 (11.9%) patients had one or more new episode(s) of critical hypertension ≤ 10 min post-PHEA. Increasing age (compared with 16–34 years): 35–54 years (OR 1.76, 95%CI 1.03–3.06); 55–74 years (OR 2.00, 95%CI 1.19–3.44); ≥75 years (OR 2.38, 95%CI 1.31–4.35), pre-PHEA Glasgow Coma Scale (GCS) motor score four (OR 2.17, 95%CI 1.19–4.01) and five (OR 2.82, 95%CI 1.60–7.09), patients with a pre-PHEA SBP > 140mmHg (OR 6.72, 95%CI 4.38–10.54), and more than one intubation attempt (OR 1.75, 95%CI 1.01–2.96) were associated with post-PHEA critical hypertension.ConclusionDelivery of PHEA to seriously injured trauma patients risks haemodynamic fluctuation. In adult trauma patients undergoing PHEA, 11.9% of patients experienced post-PHEA critical hypertension. Increasing age, pre-PHEA GCS motor score four and five, patients with a pre-PHEA SBP > 140mmHg, and more than intubation attempt were independently associated with post-PHEA critical hypertension.

Trauma patient transport to hospital using helicopter emergency medical services or road ambulance in Sweden: a comparison of survival and prehospital time intervals

BackgroundThe benefits of helicopter emergency medical services (HEMS) transport of adults following major trauma have been examined with mixed results, with some studies reporting a survival benefit compared to regular emergency medical services (EMS). The benefit of HEMS in the context of the Swedish trauma system remains unclear.AimTo investigate differences in survival and prehospital time intervals for trauma patients in Sweden transported by HEMS compared to road ambulance EMS.MethodsA total of 74,032 trauma patients treated during 2012–2022 were identified through the Swedish Trauma Registry (SweTrau). The primary outcome was 30-day mortality and Glasgow Outcome Score at discharge from hospital (to home or rehab); secondary outcomes were the proportion of severely injured patients who triggered a trauma team activation (TTA) on arrival to hospital and the proportion of severely injured patients with GCS ≤ 8 who were subject to prehospital endotracheal intubation.Results4529 out of 74,032 patients were transported by HEMS during the study period. HEMS patients had significantly lower mortality compared to patients transported by EMS at 1.9% vs 4.3% (ISS 9–15), 5.4% vs 9.4% (ISS 16–24) and 31% vs 42% (ISS ≥ 25) (p < 0.001). Transport by HEMS was also associated with worse neurological outcome at discharge from hospital, as well as a higher rate of in-hospital TTA for severely injured patients and higher rate of prehospital intubation for severely injured patients with GCS ≤ 8. Prehospital time intervals were significantly longer for HEMS patients compared to EMS across all injury severity groups.ConclusionTrauma patients transported to hospital by HEMS had significantly lower mortality compared to those transported by EMS, despite longer prehospital time intervals and greater injury severity. However, this survival benefit may have been at the expense of a higher degree of adverse neurological outcome. Increasing the availability of HEMS to include all regions should be considered as it may be the preferrable option for transport of severely injured trauma patients in Sweden.

Validation of Air Medical Prehospital Triage Score in Determining Resource Utilization at Level 1 Trauma Centers

ObjectiveOvertriage (ie, delivering less severely injured patients via helicopter) is costly, raises safety concerns, and reduces efficiency of the trauma system. The Air Medical Prehospital Triage (AMPT) scoring system was developed to determine which trauma patients would gain a survival benefit by air transport. The objective of this study was to evaluate the AMPT scoring system as a method of reducing trauma overtriage when helicopter emergency medical services were used. MethodsA retrospective study of all scene trauma transports delivered by helicopter to 1 of 2 level 1 trauma centers was evaluated for 1) hospital stay less than 1 day and 2) failure to meet 1 of the following criteria for resource utilization: intensive care unit admission, an operative procedure within the first 24 hours, the need for blood products, Injury Severity Score ≥ 16, or death during hospitalization. Helicopter emergency medical services personnel recorded specific criteria from the Centers for Disease Control and Prevention (CDC) field trauma triage guidelines and AMPT that were met by transported trauma patients. ResultsThere were 244 patients in the study population. Eighty-one (33.2%) patients were discharged within 24 hours; 11 (13.5%) of these patients were positive using AMPT scoring, whereas 44 (54.3%) patients met 1 of the CDC criteria. Similarly, 141 (57.8%) patients failed to meet 1 of the level 1 resource criteria; 19 (13.5%) met the AMPT criteria for air medical transport, whereas 84 (59.6%) met 1 of the CDC criteria. Undertriage was 63.5% for AMPT and 20.2% for CDC based on resource utilization criteria. ConclusionThe AMPT score reduced the number of patients who were inappropriately transported to a trauma center. However, this appeared to be at the expense of undertriage. Future studies should focus on developing a refined air medical–specific triage tool that has both low overtriage rates as well as lower undertriage rates.

Prehospital interventions and outcomes in traumatic cardiac arrest: a population-based cohort study using the Danish Helicopter Emergency Medical Services data.

Traumatic cardiac arrest is associated with poor prognosis, and timely evidence-based treatment is paramount for increasing survival rates. Physician-staffed helicopter emergency medical service use in major trauma has demonstrated improved outcomes. However, the sparsity of data highlights the necessity for a comprehensive understanding of the epidemiology of traumatic cardiac arrest. The primary objective of the present study was to evaluate survival and return of spontaneous circulation (ROSC) and to investigate the characteristics of patients with traumatic cardiac arrest assessed by the Danish HEMS. This was a population-based cohort study based on data from the Danish helicopter emergency medical service database. The study included all patients assessed by the Danish helicopter emergency medical services between 2016 and 2021. Data were analysed using descriptive statistics, non-parametric testing and logistic regression analyses. Descriptive analysis of prehospital interventions included cardiopulmonary resuscitation, defibrillation, airway management, administration of blood products, and thoracic decompression. The primary outcome was 30-day survival, and the key secondary outcome was prehospital ROSC. A total of 223 patients with TCA were included. The median age was 54 years (IQR 34-68), and the majority were males. Overall, 23% of patients achieved prehospital ROSC, and the 30-day survival rate was 4%. Factors associated with an increased likelihood of ROSC were an initial shockable cardiac rhythm, odds ratio (OR) of 3.78 (95% CI 1.33-11.00) and endotracheal intubation, OR 7.10 (95% CI 2.55-22.85). This study highlights the low survival rates observed among patients with traumatic cardiac arrest assessed by helicopter emergency medical services. The findings support the positive impact of an initial shockable cardiac rhythm and endotracheal intubation in improving the likelihood of ROSC. The study contributes to the limited literature on traumatic cardiac arrests assessed by physician-staffed helicopter emergency services. Finally, the findings emphasise the need for further research to understand and improve outcomes in this subgroup of cardiac arrest.

Ascending with ultrasound: telementored eFAST in flight—a feasibility study

PurposeTeleultrasound uses telecommunication technologies to transmit ultrasound images from a remote location to an expert who guides the acquisition of images and interprets them in real time. Multiple studies have demonstrated the feasibility of teleultrasound. However, its application during helicopter flight using long-term evolution (LTE) for streaming has not been studied. Therefore, we conducted a study to examine the feasibility of teleultrasound in an Airbus H145 helicopter.MethodsFour anesthesiologists and one military physician were recruited to perform telementored extended Focused Assessment with Sonography in Trauma (eFAST) during nine helicopter flights, each with a unique healthy volunteer. A radiologist was recruited as a remote expert, guiding the physicians in their examinations. The examining physicians reported the user experience of telementored eFAST on a questionnaire, while the remote expert rated the diagnostic quality of the images on a 1–5 Likert scale. In addition, we measured the duration of the examinations and key LTE network parameters including signal strength, quality, and continuity.ResultsThe images were rated to an average of 4.9 by the remote expert, corresponding to good diagnostic quality. The average duration of telementored eFAST was 05:54 min. LTE coverage was negatively affected by proximity to urban areas and ceased above 2000 ft altitude. Occasional audio problems were addressed by using the Voice over LTE network for communication. The examining physicians unanimously reported on the questionnaire that they would use telementored eFAST on patients.ConclusionTelementored eFAST is feasible in ambulance helicopters and can produce images of good diagnostic quality. However, it relies on stable LTE coverage, which is influenced by many factors, including the helicopter’s altitude and flight path. Furthermore, its benefit on patient outcomes remains to be proven.Graphical abstract

Natural Experiment Outcomes Studies in Rotor Wing Air Medical Transport: Systematic Review and Meta-Analysis of Before-and-After and Helicopter-Unavailable Publications From 1970 to 2022

ObjectiveHelicopter emergency medical services (HEMS) is widely used for prehospital and interfacility transport, but there is a paucity of HEMS outcomes data from studies using randomized controlled trial designs. In the absence of robust randomized controlled trial evidence, judgments regarding HEMS potential benefit must be informed by observational data. Within the study design set of observational analyses, the natural experiment (NE) is notable for its high potential methodologic quality; NE designs are occasionally denoted “quasi-experimental.” The aim of this study is to examine all NE outcomes studies in the HEMS literature and to discern what lessons can be learned from these potentially high-quality observational data. MethodsHEMS NE studies were identified during the development of a new HEMS Outcomes Assessment Research Database (HOARD). HOARD was constructed using a broad-ranging search of published and gray literature resources (eg, PubMed, Embase, and Google Scholar) that used variations of the terms “helicopter EMS,” “air ambulance,” and “air medical transport.” Among the 221 studies ultimately included in HOARD, 16 NE publications describing 13 sets of observational data comprising myriad diagnostic groups were identified. Of these 16 HEMS NEs, 4 HEMS NE studies assessing trauma outcomes were used in a meta-analysis. A meta-analysis was also performed of 4 HEMS NE studies. ResultsAlthough the disparity of studies (in terms of both case mix and end points) precluded the generation of a pooled effect estimate of an adjusted mortality benefit of HEMs versus ground emergency medical services, HEMS was found to be associated with outcomes improvement in 8 of the 13 cohorts. ConclusionThe weight of the NE evidence supports a conclusion of some form of HEMS-mediated outcomes improvement in a variety of patient types. Meta-analysis of 4 HEMS NE studies assessing trauma outcomes generated a model with acceptable heterogeneity (I2 = 43%, Q test: P = .16), which significantly (P < .01) favored HEMS use with a pooled HEMS survival odd ratio estimate of 1.66 (95% confidence interval, 1.23-2.22).