Aeromedical Research Articles

Implementation of prehospital point-of-care ultrasound using a novel continuous feedback approach in a UK helicopter emergency medical service.

There has been increased use of prehospital point-of-care ultrasound (PoCUS) by helicopter emergency medical services (HEMS) in recent years. Lack of governance structure and evidence of benefit have been described as major barriers to its implementation. This paper describes a novel approach to implementation of prehospital PoCUS and clinical governance framework in a UK HEMS. A retrospective database review was undertaken at London's Air Ambulance (LAA) from 1st September 2021 to 31st March 2023. All patients who had PoCUS examination were included. Scans were archived in a cloud-based server and reviewed weekly by expert clinicians. They were graded in adequacy, agreement between reviewer and clinician was recorded and fed back to the clinicians allowing continuous feedback learning. In-hospital diagnosis was sought for patients having the full Pump, Pleura and Pouring blood (PPPB) protocol. Cohen's Kappa (ƙ) was calculated for inter-rater reliability. Sensitivity and specificity analysis was performed using 2 × 2 tables. LAA attended 3,068 missions. Our reviewers identified 701 PoCUS scanning encounters and 628 were included in the final analysis. Clinicians performed 420 scans for pneumothorax, 308 for free fluid and 305 pericardial effusions respectively. Majority of the population were male (85%) who sustained traumatic (93.5%) thoracic injuries (65%). Paramedics performed 29% of the scans. Reviewers deemed 83% of the scans of adequate quality. Inter-rater reliability between clinicians and reviewers was 0.6 for pericardial effusion, 0.67 for pneumothorax and 0.71 for free fluid respectively. A full PPPB protocol was performed in 52 patients out of which 46 were included. The sensitivity and specificity of PPPB protocol for diagnosis life-threatening injuries was 0.5 and 0.9 respectively. Introduction of prehospital PoCUS in a HEM service utilizing high quality training, user-friendly workflow and image archiving system, robust governance framework and continuous feedback may be feasible allowing high quality ultrasound examinations. The bespoke PPPB protocol in prehospital may improve diagnosis of life-threatening injuries.

The incidence and outcomes of hyperacute cardiovascular dysfunction following isolated traumatic brain injury: an observational cohort study.

The relationship between early cardiovascular dysfunction (CVD) in isolated traumatic brain injury (iTBI) and outcome has not been fully described. We aimed to (1) determine the prevalence and phenotype of CVD after iTBI in the hyper-acute phase and (2) compare treatment and outcomes in those with CVD vs non-CVD. An observational cohort database study of severe iTBI patients (Head AIS 3+) at a level 1 trauma centre (2008-2019) and physician-led air ambulance service (2019-2020). CV dysfunction was defined as tachycardia or bradycardia, with hypotension. Physiology, laboratory results, 24-hour transfusion, and computer-topography (CT) findings were recorded. Outcomes were 28-day mortality and Glasgow Outcome Score (GOS). A total of 168 patients met inclusion criteria, average age 46years (IQR 30-61), 77% male, median ISS 25 (IQR 17-29) with 51% Head AIS 5. Time from injury to pre-hospital assessment was 31minutes (IQR 20-42) with 20% demonstrating CVD on initial observations. The CVD group were more shocked (lactate 6.1 (1.7-10.9) vs. 2.4 (1.4-3.3), P <0.001) and coagulopathic (43% vs. 15%, P =0.001). There was no difference in Head AIS or CT findings between groups, except frequency of hypoxic ischemic encephalopathy (HIE) (CVD: 21% vs. non-CVD: 1%, P <0.001). A 24-hour transfusion was higher in CVD patients: 3 (0-8) vs. 0 (0-0) units, P <0.001. Mortality was greater in CVD vs non-CVD iTBI (61% vs. 31%, P =0.002), but in patients with AIS 5, there was no difference (P =0.262). One-third of CVD survivors (13/33) were discharged home, and 4/18 patients with recorded GOS had good neurological outcome. One in five patients with severe iTBI develop early CVD, associated with increased mortality, coagulopathy, and HIE. However, mortality and neurological outcome is highly variable in those with CVD across the iTBI severity spectrum. Further research is needed to define the pathophysiology and optimal treatment to improve outcomes for this subgroup of iTBI.

Pediatric Readiness and Trauma Center Access for Children.

Children initially treated in a timely fashion at trauma centers with high levels of pediatric readiness have been shown to have improved survival, but children historically have had geographically disparate access to pediatric trauma center care. Considerable effort has been invested in improving pediatric readiness nationally, including the implementation of new standards to improve emergency department pediatric readiness at all trauma centers. To assess current access to US pediatric-ready trauma center care and to estimate potential improvement in access if all high-level trauma centers had optimal pediatric readiness. This descriptive cross-sectional study collated trauma centers from national organizational lists, state government websites, and online searches. A geospatial analysis was performed of access by pediatric patients (aged ≤18 years) to trauma centers by ground or air ambulance within 60 minutes, stratified by trauma center type and pediatric readiness status. Population density was estimated using 2020 US census data. Weighted pediatric readiness scores (wPRS) were obtained from the 2021 National Pediatric Readiness Project assessment. The data analysis was performed between April 1 and June 30, 2023. Access times to trauma centers. The main outcome of interest was access to a pediatric-ready trauma center, defined as a high-level pediatric trauma center (level I-II) or high-level adult trauma center (level I-III) with a wPRS of at least 93 (out of 100). Access times were calculated using previously validated methods and service network model analysis for each trauma center to census block group centroid. The analysis included 148 pediatric and 1075 high-level adult trauma centers. A total of 273 adult centers (25%) were pediatric ready. Pediatric trauma center access within 60 minutes by ground or air ambulance was available for 65% of all 74 090 665 children; 73% of children had access to a pediatric-ready trauma center within 60 minutes, and 92% had access to any high-level trauma center within 60 minutes. These findings suggest that access to pediatric trauma center care is limited, even with air ambulance transport. Ensuring pediatric readiness at all high-level adult trauma centers may substantially improve access to early high-quality initial resuscitative trauma care for children.

Factors Contributing to Fatalities in Helicopter Emergency Medical Service Accidents

INTRODUCTION: This study aimed to update and reinforce previous research on helicopter emergency medical service accidents in the United States. By investigating predictors of fatalities after helicopter emergency medical service crashes through the application of machine learning techniques, we updated existing data sets and sought to uncover patterns that traditional analysis might not reveal. METHODS: Using the National Transportation Safety Board database, the authors analyzed a dataset of 267 helicopter emergency medical service accidents between 1991–2022. We first calculated fatalities odds ratios for each condition. We then plotted geospatial locations of all reported accidents. Finally, we used XGBoost regression to understand the most important features contributing to fatality after an accident. RESULTS: The findings reaffirm previous research and identify significant predictors of fatalities in helicopter emergency medical service accidents. Key factors such as adverse flight conditions (weather), the absence of a copilot, and postcrash fires are highlighted as critical to understanding and mitigating risks of fatality. DISCUSSION: These findings emphasize the utility of machine learning in extracting meaningful insights from accident data, suggesting that such techniques offer a more nuanced understanding of the conditions leading to fatalities. It points out the potential of these methods to not only enhance aviation safety but also to be applied across other sectors. We conclude by underlining the significant potential of techniques like XGBoost in advancing safety measures within helicopter emergency medical service and possibly other aviation sectors. Korentsides J, Keebler JR, Berezovski M, Chaparro A. Factors contributing to fatalities in helicopter emergency medical service accidents. Aerosp Med Hum Perform. 2025; 96(2):111–115.

Coagulation and platelet function in cold-stored whole blood on missions in a helicopter emergency service.

Haemorrhage is a leading cause of morbidity and mortality in trauma, and prehospital transfusion of blood products is often necessary. Whole blood has been proposed to be the best alternative, but it is unclear whether, and how, storage and transport of the blood in a helicopter affects the blood units. We investigated the coagulation capacity and platelet function in whole blood at different time points during helicopter missions. Twenty units of low-titre group O RhD negative whole blood were collected from healthy volunteers and analysed before, during and after transport in a helicopter. Coagulation and platelet function, as measured by thromboelastography, and blood samples for pH, electrolytes, glucose and lactate were assessed at baseline and 24, 72 and 168 h after storage in the helicopter. Plasma concentrations of coagulation factors and haemoglobin and blood counts were measured at baseline and after 168 h. Plasma concentrations of coagulation factors and haemoglobin did not change during storage and transport. Platelet counts decreased from a baseline mean of 172 ± 29 × 109/L to a mean of 120 ± 28 × 109/L after 168 h, and platelet function worsened slightly but significantly by 8%-9% during storage and transport. pH and glucose decreased while potassium and lactate levels increased after 168 h compared with baseline. Storage and transport of whole-blood units in a rescue helicopter, for up to 168 h, had a slight impact on the blood quality. Storage of whole blood on board of the helicopter holds up to European standard, measured as temperature and haemolysis.

Words to live by: Using medic impressions to identify the need for prehospital lifesaving interventions.

Prehospital emergencies require providers to rapidly identify patients' medical condition and determine treatment needs. We tested whether medics' initial, written impressions of patient condition contain information that can help identify patients who require prehospital lifesaving interventions (LSI) prior to or during transport. We analyzed free-text medic impressions of prehospital patients encountered at the scene of an accident or injury, using data from STAT MedEvac air medical transport service from 2012 to 2021. EMR records were used to identify LSIs performed for these patients in prehospital settings. Text was cleaned via natural language processing and transformed using term frequency-inverse document frequency. A gradient boosting machine learning (ML) model was used to predict individual patient need for prehospital LSI as well as seven LSI subcategories (e.g., airway interventions, blood transfusion, vasopressor medication). A total of 12,913 prehospital patients were included in our sample (mean age = 52.3 years, 63% men). We observed good ML performance in predicting overall LSI (area under the receiver operating curve = 0.793, 95% confidence interval = [0.776-0.810]; average precision = 0.670, 95% confidence interval = [0.643-0.695] vs. LSI rate of 0.282) and equivalent-or-better performance in predicting each LSI subcategory except for crystalloid fluid administration. We identified individual words within medic impressions that portended high (e.g., unresponsive, hemorrhage) or low (e.g., droop, rib) LSI rates. Calibration analysis showed that models could prioritize correct LSI identification (i.e., high sensitivity) or accurate triage (i.e., low false-positive rate). Sensitivity analyses showed that model performance was robust when removing from medic impressions words that directly labeled an LSI. ML based on free-text medic impressions can help identify patient need for prehospital LSI. We discuss future work, such as applying similar methods to 9-1-1 call requests, and potential applications, including voice-to-text translation of medic impressions.

Racial and Ethnic Disparities in Use of Helicopter Transport After Severe Trauma in the US

In the US, traumatic injuries are a leading cause of mortality across all age groups. Patients with severe trauma often require time-sensitive, specialized medical care to reduce mortality; air transport is associated with improved survival in many cases. However, it is unknown whether the provision of and access to air transport are influenced by factors extrinsic to medical needs, such as race or ethnicity. To examine the current trends of racial and ethnic disparities in air transport use for patients who sustain severe trauma. This population-based cohort study used data from the National Trauma Data Bank from 2016 to 2022. Participants were patients older than 15 years who sustained a severe injury and required an urgent surgical procedure or intensive care unit (ICU) admission at level I or II trauma centers with helicopter service. Severe injury requiring treatment at a level I or II trauma center. The primary mode of transport, categorized as either helicopter ambulance or ground ambulance. A multifaceted approach was used to narrow the observed racial and ethnic disparities in helicopter deployment. The secondary outcome was mortality after helicopter transport vs ground ambulance transport. Data were included for 341 286 patients at 458 level I or II trauma centers with helicopter service. Their mean (SD) age was 47 (20) years; 243 936 patients (71.6%) were male and 96 633 (28.4%) female. Asian individuals were less likely to receive helicopter transport compared with White individuals (6.8% vs 21.8%; aRR, 0.38; 95% CI, 0.30-0.48; P < .001), driven by lower use for Asian patients in teaching hospitals (aRR, 0.29; 95% CI, 0.21-0.40; P < .001) and level I trauma centers (aRR, 0.33; 95% CI, 0.24-0.44; P < .001). In addition, Black patients were less likely to receive helicopter transport (8.7% vs 21.8%; aRR, 0.42; 95% CI, 0.36-0.49; P < .001), particularly in teaching hospitals (aRR, 0.41; 95% CI, 0.33-0.50; P < .001) and level I trauma centers (aRR, 0.40; 95% CI, 0.34-0.49; P < .001). A similar but less pronounced disparity was noted for Hispanic patients. Helicopter transport was associated with a lower mortality risk compared with ground transport (37.7% vs 42.6%; adjusted relative risk [aRR], 0.87; 95% CI, 0.85-0.89; P < .001). This study found that racial and ethnic minority patients, particularly Asian and Black patients, and notably those treated at level I teaching hospitals were less likely to receive airlift services compared with White patients. The current expansion of helicopter emergency medical services has yet to translate into equitable care for patients of all races and ethnicities.

Team Cohesion and Mental Disorder Symptoms in Canadian Helicopter Emergency Medical Service Personnel

Team Cohesion and Mental Disorder Symptoms in Canadian Helicopter Emergency Medical Service Personnel

Addressing Neurological Inequities in Developing Countries: Challenges and Strategic Solutions

Abstract Neurological disorders pose one of the most urgent healthcare challenges globally, with a particularly severe impact on low-resource settings. Effective responses to this crisis require timely, intersectoral strategies, and coordinated actions to drive substantial positive changes. Political determinants of health play a crucial role in advancing initiatives in surveillance, prevention, acute care, and rehabilitation for neurological conditions. An essential life-course approach to brain health focuses on early intervention and sustained care throughout an individual’s lifespan. Building a comprehensive system of care, underpinned by robust policies and financial investments, is critical for progress in low-resource countries. In addition, urgent reforms in education are needed to cultivate a skilled neurological workforce that is equipped to meet the demands of these regions. Intersectoral strategies, including telemedicine, mobile health, organized systems of care, helicopter ambulance services, and widespread public awareness campaigns, are vital components for creating an equitable and responsive neurological healthcare framework.

Helicopter emergency medical services demonstrate reduced time to emergency anaesthesia in an undifferentiated trauma population: a retrospective observational analysis across three major trauma networks

BackgroundEarly rapid sequence induction of anaesthesia (RSI) and tracheal intubation for patients with airway or ventilatory compromise following major trauma is recommended, with guidance suggesting a 45-min timeframe. Whilst on-scene RSI is recommended, the potential time benefit offered by Helicopter Emergency Medical Services (HEMS) has not been studied. We compared the time from 999/112 emergency call to delivery of RSI between patients intubated either in the Emergency Department or pre-hospital by HEMS.MethodsA retrospective observational cohort study of major trauma patients in South-East England who received a pre-hospital RSI (PHRSI) or Emergency Department RSI (EDRSI) between 2 January 2018 and 24 September 2019. Data were extracted from the UK Trauma Audit and Research Network database. The primary outcome was the time from emergency call to delivery of RSI. Secondary outcomes included mortality at 30-days or hospital discharge, time from arrival of service at hospital or scene to RSI, time from emergency call to Computerised Tomography scan, and conveyance interval. Linear regression was used to model time to RSI in both groups.ResultsOf 378 eligible patients, 209 patients met inclusion criteria. 103 received a PHRSI and 106 received an EDRSI. Most patients were male (n = 171, 82%) and the median age was 48 years (IQR 28–65). 94% sustained a blunt injury mechanism and head was the most injured body region for both cohorts (n = 134, 64%). 63% (n = 67) of patients receiving a PHRSI were conveyed by helicopter. PHRSI was delivered significantly earlier with a median of 64 [IQR 51–75] minutes (95% CI, 60–68) compared with EDRSI with a median of 84 [IQR 68–113] minutes (95% CI, 76–94), p < 0.001).ConclusionMajor trauma patients who had a pre-hospital RSI received this time-critical intervention sooner after their injury than those who received an emergency anaesthetic after conveyance to a specialist hospital. Patient outcome benefit of HEMS delivered early RSI should be explored.

Investigating the barriers to air medical services in accidents and disasters in Iran and suggesting solutions: a qualitative study

ObjectiveToday, air medical services play a key part in providing emergency medical services in accidents and disasters in many countries, including Iran. The present study aims to investigate the barriers to air medical services in accidents and disasters in Iran and suggest solutions to them.ResultsAnalysis of the qualitative data resulted in extraction of 84 codes, which were classified into 13 subcategories and eventually into four themes, namely planning, management of resources, updating procedures, and empowerment of human resources. The findings also underscored the role of general policies, safety of flights and the scene of the accident, the cost and length of arriving at the scene of the accident, training programs designed to enhance the personnel’s preparation, and management of disasters and accidents. Senior medical emergency services managers can use the findings of the present study to identify the challenges which pre-hospital emergency care personnel are faced to air medical services in accidents and disasters and take the necessary measures to eliminate them toward improving the quality of pre-hospital care in air medical services in accidents and disasters.

3D Visualization Analysis of Helicopter Rescue Range Based on Cat Boost Algorithm

3D Visualization Analysis of Helicopter Rescue Range Based on Cat Boost Algorithm

Characteristics of Helicopter Emergency Medical Services (HEMS) Interventions for Burn Patients-A Four-Year Retrospective Analysis.

Background: The World Health Organization (WHO) estimates that 180,000 patients die from burns every year, which is considered a serious public health issue. Patients with burns require immediate pre-hospital care and transport to specialized treatment facilities. The aim of this study was to outline the profile of the burn patient from the perspective of the Polish Medical Air Rescue (PMAR), as well as to analyze the medical procedures being implemented. Methods: The study includes 2154 interventions by air emergency medical teams (AEMS) which provided aid for burn patients. The analysis covered the period from 2018 to 2022, including nationwide data made available from the IT systems of the PMAR. Statistical design was used, allowing for correlations of variables, at a significance level of p < 0.05. Results: Patients' ages ranged from 1 month to 96 years (mean 35.05; SD ± 26.88). Adult patients (n = 1409; 65.41%) constituted the vast majority. The number of interventions to children below 1-year-old was noticeable (n = 394; 18.29%). Men were the most likely to suffer burns, up to three times more often than women (n = 1574, 73.07% vs. n = 570, 26.46%. T29-burns to multiple body areas (n = 890)-and T21-burns to the trunk (n = 255)-were most frequently reported as diagnoses according to the ICD-10 classification. A statistically significant association was found between age group and ICD-10 diagnosis (p < 0.001). The vast majority of patients were transported from the scene directly to Burn Treatment Centers (n = 1373; 63.74%). Treatment of pain by helicopter emergency medical services (HEMS) crews appeared to be effective (p < 0.001), and other interventions consisted of administering medications-ketamine (23.72%), rocuronium bromide (15.78%), propofol (14.02%)-and procedures such as sedation (30.87%), as well as intubation (13.42%) and mechanical ventilation (13.23%). Conclusions: The burn patient profile indicates men with a mean age of 35 years. Nevertheless, HEMS crews often carry out missions to infants and newborns. The most common diagnosis was extensive body burns. In 63.74% of the missions, patients were transported to the Burn Treatment Center. The HEMS crews implement effective pharmacological analgesia, and handle rescue medications and procedures to stabilize the patient's condition.

Methods and equipment available for prehospital treatment of accidental hypothermia: a survey of Norwegian prehospital services

BackgroundAccidental hypothermia is associated with increased morbidity and mortality and poses a significant challenge for both professional and volunteer rescue services in prehospital settings. This study investigated the methods and equipment available to treat patients with cold stress or accidental hypothermia before reaching hospital in Norway.MethodsWe surveyed 156 respondents representing 708 units from both the professional and volunteer Norwegian prehospital chain of care between 2023 and 2024. Professional services included national ground ambulances, boat ambulances, national fixed wing and helicopter air ambulance services, search and rescue helicopter services, and urban search and rescue services. Volunteer services included Norwegian People’s Aid and the Norwegian Red Cross Search and Rescue Corps. The survey queried the availability of active warming equipment, passive insulation materials, thermometers for detecting hypothermia, and preferred sites for temperature measurements. The study also investigated whether there has been a development in available equipment compared to a similar study conducted in 2013.ResultsThe survey achieved a response rate of 70.5%. Chemical heat pads were the most frequently used type of equipment for active external warming and were the only equipment used by volunteer rescue services. All services possessed equipment for passive external warming, with duvets, space blankets and wool- or cotton blankets being the most commonly available. Thermometers for detecting hypothermia were found in 86.3% of professional rescue services and 15% of volunteer units. Almost all respondents reported consistent equipment setups year-round.ConclusionAll Norwegian prehospital services, both professional and volunteer, reported having equipment available for active and passive external warming. Thermometers for detecting hypothermia were reported by all professional services. The most notable change in the equipment available to treat patients with prehospital cold stress and accidental hypothermia in Norway was the increased availability of active external rewarming equipment in 2024 compared with that in 2013.

Implementation of nasal high flow therapy for infants with bronchiolitis: An integrative review

Objective: Identify factors relevant to the implementation of nasal high flow for infants with bronchiolitis in rural and remote contexts. Background: Healthcare services in rural and remote Australia must be resilient in responding to paediatric respiratory illness and provide equitable access of care to the tertiary contexts. Retrievals cannot be the only option to provide equitable care, particularly in examples of cyclones reducing aeromedical retrieval services. Nasal high flow (NHF) therapy is available for use in tertiary contexts for treating infants with respiratory illness. However, its use in rural and remote services is inconsistent and implementations to support routine implementation into this context are unknown. Study Design and methods: An integrative review was completed using an adapted implementation science framework. The COM-B (Capability, Opportunity, Motivation - Behaviour) framework was used to structure and analyse the results in alignment with translatable clinical care setting implementations. Seven databases were searched using specified search terms such as nasal high flow therapy, bronchiolitis, and implementation. Results: The original search terms ‘rural’ and/or ‘remote’ yielded zero results and were therefore removed from the search criteria. Sixteen publications were included in the final analysis that yielded 73 implementation factors. Eight related to capability, 61 were opportunity factors and four were motivation factors. Many of the factors were relating to the local context level, such as using observation regimes. One study (two publications) explicitly reported using an implementation framework where context was considered as an important component in identifying implementation strategies. Discussion: Implementation strategies included staff training (capability). The opportunity for staff to use NHF was the most common factor with using guidelines. The least represented motivation strategies focused on the clinician’s confidence to use NHF therapy. Conclusion: The lack of reported NHF studies in rural and remote hospitals highlights a knowledge gap. Implementation science is recommended for use in contexts such as the rural/remote setting where the context is unique and requires targeted implementation strategies. Implications for research, policy, and practice: Research exploring the use of NHF therapy should consider the unique rural and remote context using appropriate implementation strategies. Implementation science has shown that factors such as local champions, guidelines, use of observational data, and having locally tailored training and supportive approaches does improve the implementation of NHF therapy. The authors recommend these strategies be applied in rural and remote contexts to inform future research, policies, procedures, and practices that will promote and support clinicians’ confidence and ability to implement NHF therapy. What is already known on the subject NHF therapy is used for infants with bronchiolitis within the tertiary environment. NHF is used outside of paediatric intensive care units. Implementation science frameworks hasten evidence-based clinical practice routine uptake. What this paper adds Identifies a gap in the literature reporting implementation factors relevant for NHF therapy. Identifies no published literature reporting NHF use in rural and remote contexts. Describes, using an implementation framework, relevant factors for the use of NHF therapy in rural and remote hospitals.

The impact of a dedicated checklist on the quality of onsite management of critically buried avalanche victims in cardiac arrest in a Swiss helicopter emergency medical service

BackgroundThe management of avalanche victims in cardiac arrest (CA) is a challenging situation for rescuers. Despite existing specific management algorithms, previous studies have reported poor compliance with international guidelines and incomplete documentation and transmission of the information required for patient management. The Avalanche Victim Resuscitation Checklist (AVRC) was developed in 2014 in response by the International Commission for Mountain Emergency Medicine. Our aim was to assess the impact of the AVRC on the quality of onsite management of critically buried avalanche victims in CA, i.e. the compliance of management with international guidelines and the completeness of documentation of avalanche specific information.MethodsWe assessed compliance and documentation in a Swiss helicopter emergency medical service (HEMS) between January 2010 and April 2020. Victims buried for more than 24 h were excluded.ResultsIn the 10-year study period, 87 critically buried avalanche victims in CA were treated by the HEMS, 44 of them after the introduction of the AVRC. Enough information was available to assess management compliance in over 90% of cases (n = 79). Inadequate management (n = 25, 32%) and incomplete documentation occurred more often in patients with a long burial duration. After the introduction of the AVRC, the compliance of patient management with the guidelines increased by 36% (from 59 to 95%, p < 0.05) and led to complete documentation of the required information for patient management.ConclusionsThe use of the AVRC improves the quality of management of critically buried avalanche victims in CA and ensures complete documentation of avalanche specific information. Quality improvement efforts should focus on the management of avalanche victims with a long burial duration. The use of the AVRC enables identification and appropriate treatment of patients with hypothermic cardiac arrest.

The Role of Medical Helicopter and Ground Medical Crews in Polytrauma Management: An Evaluative Perspective.

Polytrauma remains a major global health challenge, with rapid intervention being critical for survival, especially during the "Golden Hour". This study examines the impact of Helicopter Emergency Medical Services (HEMS) on procedural care during the transfer of polytraumatized patients to urban hospitals in Romania. A retrospective cohort study was conducted at the County Emergency Hospital "St. Ap. Andrei" in Galați, covering January 2020 to October 2021. The study analyzed data from 89 patients transported by the Romania's Mobile Emergency Service for Resuscitation and Extrication (SMURD) Galați air unit. Key parameters included demographics, injury mechanism, vital statistics, and prehospital interventions. Statistical analyses were performed using SPSS, with significance set at p < 0.05. Out of 89 patients (mean age 21.6 years, 80.3% male), trauma causes were primarily traffic accidents (34.8%) and falls (33.7%). A Glasgow Coma Scale (GCS) score ≤8 was noted in 28.1% of cases, with head trauma observed in 51.6% of patients. HEMS interventions frequently involved oxygen therapy (89.5%) and patient stabilization maneuvers, leading to a mortality rate of 6.7%. Notably, helicopter transport enabled efficient transfer and improved survival outcomes in this cohort. HEMS demonstrated benefits in reducing intervention times and enhancing prehospital care quality for polytrauma patients, especially in hard-to-reach areas. The study aligns with global data on HEMS's role in trauma systems, underlining the importance of multidisciplinary collaboration and rapid transport. HEMS plays a crucial role in improving survival rates for severely injured patients through timely interventions and specialized care. Further research comparing HEMS and ground services could refine trauma management protocols in similar settings.

Aeromedical retrieval for suspected preterm labour or rupture of membranes in the Northern Territory, Australia: may some cases be safely not retrieved?

BackgroundSuspected preterm labour (PTL) and prelabour rupture of membranes (PPROM) are common indications for aeromedical retrieval in the Top End, Northern Territory, Australia, where many women reside remotely and preterm birth (< 37 completed weeks of gestation) is common. The primary objective of this study was to determine rate of delivery during the index admission following aeromedical transfers from remote clinics to Royal Darwin Hospital for suspected PTL/PPROM.MethodsA retrospective cohort study of aeromedical transfers for suspected PTL/PPROM from 1 January 2020 to 31 July 2022 was undertaken. Transfers were identified through CareFlight, the regional air ambulance service, and complemented with data from hospital records. Clinical and sociodemographic characteristics were compared by delivery status during the index (post-retrieval) admission using parametric and non-parametric tests and multivariable linear regression analysis.Results238 women with singleton pregnancies were retrieved for suspected PPROM (n = 77, 32.4%) or PTL (n = 161, 67.6%), together accounting for 49.2% of all obstetric transfers (n = 483). Of 77 patients transferred for suspected PPROM, 47 (61.0%) had ruptured membranes confirmed on arrival, and 45 (95.7%) of them delivered during the index admission. None of the 30 women transferred for suspected PPROM with intact membranes on arrival delivered during the index admission. Of 161 patients transferred for suspected PTL, 13 (8.1%) had ruptured membranes confirmed on arrival, and 12 (92.3%) of them delivered during the index admission. Amongst women transferred for suspected PTL with intact membranes confirmed on arrival, 14.9% (22/149) delivered during the index admission. Prior to arrival, 120 women (50.4%) had a documented speculum examination, and 15 (6.3%) and 9 (3.8%) had cervicovaginal swab tests to assess their risks of a PPROM and PTL, respectively. Half of women who did not deliver during the index admission had received antenatal corticosteroids (n = 76).ConclusionsMany aeromedical retrievals for suspected PTL/PPROM did not result in delivery during the index admission. Women retrieved for suspected PPROM with intact membranes on arrival were less likely to deliver. Upskilling remote clinic staff and better point-of-care testing may reduce retrievals and unnecessary interventions. Prospective cohort studies designed to enable accurate prediction of which cases can be safely not retrieved are required.Trial registrationNot applicable.

P106 The contribution of workload to fatigue risk in helicopter Search and Rescue operations

Abstract Introduction Routine offshore aviation transport services often co-provide Search and Rescue (SAR) operations. SAR crewmembers are required to be on immediate or standby readiness 24-hours a day and perform complex high-risk tasks when called. This study investigated work and sleep-based factors associated with workload and the contribution of those same factors to fatigue in this operation. Methods Across two 21-day rosters, SAR crewmembers recorded sleepiness (Karolinska Sleepiness Scale, KSS), fatigue (Samn-Perelli Fatigue Checklist, SP) and workload ratings (Overall Workload, OW and NASA Taskload Index, NASATLX), wore an actigraph to measure sleep, and completed a 3-minute Psychomotor Vigilance Task (PVT). Mixed model ANCOVAs investigated sleep and work-related factors associated with OW and NASATLX ratings and separately work-related factors associated with KSS and SP ratings and PVT performance at the end of a shift. Results A callout or training during a shift resulted in higher OW and NASATLX ratings (all p=&amp;lt;0.001). If a shift involved administration, OW and NASATLX were lower (all p≤.05). Prior sleep/wake history and shift worked were not significantly associated with workload measures. End of shift fatigue ratings were higher when a callout or training occurred, and end of shift sleepiness ratings were higher when training occurred (all p≤.05). Administrative work was not associated with changes in fatigue or sleepiness. No work-based factors were associated with PVT. Discussion Key contributors to both increased workload and greater fatigue and sleepiness were callouts and training. These aspects of work may directly impact fatigue and sleepiness and also indirectly, via greater workload.

The London Regional Major Trauma System: A Literature Review of Epidemiology and Current and Future Challenges.

Trauma has been one of the world's most common causes of death among younger age groups. In the UK, a lack of an organized and streamlined approach was reported in the management of traumatic injuries and patients involved in trauma cases in the UK. Therefore, a major trauma network system was devised to address these issues in line with other trauma systems around the world. This was followed by the establishment of the London trauma network with four major trauma centers (MTCs) spread across the London region, with each of these MTCs connected to a group of smaller hospitals called trauma units (TUs). The functioning of all these MTCs is governed by national standards. A trauma system involves an inclusive network of trauma care providers. This network includes pre-hospital care services, hospitals receiving acute trauma admissions, and post-hospital rehabilitation services working in close coordination with social care services and community services to achieve optimal use of these resources to deliver the correct treatment at the correct time by specialist MTCs. Specifically designed major trauma triage tools are used by the prehospital teams to identify severely injured patients, and those who have been identified as triage-positive patients are airlifted and transferred by air ambulances to the MTCs within 60 minutes. For instance, the Royal London Hospital's Helicopter Emergency Medical Service (HEMS) is the pride of London's trauma network system and plays an important role in reducing the transfer time. First, MTCs are expected to handle massive volumes of trauma, and they are constantly under pressure to meet national standards. Therefore, it becomes necessary for the smaller TUhospitals to ensure the patients who are to be transferred have adequately undergone triage through established specific local triage protocols, which could, however, result in under-triage errors because of misjudgment of major injuries as minor injuries, which subsequently get less priority while managing minor trauma. Second, the changing landscape of surgical training with increasing demands and pressure on the system has put the trainees in a dilemma about the sustainability of the current training curriculum. Emphasis should be given to simulation-based training, which could address the issues of reduced theater time and could work as a good alternative, both for learning and teaching. Third, the lack of self-directed therapy that is tailored to meet a patient's demands has resulted in a disorganized delivery of rehabilitation services for patients suffering from polytrauma. However, like any system trying to make a paradigm shift, having pros and certain distinctive characteristics, the trauma system also has certain deficits, which, when appropriately addressed, as mentioned earlier, may ensure smoother functioning of the trauma system.