The practice of neonatal/pediatric transport medicine continues to advance. Teams have evolved from providing critical care outside tertiary care centers to participating in collaborative research efforts, benchmarking a...The practice of neonatal/pediatric transport medicine continues to advance. Teams have evolved from providing critical care outside tertiary care centers to participating in collaborative research efforts, benchmarking and quality improvement, developing innovative partnerships, and pushing the limits of care provision during interfacility transport. The most recent consensus document on neonatal and pediatric transport medicine was published more than a decade ago. Advancements in the field necessitate the dissemination of new practices in transport medicine. The following manuscript details the current evidence-supported, expert consensus opinions on the practice of neonatal and pediatric transport medicine and recommendations for its future direction.
This brief communication is intended to share with all colleagues working in helicopter emergency medical services and prehospital emergency care the methods for managing blood components and transfusions with O-negative...This brief communication is intended to share with all colleagues working in helicopter emergency medical services and prehospital emergency care the methods for managing blood components and transfusions with O-negative packed red blood cells (PRBCs) in our operational setting. The "Blood on Board" project was initiated in our Unit 4 and a half years ago, and the number of patients transfused with O-negative PRBCs has progressively increased, demonstrating the efficacy and safety of the procedure.
Saskatchewan relies extensively on air transport to deliver acute care to remote regions. This article applied Royal Canadian Air Force air power doctrine to evaluate and optimize the province's civilian medevac system....Saskatchewan relies extensively on air transport to deliver acute care to remote regions. This article applied Royal Canadian Air Force air power doctrine to evaluate and optimize the province's civilian medevac system. Doctrinal analysis was used to assess existing medevac coordination structures. Operational modeling, including an optimized combined air operations model, was developed to compare the efficiency of fixed- and rotary-wing transport across representative provincial locations. Data were analyzed for time to tertiary care. The application of air power principles, including centralized control, decentralized execution, and a common operating picture, identified significant opportunities to enhance responsiveness and increase efficiency. Modeling showed that the correct selection of transport modality improves efficiency by up to 42%, with fixed-wing aircraft favored beyond approximately 150 miles from Saskatoon. The analysis demonstrates that Saskatchewan's current air medical system could achieve improved safety, timeliness, and efficiency through a centralized command structure. Establishing a provincial medevac operations center would enable real-time tasking, integrated situational awareness through a common operating picture, and better alignment of air assets with clinical needs.
OBJECTIVE: Obesity is a growing epidemic with significant implications on all aspects of health care, including prehospital care. As body mass index increases, the risk of comorbidities increases, as do potential challen...OBJECTIVE: Obesity is a growing epidemic with significant implications on all aspects of health care, including prehospital care. As body mass index increases, the risk of comorbidities increases, as do potential challenges in the prehospital setting. In addition, there are concerns about clinician injuries when moving and transporting patients. This narrative literature review aimed to identify how obesity influences medical care in the prehospital environment. METHODS: A literature search regarding obesity in the prehospital environment was performed using PubMed, Web of Science, and Embase until January 2026. Data were extracted in a qualitative manner to form this narrative review, with comparisons made with in-hospital literature. RESULTS: From 3,753 articles, 55 studies were included with 6 themes identified based on frequency of occurrence: endotracheal intubation (n = 12); alternative airway management (n = 2); cardiac arrest management and outcomes (n = 22); triage, scene time and transportation (n = 5); nonairway interventions (n = 2); and the challenges of moving patients (n = 12). There were conflicting results in the effect of obesity on cardiac arrest outcomes and prehospital intubation. Scene times are likely to increase with obesity, and triage remains problematic given that injury burdens are difficult to assess in the prehospital setting. Obesity presents additional challenges, such as ensuring adequate chest compressions, moving, transferring, and intravenous access. CONCLUSION: Patients living with obesity are seen regularly in the prehospital setting, and consideration of their requirements is recommended. This population may benefit from specific guidelines to optimize airway management, cardiac arrest management, and triage decisions, ensuring optimal ongoing care.
OBJECTIVE: Long-distance medical evacuation by ground, maritime, and fixed-wing air transport (EVASAN) from Mayotte to La Réunion is frequent for pediatric neurocritical patients. The impact of EVASAN on intracranial pre...OBJECTIVE: Long-distance medical evacuation by ground, maritime, and fixed-wing air transport (EVASAN) from Mayotte to La Réunion is frequent for pediatric neurocritical patients. The impact of EVASAN on intracranial pressure (ICP) control is poorly documented, especially in this geographic and socioeconomic context. We aimed to analyze ICP variations during EVASAN and to describe associated physiological parameters and short-term outcomes. METHODS: Retrospective cohort study of pediatric patients (< 18 lt; 18 years) evacuated from Mayotte to La Réunion between January 2019 and December 2024 with invasive ICP monitoring at departure (n = 22). ICP values and clinical variables (mean arterial pressure [MAP], heart rate [HR], oxygen saturation [SpO], end-tidal carbon dioxide [EtCO], fraction of inspired oxygen [FiO], temperature, sedation, and vasopressor use) were extracted at predefined time points: initial (baseline), departure (intensive care unit), ferry transfer, takeoff, during flight, landing, and arrival at La Réunion pediatric intensive care unit. Primary outcome was ICP variation during EVASAN. Wilcoxon signed-rank tests compared paired time points; Spearman correlations explored associations. The study was approved under MR-004; consent was obtained as described. RESULTS: A total of 22 patients (mean age 9.4 years, 73% pediatric traumatic brain injury) were included. The ferry phase was associated with a modest but statistically significant median increase in ICP (+ 5 mm Hg, P = .038). No sustained increase between departure and arrival was observed (median + 3 mm Hg, P = .251). FiO increased from a median of 0.3 to 0.4 (P = .008), whereas SpO, MAP, HR, and EtCO remained stable. There was no correlation between ICP variation and 6-month Pediatric Glasgow Outcome Scale scores. Missing data and heterogeneity of care restricted inference. CONCLUSION: In this single-center retrospective series, EVASAN was associated with transient ICP increases during the maritime ferry phase but not with sustained intracranial hypertension at arrival nor worse mid-term neurological outcome.
OBJECTIVE: An open abdomen (OA) is a critical surgical condition in which the abdominal wall is intentionally left open to prevent or manage intra-abdominal hypertension or abdominal compartment syndrome or facilitate st...OBJECTIVE: An open abdomen (OA) is a critical surgical condition in which the abdominal wall is intentionally left open to prevent or manage intra-abdominal hypertension or abdominal compartment syndrome or facilitate staged re-exploration. Although OA management is well described in surgical literature, the safe transport of patients with an OA-particularly in air medical and critical care transport settings-presents unique challenges that are less frequently addressed. METHODS: This review summarizes current evidence and best practices for the transport of patients with an OA, focusing on physiologic considerations, temporary abdominal closure (TAC) methods, equipment, monitoring, and emergency management during interfacility transfer. RESULTS: Key elements of OA transport include secure and intact TAC devices, vigilant monitoring of hemodynamic and ventilatory parameters, and preparedness for complications such as vacuum-assisted closure failure, re-elevated intra-abdominal pressure, and hemodynamic decompensation. Coordination between surgical, critical care, and transport teams is essential. The review details the advantages and limitations of TAC options-such as negative pressure wound therapy, Bogotá bags, and Wittmann patches-and outlines practical recommendations for troubleshooting and in-flight stabilization. CONCLUSION: Transporting patients with an OA requires specialized knowledge of pathophysiology, meticulous preparation, and clear communication among multidisciplinary teams. Establishing standardized protocols and incorporating OA-specific competencies into air medical training can enhance patient safety and outcomes during these complex transfers.
OBJECTIVE: Atrial fibrillation is the most common cardiac arrhythmia in clinical practice making proficient diagnosis and treatment vital to patient outcomes. The increased incidence of new-onset symptomatic rapid atrial...OBJECTIVE: Atrial fibrillation is the most common cardiac arrhythmia in clinical practice making proficient diagnosis and treatment vital to patient outcomes. The increased incidence of new-onset symptomatic rapid atrial fibrillation (NOSRAF) necessitates consistent provider training. This practice improvement project created a simulation-based training (SBT) program to prepare prehospital health care providers for responding to NOSRAF. METHODS: A pre/post design was used to evaluate SBT for prehospital health care providers during biannual training. A protocol-based checklist, knowledge questionnaire, and the Simulation Effectiveness Tool-Modified (SET-M) were used to collect data on protocol fidelity, knowledge, and simulation effectiveness, respectively. RESULTS: SBT improved NOSRAF protocol compliance; however, the SET-M survey data revealed no change in provider confidence. Further studies focused on SBT for the prehospital health care provider are warranted. CONCLUSION: SBT can improve prehospital health care provider preparedness in caring for patients with NOSRAF. Further studies are needed to better represent the influence of simulation-based learning in the prehospital health care provider population and to identify knowledge deterioration time frames.
OBJECTIVE: Helicopter emergency medical services (HEMS) provide rapid evacuation of critically ill and injured patients, overcoming the limitations of ground transport in regions with challenging terrain, poor infrastruc...OBJECTIVE: Helicopter emergency medical services (HEMS) provide rapid evacuation of critically ill and injured patients, overcoming the limitations of ground transport in regions with challenging terrain, poor infrastructure, or traffic congestion. In Nepal, mountainous landscapes and dispersed populations make HEMS a vital component of the health care system since its formal introduction in 2013. This study aimed to review the current state of HEMS in Nepal, highlighting operational benefits, key challenges, and potential strategies to enhance service efficiency, safety, and accessibility. METHODS: A narrative review was conducted using national and international literature, operational reports, and available data on HEMS in Nepal. Challenges were analyzed across financial, infrastructural, logistical, and human resource domains. RESULTS: HEMS significantly reduces evacuation times and facilitates access to multidisciplinary medical teams, improving outcomes in time-critical conditions such as trauma, stroke, myocardial infarction, and obstetric emergencies. However, service delivery is constrained by high operational costs, reliance on private commercial helicopters, limited trained personnel and pilots, centralized communication systems, pilot fatigue, and hazards from mountainous terrain and unpredictable weather. These barriers particularly affect patient access in remote regions. CONCLUSION: Although HEMS has markedly enhanced prehospital care in Nepal, systemic limitations hinder its full potential. Strategic investment in dedicated medical helicopters, decentralized operational bases, workforce development, and supportive policy frameworks is essential to improve timely access, reduce preventable mortality, and strengthen Nepal's emergency medical system.
OBJECTIVE: Rapid sequence intubation (RSI) in helicopter emergency medical services (HEMS) is conventionally performed at the scene before transport, potentially delaying time to definitive care. The feasibility of perfo...OBJECTIVE: Rapid sequence intubation (RSI) in helicopter emergency medical services (HEMS) is conventionally performed at the scene before transport, potentially delaying time to definitive care. The feasibility of performing RSI during flight in civilian HEMS operations has not been established in the United Kingdom. We evaluate the feasibility, safety, and temporal efficiency of performing simulated in-flight RSI in an AW169 helicopter under operational flight conditions. METHODS: A prospective proof-of-concept study using high-fidelity simulation was conducted across 2 phases (May 2023, January 2025) at the Air Ambulance Charity Kent Surrey Sussex. Eight simulations were completed by 4 distinct clinical teams comprising operationally experienced HEMS physicians and paramedics. Scenarios replicated a standardized traumatic brain injury scenario requiring RSI during the return transit phase. The primary outcome was time from RSI checklist initiation to confirmed intubation. Secondary outcomes included overall mission times, safety events, and crew-perceived feasibility assessed via post-scenario questionnaires. RESULTS: All simulations (8/8, 100%) achieved successful first-pass intubation. Median time from checklist initiation to confirmed intubation was 5 minutes (interquartile range [IQR]: 5-7). Median total mission time from base departure to RSI completion was 42 minutes (IQR 40-44). No safety events, procedural complications, or communication failures occurred. Crew questionnaires (93% response rate) confirmed unanimous perceived feasibility, with participants identifying adequate workspace, effective communication, and manageable equipment accessibility. CONCLUSION: High-fidelity simulation demonstrates that in-flight RSI is technically feasible in an AW169 helicopter, with consistent procedural times and no safety events. These findings may support further evaluation of in-flight RSI as a complementary strategy for time-critical patients where scene-based airway management may delay definitive care.
OBJECTIVE: To evaluate the impact of frequently used medical transport helicopters on neonatal physiology and the delivery of in-flight care and to identify the relevant aircraft characteristics. METHODS: A targeted revi...OBJECTIVE: To evaluate the impact of frequently used medical transport helicopters on neonatal physiology and the delivery of in-flight care and to identify the relevant aircraft characteristics. METHODS: A targeted review of air medical literature, aerospace engineering sources, and manufacturer documentation was performed. The following 10 helicopter models frequently used in neonatal transport were evaluated: UH-60, S-92, AW101 (EH-101), Mi-171, AB412, EC145 (H145), S76, AW139, Bell 430, and AW109. The comparative analysis focused on cabin design, noise and vibration exposure, high-altitude performance, speed and range, power redundancy, and the ability to maintain a thermally stable environment. RESULTS: There is substantial variability among platforms in features relevant to neonatal safety and care delivery. Medium twin-engine helicopters with spacious cabins (eg, AW139, Bell 412, H145, and S-76) offer superior accessibility for patients and equipment and better overall clinical working conditions. Across all models, noise and vibration levels often exceed the recommended exposure limits for neonates. CONCLUSION: On the basis of these findings, the type of helicopter significantly influences the quality and safety of neonatal transport. Selection should optimally prioritize aircraft that support neonatal physiological stability and clinical intervention needs rather than relying solely on availability or operational logistics. Strong collaboration between medical teams and aviation operators is essential to optimize the transport environment for vulnerable newborns.
OBJECTIVE: Helicopter emergency medical services (HEMS) and search and rescue operations represent the intersection of aviation complexity and clinical criticality. Despite technological advances in simulation, most trai...OBJECTIVE: Helicopter emergency medical services (HEMS) and search and rescue operations represent the intersection of aviation complexity and clinical criticality. Despite technological advances in simulation, most training programs remain fragmented across aviation and medical domains, failing to integrate the human factors that determine mission success. This program report describes the longitudinal development of an integrated HEMS simulation training system, from early low-fidelity cabin prototypes to contemporary multi-sensory and hybrid simulation environments, and proposes a systems architecture framework applicable to next-generation air medical crew training. METHODS: We describe the staged development of a longitudinal HEMS simulation training initiative in multiple years, evaluate relevant regulatory and competency-based training frameworks, review international centers of excellence, and synthesize lessons learned into an architectural proposal for integrated air medical training systems. RESULTS: Early multi-sensory simulation incorporating cabin noise, smoke, temperature changes, and communication systems demonstrated that clinical performance degrades significantly under operational stress-a finding now validated by evidence-based training frameworks. The September 2024 European Union Aviation Safety Agency regulatory update removing Full Flight Simulator mandates for helicopters, combined with virtual and mixed reality qualification milestones, creates unprecedented opportunity for hybrid training architectures. CONCLUSION: HEMS training requires systems thinking-not isolated course development. Organizations designing next-generation programs need professionals who can integrate competency frameworks, immersive technologies, behavioral assessment tools, and clinical-operational training into unified ecosystems. This report provides an architectural blueprint applicable to HEMS, search and rescue, and critical care transport.
OBJECTIVE: Helicopter emergency medical services (HEMS) are traditionally valued for their advanced clinical interventions and rapid transport capabilities. This study explores the broader contributions of HEMS in the Ea...OBJECTIVE: Helicopter emergency medical services (HEMS) are traditionally valued for their advanced clinical interventions and rapid transport capabilities. This study explores the broader contributions of HEMS in the East of England, including nonclinical roles such as crew empowerment, decision-making, and scene management. METHODS: A 2-phase survey was conducted in 2021 and 2022 among HEMS and ground emergency medical services (GEMS) crews. The survey assessed perceived benefits of HEMS, with matched responses analyzed using Cohen's kappa to evaluate interprofessional agreement. Statistical analyses were performed in R, with significance set at P < .05. Ethical approval was obtained from Anglia Ruskin University. RESULTS: Across 1,403 HEMS taskings, 70.8% involved advanced clinical interventions and 66.9% were perceived to empower GEMS crews. Only 9.8% of missions were reported as offering no additional benefit. Fair agreement was found between HEMS and GEMS on clinical interventions and triage decisions, though discrepancies emerged in advisory roles and scene management. CONCLUSION: HEMS crews perceive their impact as extending beyond clinical care, contributing meaningfully to emergency response through advisory and collaborative roles. Differences in perception between HEMS and GEMS highlight the subjective nature of interprofessional assessments. Further research using larger samples and qualitative methods is recommended to deepen understanding of HEMS contributions to prehospital care.
This paper aims to promote international collaboration among air medical organizations and provide an overview of the Japanese Society for Aeromedical Services (JSAS) Annual Congress. In 2025, the 32nd Annual Congress of...This paper aims to promote international collaboration among air medical organizations and provide an overview of the Japanese Society for Aeromedical Services (JSAS) Annual Congress. In 2025, the 32nd Annual Congress of the JSAS was held in Numazu City from November 13 to 15 under the theme "Toward a Shared Vision: A New Era in Aeromedical Care." The congress included 220 presentations and was attended by 980 participants. It remains the only national conference in Japan dedicated exclusively to air medical care. The meeting provided a comprehensive overview of current air medical services and future directions. Key topics included the status of helicopter emergency medical services in Europe, lifesaving cases involving Japan's doctor-helicopter (DH) system, helicopter underwater escape training, international air medical evacuation, and operations of the US Air Force Critical Care Air Transport Team. Sessions also addressed challenges related to prehospital blood product administration, ventilator requirements, safety management, and aircraft maintenance systems. Additional discussions focused on the standardization of clinical protocols, dispatch criteria, and flight physician education, as well as the development of quality indicators through multidisciplinary collaboration. The program further highlighted nationwide public awareness initiatives, nursing practices in air medical settings, responses to large-scale disasters, activities of related organizations, and international air medical evacuation. We believe that the face-to-face relationships fostered through the JSAS Annual Congress play a vital role in strengthening collaboration among DH teams and other aerospace-related organizations.
Fatigue is a predictable operational hazard in air medical transport, impairing vigilance, reaction time, decision making, and communication-capabilities essential for both aviation and critical care. Despite widespread...Fatigue is a predictable operational hazard in air medical transport, impairing vigilance, reaction time, decision making, and communication-capabilities essential for both aviation and critical care. Despite widespread emphasis on team communication and risk management, fatigue is often managed informally at the individual level. We propose a practical fatigue-readiness framework for rotor- and fixed-wing air medical programs centered on 2 checkpoints: a routine readiness check at the start of shift and a premission "Safety Pause" for elevated-risk operations. The framework optionally incorporates objective alertness assessment (eg, brief psychomotor vigilance testing [PVT]) to complement subjective self-assessment and uses a green/amber/red ladder to guide mitigation and documentation in a nonpunitive manner. Drawing on air medical experience with PVT, established aviation fatigue countermeasures, and health care fatigue risk management literature, we discuss implementation considerations, governance needs, and limitations. A single, standard operating procedures-ready figure summarizes the workflow and provides a shared vocabulary for team-based readiness decisions. Implementation requires explicit nonpunitive governance, protected reporting, and careful attention to privacy to avoid unintended deterrence of fatigue disclosure. The intent is to shift fatigue management from "endurance" to "readiness" while preserving operational feasibility and psychological safety for crew members.
OBJECTIVE: Out-of-hospital cardiac arrests (OOHCAs) occur at sporting events. In the United Kingdom (UK), the outcomes remain unclear. This study aimed to perform a systematic literature review to establish the outcomes...OBJECTIVE: Out-of-hospital cardiac arrests (OOHCAs) occur at sporting events. In the United Kingdom (UK), the outcomes remain unclear. This study aimed to perform a systematic literature review to establish the outcomes of OOHCA associated with sports in the UK, alongside a literature search of online media. METHODS: PubMed, ISI Web of Knowledge, and Embase were searched from inception to March 2025 (PROSPERO CRD42024557120). Data were extracted relating to demographics, sports, medical care received, and outcomes. A quality review was undertaken with the Newcastle-Ottawa scale. In addition, an online media search of Google News and BBC News between June 2021 and October 2025 was performed, with similar data extracted. RESULTS: From 10,026 studies, 12 studies were included, totaling 578 patients. Most were male (91%), with a mean age of 43.2 years. Limited data were presented regarding the actual OOHCA event, for example, presenting rhythm. Twelve patients were detailed as having a full neurological recovery. Postmortem data suggested that cardiomyopathy and sudden arrhythmic death syndrome were common causes. In addition, 82 OOHCAs (95% male) were identified from the media search, with 29% younger than 40 years and an estimated survival rate of 62%. CONCLUSION: The exact outcomes of OOHCA associated with sports in the UK are difficult to establish, with the incidence potentially under-reported. Survival rates do seem to be higher than the general population, based mainly on online media evidence. A prospective data collection tool would allow a greater understanding of the outcomes, incidence, and contributing factors for a UK population, to help plan prehospital medical input.