Air Medical Journal[JOURNAL]

Point-of-care ultrasound (POCUS) is a valuable diagnostic tool in prehospital and transport medicine, particularly for critically ill patients with hemodynamic instability. This case study illustrates the use of focused... Point-of-care ultrasound (POCUS) is a valuable diagnostic tool in prehospital and transport medicine, particularly for critically ill patients with hemodynamic instability. This case study illustrates the use of focused cardiac and inferior vena cava ultrasound in the prehospital transport of a patient with septic shock. The imaging obtained in flight guided both fluid management and vasopressor titration, which improved clinical decision making in a resource-limited, dynamic environment. Using the handheld Butterfly iQ+ ultrasound device facilitated high-quality images and documentation enroute, reinforcing the importance of POCUS in modern air medical practice.

Get PDF PubMed ↗

Prolonged In-Flight Management of Life-Threatening Pediatric Asthma on a Long-Haul Commercial Flight: A Case Report.

Kefyalew M, Yonathan G, Wondimu H … +1 more , Nkansah K

Air Med J · 2026 · PMID 42069368 · Publisher ↗

A 3-year-old male passenger developed acute respiratory distress approximately 30 minutes after takeoff during an international flight from the United States to Addis Ababa. Despite multiple rounds of nebulized albuterol... A 3-year-old male passenger developed acute respiratory distress approximately 30 minutes after takeoff during an international flight from the United States to Addis Ababa. Despite multiple rounds of nebulized albuterol and escalating oxygen therapy, his respiratory status progressively deteriorated. A multidisciplinary team of onboard physicians administered epinephrine and hydrocortisone from the emergency medical kit while coordinating with ground medical control. The aircraft was subsequently diverted to Athens, Greece, where the child was handed over to emergency services and later stabilized. This case highlights the challenges of managing pediatric respiratory distress in-flight and the critical importance of prompt coordination, adequate medical supplies, and crew preparedness.

Get PDF PubMed ↗

Refractory Hypoxemia and Resuscitation in the Setting of Catastrophic Hemorrhage From Uterine Rupture: A Case Study.

Guyther JE, Omidvar AA, Smith JJ … +2 more , Winniford C, Lawner BJ

Air Med J · 2026 · PMID 42069367 · Publisher ↗

Catastrophic hemorrhage from uterine rupture is a rare but life threatening obstetric emergency. Patients often present in extremis with concurrent hemodynamic instability. The case study describes the retrieval of a cri... Catastrophic hemorrhage from uterine rupture is a rare but life threatening obstetric emergency. Patients often present in extremis with concurrent hemodynamic instability. The case study describes the retrieval of a critically ill patient and the challenges encountered during patient transfer and resuscitation. The patient was profoundly hypovolemic and hypoxemic and required intensive therapies such as massive transfusion and adjustments to mechanical ventilation. The case review highlights therapies relevant to the practice of critical care transport medicine including damage control resuscitation. Novel hemorrhage control techniques such as resuscitative endovascular balloon occlusion of the aorta were also considered. Finally, the case report describes complications linked to ongoing resuscitation including transfusion associated circulatory overload. The case emphasizes the utility of multidisciplinary collaboration for complex patient retrievals.

Get PDF PubMed ↗

Delayed Sequence Intubation and Its Role in Prehospital Emergency Medicine: A Scoping Review.

Jones O, Rees L, Anderson N

Air Med J · 2026 · PMID 42069366 · Publisher ↗

OBJECTIVE: Preoxygenation is a key component of prehospital emergency anesthesia (PHEA), reducing hypoxemia and increasing safe apnea time. Delayed sequence intubation (DSI) involves the use of sedation without blunting... OBJECTIVE: Preoxygenation is a key component of prehospital emergency anesthesia (PHEA), reducing hypoxemia and increasing safe apnea time. Delayed sequence intubation (DSI) involves the use of sedation without blunting respiratory drive to facilitate optimization, primarily oxygenation, before paralytic administration and subsequent intubation in patients with agitation who are unable to tolerate preoxygenation. This scoping review explored the evidence supporting DSI in emergency and prehospital practice. METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided scoping review was conducted. MEDLINE and Embase were searched from inception to May 5, 2025, for studies reporting DSI. Primary studies, case series, case reports, and guidelines involving adult or pediatric patients were included; reviews, editorials, and letters were excluded. Titles, abstracts, and full texts were independently screened by 2 reviewers, with disagreements resolved by a third. RESULTS: Fourteen studies met the inclusion criteria. Across these studies, 310 DSI cases were reported, including 140 performed prehospital by physician- and paramedic-led teams. Emergency department evidence suggests that DSI may reduce hypoxemia in agitated patients compared with rapid sequence intubation (RSI), with 1 randomized controlled trial reporting hypoxemia rates of 8% versus 35% (P = .001). Evidence specific to prehospital DSI was limited to retrospective studies, with no randomized controlled trials identified. CONCLUSION: Limited evidence suggests that DSI can be performed by teams already delivering PHEA using an RSI technique and may reduce hypoxemia in those patients unable to tolerate preoxygenation. Further prospective research directly comparing RSI and DSI techniques in the prehospital setting is required to inform future practice.

Get PDF PubMed ↗

Seizure Management in Adult Patients During Air Medical Transport.

Thompson BL, Lauria M, Grassley D … +2 more , Braude D, Alunday RL

Air Med J · 2026 · PMID 42069365 · Publisher ↗

Seizures exist on a clinical spectrum, and providers must adopt a nuanced yet assertive treatment approach, as the transition from benign to life-threatening can occur rapidly. Critical care transport teams are moving th... Seizures exist on a clinical spectrum, and providers must adopt a nuanced yet assertive treatment approach, as the transition from benign to life-threatening can occur rapidly. Critical care transport teams are moving these patients more frequently as neuro-specialty care continues to concentrate at quaternary centers and rural health facilities face resource challenges. Patients with seizures can have a variety of physical and physiologic symptoms, and transport crews must be aware of the more subtle symptoms as to intervene appropriately. The priority in seizure management is stopping the seizure, starting with benzodiazepine administration and then escalating to second-line anti-epileptics if benzodiazepines are ineffective. The longer seizure activity continues, the more difficult it is to stop, and the risk of permanent neuronal damage increases. Additional priorities include patient safety/positioning and airway management. Critical care transport crews should be prepared to perform advanced airway management in patients who present in status epilepticus and should get the patient to a facility with magnetic resonance imaging, electroencephalography, and neurocritical care resources. The unique environment of air transport makes management and assessment of these patients especially challenging, and we provide updated guidance to consider.

Get PDF PubMed ↗

Time Intervals in Helicopter Emergency Medical Services in Iran: A Systematic Review and Meta-Analysis.

Sahebi A, Ebrahimi H, Kamali H … +3 more , Farahmandnia H, Alizadeh S, Karami M

Air Med J · 2026 · PMID 42069364 · Publisher ↗

OBJECTIVE: Helicopter Emergency Medical Services (HEMS) play a crucial role in providing timely emergency care, leading to improved patient outcomes. This study aimed to analyze HEMS time intervals in Iran through a syst... OBJECTIVE: Helicopter Emergency Medical Services (HEMS) play a crucial role in providing timely emergency care, leading to improved patient outcomes. This study aimed to analyze HEMS time intervals in Iran through a systematic review and meta-analysis. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search was conducted in various databases up to August 2025. Ten studies were included for quality assessment and meta-analysis using a random-effects model. Data analysis was performed using STATA 14 software. RESULTS: The meta-analysis revealed that the mean response time, on-scene time, and transport time for HEMS in Iran were 19.55 minutes, 10.46 minutes, and 14.63 minutes, respectively. The overall mean HEMS time was reported as 50.59 minutes. Meta-regression analysis revealed a decreasing trend in response and on-scene times over the years, whereas transport time and overall HEMS time exhibited an increasing trend. CONCLUSION: HEMS in Iran demonstrate acceptable operational times, but improvements in triage, fleet enhancement, and the establishment of a national HEMS registry are needed to enhance efficiency and evidence-based decision-making.

Get PDF PubMed ↗

Evaluation of Prehospital Endotracheal Intubation in Pediatric Patients in a German Helicopter Emergency Medical Service: An Analysis of 920 Cases.

Rudolph M, Reifferscheid F, Kies L … +5 more , Braun J, Beck G, Landsleitner B, Terboven T, Rudolph M

Air Med J · 2026 · PMID 42069363 · Publisher ↗

Management of the pediatric airway is a challenging procedure in prehospital emergency medicine. This retrospective study evaluates prehospital airway management in 920 pediatric patients in a German helicopter emergency... Management of the pediatric airway is a challenging procedure in prehospital emergency medicine. This retrospective study evaluates prehospital airway management in 920 pediatric patients in a German helicopter emergency medical service (HEMS) system from 2012 to 2021. Prehospital pediatric intubation was a rare event (0.2% of all missions). Good visualization of the glottis (Cormack-Lehane I or II) was possible in 96.3% of the intubations. The first-pass intubation success was 86.6%; all children could finally be intubated successfully. The use of muscle relaxants significantly improved first-pass success in prehospital emergency anesthesia (90.1% vs. 83.1%; P = .002). We recognized a low rate of the use of aids such as stylet, bougie, or video laryngoscopy. The use of video laryngoscopy increased over the years, but did not translate into a higher first-attempt success rate. When taking over children with an already managed airway, HEMS teams found tube malplacement in 8.4% of the cases in primary missions. In the analyzed data, pediatric airway management was on a comparable level with adult airway management. Nevertheless, room for improvement and a need for further studies were identified.

Get PDF PubMed ↗

Heated and Humidified Oxygen in Critical Care Transport: Evaluating the Use of Aerogen Pro-X Nebulizer as an Alternative to Traditional High-Flow Humidifiers.

Karas M, Choulat T, Persten J … +6 more , Rucks C, Panchigar R, Beqaj E, Puckett E, Joseph A, Hunt D

Air Med J · 2026 · PMID 42069362 · Publisher ↗

OBJECTIVE: Heated, humidified oxygen therapy is commonly used to support hypoxemic, nonintubated patients. Conventional high-flow nasal cannula (HFNC) systems are effective in hospital settings but are often large and le... OBJECTIVE: Heated, humidified oxygen therapy is commonly used to support hypoxemic, nonintubated patients. Conventional high-flow nasal cannula (HFNC) systems are effective in hospital settings but are often large and less practical for use during critical care transport. Portable aerosol-generating devices offer a compact, transport-friendly alternative; however, a performance gap exists in their ability to maintain appropriate temperature and humidity under varying conditions compared with HFNC. We compared the effectiveness of a heated humidification device, Hamilton H900 (H900), with that of an aerosol-generating device, Aerogen Pro-X (Aerogen). METHODS: The Aerogen was tested with a Hamilton T1 ventilator set to "high-flow oxygen device mode," as used in emergency responses. Using a hygrometer, we measured humidity and temperature outputs at 3 different set flow rates and 6 different set fractions of inspired oxygen (FiO) levels. Each condition was tested the following 3 times: baseline establishment, Aerogen, and H900. RESULTS: Across all conditions, the H900 delivered significantly higher temperatures than the Aerogen, with an estimated marginal mean of 38.56°C ± 0.34°C (101.41°F ± 2.61°F) compared with 19.62°C ± 0.34°C (67.32°F ± 2.61°F) for the Aerogen (95% confidence interval [CI]). In contrast, the Aerogen delivered significantly higher relative humidity (RH) than the H900 at 85.9% ± 0.9% compared with 57.7% ± 0.9% for the H900 (95% CI); however, its absolute humidity was lower than that of the H900 (14.53 mg/L vs. 27.42 mg/L for the H900). For both devices, RH decreased as FiO and flow rate increased (P < .001). At the highest settings (FiO 100%, 60 liters per minute), RH declined to 71.3% ± 3.8% for the Aerogen and 42.3% ± 3.8% for the H900 (95% CI). CONCLUSION: The H900 maintained near-physiological temperatures, whereas the Aerogen demonstrated near-physiological RH. Although each device performed well within a specific domain, neither independently provided guideline-compliant humidification and temperature control across tested conditions. These findings support the development of a portable HFNC system that integrates efficient humidification with active temperature control for use in transport settings.

Get PDF PubMed ↗

Transportation of Critically Ill Pediatric Patients as Disaster Relief by the Aeromedical Evacuation Squadron of the Japan Air Self-Defense Force.

Kurokawa T, Kimura M, Tamura S … +2 more , Yamaguchi D, Kuwada N

Air Med J · 2026 · PMID 42069361 · Publisher ↗

OBJECTIVE: This study reviewed pediatric cases managed by the Aeromedical Evacuation Squadron (AMES) of the Japan Air Self-Defense Force and analyzed patient characteristics. METHODS: Pediatric transportation cases (n =... OBJECTIVE: This study reviewed pediatric cases managed by the Aeromedical Evacuation Squadron (AMES) of the Japan Air Self-Defense Force and analyzed patient characteristics. METHODS: Pediatric transportation cases (n = 34) between 2006 and 2023 were reviewed. Data on patient age, main disease, transportation purpose and distance, and use of mechanical ventilators or extracorporeal membrane oxygenation (ECMO) were obtained by referring to the records. RESULTS: The average (standard deviation) patient age was 5.7 (5.8) years (range: 0-16 years), and 17 patients (50%) were younger than 1 year of age. Furthermore, 10 (58.8%) of these 17 children were younger than 7 months of age and 1 child was under 1 month of age. The most common diseases in the overall patient population were cardiovascular diseases (CVDs, n = 18) and respiratory diseases (RDs, n = 14). The purposes of transportation in cases of 17 patients with CVDs and 3 patients with RDs were the implantation of a ventricular assist device and lung transplantation, respectively. The average transportation distance was 453.7 (218.6) (range: 176.9-962.8) miles or 730.2 (351.8) (range: 284.7-1,549.5) km, and in 8 cases, the transportation distance was > 600 miles. Of the patients, 29 (85.3%) were fitted with a ventilator, of whom 8 received ECMO (6 with CVDs and 2 with RDs). In all cases, physicians from the transporting hospitals were on board. There were no cases of cardiac arrest during the transportation. CONCLUSION: AMES plays an important role, especially in the long-distance transportation of critically ill children.

Get PDF PubMed ↗

Utility of Prehospital Emergency Resuscitative Thoracotomy in Trauma Patients: An Analysis Using the Japanese Society for Aeromedical Services Registry.

Ueno D, Shiino Y, Miyamoto S … +1 more , Takahashi J

Air Med J · 2026 · PMID 42069360 · Publisher ↗

OBJECTIVE: Emergency resuscitative thoracotomy (ERT) is a crucial intervention employed in prehospital settings to address life-threatening conditions, such as cardiac tamponade, hemorrhage, and air embolism. Despite its... OBJECTIVE: Emergency resuscitative thoracotomy (ERT) is a crucial intervention employed in prehospital settings to address life-threatening conditions, such as cardiac tamponade, hemorrhage, and air embolism. Despite its critical nature, the efficacy of prehospital ERT in enhancing survival rates compared with in-hospital procedures remains controversial. METHODS: This retrospective analysis was conducted using data from the Japanese Society for Aeromedical Services Registry between January 2020 and December 2022. After excluding nontraumatic cases, non-ERT cases, and records with missing data, 143 prehospital ERT cases were identified. The cohort was categorized into survivors (n = 3) and nonsurvivors (n = 140) based on patient outcomes. Comparative analyses were conducted on variables such as age, injury severity, time intervals, and transportation modalities using the Wilcoxon rank-sum test and Pearson's chi-square test, with the statistical significance set at P < .05. RESULTS: The overall survival rate after prehospital ERT was 2.1% (3 of 143). Only a few variables, such as hospital length of stay, showed statistically significant differences between the groups; most patient characteristics and prehospital time intervals did not. The patients who experienced cardiac arrest at the time of contact with the emergency medical service (EMS) contact had a survival rate of 0%, whereas those who arrived at the hospital with vital signs had the highest survival rate (11.1%). The presence of vital signs upon hospital arrival and the rapid initiation of intervention were identified as key factors influencing survival. CONCLUSION: These findings suggest that prehospital ERT provides limited survival benefits, with a 0% survival rate in cases of cardiac arrest at EMS contact. Therefore, further research is essential to refine the patient selection criteria and optimize ERT deployment to improve prehospital patient outcomes.

Get PDF PubMed ↗

Predicting Time-Critical Pathology and Cardiorespiratory Deterioration in Infants Retrieved for Bilious Vomiting: An Observational Study.

Wright J, Hennebry B

Air Med J · 2026 · PMID 42069359 · Publisher ↗

OBJECTIVE: Bilious vomiting in infants is recognized as a sign of potential surgical pathology, and these infants often require retrieval from the peripheral hospital to a surgical center for specialist investigation. We... OBJECTIVE: Bilious vomiting in infants is recognized as a sign of potential surgical pathology, and these infants often require retrieval from the peripheral hospital to a surgical center for specialist investigation. We set out to show the frequency of surgical pathology, time-critical pathology, and cardiorespiratory deterioration during retrieval among infants with bilious vomiting. In addition, we aimed to show whether there is an association between the need for cardiorespiratory support at the time of referral and time-critical pathology or cardiorespiratory deterioration during the retrieval. METHODS: We completed a retrospective observational study of 104 infants younger than 44 weeks' corrected gestational age retrieved for bilious vomiting or aspirates over a 103-month period identified from the electronic retrieval record database of an Australian retrieval service. RESULTS: Of the infants included in the study, 21 (20.19%) had a surgical pathology, 6 (5.77%) had a time-critical pathology, and 10 (9.62%) experienced a cardiorespiratory deterioration during the retrieval. Infants receiving cardiorespiratory support at the time of referral were more likely to have a time-critical pathology (risk difference [RD], 24.45%; 95% confidence interval [CI], 3.23-60.07; risk ratio [RR], 6.93; 95% CI, 1.52-31.5) and more likely to experience a cardiorespiratory deterioration (RD, 50.95%; 95% CI, 18.17-78.19; RR, 9.24; 95% CI, 3.38-25.27). CONCLUSION: Our findings can help the retrieval service plan their response to referrals for infants with bilious vomiting. Awareness of the frequency of time-critical pathology and of deterioration during retrieval and the increased risk of both among those requiring cardiorespiratory support at the time of referral could inform the timing of response and team composition.

Get PDF PubMed ↗

Advanced Medical Priority Dispatch System Codes and Air Ambulance Helicopter Tasking in New Zealand: A Retrospective Observational Study.

Bates IEF, Griffiths R, Clarke R

Air Med J · 2026 · PMID 42069358 · Publisher ↗

OBJECTIVE: Air ambulance helicopters are a scarce and costly resource in New Zealand. Despite widespread use of the Advanced Medical Priority Dispatch System (AMPDS), no validated framework exists to determine which dete... OBJECTIVE: Air ambulance helicopters are a scarce and costly resource in New Zealand. Despite widespread use of the Advanced Medical Priority Dispatch System (AMPDS), no validated framework exists to determine which determinant codes are associated with helicopter tasking. This study aimed to examine whether specific AMPDS codes are associated with an increased likelihood of helicopter arrival at the scene in New Zealand. METHODS: A retrospective observational study using all AMPDS-coded incidents recorded by the Emergency Ambulance Communications Centre from January 1, 2023, to December 31, 2024, was conducted. Exclusions included interhospital transfers, search and rescue events, direct air desk notifications, and nonpatient incidents. For each code, incident volume and helicopter arrivals at the scene were measured. Codes were classified as high volume (≥ 50 helicopter arrivals) or high yield (arrival ratio, ≤ 1:10). RESULTS: Among 1,161,169 AMPDS-coded incidents, 34,869 (3.0%) were reviewed by an air desk clinician and 7,688 (0.66%) resulted in a helicopter arrival. Thirty-seven codes generated ≥ 50 arrivals, accounting for 59.3% of helicopter responses but representing 440,781 incidents overall. An additional 102 codes had arrival ratios of ≤ 1:10, although most had low absolute volumes. Only 3 traffic-related codes (29D06, 29D02N, 29D02K) met both criteria, accounting for 823 incidents (0.07%) and 192 arrivals (2.5%). In contrast, 791 codes never produced a helicopter arrival, including 133 with > 100 incidents. CONCLUSION: AMPDS codes alone have limited discriminative capacity for helicopter tasking in New Zealand. A small subset of traffic-related codes demonstrated predictive value and may support more targeted referral pathways. Integrating selected high-yield codes with geospatial thresholds and availability of local critical care resources may streamline clinician review, reduce overtriage, and optimize deployment of scarce aeromedical assets.

Get PDF PubMed ↗

Sound and Vibration Exposure During Fixed-Wing Aircraft Neonatal Patient Transport.

Gibb K, Chen E, Law A … +7 more , Gerson E, Greenwood K, Ngoie J, Redpath S, Chan ADC, Green JR, Langlois RG

Air Med J · 2026 · PMID 42069357 · Publisher ↗

OBJECTIVE: Specialized transport systems are used for newborns who require medical care. These complex systems are subjected to vehicle-specific vibration and sound during transport. Prolonged exposure to high levels of... OBJECTIVE: Specialized transport systems are used for newborns who require medical care. These complex systems are subjected to vehicle-specific vibration and sound during transport. Prolonged exposure to high levels of sound and vibration can be harmful to humans. This study aimed to quantify the sound and vibration levels experienced within a fixed-wing aircraft (Pilatus PC-12) during neonatal transport. METHODS: A dedicated flight test was performed in a PC-12. Acceleration and sound data were captured in the cabin at the approximate position of the neonatal patient transport system, were it loaded. Resultant motions of the transport system and patient were estimated using experimentally derived transfer functions. RESULTS: Vertical vibration was most significant, and the average motion of the cabin floor and pilot seat was comparable in the 1 to 80 Hz frequency range. The greatest motion occurred during segments of rough turbulence, when patient levels were estimated to reach the ISO 2631 "very uncomfortable" threshold. Sound levels exceeded the 60 dBA limit recommended by the CSA Group and the European Committee for Standardization across all phases of flight, peaking at 89.3 dBA during a short-field landing. CONCLUSION: Measured cabin sound exceeded recommended limits, and vertical accelerations reached levels considered uncomfortable under ISO 2631, highlighting the potential risk to this physiologically vulnerable population, compelling further research into vibration mitigation strategies. Aircraft acceleration data have enabled more extensive laboratory testing of the transport system. Establishing neonatal-specific whole-body vibration guidelines remains essential to fully understand and address the clinical implications of these exposures.

Get PDF PubMed ↗

Experience With Electrostatic Discharge During Hoist Operations in the Norwegian Search-and-Rescue Helicopter Service: A Nationwide Cross-Sectional Study.

Brede JR, Storli A, Tangen-Jordan SBV … +1 more , Coucheron L

Air Med J · 2026 · PMID 42069356 · Publisher ↗

OBJECTIVE: Electrostatic charging during helicopter flight is well known. In a helicopter search-and-rescue (SAR) service, a winch is often used to access or extract patients. To avoid injury to the personnel who are hoi... OBJECTIVE: Electrostatic charging during helicopter flight is well known. In a helicopter search-and-rescue (SAR) service, a winch is often used to access or extract patients. To avoid injury to the personnel who are hoisted, electrostatic discharge between the helicopter and the ground should be transferred through an electrostatic discharge line. Still, rescue paramedics (RPs) and physicians involved in hoist operations are familiar with electrostatic discharge episodes, so-called "static." There is a surprising lack in medical literature that describes the scope of static. We aimed to investigate the experience with electrostatic discharge during hoist operations among the personnel in the Norwegian SAR service. METHODS: A nationwide, de-identified, web-based cross-sectional survey. All RPs and physicians who work in the SAR service operated by the 330 Squadron in Norway were invited to participate. RESULTS: Of 81 invited, 74 responded (91%). The mean length of experience was 13 years (range, 2-31), and all RPs and 73% of physicians had experienced static. The median number of static experienced was 10 (range, 1-200). Mild static had been experienced by 85%, moderate static by 61%, and severe static by 23%. RPs were both significantly more experienced than physicians and had experienced more static, with a higher degree of severity. Notably, 30% of participants answered that static is a problem for the SAR service, and 24% of participants were worried about potential long-term effects. CONCLUSION: In this nationwide survey, we found that experience with electrostatic discharge, "static," is common among personnel involved in hoist operations in the Norwegian SAR service. Many participants had experienced a severe degree of static, and 24% of participants were concerned about long-term effects. This survey establishes a need to further assess the scope and implications of static in the SAR service.

Get PDF PubMed ↗

Description of Critical Care Transport First Pass Endotracheal Intubation Failures.

Blake AL, Fjeld KJ, Oelke P … +2 more , Roginski MA, Atchinson PRA

Air Med J · 2026 · PMID 42069355 · Publisher ↗

OBJECTIVE: Endotracheal intubation is performed by health care providers from different training backgrounds and in diverse locations. The first pass failure rate has been reported to be variable, and complications can a... OBJECTIVE: Endotracheal intubation is performed by health care providers from different training backgrounds and in diverse locations. The first pass failure rate has been reported to be variable, and complications can arise from multiple intubation attempts. This is a hypothesis-generating descriptive analysis of first pass endotracheal intubation failure performed by a critical care transport team. Secondary outcomes included patient and procedural factors associated with failure. METHODS: This is a retrospective chart review of adults (≥18 years) intubated by a critical care transport service between January 2017 and June 2024. One intubation attempt was defined as the insertion of the laryngoscope past the lips. First pass failure was defined as failure to place an endotracheal tube through the vocal cords on the first intubation attempt. RESULTS: There were 388 patients intubated with 54 first pass failures (13.9%). Multiple reasons for failure were cited in 20 first pass intubation failures (37.0%). The most common reasons for failure were desaturation during intubation (7; 13.0%); contamination with blood, secretions, emesis, or foreign bodies (23; 42.6%); and anatomy (33; 61.1%). There was an association between first pass failure and retrospectively documented predicted difficult airway (adjusted odds ratio, 2.96; 95% confidence interval, 1.57-5.56). CONCLUSION: First pass failure occurred in 13.9% of intubations. This descriptive analysis serves as a starting point for further quality improvement work that includes a systematic review of intubations with objective data (ie, video-recorded laryngoscopy) and the use of an airway failure taxonomy to describe errors.

Get PDF PubMed ↗

Using Discharge From the Emergency Department or Admission of Less Than 24 Hours as a Metric for Inappropriate Helicopter Emergency Medical Services Utilization in Adult Trauma Patients Transported to the Emergency Department.

Kolman T, Young K, Nickel L … +1 more , Lenz T

Air Med J · 2026 · PMID 42069354 · Publisher ↗

OBJECTIVE: The Commission on Accreditation of Medical Transport Systems has used patients being admitted for less than 24 hours at the receiving facility as a surrogate marker for improper helicopter emergency medical se... OBJECTIVE: The Commission on Accreditation of Medical Transport Systems has used patients being admitted for less than 24 hours at the receiving facility as a surrogate marker for improper helicopter emergency medical services (HEMS) utilization, therefore triggering a review to determine proper HEMS utilization. Recent guidelines modified this to use discharge directly from the emergency department (ED) after transfer as a marker for inappropriate HEMS utilization. This study aimed to evaluate which metric is associated with better adherence to Wisconsin (WI) HEMS utilization criteria in adult trauma patients transported to the ED. METHODS: This was a retrospective chart review of 1,520 transports by a midwestern HEMS service to a level 1 adult trauma center between January 1, 2013, and December 31, 2022. Charts with a disposition of discharge home, admission of less than 24 hours, or death in the ED were evaluated for adherence to WI HEMS utilization guideline criteria. RESULTS: A total of 287 patients met the inclusion criteria. Most patients were transported directly from the scene; 53% of transports met utilization criteria. Interfacility transports were more likely to meet utilization criteria than scene transports. Patients admitted for less than 24 hours were more likely to meet utilization criteria than patients discharged directly from the ED. This significance occurred for both scene and interfacility transports. Patients transported after a motor vehicle crash were less likely to have met utilization criteria. CONCLUSION: Patients admitted for less than 24 hours were more likely to have met WI HEMS utilization guidelines than patients discharged from the ED. The relatively low adherence rate to the WI HEMS utilization guidelines suggests that stricter guidelines may be necessary to reduce overtriaging in HEMS transport.

Get PDF PubMed ↗

Invasive Arterial Blood Pressure Monitoring to Detect Postintubation Hypotension in Patients Who Receive a Prehospital Emergency Anesthetic for Suspected Traumatic Brain Injury.

Houghton Budd S, Haslam N, Griggs J … +6 more , Barrett J, Clarke S, Burrell L, Bootland D, Lyon R, Air Ambulance Charity Kent Surrey Sussex

Air Med J · 2026 · PMID 42069353 · Publisher ↗

OBJECTIVE: The prehospital management of moderate/severe traumatic brain injury (TBI) centers on preventing secondary brain injury. Prehospital emergency anesthesia (PHEA) may be required for optimal neuroprotective care... OBJECTIVE: The prehospital management of moderate/severe traumatic brain injury (TBI) centers on preventing secondary brain injury. Prehospital emergency anesthesia (PHEA) may be required for optimal neuroprotective care. Continuous invasive arterial blood pressure (IBP) monitoring is increasingly used in this cohort. PHEA can result in significant blood pressure (BP) changes, particularly around induction. IBP allows targeted BP management. This study analyzed hypotension frequency, depth, and duration in patients with suspected TBI monitored with IBP before PHEA. METHODS: This was a retrospective analysis of patients with suspected TBI attended by Air Ambulance Charity Kent Surrey Sussex (KSS) who received IBP before PHEA between January 6, 2022, and July 6, 2024. The magnitude and duration of "absolute hypotension" (systolic BP [SBP], < 90 mm Hg) were combined to establish a dose of absolute hypotension (mm Hg × minutes). The primary endpoints were incidence and dose of absolute hypotension. RESULTS: A total of 305 patients were identified; 140 (45.9%) were included. The median age was 58 years (interquartile range [IQR], 42-73), the predominant sex was male (n = 108; 77%), and the median Glasgow coma scale score was 6/15 (IQR, 4.0-7.5). Thirteen patients (9.3%) had absolute hypotension before PHEA, increasing to 53 (37.9%) after PHEA. Twenty-five patients (47.2%) had initial absolute hypotensive episodes that occurred 5 minutes after PHEA, with a median duration of 3 minutes (IQR, 1.0-4.5). The median dose of absolute hypotension was 144 mm Hg × minutes (IQR, 3.75-1,675.5). Twenty-five patients (17.9%) had "clinically important hypotension" (SBP, < 110 mm Hg) before PHEA, increasing to 80 after PHEA (57.1%). Pre-PHEA absolute and clinically important hypotension were associated with both incidence and dose of post-PHEA absolute hypotension. CONCLUSION: This study highlights a higher incidence of absolute hypotension using IBP than previous studies using intermittent noninvasive monitoring. Although post-PHEA absolute hypotension was common, more than half of these events were brief (< 5 minutes). These findings highlight the importance of analyzing hypotension depth and duration and suggest the need for prehospital outcome-based studies using continuous IBP.

Get PDF PubMed ↗

Air Medical Journal[JOURNAL]

About