Air Medical Journal[JOURNAL]
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200 papers
Transitioning From Fire-Based EMS to Critical Care Flight Medicine.
Warren CA
Air Med J · 2026 · PMID 41534968 · Publisher ↗
Transitioning from fire-based emergency medical services to the world of critical care flight medicine represents a dramatic professional evolution. This shift demands not only new clinical competencies but also a profou...
Transitioning from fire-based emergency medical services to the world of critical care flight medicine represents a dramatic professional evolution. This shift demands not only new clinical competencies but also a profound transformation in mindset, autonomy, and operational readiness. Fixed-wing critical care flight paramedics must master complex equipment, medications, and physiology under unique constraints, including altitude and international operations. This subject review explores the nuances of this transition from firsthand experience, offering insight to clinicians considering or undergoing the shift into aeromedical transport.
Air Embolism After Diving and Decisions Surrounding Air Transport.
Kraby M, Dunn M, Tsai A … +3 more , Frakes M, Cohen J, Wilcox SR
Air Med J · 2026 · PMID 41534967 · Publisher ↗
A healthy young woman sustained severe hyperbaric injury after scuba diving, despite having done previous dives. She had an asystolic cardiac arrest immediately after ascent and was resuscitated for 90 minutes before ret...
A healthy young woman sustained severe hyperbaric injury after scuba diving, despite having done previous dives. She had an asystolic cardiac arrest immediately after ascent and was resuscitated for 90 minutes before return of spontaneous circulation (ROSC). After ROSC, she remained profoundly unstable, on multiple vasopressors, with refractory hypothermia and hypoxemia. She was diagnosed with arterial gas emboli (AGE) leading to arrest. The only treatment for AGE is rapid hyperbaric oxygen therapy, but she was too acute to be cared for in any local hyperbaric chamber. The closest chamber that could accommodate a patient of her acuity was 440 miles away. The critical care transport team was prepared to transport her, but such a transport created numerous clinical and logistical challenges.
Operation of Doctor Helicopters in Eastern Shizuoka Prefecture During the Tsunami Caused by the Massive Earthquake Near the Kamchatka Peninsula.
Yanagawa Y
Air Med J · 2026 · PMID 41534966 · Publisher ↗
On July 30, 2025, at approximately 08:25, a magnitude 8.7 earthquake occurred near the Kamchatka Peninsula. Although the earthquake itself caused no direct damage in eastern Shizuoka Prefecture, a tsunami was predicted t...
On July 30, 2025, at approximately 08:25, a magnitude 8.7 earthquake occurred near the Kamchatka Peninsula. Although the earthquake itself caused no direct damage in eastern Shizuoka Prefecture, a tsunami was predicted to reach Japan, prompting the issuance of a tsunami warning. In response to the forecast-predicting tsunami heights of up to 3 m in eastern Shizuoka-operations of the physician-staffed helicopter were relocated to an inland landing site, away from the coastal area, to ensure the safety of patients, medical personnel, and the aircraft. To the best of our knowledge, no similar operational reports have been published in English-language medical literature. This report was therefore compiled as a reference for future documentation and disaster preparedness.
Use of Health Care Simulation in Air Medical Settings: A Scoping Review.
Belk WB, Wiedemann M, O'Connor P … +1 more , O'Malley R
Air Med J · 2026 · PMID 41534965 · Publisher ↗
OBJECTIVE: Simulation-based training is well suited to unique and high-risk settings such as air medicine. Given that the use of simulation to educate air medical professionals continues to grow, there is a need to under...
OBJECTIVE: Simulation-based training is well suited to unique and high-risk settings such as air medicine. Given that the use of simulation to educate air medical professionals continues to grow, there is a need to understand how simulation-based training methods have been used in air medicine thus far. This scoping review aimed to explore the use of simulation as a training method for air medical professionals. METHODS: The current review was conducted according to the 5-step process established by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Five electronic databases were searched, alongside gray literature and reference list screening. Studies that used simulation-based methods to train air medical professionals were included. RESULTS: Of the 21 included studies, most programs used scenario-based simulation (65.0%), multimodal simulation (30.0%), or simulated participants (5.0%). Simulation programs typically involved native teams and targeted team development (50.0%) or focused on contextualized clinical skill building with partial teams (40.0%), whereas a single study focused on hands-on instruction of foundational clinical skills (5.0%) and observed and debriefed teams in the clinical setting (5.0%). The most common form of assessment was of reactions to the simulation program (55.0%), followed by changes in learning (45.0%), behavior (5.0%), and organizational impact (5.0%). CONCLUSION: Research is required to identify the unique needs of the air medical setting and develop effective and feasible methods to address learning outcomes, the impact of which must be evaluated. Simulation should be embedded into air medical training programs, and educators should be supported with the resources, materials, and learning facilities needed to develop effective simulation programs.
Pilot Study Assessing Feasibility of Focused Newborn Cardiac Ultrasound by Transport Team Members to Identify Hypoxemic Congenital Heart Disease.
Shutes B, Wheeler JA, McCombs C … +6 more , Carmin C, Gee S, Texter K, Kovalchin J, Cua CL, Gold D
Air Med J · 2026 · PMID 41534964 · Publisher ↗
OBJECTIVE: Hypoxemia is a common presentation of neonatal critical illness. Identifying critical congenital heart disease (CHD) causing hypoxemia is pivotal in determining immediate medical management. In this work, the...
OBJECTIVE: Hypoxemia is a common presentation of neonatal critical illness. Identifying critical congenital heart disease (CHD) causing hypoxemia is pivotal in determining immediate medical management. In this work, the preliminary results from development of a transport team-focused cardiac ultrasound (US) protocol were presented. METHODS: Phase 1 involved baseline survey of transport team motivation and prior experience followed by structured education and hands-on simulation sessions to teach the basics of cardiac anatomy and US. Participants complete pre- and post-education knowledge assessments. In phase 2, participants performed supervised bedside US on hospitalized infants to practice skills, familiarize themselves with the handheld US device, and learn the focused cardiac US protocol. The US images were compared with a recent comprehensive echocardiogram and assessed for image quality and diagnostic certainty by 2 pediatric cardiologists. RESULTS: A total of 25 transport team members completed paired pre- and post-testing in phase 1. They had high team member motivation to improve US skills and cardiac anatomy knowledge and demonstrated improved post-education scoring with median score increasing from 20/43 (47%) (interquartile range [IQR]: 17-25) to 34/43 (79%) (IQR: 34-41.5) (P < .05). In phase 2, 17 transport members completed 42 scans on 14 unique infants, 10 with CHD. Of 42 scans, 39 (93%) had sufficient image quality to make a diagnosis, with 37 (88%) having "high" diagnostic certainty and 36 (86%) matched complete transthoracic echocardiogram, without missed diagnosis. The median completion time was 17 (IQR: 12.8-20.6) minutes. CONCLUSION: The first 2 phases of this study have demonstrated that transport team members can use handheld US technology to obtain timely and sufficient quality cardiac images to allow for identifying and triaging of CHD in infants. This novel, resource-conscious application has the potential to streamline the care of hypoxemic newborns after undergoing protocol efficiency refinement, independent proficiency testing, and study of remote application.
Effects of Transport Team Composition on Neonatal Intubation Success.
Averhoff AJ, Lee J, Sawyer R … +3 more , Mohs E, Kerr C, McLean C
Air Med J · 2026 · PMID 41534963 · Publisher ↗
OBJECTIVE: Neonatal transport is necessary to move the smallest and sickest patients. Transport team configuration can vary among institutions. One major concern with varied team composition is the ability to intubate ne...
OBJECTIVE: Neonatal transport is necessary to move the smallest and sickest patients. Transport team configuration can vary among institutions. One major concern with varied team composition is the ability to intubate neonates. This study investigates team composition effects on neonatal intubation success when performed by a neonatal nurse practitioner (NNP) or critical care transport (CCT) registered nurses (RNs) and paramedics. METHODS: Neonates <4 weeks of age who were intubated on transport between 2016 and 2023 were analyzed by retrospective chart review. Intubation success and number of attempts were compared between NNP and CCT, while controlling for confounding factors such as birth weight, age, and use of premedication or video laryngoscope. RESULTS: A total of 111 neonates were included in the study with 119 intubation procedures by transport team members. There was no difference in the overall intubation success rate between the NNP and CCT with an average of 84% (P = .68). An increase in first-attempt success rate with the CCT was found, which was not significant after controlling for the use of premedication and video laryngoscope. CONCLUSION: During the study period, neonatal intubation success on transport did not differ when comparing NNP with CCT. This result supports staffing neonatal transport teams based on staffing availability.
Prospective Development and Validation of a Weight Prediction Tool for Patients With Obesity Undergoing Critical Care Transport Using Width and Arm Circumference.
Williams K, Peddle M, Smith J … +2 more , Ahghari M, Nolan B
Air Med J · 2026 · PMID 41534962 · Publisher ↗
OBJECTIVE: Obesity rates are rising, affecting health care systems and causing potential delays in critical care transfers. Accurate weights are important for critical care transport to ensure the appropriate transport a...
OBJECTIVE: Obesity rates are rising, affecting health care systems and causing potential delays in critical care transfers. Accurate weights are important for critical care transport to ensure the appropriate transport asset is selected and dispatched in a timely fashion. Inaccurate weight measurements can lead to various unnecessary delays, including not sending appropriate nonbariatric assets, delays due to secondary dispatch, and delays due to systemic overuse of these bariatric capable assets. The primary objective of this study was to develop and validate a weight prediction tool for patients with obesity undergoing critical care transport. The secondary objective was to compare the performance of this model to the Crandall weight prediction tool. METHODS: A prospective observational study was conducted, collecting data from patients transported by Ornge air ambulance between May 2022 and April 2023. Adults weighing >100 kg undergoing interfacility transfers were included. Four predictive models, using height, arm circumference, width, and girth measurements, were evaluated against actual patient weights and analyzed separately for males and females. Model performance was evaluated by mean squared error, mean absolute error (MAE), mean absolute percentage error, R, and F-statistic. RESULTS: The Ornge model using arm circumference and width demonstrated the highest accuracy and stability in predicting patient weight for both males and females. This model exhibited the lowest MAE of 12.2 kg, was within a margin of 20% error 91.2% of the time, and had an overall false negative error of 6.9%, outperforming all other models. CONCLUSION: The Ornge arm circumference and width-based model offers a reliable method for predicting patient weight in air ambulance settings. Implementing this tool could improve the efficiency and safety of patient transfers by reducing delays caused by inaccurate weight estimations, thereby expediting access to critical care. Further research is recommended to validate these findings in larger and more diverse populations.
Boosting Confidence Through Interagency Air Medical Simulation: A Quality Assurance Exercise of a Critical Care Helicopter Landing at a Tertiary Trauma Hospital.
Iliff J, Spring B, Kumaradevan S … +4 more , Cosford D, Vance J, Richardson A, Gardiner F
Air Med J · 2026 · PMID 41534961 · Publisher ↗
OBJECTIVE: Emergency preparedness training in health care improves patient outcomes. For critically unwell patients outside the hospital setting, air medical helicopter hospital landings expedite emergency health care ac...
OBJECTIVE: Emergency preparedness training in health care improves patient outcomes. For critically unwell patients outside the hospital setting, air medical helicopter hospital landings expedite emergency health care access. However, little is known of interagency staff experiences during this multifaceted health care provision. We captured staff experiences during the first interagency air medical helicopter landing simulation exercise between the Royal Flying Doctor Service of Australia and Royal Perth Hospital in Western Australia as a quality assurance exercise. METHODS: The simulation exercise yielded 21 participants (hospital and air medical clinicians, logisticians, and pilots) and 8 simulation facilitators who consented to provide data between June and October 2023. Data were collected by phone interviews and surveys and analyzed descriptively and qualitatively. RESULTS: Facilitators reported that conducting successful interagency helicopter retrieval simulations requires extensive planning and preparation. After the simulation, participants reported increased clinical confidence in their specific role, with a desire for greater exposure to diverse simulation training to optimize their future performances for real scenarios. Simulation debriefs allow for further participant clarification surrounding the overall process. They provide a medium for valuable feedback to health service providers in process refinement in the management of the critically unwell, enhancing a culture of safety. CONCLUSION: This study highlighted that interagency simulations are a valuable exercise when multiple health service providers are involved in the management of individual patients who are critically unwell. The significant effort to organize and coordinate to create high-fidelity scenarios by facilitators is rewarded with significant benefit found by the participants in their ability to be prepared for the real-life scenario. Such findings have important implications for ongoing interagency collaboration and ongoing health care and educational strategy.
Air Medical and Transport Simulation Training of Critically Ill Cases With Radioactive Contamination in Nuclear Power Stations by Japanese Helicopter Emergency Medical Services.
Tanizaki S, Azuma H, Ishii H … +6 more , Okabe N, Yoshinaga T, Nakaya K, Kobuchi T, Kimura T, Maeda S
Air Med J · 2026 · PMID 41534960 · Publisher ↗
OBJECTIVE: Helicopter emergency medical service (HEMS) personnel require specialized training and continuous skill development tailored to their unique operational demands. These demands may include managing critically i...
OBJECTIVE: Helicopter emergency medical service (HEMS) personnel require specialized training and continuous skill development tailored to their unique operational demands. These demands may include managing critically ill patients with radioactive contamination within radiologically controlled areas to ensure the delivery of high-quality care and safety. A unified consensus was archived after several discussions among relevant agencies, incorporating the safety of flight personnel of the helicopter-operating company and HEMS medical staff. Standardized procedures were developed. To our knowledge, no simulation-based training program for HEMS crew currently exists that specifically addresses the management of critically ill patients with radioactive contamination in such environments. This report aims to assess the validity of the training scenario based on newly established procedures throughout participant's self-reported questionnaires. METHODS: An air medical and transport simulation training was conducted for life-threatening illnesses involving radioactive contamination at nuclear power stations. Participants completed self-reported evaluations using a 5-point Likert scale to assess the training. RESULTS: The specialized simulation scenario involved a patient with subarachnoid hemorrhage and suspected localized external contamination. The median scores for scenario-related scores were 1, indicating the highest levels of agreement, whereas the median scores for overall training and post-training feedback were 2, also demonstrating relatively high levels of agreement. CONCLUSION: In our experience, simulation training scenarios involving critically ill patients with radioactive contamination in nuclear facilities enhance the competencies of both flight personnel and HEMS medical staff. These scenarios also support smoother implementation of HEMS responses to incidents within nuclear facilities and provide a basis for ongoing refinement and improvement of operational procedures.
External Ventricular Devices in Air Medical Retrievals.
Wall A, Gibbs C, Quick L … +3 more , Sadewasser J, Clift K, Franklin RC
Air Med J · 2026 · PMID 41534959 · Publisher ↗
OBJECTIVE: Describe the clinical characteristics of patients with an external ventricular drain (EVD) air medically retrieved. METHODS: A retrospective chart audit of adults with an EVD air medically retrieved between Ja...
OBJECTIVE: Describe the clinical characteristics of patients with an external ventricular drain (EVD) air medically retrieved. METHODS: A retrospective chart audit of adults with an EVD air medically retrieved between January 2018 and June 2022 was conducted using the Retrieval Services Queensland database. Patients with a diagnosis of subarachnoid hemorrhage were identified, and then a manual review was conducted to identify EVD cases. RESULTS: A total of 60 patients met the review criteria. However, 34 patients did not have an EVD in situ, 1 was not transported, and 2 charts were non-retrievable, leaving 21 patients in this review. Of the patients, 76% were mechanically ventilated and 10% had no EVD drainage (suspected to be blocked). Blood pressure fluctuations occurred in 67% of the cases (79% during flight). Separate analgesia/anesthetic infusions were administered in 75% of the patients, with 83% requiring rate increases and 100% requiring boluses for increases in blood pressure. Hypertension in 3 patients occurred post-EVD being turned off and resolved when EVD was turned back on, and bolus sedation/analgesia was provided. CONCLUSION: The air medical transport of patients with an EVD is a low-frequency transfer. Therefore, the use of clinical practice guidelines will enable best practice assessment and management.
Obesity Status Is a Predictor of Prolonged Interfacility Transport by Air Ambulance: A Population-Based Retrospective Cohort Study.
Belhouari SI, Nolan BT, Jung JJ
Air Med J · 2026 · PMID 41534958 · Publisher ↗
OBJECTIVE: Delays in access to emergency care are potentially detrimental to patient health. Evidence suggests that patients with obesity may be more prone to delays in health care settings. METHODS: The primary objectiv...
OBJECTIVE: Delays in access to emergency care are potentially detrimental to patient health. Evidence suggests that patients with obesity may be more prone to delays in health care settings. METHODS: The primary objective of this study is to determine whether obesity status is an independent predictor of prolonged interfacility transport by air ambulance to access definitive care in Ontario, Canada. This was a population-based retrospective cohort study of all emergent interfacility transfers of patients, at least 16 years of age, performed by Ontario's sole air ambulance provider, a total of 15,466 patients, from January 2017 to December 2020. Six different time intervals were identified during the patients' transfers from the site of emergency to a sending facility and, then, to a receiving facility. Obesity status was defined by the ambulance provider as weight ≥120 kg, and covariables included patient-, paramedic-, and institution-level characteristics. The primary outcome was the change in total modifiable time of transfer, defined as the sum of the 6 time intervals. Multivariable regression analyses explored the relationship between obesity status and total modifiable time after risk adjustment. RESULTS: Of the 15,466 patients transferred, 739 (4.8%) were classified with obesity status. The median total modifiable time was 137 minutes. Obesity status was associated with increase of 41 minutes in total modifiable time (95% confidence interval, 14-67 minutes; P < .01). Use of a rotor aircraft was associated with a reduction in total modifiable time of 154 minutes (95% confidence interval, 131-177 minutes; P < .01). CONCLUSION: Obesity status was associated with an increase in modifiable duration of emergent air ambulance interfacility transfers in Ontario.
One Mission, One Team: Celebrating 40 Years of Duke Life Flight.
Sapp A
Air Med J · 2026 · PMID 41534957 · Publisher ↗
BACKGROUND: Duke LifeFlight, established in 1985, has provided four decades of exceptional critical care transport to patients across the Southeast. As one of the first hospital-based air medical programs in North Caroli...
BACKGROUND: Duke LifeFlight, established in 1985, has provided four decades of exceptional critical care transport to patients across the Southeast. As one of the first hospital-based air medical programs in North Carolina, it has set the standard for safety, innovation, and clinical excellence. OBJECTIVE: To commemorate the 40-year anniversary, celebrated last year, of Duke LifeFlight by highlighting its historical milestones, evolving capabilities, and lasting impact on patient outcomes and prehospital care. METHODS/APPROACH: A retrospective review of archival data, program development timelines, and patient care advancements. Key performance indicators and patient transport volumes were analyzed to illustrate growth and effectiveness. RESULTS: Since inception, Duke LifeFlight has completed thousands of transports, expanded to include rotor- and fixed-wing aircraft capabilities as well as critical care ground teams, and maintained accreditation from the Commission on Accreditation of Medical Transport Systems (CAMTS). Innovations in training, telemedicine, and trauma care have further elevated its regional and national standing. CONCLUSION: Over 40 years, Duke LifeFlight has exemplified resilience, clinical excellence, and leadership in critical care transport. As it enters a new era, the program remains dedicated to advancing prehospital medicine and continuing its mission of delivering lifesaving care when seconds matter most.
Facilitators and Barriers Influencing Resilience Amongst Critical Care Transport Professionals in a Fixed-Wing Air Ambulance Environment.
Basson K, Coetzee-Prinsloo I, van der Wath A … +1 more , Greenberg L
Air Med J · 2026 · PMID 41534956 · Publisher ↗
OBJECTIVE: This study describes the facilitators and barriers influencing resilience in a fixed-wing air ambulance environment. METHODS: Self-reported interview guides were used to explore and describe the facilitators a...
OBJECTIVE: This study describes the facilitators and barriers influencing resilience in a fixed-wing air ambulance environment. METHODS: Self-reported interview guides were used to explore and describe the facilitators and barriers influencing resilience among critical care transport professionals in a fixed-wing air ambulance environment. RESULTS: The findings revealed 12 facilitators and 8 barriers influencing resilience among critical care transport professionals in a fixed-wing air ambulance environment in South Africa. CONCLUSION: The findings revealed 12 facilitators and eight barriers influencing resilience among CCTPs in the fixed-wing air ambulance environment in South Africa.
January-February 2026 Forum.
Air Med J · 2026 · PMID 41534955 · Publisher ↗
Abstract loading — click title to view on PubMed.
Prehospital Symptom Management for Pediatric Patients.
Macdonald AA, Lee J, Lacy AJ … +1 more , Li JL
Air Med J · 2026 · PMID 41534954 · Publisher ↗
Abstract loading — click title to view on PubMed.
Obstetric Transport and Factors Associated With Transport to the Intensive Care Unit.
Dahl CM, Debbink MP, Rogers S … +5 more , Pappas L, Wahi S, Metz TD, Porter F, Smid MC
Air Med J · 2025 · PMID 41161888 · Publisher ↗
Obstetric transport to higher levels of maternal care for critically ill pregnant individuals is recommended to reduce maternal and neonatal morbidity, yet data on these transports are lacking. We aimed to describe the c...
Obstetric transport to higher levels of maternal care for critically ill pregnant individuals is recommended to reduce maternal and neonatal morbidity, yet data on these transports are lacking. We aimed to describe the characteristics of obstetric transports of 1 integrated health system's perinatal transport service from January 2020 to December 2023, with a specific focus on assessing factors associated with transport directly to an intensive care unit (ICU) rather than an emergency room or labor and delivery unit. During the study period, 1,087 obstetric transports occurred, most frequently for preterm labor (28.8%), preeclampsia (28.7%), and preterm prelabor rupture of membranes (18.7%). Transport most often occurred via rotor wing (48.0%). Transport to the ICU occurred in 3.2% of cases. Transport to the ICU was associated with longer physician consultation time (17.0 minutes [interquartile range 9.75-31.0] vs. 11.0 minutes [7.0-18.0], P = .006), shorter flight team dispatch time (13 minutes [8.0-33.0] vs. 20.0 minutes [13.5-29.0], P = .03), longer stabilization time before departure (19.0 minutes [15.0-33.0] vs. 15.0 minutes [12.0-20.0], P < .001), and longer time to load the patient to the aircraft (10.0 minutes [7.0-14.0] vs. 7.0 minutes [5.0-10.0], P = .002). Factors associated with transport to the ICU included a diagnosis of coronavirus disease 2019 (adjusted odds ratio [aOR], 11.85, 95% confidence interval [CI] 3.14-36.79), being postpartum (aOR 54.93, 95% CI 21.52-144.81), and further distance traveled (aOR 1.01 per mile traveled, 95% CI 1.00-1.01). Obstetric transports to the ICU are uncommon but require specialized patient care.
Vasodilatory Shock-From Initial Resuscitation to Rescue Therapies: Narrative Review and Considerations for Critical Care Transport.
Bernardoni B, Sayre M, Roginski M … +4 more , Gottula AL, Esteves A, Tschautscher C, Lauria M
Air Med J · 2025 · PMID 41161887 · Publisher ↗
Vasodilatory shock is a critical condition marked by maldistribution of blood flow leading to decreased oxygen delivery and organ dysfunction. Although sepsis is the most well-studied cause, other causes include anaphyla...
Vasodilatory shock is a critical condition marked by maldistribution of blood flow leading to decreased oxygen delivery and organ dysfunction. Although sepsis is the most well-studied cause, other causes include anaphylaxis, endocrine or neurologic dysfunction, toxidromes, and the post-cardiac arrest or post-cardiopulmonary bypass state. After appropriate volume resuscitation, vasopressors may be added in a stepwise manner targeting a mean arterial pressure of >65 mm Hg to ensure organ perfusion. If a patient does not respond adequately to these initial measures, a "resuscitation checkpoint" can be used as a debiasing strategy to consider other contributing factors to shock. If cardiac dysfunction is present, consider addition of inotropes. Metabolic resuscitation may be accomplished in appropriate patients with corticosteroids, calcium, or sodium bicarbonate. Finally, emerging treatments may be considered for refractory vasodilatory shock, including angiotensin II, methylene blue, and hydroxocobalamin. Overall, this review presents an evidence-based tiered approach to management of refractory vasodilatory shock in critical care transport.
Prehospital Whole Blood in Trauma-A Scoping Review.
Kuza CM, Denton AH, Streit S … +3 more , Rossano J, Chung S, Tobin JM
Air Med J · 2025 · PMID 41161886 · Publisher ↗
OBJECTIVE: The management of blood resuscitation in hemorrhagic shock in trauma patients is evolving. Prehospital whole blood (WB) re-emerged into practice to correct coagulopathy, replace blood loss, and improve surviva...
OBJECTIVE: The management of blood resuscitation in hemorrhagic shock in trauma patients is evolving. Prehospital whole blood (WB) re-emerged into practice to correct coagulopathy, replace blood loss, and improve survival. This scoping review evaluated the use of prehospital WB in adult trauma patients with hemorrhagic shock. METHODS: We performed a literature search using PubMed, Embase, and CINAHL, including studies published between January 2015 and March 2024. RESULTS: A total of 10 studies (n = 9,621) were reviewed. Studies included 2 case series, 1 prospective randomized controlled trial, and 7 observational studies. Eight studies evaluated civilian patient populations (1 non-trauma, 7 trauma) and 2 were military (1 trauma, 1 mixed trauma/non-trauma). CONCLUSION: Prehospital WB programs are feasible and relatively safe. They may be beneficial in trauma and other populations; however, the reviewed studies are poor in quality and suboptimal in study design. Thus, definitive recommendations cannot be made. Additional studies are required.
Considerations for Regional Anaesthesia in the Prehospital Environment.
Lewandowski-Barrett LJ, King C
Air Med J · 2025 · PMID 41161885 · Publisher ↗
Regional anesthesia has become an established and effective form of in-hospital pain relief, offering significant benefits than systemic analgesia. Its application in the prehospital setting remains limited and underused...
Regional anesthesia has become an established and effective form of in-hospital pain relief, offering significant benefits than systemic analgesia. Its application in the prehospital setting remains limited and underused. The prehospital environment poses many different challenges compared with in-hospital care, and, therefore, practice cannot necessarily be directly translated. This review explores the current prehospital applications of regional anesthesia, perceived advantages, and indications. It evaluates contraindications and complications, in particular the risk of masking compartment syndrome and iatrogenic nerve injury in the traumatically injured patient, and the implications for prolongation of scene time. Finally, it addresses some of the practical, logistical, safety, and training considerations for implementation.
The Race Against Sepsis: Are Helicopters Always Necessary? A Single-Center Analysis at a Tertiary Pediatric Hospital.
Rayborn CH, Clamp K, Sampson M … +1 more , Kink RJ
Air Med J · 2025 · PMID 41161884 · Publisher ↗
OBJECTIVE: Although numerous studies have evaluated transport modes for pediatric trauma, few have addressed strategies for sepsis. This study evaluates whether ground versus rotor wing transport affects transport time,...
OBJECTIVE: Although numerous studies have evaluated transport modes for pediatric trauma, few have addressed strategies for sepsis. This study evaluates whether ground versus rotor wing transport affects transport time, hospital length of stay (LOS), or mortality in pediatric patients with suspected sepsis. METHODS: We performed a retrospective chart review at a 255-bed tertiary children's hospital and level 1 trauma center (∼81,000 annual emergency department visits). Patients aged 0 to 18 years with a referring diagnosis of possible sepsis and transported by Pedi-Flite, a specialized neonatal/pediatric critical care team, between January 1, 2010, and January 1, 2020, were included; neonatal intensive care unit admissions were excluded. Data included demographics, transport time, fluid/antibiotic administration, vasopressor use, blood culture results, LOS, discharge disposition, and insurance status. RESULTS: Of 87 patients, 63 were transported by ground and 24 by rotor wing. Baseline characteristics and outcomes did not differ significantly. Mean transfer time was 150 ± 80 minutes for ground and 210 ± 297 minutes for rotor (P = .40). Team arrival to the referring hospital was 72 ± 51 minutes for ground and 125 ± 296 minutes for rotor (P = .40). LOS was 10.78 days (ground) versus 9.22 days (rotor; P = .6), and survival was 97% (rotor) versus 90% (ground; P = .40). Most patients received intravenous fluids (97%) and antibiotics (95%), with no group differences in administration rates or mean volume (33.4 vs. 33.3 mL/kg; P = .77). Vasopressors were started during transport in 10% and by the receiving hospital in 63%. In addition, 12 patients (14%) were intubated. Blood cultures were obtained in 40%, with 17% positive; no differences were observed between the groups (all P > .30). CONCLUSION: Transport mode was not associated with differences in care or outcomes for suspected pediatric sepsis. In regions with similar geography and dispatch logistics, ground transport by a specialized critical care team may provide equivalent outcomes to rotor wing.
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