Climate change poses a significant challenge to public health, yet the health care industry contributes substantially to greenhouse gas emissions, with approximately 8.5% of the US emissions linked to health care operati...Climate change poses a significant challenge to public health, yet the health care industry contributes substantially to greenhouse gas emissions, with approximately 8.5% of the US emissions linked to health care operations. Among the sector's overlooked environmental impacts, helicopter air ambulances (HAAs), essential for patient transport, have a notable environmental cost due to high fuel consumption and emissions. This study explores the potential for optimizing HAA dispatch strategies to reduce fuel use and emissions. Focusing on interfacility transports within STAT MedEvac's network, we introduce a method to minimize total roundtrip travel distance while adhering to clinically acceptable time thresholds. By optimizing dispatch decisions for interfacility transport, we calculated potential annual savings of >6,000 miles (1.8% of total distance) and corresponding reductions in fuel consumption and emissions. Further optimization using more flexible time thresholds could double these savings. This research demonstrates that minor changes in HAA dispatch strategies can lead to significant environmental benefits while maintaining high patient care standards, suggesting a scalable model for improving sustainability in the health care sector.
OBJECTIVE: The prehospital care of patients with acute ischemic stroke (AIS) is fraught with many challenges. Knowledge gaps within the prehospital care of patients with AIS contribute to inconsistent practices regarding...OBJECTIVE: The prehospital care of patients with acute ischemic stroke (AIS) is fraught with many challenges. Knowledge gaps within the prehospital care of patients with AIS contribute to inconsistent practices regarding diagnosis, pre-intervention positioning during transport, evaluation for stroke mimics, optimal patient destination, and hemodynamic management. The Air Medical Physician Symposium Lite held in Salt Lake City, Utah, gave experts in the field of critical care transport medicine (CCTM) a venue to discuss the current and optimal states of the prehospital patient with AIS. METHODS: The Air Medical Physician Symposium Lite was held on November 4, 2024, in Salt Lake City, Utah. Participants included international CCTM professionals. Attendees completed a survey on best practices, knowledge gaps, barriers to translation, and research priorities related to in-flight sedation and agitation protocols. The survey results informed lectures and panel discussions, followed by electronic audience voting to rank priority items. RESULTS: The analysis reveals significant challenges such as limited accuracy of AIS identification tools, unclear destination protocols, and conflicting guidelines for hemodynamic management. Effective blood pressure management in the prehospital setting and the impact on air medical transport on the outcome of patients with AIS remain the top research priorities. CONCLUSION: This statement underscores the need for additional future studies and standardized guidelines in CCTM, emphasizing improved diagnostic tools, clear destination protocols, and evidence-based hemodynamic management to enhance outcomes for patients with AIS during critical care transport.
OBJECTIVE: A catastrophic earthquake struck the southeastern parts of Turkey and Syria in February 2023, causing massive destruction of infrastructure and approximately 50,000 deaths and 120,000 injuries. Regional and gl...OBJECTIVE: A catastrophic earthquake struck the southeastern parts of Turkey and Syria in February 2023, causing massive destruction of infrastructure and approximately 50,000 deaths and 120,000 injuries. Regional and global medical assistance were initiated, and The Norwegian Armed Forces contributed with air medical evacuation (AE). A detachment consisting of a Hercules C-130 J airplane with personnel from the Royal Norwegian Airforce and a critical-care air transport team (CCATT) from The Norwegian Armed Forces Joint Medical Services responded. The AE setting is demanding and requires special training and preparations. We aim to describe the Norwegian AE platform and key findings regarding operational and medical aspects of the response to Turkey. METHODS: Patient data were collected on "The NATO medical history chart" and supplemented by observations from the CCATT. We describe the Norwegian AE detachment in detail regarding personnel and equipment. RESULTS: A total of 184 patients were transported on 6 flights. All missions were secondary transports. Of the patients, 45.7% presented deviant physiological parameters, with tachycardia and hypoxia as the most frequent. The dominating primary diagnosis was severe crush injuries. The patient´s age ranged from newborns to patients in their late 80s. The need for medical treatment during transport turned out to be big. CONCLUSION: The Norwegian AE system uses both military and civilian emergency medicine competence and represents a readily available contribution to disasters. Patients from earthquakes are seriously injured with a high demand for medical monitoring and treatment.
OBJECTIVE: Helicopter emergency medical services (HEMS) provide time-sensitive transport and advanced prehospital care. Although traditional bibliometrics (eg, citation counts) have measured academic impact, the role of...OBJECTIVE: Helicopter emergency medical services (HEMS) provide time-sensitive transport and advanced prehospital care. Although traditional bibliometrics (eg, citation counts) have measured academic impact, the role of alternative metrics (altmetrics), such as social media and news mentions, in capturing real-time scholarly influence remains underexplored in HEMS research. To evaluate the relationship between traditional citation metrics and altmetric indicators in HEMS-related publications and to identify trends in online engagement and academic dissemination. METHODS: This cross-sectional analysis included 817 HEMS-related articles published between 1984 and 2025, identified using Altmetric Explorer. Data were extracted from Altmetric Explorer, PlumX Metrics, and Springer Nature Citations, covering various traditional and alternative impact indicators. Descriptive statistics summarized citation and altmetric indicators. Spearman's correlation analysis assessed relationships between Altmetric Attention Score (AAS), Mendeley readership, and citation counts from multiple sources (Dimensions, CrossRef, Scopus, PubMed). Geographic and temporal engagement patterns were also evaluated. RESULTS: The mean AAS was 11.18 ± 28.80, and the mean citation count (Dimensions) was 17.04 ± 24.48. A strong positive correlation was found between AAS and X (formerly Twitter) mentions (ρ = 0.723, P < .001). Mendeley readers had strong positive correlations with citation counts. However, overall correlations between AAS and citation counts were weak. Social media engagement was highest in the United Kingdom and the United States. Nordic countries dominated policy and guideline citations. CONCLUSION: This is the first comprehensive altmetric analysis of HEMS-related publications. Although AAS reflects online attention, it correlates only modestly with traditional academic impact. Altmetrics offer complementary insight into research dissemination, especially in the digital age, and may inform more holistic evaluation strategies in prehospital and emergency medicine scholarship.
OBJECTIVE: To evaluate the post-pandemic staffing status of interfacility pediatric and neonatal transport teams and the impact of resilience promotion strategies. METHODS: A cross-sectional survey was distributed to mem...OBJECTIVE: To evaluate the post-pandemic staffing status of interfacility pediatric and neonatal transport teams and the impact of resilience promotion strategies. METHODS: A cross-sectional survey was distributed to members of the American Academy of Pediatrics Section on Transport Medicine. RESULTS: A total of 34 teams respond (30.9% response rate) to the survey. Most of them (58.8%) reported post-pandemic vacancies. Of the teams with vacancies, 90% cited a lack of qualified applicants as the reason for being unable to fill the vacant slots (P < .01). Increased turnover was reported by 50% of the teams resulting in change in the on-boarding/orientation process for the new hires. Burnout was identified by 26 of the teams (76.4%, P < .01), and 25 respondents (73.5%, P < .01) reported that they had received training to recognize burnout. CONCLUSION: In our survey, most of the responding pediatric and neonatal transport teams faced post-pandemic staffing vacancies, primarily due to a shortage of qualified applicants. Our data suggest that there were subsequent deviations from ideal team compositions and alteration in the on-boarding process for new hires, secondary to personnel shortages.
OBJECTIVE: Cardiopulmonary resuscitation (CPR) during interfacility neonatal and pediatric transport is a rare phenomenon (0.33% and 0.18%, respectively). The ability to maintain high-quality manual CPR in a moving vehic...OBJECTIVE: Cardiopulmonary resuscitation (CPR) during interfacility neonatal and pediatric transport is a rare phenomenon (0.33% and 0.18%, respectively). The ability to maintain high-quality manual CPR in a moving vehicle with limited personnel and equipment impacts its effectiveness. There are limited data about neonatal and pediatric transport teams training staff on resuscitation during transport. This study evaluated the feasibility of in situ, simulation-based CPR training for a tertiary hospital's pediatric-neonatal transport team to better replicate real-world constraints. METHODS: Critical care teams-each comprising a nurse, respiratory therapist, and paramedic-completed an in situ simulation aboard a moving ambulance. Generally, 18 participants formed 6 teams, managing a hypoxia-induced bradycardia scenario requiring CPR. Operational metrics, teamwork, and resource management were evaluated. Post-simulation, participants completed a deidentified survey. RESULTS: The mean participant age was 41.7 (standard deviation [SD] = 8.29) years with 8.9 (SD = 6.19) years of transport experience; 27% had not previously performed CPR during transport. Median time for bag-valve-mask initiation was 0.47 (SD = 0.41) minutes, CPR start was 0.62 (SD = 0.65) minutes, epinephrine administration was 1.25 (SD = 1.61) minutes, and contact with medical command was 1.40 (SD = 0.76) minutes. Post-simulation, 89% preferred in situ training over traditional simulation. Confidence improvements in prehospital care, logistics, and team resource management were negatively correlated with years of transport experience (P < .05). CONCLUSION: In situ simulation enhances training fidelity, improves provider confidence, and may be especially valuable for onboarding new transport team members, supporting safer patient care during transport.
OBJECTIVE: Although endotracheal intubation is the cornerstone of advanced airway management, there are cases where surgical airway becomes the only alternative. Since the coronavirus disease 2019 pandemic, there has bee...OBJECTIVE: Although endotracheal intubation is the cornerstone of advanced airway management, there are cases where surgical airway becomes the only alternative. Since the coronavirus disease 2019 pandemic, there has been increased telemedicine physician consultation, including in trauma and emergency care. The objective of this study is to reveal that telemedicine was a viable means of coaching a prehospital clinician through a simulated cricothyroidotomy. METHODS: Paramedic and registered nurse participants from a critical care transport team were observed performing surgical cricothyroidotomy on a task trainer during 2 separate quarterly airway skills assessments. During the control session, participants completed a bougie-assisted cricothyroidotomy with no assistance. During the intervention, session participants used a trauma surgeon through video conferencing as a procedural coach. Skill completion was timed, performance was rated using a global rating scale, and participants completed the National Aeronautics and Space Administration Task Load Index. RESULTS: There were 15 participants with paired observations available for analysis. There was no significant difference in total task time between solo and telementored sessions (effect size -22.47 [-52.82 to 7.89], P = .13). There was no significant difference in overall global rating scale between solo and telementored sessions (difference -0.27 [-1.63 to 1.10], P = .68). There were no differences in overall task load (difference 3.93 [-1.20 to 9.07], P = .12) or in any of the individual task load components between the solo and telementored sessions. CONCLUSION: Telementorship was not associated with changes in procedural performance, task load, or time to complete a surgical cricothyroidotomy in a critical care transport team.
OBJECTIVE: Air medical evacuation (AE) plays a vital role in emergency medical services by facilitating swift transfer of critically ill or injured patients to advance health care facilities. Despite its increasing impor...OBJECTIVE: Air medical evacuation (AE) plays a vital role in emergency medical services by facilitating swift transfer of critically ill or injured patients to advance health care facilities. Despite its increasing importance, standardized protocols and comprehensive research on AE outcomes remain scarce, particularly in Nepal. This study evaluates clinical characteristics, interventions, and prognostic determinants of AE cases managed by anesthesiologists at a military tertiary care hospital. METHODS: This retrospective observational study analyzed AE cases handled by anesthesiologists in an 11-year period (July 2013-July 2024). Data were retrieved from hospital records, encompassing patient demographics, clinical characteristics, air medical factors, and outcomes. The primary outcomes assessed were in-hospital mortality and recovery. Chi-square tests and logistic regression analyses were used to evaluate associations between key clinical variables and patient outcomes. RESULTS: The study included 83 patients, with a median age of 30 years (interquartile range: 23-36) and a male-to-female ratio of 16:1. Road traffic accidents were leading cause of AE (39.8%), followed by high-altitude illness and heat-related conditions (9.6% each). Mortality was significantly associated with hemodynamic instability (odds ratio: 96.67, 95% confidence interval: 11.34-823.77, P < .001) and intubation status (odds ratio: 12.75, 95% confidence interval: 3.236-50.191, P < .001), whereas no significant correlation was observed between the reason for AE and mortality. CONCLUSIONS: Our study represents first in-depth analysis of AEs involving anesthesiologists in Nepal, identifying illness severity, hemodynamic instability, and intubation status as significant predictors of mortality. The findings underscore urgent need for improved AE infrastructure, implementation of standardized protocols, and specialized training to enhance patient outcomes.
OBJECTIVE: This study aimed to determine the impact of having 2 physicians versus 1 physician in a helicopter emergency medical team on OST. METHODS: This retrospective observational study analyzed 828 patients who under...OBJECTIVE: This study aimed to determine the impact of having 2 physicians versus 1 physician in a helicopter emergency medical team on OST. METHODS: This retrospective observational study analyzed 828 patients who underwent helicopter emergency medical services in 2 years (2020-2021). We used chi-square and t tests to analyze the difference in OST between patients attended by 1 versus 2 physicians. We then used general linear model analysis to evaluate the impact of the number of physicians on OST. RESULTS: Of the 828 patients, we observed 1 physician group (n = 356) and 2 physician groups (n = 472). Analysis revealed significant main effects of diagnosis type (F = 10.78, P < .001) and the number of physicians (F = 18.60, P < .001) on OST, whereas the interaction was not significant (F = 0.30, P = .911). In another analysis, the interaction between the transport facility and the number of physicians was significant (F = 7.00, P = .008), including their main effects. CONCLUSIONS: Having 2 physicians on board the helicopter emergency medical services seems to reduce OST compared with having 1, particularly in trauma and neurology cases.
OBJECTIVE: Greenland presents unique challenges for medical evacuations due to its vast distances, Arctic weather, and limited infrastructure. The aim of this study was to assess whether the time from booking of an evacu...OBJECTIVE: Greenland presents unique challenges for medical evacuations due to its vast distances, Arctic weather, and limited infrastructure. The aim of this study was to assess whether the time from booking of an evacuation from any location in Greenland to the patient arrived at Queen Ingrid's Hospital (QIH) in the capital, Nuuk, was associated with mortality. It was hypothesized that a longer time interval was associated with a higher 30-day mortality. METHODS: An observational cohort study was conducted to all medical evacuations attended by physicians from anywhere in Greenland to QIH in Nuuk, Greenland, between January 1, 2020, and July 31, 2024. Data were extracted from travel logs and medical records and included demographic information, evacuation details, and a 30-day outcome period. Logistic regression was used to compute odds ratios (ORs) associating the time interval from booking to admission with 30-day mortality. RESULTS: Of 1303 records of patients identified through the travel logs, 690 patients met the inclusion criteria. The 30-day mortality was 7.5%, with the median time from booking to hospital admission of 7.9 hours (interquartile range 5.1-19.3). The unadjusted OR of 30-day mortality per hour from booking to admission at QIH was 0.99 (95% confidence interval [CI] 0.97-1.01; P = .50) and 1.00 (95% CI 0.96-1.02; P = .73) in the adjusted analysis. CONCLUSIONS: In this study of all medical evacuations attended by physicians in Greenland in a 4.5-year period, there was no association between the time interval from booking to hospital admission at QIH in Nuuk and 30-day mortality.
OBJECTIVE: In Norway, physician-staffed helicopter emergency medical services (HEMS) provide critical care for patients needing advanced prehospital treatment. To measure the quality of care, 15 quality indicators (QIs)...OBJECTIVE: In Norway, physician-staffed helicopter emergency medical services (HEMS) provide critical care for patients needing advanced prehospital treatment. To measure the quality of care, 15 quality indicators (QIs) are monitored, including the occurrence of "debriefing," a discussion aimed at promoting communication, team learning, and safety. At Trondheim HEMS, the "debriefing" quality indicator has been identified as underperforming compared with other Nordic HEMS bases, suggesting missed opportunities for communication and learning. Given that human error is a major factor in adverse events both in medicine and aviation, enhancing debriefing practices may be crucial for improving quality and safety. The objective of this study was to assess the impact of two interventions on debriefing rates. METHODS: In this prospective quality improvement study at Trondheim HEMS, HEMS crews recorded debriefing occurrences in a QI database. The primary measure was the debriefing rate per shift, analyzed using statistical process control. Before the interventions, baseline data were collected in a 2-month period. The first intervention involved placing reminder posters in high-traffic areas. The second intervention provided feedback through a continuously displayed chart of debriefing performance, allowing crews to compare their rates to overall trends. Each intervention lasted 2 months, followed by washout periods where interventions were removed to evaluate sustained effects. RESULTS: The first intervention had no significant improvement in debriefing rates. Notable variation between physicians was observed during the first intervention and washout period. The second intervention stabilized the process and increased the average debriefing rate from 58% in the baseline period to 71% during the intervention. This continued during the following washout period. CONCLUSION: Prominent variation in performance between physicians indicates a lack of framework for debriefing to occur. The increased debriefing rate is still not ideal. Further approaches are needed to improve debriefing practices in the service.
This case study evaluates the strategic growth, operational challenges, and decision-making complexities faced by Aeromed International Rescue Services Pvt. Ltd., India's leading air ambulance provider. Established in 20...This case study evaluates the strategic growth, operational challenges, and decision-making complexities faced by Aeromed International Rescue Services Pvt. Ltd., India's leading air ambulance provider. Established in 2013 by Dr. Amod Jaiswal, Aeromed has expanded from a single-charter operation to conducting >300 missions annually, serving patients across India and neighboring countries. The case opens with a real-time scenario involving an extracorporeal membrane oxygenation (ECMO)-supported emergency transfer from Guwahati to Chennai, framing Aeromed's commitment to its core value: "Critical Care. Anywhere. Anytime." The narrative traces Aeromed's evolution from initial market entry, expansion into tier 2 and tier 3 cities, technological innovations such as ECMO and neonatal air transport, and resilience during the coronavirus disease 2019 pandemic. At the center of the case is a strategic dilemma in 2024, where Aeromed must choose 1 of the following 3 growth paths: invest in artificial intelligence-driven triage and dispatch platforms, deepen regional access through private helipad infrastructure, or scale nationally and internationally through a licensing/franchise model. Through analytical frameworks such as SWOT, SALT, and PESTLE and exhibits including cost analyses and service data, learners are encouraged to critically evaluate Aeromed's mission, scalability, and financial sustainability.
This study investigates the determinants of oxygen consumption in transport ventilators, a critical factor for patient safety, especially during long-distance transfers and in resource-limited settings. A bench study was...This study investigates the determinants of oxygen consumption in transport ventilators, a critical factor for patient safety, especially during long-distance transfers and in resource-limited settings. A bench study was conducted on 4 ventilators to measure oxygen consumption under various ventilation settings. The main factor influencing oxygen consumption was the bias flow, a specific flow not contributing to patient ventilation. A formula incorporating bias flow was assessed to estimate oxygen consumption. The accuracy of this formula was then compared with clinical data assessed during a long-distance air medical evacuation with mechanically ventilated patients. The high heterogeneity of oxygen consumption observed between the ventilators was mainly explained by the different levels of bias flow. The clinical experience revealed that including this parameter in the prediction may permit to improve oxygen consumption accuracy.
BACKGROUND: Helicopter emergency medical service (HEMS) personnel regularly respond to severe and life-threatening situations, often involving critically ill or injured patients. Yet limited research exists on their ment...BACKGROUND: Helicopter emergency medical service (HEMS) personnel regularly respond to severe and life-threatening situations, often involving critically ill or injured patients. Yet limited research exists on their mental health outcomes compared with ground-based emergency medical services (EMS). This systematic review synthesizes empirical evidence on mental health symptoms among HEMS personnel, focusing on prevalence rates and key psychological outcomes. METHODS: A systematic search of PubMed, PsycINFO, and Scopus identified original, quantitative studies in English or Scandinavian languages. Studies were included if they reported on at least 1 mental health outcome of interest in HEMS personnel. Study quality was rated using criteria adapted from the National Institute of Health's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. RESULTS: From 987 identified articles, 33 full texts were screened, and 9 studies were included, comprising 1 longitudinal and 8 cross-sectional designs. Six studies were rated as being fair quality, 2 as good, and 1 as poor. Outcomes evaluated included depression (5 studies), stress (5 studies), post-traumatic stress disorder/symptoms (PTSD; 3 studies), burnout (3 studies), anxiety (2 studies), secondary traumatic stress (1 study), and compassion fatigue (1 study). Across all studies, HEMS personnel reported low prevalence rates for mental health symptoms. However, burnout and depression were more frequently highlighted as concerns than PTSD. CONCLUSION: Despite regular exposure to traumatic stressors, HEMS personnel report low levels of stress, PTSD, anxiety, and secondary traumatic stress, whereas burnout and depression had slightly higher levels, suggesting the need for targeted preventive interventions and support mechanisms within HEMS environments.
Rapid sequence intubation is a standard procedure in critical care transport (CCT). Owing to its numerous benefits and clinical uses, rocuronium has become the first-line neuromuscular blocking agent in rapid sequence in...Rapid sequence intubation is a standard procedure in critical care transport (CCT). Owing to its numerous benefits and clinical uses, rocuronium has become the first-line neuromuscular blocking agent in rapid sequence intubation, supplanting succinylcholine in many transport services. The deferred resumption of muscle activity with rocuronium may delay administering analgesia or sedation after intubation, resulting in awareness while paralyzed. We undertook a narrative review to evaluate this hazard in the existing literature. Numerous studies have revealed that 10% to 50% of intubated emergency department (ED) patients receive no sedation. Several retrospective reviews of intubated ED and transport patients found that the mean time to sedation or analgesia was longer for those receiving rocuronium than succinylcholine. Patients intubated with rocuronium in transport are more likely to receive neither analgesia nor sedation. Another study of a CCT program assesses data from 264 intubations, using a before and after model to analyze time to sedation after a formulary change from succinylcholine to rocuronium. Guidelines and prompts have not been successful at improving analgosedation systems. EDs have used pharmacists with success to improve post-intubation analgesia and sedation practices, but this is not feasible for transport. Although rocuronium has numerous benefits over succinylcholine for CCT systems, the existing literature demonstrates an ongoing risk of delays in sedation after intubation with rocuronium, with some patients not receiving any analgesia or sedation at all. Guidelines and prompts have not been successful, and ED solutions are impractical for the transport environment. Transport systems must remain vigilant for proper sedation after rocuronium administration.
OBJECTIVE: Collaboration between ambulance emergency medical service (EMS) professionals and helicopter EMS (HEMS) physicians has not been extensively highlighted in the literature. This study aims to address this gap by...OBJECTIVE: Collaboration between ambulance emergency medical service (EMS) professionals and helicopter EMS (HEMS) physicians has not been extensively highlighted in the literature. This study aims to address this gap by exploring the perspectives of ambulance EMS professionals on their collaboration with the physician-staffed HEMS unit in Finland. METHODS: This survey study was conducted in Finland's first rural physician-staffed HEMS unit's, FinnHEMS40 (FH40), operating area in the autumn of 2023 and repeated after a year. A digital survey link was sent through e-mail to all EMS professionals working in ambulance units. The surveys consisted of 5-point Likert-scale questions, multiple-choice questions, and open-ended questions. Likert-scale answers were analyzed with contingency tables and the chi-square test and Fisher's exact test. RESULTS: Response rates were 210 of 522 (40%) for the first survey and 200 of 518 (39%) for the second survey. Most of all respondents (90%) felt that collaboration with FH40 has been good or excellent. The opinions on the importance of a HEMS physician's attendance on EMS missions depended on their educational background and previous work experience in EMS. Results indicated that EMS professionals with 2 to 5 years of work experience seemed to feel more confident in managing various EMS missions independently without assistance from a HEMS physician. CONCLUSION: Collaboration between HEMS physicians and ambulance units is appreciated and deemed important among EMS professionals working in ambulances. Educational background and work experience influence opinions on the necessity of HEMS physicians' attendance in EMS missions.