Air Medical Journal[JOURNAL]
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200 papers
The Importance of a Transport Medicine Rotation for a Pediatric Critical Care Fellowship.
Pfister JK, McDermott KL, Schindler CA … +4 more , Petersen TL, Yan K, Liegl MA, Rajapreyar P
Air Med J · 2025 · PMID 40849157 · Publisher ↗
BACKGROUND: Pediatric critical care medicine (PCCM) fellowship programs must meet established educational standards; however, interfacility transport opportunities vary across sites. OBJECTIVE: To query key stakeholders,...
BACKGROUND: Pediatric critical care medicine (PCCM) fellowship programs must meet established educational standards; however, interfacility transport opportunities vary across sites. OBJECTIVE: To query key stakeholders, is the interfacility transport medicine rotation still an important component of the PCCM fellowship? METHODS: A multi-methods questionnaire was sent to a convenience sample (n = 66) of key stakeholders, including attending physicians, PCCM fellows, and transport team members, from a single site. An 80% response rate resulted in a total of 53 participants. Quantitative items used a Likert-scale and forced ranking response options. Qualitative responses were obtained regarding challenges and barriers during the rotation and to discern attributes of a successful fellow on transport. RESULTS: The transport rotation was rated as important by 92% of the respondents (n = 53). Identified challenges included autonomy, decision-making, and teamwork. All stakeholder groups similarly ranked medical control principles as the most important. Fellows ranked flight physiology as highly important, whereas attending physicians and transport team members ranked medical protocols as highly important. CONCLUSION: A transport medicine rotation during PCCM fellowship is important and highly valued by key stakeholders. Differences in perceptions exist regarding topics of importance and qualities of a successful provider performing medical transport across the stakeholder groups.
Association Between Intraosseous Access Establishment and Prehospital Vasopressor Administration in Patients With Out-of-Hospital Cardiac Arrest in Helicopter Emergency Medical Services: Analysis of the Japanese Society for Aeromedical Services Registry.
Kudo H, Ohbe H, Kudo D … +2 more , Sato T, Kushimoto S
Air Med J · 2025 · PMID 40849156 · Publisher ↗
OBJECTIVE: The establishment of intraosseous (IO) access in patients with out-of-hospital cardiac arrest (OHCA) enables reliable vasopressor administration. However, no studies have examined the association between IO ac...
OBJECTIVE: The establishment of intraosseous (IO) access in patients with out-of-hospital cardiac arrest (OHCA) enables reliable vasopressor administration. However, no studies have examined the association between IO access and vasopressor administration in a nationwide prehospital setting. We aimed to examine the association between IO access and vasopressor administration in patients with OHCA using a nationwide database. METHODS: This retrospective cohort study used data from the Japanese Society for Aeromedical Services Registry (JSAS-R) between April 2020 and March 2023. The primary outcome was vasopressor administration before hospital arrival. Secondary outcomes included in-hospital mortality, length of hospital stay, doctor contact-to-hospital arrival time, and return of spontaneous circulation (ROSC) on hospital arrival. The association between IO access establishment and clinical outcomes was examined using multivariate logistic regression with multiple imputation. RESULTS: Among 3,264 patients with OHCA, 321 (9.8%) received IO access (IO group), while the remaining 2,943 (90.2%) who did not receive IO access formed the control group. Prehospital vasopressor administration was significantly more frequent in the IO group than in the control group (82.9% vs. 70.6%; p < 0.001; odds ratio [OR]: 1.77; 95% confidence interval [CI]: 1.28-2.46). However, the IO group showed a significant decrease in ROSC on hospital arrival (OR, 0.64; 95% CI: 0.45-0.91). No significant intergroup differences were observed in other secondary outcomes. CONCLUSION: IO access was associated with increased prehospital vasopressor administration, suggesting higher success rates of IO vascular access among patients with OHCA in the helicopter emergency medical service setting.
Association Between Collar Type and Incidence of Cervical Spinal Cord Injury in Trauma Patients.
Shaw MR, Liu J, Segel N … +6 more , Hudson M, Godzdanker I, Lyman Z, Miedema T, Tallman H, Gaither JB
Air Med J · 2025 · PMID 40849155 · Publisher ↗
OBJECTIVE: Debate exists on how to best immobilize the cervical spine in the prehospital setting. Rigid cervical collars have been considered the standard of care for both the prevention and care of patients with suspect...
OBJECTIVE: Debate exists on how to best immobilize the cervical spine in the prehospital setting. Rigid cervical collars have been considered the standard of care for both the prevention and care of patients with suspected cervical spinal cord injury (c-SCI). Recently, soft c-collars have begun replacing rigid collars as they are better tolerated by patients. The aim of this study was to compare the safety of these 2 devices by evaluating the prevalence of c-SCI in patients immobilized with a rigid c-collar with those in a soft c-collar. METHODS: A retrospective review of data collected for the purpose of quality improvement was conducted. All cases with possible c-SCI were included. Cases with missing hospital International Classification of Disease code or documentation of emergency medical service neurologic examination were excluded. The primary outcome was c-SCI diagnosis at hospital discharge. A secondary outcome was the prevalence of c-SCI among those at high risk for c-SCI. Descriptive and chi-square analyses were completed to compare the cohorts. RESULTS: Of 882 patients with possible c-SCI, 267 were placed in a rigid collar and 615 in soft collars. Respectively, of those in the rigid and soft collar groups, the median age was 36 (interquartile range 24.5-53) years and 39 (interquartile range 24-58) years, and 54% (134) versus 64% (313) were male. Incidence of c-SCI was 0.8% in the rigid c-collar versus 1.5% in the soft collar group (P = .460). Among those cases with neurologic deficit noted by emergency medical services, there was no difference in incidence of c-SCI in the rigid (2/29, 6.9%) versus the soft (5/87, 5.7%) collar groups (P = .833). CONCLUSION: In this limited retrospective review, no statistically significant difference in the rates of c-SCI was observed between patients who were immobilized using a rigid versus soft c-collar. Additional investigation is needed to determine whether rigid and soft c-collars provide equal protection.
Clinical Outcomes of Patients Experiencing Seizures Treated With Antiemetic Drugs During Transport by Physician-Staffed Helicopters in Japan.
Yanagawa Y, Maekawa C, Tanaka N … +5 more , Suda N, Hirooka Y, Kawai K, Hamada M, Taniguchi H
Air Med J · 2025 · PMID 40849154 · Publisher ↗
OBJECTIVE: We conducted a retrospective study to evaluate the clinical significance of antiemetic drug use in patients with seizures who were transported by physician-staffed helicopters (Doctor Helicopters [DHs]) in Jap...
OBJECTIVE: We conducted a retrospective study to evaluate the clinical significance of antiemetic drug use in patients with seizures who were transported by physician-staffed helicopters (Doctor Helicopters [DHs]) in Japan. METHODS: Data retrieved included patient age, sex, presence or absence of cardiac arrest on DH staff contact, vital signs at the time of contact, details of medical interventions, duration of hospitalization, and final outcome. Patients who experienced cardiac arrest at the time of DH contact and those with missing final outcome data were excluded. Given the established prognostic significance of age and level of consciousness in patients with seizures, individuals younger than 46 years and those with a Glasgow Coma Scale score of <9 were excluded to minimize baseline variability between the 2 groups, based on the results of a preliminary analysis. Subjects were divided into the following 2 groups: the Control group (no antiemetic administered prehospital) and the Antiemetic group. RESULTS: The Control group included 532 patients, whereas the Antiemetic group comprised 149 patients. No significant differences were observed between the 2 groups in terms of sex, age, respiratory rate, systolic blood pressure, Glasgow Coma Scale score, mortality rate, or hospitalization rate. However, the Antiemetic group demonstrated a significantly lower rate of endotracheal intubation and a significantly better cerebral performance category score compared with the Control group. CONCLUSION: This is the first study to evaluate the prognostic role of antiemetic use in older adults with seizures during helicopter transport in Japan. Future prospective, randomized, double-blind studies are warranted to determine whether the use of antiemetic agents serves as a prognostic factor in patients with seizures.
The Potential of Flight Simulation to Support Pilot Training for Mountain Helicopter Emergency Medical Services.
Watson NA, Fernandez N, Owen I … +1 more , White MD
Air Med J · 2025 · PMID 40849153 · Publisher ↗
OBJECTIVE: To demonstrate how piloted flight simulation can be used to replicate rescue helicopter missions in mountainous terrain. To meet this objective, a piloted flight simulation environment has been created in whic...
OBJECTIVE: To demonstrate how piloted flight simulation can be used to replicate rescue helicopter missions in mountainous terrain. To meet this objective, a piloted flight simulation environment has been created in which a helicopter pilot can "fly" over a mountain terrain and through realistic turbulent air flow. METHODS: A solid model, 550 metres across, of a mountainous island has been created and which contains topographic features such as a bowl, pinnacle, ridge, canyon, and cliff. The air flow over this terrain has been computed for a 20-knot wind and integrated with a helicopter flight model representative of a UH-60 Black Hawk. Using a full-motion flight simulator, two test pilots explored the island and conducted a stable hover flight test up the face of the cliff. RESULTS: The simulation demonstrates great promise and was judged by the test pilots to be an impressive first attempt at developing a search and rescue "training landscape." The flight test results revealed how the pilots found it difficult to maintain a stable hover when exposed to the turbulent shear layer at the top of the cliff, consistent with their real-world experience. CONCLUSION: The exploratory study was considered to be successful, meriting further research and development to increase the range of wind conditions and to explore the other topographic features in the terrain.
Flight-Crew Administration Speeds Time to Tranexamic Acid: FAST TXA Study.
Fritz CL, Schoenfeld DW, Bivens MJ … +7 more , Dunn K, Stocking JC, Zernicke L, Thomas CE, Racht E, Rosen CL, Thomas SH
Air Med J · 2025 · PMID 40849152 · Publisher ↗
OBJECTIVE: Tranexamic acid (TXA) is a standard therapy for the early treatment of life-threatening traumatic hemorrhage. Multiple studies suggest a benefit to earlier TXA, and meta-analysis calculates that each 15-minute...
OBJECTIVE: Tranexamic acid (TXA) is a standard therapy for the early treatment of life-threatening traumatic hemorrhage. Multiple studies suggest a benefit to earlier TXA, and meta-analysis calculates that each 15-minute time savings achieved by prehospital TXA improves mortality 10%. In trauma patients for whom helicopter emergency medical services (HEMS) initiated prehospital TXA, this study's primary aim was to calculate the minutes' time savings achieved compared with hypothetical TXA initiation at trauma centers. A secondary study aim was to evaluate whether there was geographic variation in the degree to which HEMS-initiated TXA expedited the initiation of the TXA. METHODS: Four years of data (2021-2024) were queried using the medical records database of a nationwide HEMS organization. Eligible cases were injured patients who received TXA initiated by HEMS flight crews in the prehospital setting. Variables assessed included patient age, sex, transport year, state/US Census Bureau region, time of TXA initiation, and time of hospital arrival. RESULTS: The study assessed 7,188 prehospital HEMS TXA initiations and found that flight-crew commencement of TXA therapy saved a median of 22 minutes overall and 25 minutes for pediatric patients. In all 4 regions of the United States, HEMS initiation of TXA saved at least 15 minutes; inter-regional variation in the degree to which HEMS initiation of TXA saved time was largely explained by variations in overall prehospital time. CONCLUSION: In the study dataset, HEMS was associated with significantly faster time to TXA, and despite regional variation in the degree of time savings, HEMS initiation of TXA saved at least 15 minutes in all 4 major US regions. Application of the metric of 10% survival increment per 15-minute expedited TXA initiation resulted in an estimate of mortality improvement of 14.7% overall and 16.7% for pediatric patients.
Transport-Related Risk Factors for Intraventricular Hemorrhage in Preterm Neonates: An Exploratory Analysis.
Butler C, Olshannikov J, Watts J … +3 more , Lancaster RJ, Jaiswal M, Chase J
Air Med J · 2025 · PMID 40849151 · Publisher ↗
UNLABELLED: Preterm neonates face unique risks during ground transport due to environmental factors and the urgent need for critical interventions. Neuroprotection during transport is essential to safeguard this vulnerab...
UNLABELLED: Preterm neonates face unique risks during ground transport due to environmental factors and the urgent need for critical interventions. Neuroprotection during transport is essential to safeguard this vulnerable population from developing intraventricular hemorrhage (IVH). Despite efforts to optimize neonatal transport practices, specific transport-related factors contributing to IVH remain poorly understood. OBJECTIVES: The study aims to identify transport-related factors contributing to IVH, including 1) the association between critical ground transport (miles loaded, time, infant securement) and clinical factors of IVH (hypotension, intubation, etc.) and 2) the impact of maternal and fetal factors on IVH development, including maternal infection, pre-delivery medication administration, Apgar score, respiratory support changes, and hypoxic events. METHOD: A retrospective design was used, gathering data from the electronic health records of 2 transport teams in the Midwest. Logistic regression models were used to identify transport and maternal variables associated with IVH development. RESULTS: Among the 79 neonates included in this study, 25 (31.6%) developed IVH. Data indicate a higher incidence of IVH in male neonates (P = .02). Furthermore, maintaining the patient in a midline position was associated with IVH status (P = .03). However, no association was found between critical ground transport and IVH rates. Maternal infection was associated with IVH (B = 1.82, standard error = 0.833, odds ratio = 6.17, 95% confidence interval: 1.30-37.5, P = .0288). CONCLUSION: Findings underscore the need to optimize ground transport practices, particularly for male neonates, highlighting midline positioning and maternal infections as modifiable factors in IVH prevention.
Prehospital Triage of Pediatric Emergencies Treated by Helicopter Emergency Medical Services: A Population-Based Cohort Study.
Tsuchiya EA, Rosenkrantz O, Hansen TM … +2 more , Petersen JAK, Steinmetz J
Air Med J · 2025 · PMID 40849150 · Publisher ↗
OBJECTIVE: Helicopter emergency medical services (HEMS) play a crucial role in emergency medical services across many countries. Although some patients are discharged at the scene, most are transported to tertiary or loc...
OBJECTIVE: Helicopter emergency medical services (HEMS) play a crucial role in emergency medical services across many countries. Although some patients are discharged at the scene, most are transported to tertiary or local hospital emergency departments (EDs), with critically ill pediatric patients usually triaged to tertiary EDs. We evaluated whether critically ill pediatric patients treated by HEMS were primarily triaged to the highest level of care by comparing mortality between those admitted to tertiary versus local EDs. METHODS: We conducted a cohort study of patients aged <18 years clinically evaluated by a Danish HEMS crew during 2019-2024. The primary outcome was 30-day mortality. Secondary outcomes were National Advisory Committee for Aeronautics scores, International Classification of Diseases, 10th Revision, diagnoses, and prehospital interventions. Fisher's exact test was used for categorical comparisons. RESULTS: Of 1,104 pediatric missions, 836 patients were included. The 30-day mortality was higher in tertiary ED patients with 32 patients (5.4%) compared with 1 patient (0.4%) in the local ED group (P < .001). More tertiary ED patients had critical National Advisory Committee for Aeronautics scores (42.4% vs. 10.4%, P < .001). Injuries and Poisoning was the most common International Classification of Diseases, 10th Revision, category in the tertiary ED group, whereas Factors Influencing Health Status was the most frequent in the local ED group. Prehospital interventions were more common in the tertiary ED group (35.6% vs. 10.4%, P < .001). CONCLUSION: The 30-day mortality was higher in patients transported to tertiary EDs, indicating that HEMS crews generally triaged the most critically ill pediatric patients to the highest level of care.
Care of the Agitated Patient Who Presents a Threat to Safe Transport in Critical Care Transport Medicine: A Consensus Statement.
DeMarco J, Shields B, Hinckley W … +5 more , Bates C, Jasumback M, Tschautscher C, Lawner B, Gottula AL
Air Med J · 2025 · PMID 40849149 · Publisher ↗
OBJECTIVE: Critical care transport medicine (CCTM) often encounters agitated patients who pose immediate threats to safe transport. The Air Medical Physicians Association recognized this unique risk and brought together...
OBJECTIVE: Critical care transport medicine (CCTM) often encounters agitated patients who pose immediate threats to safe transport. The Air Medical Physicians Association recognized this unique risk and brought together experts to draft consensus statements and best practices for managing such patients. 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 standardized sedation protocols, training for in-flight staff, implementing a sedation checklist, monitoring sedation levels, and using non-pharmacologic techniques as best practices for caring for agitated patients who present a threat to safe transport. Knowledge gaps, barriers to translation, and research priorities were also identified and described. CONCLUSION: This consensus statement identifies critical areas for improving patient safety and operational protocols in CCTM. Addressing the outlined best practices, knowledge gaps, and research priorities is essential to advance CCTM and ensure safe patient transport.
Analysis of Disease-Specific Outcomes According to Time of Doctor Helicopter Dispatch Request.
Yanagawa Y, Tanaka N, Maekawa C … +8 more , Nagatake Y, Tashiro A, Kato M, Tokutsu R, Ota S, Ohsaka H, Nagasawa H, Omori K
Air Med J · 2025 · PMID 40849148 · Publisher ↗
OBJECTIVE: To evaluate whether the keyword method-requesting the dispatch of a doctor helicopter (DH) based on information obtained from the emergency call before emergency medical technicians make contact with patients-...
OBJECTIVE: To evaluate whether the keyword method-requesting the dispatch of a doctor helicopter (DH) based on information obtained from the emergency call before emergency medical technicians make contact with patients-is useful for other disease category, using data from the Japan DH Registry (JDHR). METHODS: Patients (N = 41,592) enrolled in JDHR were included in the study. The following data were collected for each subject: time from emergency call to DH staff-patient contact, DH request method (keyword or not), gender, age, vital signs at the time of emergency medical technician contact, medical intervention details, disease category details which were determined by the JDHR classification, hospitalization duration, and 1-month outcome. The subjects were dichotomized into the following 2 groups in each disease category: a keyword group and a control group. RESULTS: The study revealed significant disparities of the backgrounds between the 2 groups in each disease category. The keyword group had statistically significant earlier patient contact, respectively, in each disease category, compared with the control group. Concerning the overall performance category in 1 month, the keyword group exhibited low values (favorable function) of cerebral infarction, intracerebral hemorrhage, other endogenous diseases, and trauma category compared with the control group. The keyword group exhibited a statistically significant shorter hospital stay in other endogenous diseases, trauma, and non-trauma cases of exogenous diseases. Multivariate analysis revealed that the keyword method was not selected as an independent factor related to survival, except in the intracerebral hemorrhage category. CONCLUSION: In our study, early DH involvement dispatch and rapid transport by keyword methods were associated with better outcomes or shorter hospital stay, regardless of heterogeneity in patient characteristics and disease types. However, the keyword-based dispatch system itself did not seem to improve outcomes independent of patient-specific factors and disease severity.
Human Factors in Helicopter Air Ambulance Accidents, Incidents, and Safety Reports.
Baumgartner HM, Durham J, Hu PT
Air Med J · 2025 · PMID 40849147 · Publisher ↗
Helicopter air ambulance (HAA) operations are subject to unique risks due to their time-sensitive and safety critical nature. The Civil Aerospace Medical Institute completed analyses of the National Transportation Safety...
Helicopter air ambulance (HAA) operations are subject to unique risks due to their time-sensitive and safety critical nature. The Civil Aerospace Medical Institute completed analyses of the National Transportation Safety Board's (NTSB) Case Analysis and Reporting Online aviation accident and serious incident database and the National Aeronautics and Space Administration's Aviation Safety Reporting System data in a 10-year span. In total, 102 Aviation Safety Reporting System reports, 53 final NTSB accident reports, and 3 final NTSB incident reports involving HAA from 2013 to 2023 that occurred within the United States were coded for human factors and organizational risk factors. The analyses identified several human factor risks affecting HAA pilots related to situation awareness, judgment and decision making, adherence to procedures, and experience and training. Furthermore, organizational issues influencing HAA operations, such as communication, safety culture, and those involving operator policy and procedure, were identified. These human factors and organizational safety findings suggest potential areas for safety interventions or mitigations in HAA operations.
Gaslini Neonatal Emergency Transport Service. Celebrating 30 Years of Activity, 1995-2025.
Bellini C, Ramenghi LA, Serra G
Air Med J · 2025 · PMID 40849146 · Publisher ↗
On February 1, 2025, the Neonatal Emergency Transport Service (NETS) at Gaslini Hospital in Genoa, Italy, marked an extraordinary milestone: 30 years of dedicated service. Since its establishment, NETS Gaslini has been a...
On February 1, 2025, the Neonatal Emergency Transport Service (NETS) at Gaslini Hospital in Genoa, Italy, marked an extraordinary milestone: 30 years of dedicated service. Since its establishment, NETS Gaslini has been a beacon of hope, providing rapid responses and transporting > 8,000 critically ill newborns. Each transport represents a unique story of urgency, swift action, and compassionate care. This article honors NETS Gaslini's remarkable journey, tracing its origins and evolution and celebrating the countless lives it has touched. Through heartfelt anecdotes and pivotal moments, we celebrate 3 decades of unwavering commitment to saving the most fragile lives.
Something Old and Something New: Measles, Candida auris, and Infection Prevention in the Prehospital Setting.
Liang SY, Robertson EM, Li JL … +1 more , Lacy AJ
Air Med J · 2025 · PMID 40849144 · Publisher ↗
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Air Transport Medicine: From the Field.
Harris T, Bhanderi N, Harris D … +6 more , Smith C, Breslin R, Moran J, Nguyen L, Price J, Barnard E
Air Med J · 2025 · PMID 40849143 · Publisher ↗
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Investigating Helicopter Emergency Medical Services Challenges in Transporting Pregnant Mothers: A Case Report.
Esmaeilzadeh MH, Shaghaghi F, Rostamian M … +1 more , Mostafapour M
Air Med J · 2025 · PMID 40571391 · Publisher ↗
Helicopter Emergency Medical Services (HEMS) play a vital role in transporting time-sensitive patients, including pregnant women at risk of imminent childbirth, from remote locations to appropriate medical facilities. Ho...
Helicopter Emergency Medical Services (HEMS) play a vital role in transporting time-sensitive patients, including pregnant women at risk of imminent childbirth, from remote locations to appropriate medical facilities. However, the potential for in-flight delivery presents unique challenges for emergency medical teams. We present a case report from Gonabad University of Medical Sciences documenting the only recorded instance of in-flight childbirth during a five-year period of HEMS operations. The case involved a 38-year-old multiparous woman (G6P5) transported from a remote village located 110 kilometers from the nearest appropriate medical facility. Despite activation time delays exceeding standard benchmarks, the medical team successfully managed the delivery in the confined space of a BK-117 helicopter. The mother maintained stable vital signs throughout transport, and both mother and infant were safely transferred to the receiving facility. The total mission duration was 62 minutes, with specific challenges noted in activation time and restricted cabin space for delivery management. This case highlights critical areas for HEMS protocol improvement, including the need for standardized dispatch criteria for obstetric emergencies, consideration of midwife inclusion in flight teams, and strategies to reduce activation times. The experience provides valuable insights for enhancing emergency medical services in similar scenarios.
Evaluating the Impact That a Lung Ultrasound Training Program to Detect Acute Heart Failure Has on Paramedic Behavior.
Russell FM, Supples M, Tamhankar O … +5 more , Hobson O, Pallansch J, Soriano P, Finnegan P, Liao M
Air Med J · 2025 · PMID 40571390 · Publisher ↗
OBJECTIVE: Previous studies have revealed that paramedics can learn how to perform lung ultrasound (LUS) to identify pulmonary edema and acute heart failure, but studies evaluating subsequent clinical application are lac...
OBJECTIVE: Previous studies have revealed that paramedics can learn how to perform lung ultrasound (LUS) to identify pulmonary edema and acute heart failure, but studies evaluating subsequent clinical application are lacking. We set out to evaluate how the implementation of a LUS training program affected paramedic behavior (Kirkpatrick's methodology level 3). METHODS: This was a prospective observational cohort study on paramedics from a single agency. Paramedics completed 1 hour of training including a pre- and post-intervention survey and test, 30 minutes of didactics, 30 minutes of hands-on scanning, and an independent objective structured clinical evaluation. They, then, completed a ride-along with a physician trained in LUS. For the next 15 months, paramedics independently performed and interpreted clinically indicated LUS examinations on patients being transported for shortness of breath. The number of LUS performed, accuracy of interpretation, image quality, and change in management based on LUS findings were analyzed. RESULTS: Of 26 paramedics, 22 (85%) completed 109 LUS in 15 months, with a median of 2 LUS performed per paramedic (range 1-18). Sensitivity and specificity of paramedic-performed LUS for pulmonary edema were 73.8% (confidence interval 0.58-0.85) and 91.0% (confidence interval 0.81-0.96), respectively. Of the 31 true positives, 20 patients (64.5%) were treated with nitroglycerin, furosemide, or positive pressure ventilation, whereas 11 patients were not treated despite a positive LUS result. Median image quality was 4 (range 1-5) on a 5-point scale. CONCLUSION: Implementation of a LUS training program led to most paramedics using LUS in the clinical setting and obtaining high-quality images. Specificity of paramedic-performed LUS was high when compared with hospital diagnosis. Prehospital heart failure treatment based on LUS findings was moderate.
Recent Outcomes Research in Helicopter Emergency Medical Services: A Scoping Review of Publication-Year 2024 Additions to the Helicopter Outcomes Assessment Research Database.
Fritz CL, Thomas CE, Skaggs M … +7 more , Zernicke L, McCartin MP, Blumen IJ, Price J, Hibberd O, Schoenfeld DW, Thomas SH
Air Med J · 2025 · PMID 40571389 · Publisher ↗
OBJECTIVE: This scoping review is an annual update of helicopter emergency medical services (HEMS) outcomes literature added to the HEMS outcomes assessment research database (HOARD). HOARD is maintained by the critical...
OBJECTIVE: This scoping review is an annual update of helicopter emergency medical services (HEMS) outcomes literature added to the HEMS outcomes assessment research database (HOARD). HOARD is maintained by the critical care transport collaborative outcomes research effort (CCT CORE) and is updated each year with the previous calendar year's studies assessing whether HEMS use alters patient-centered outcomes. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review (PRISMA-ScR) guidelines, we used multiple reviewers of records retrieved from multiple medical and gray literature sources: Medline (PubMed), EMBASE, Scopus, CINAHL, and Google Scholar. Eligible for review was HEMS vs. ground EMS outcomes studies either published or appearing in preprint databases during calendar year 2024. HOARD excludes case reports and review articles (unless they provide a new calculation of effect estimate). We assessed articles for subject matter (trauma vs non-trauma), journal impact factor (JIF), and geographic region of the study's correspondence author. Categorical analyses comparing 2024 studies with HOARD studies from 2023 were executed with Pearson's chi-square or Fisher's exact test, and we also calculated risk ratio with its 95% confidence interval. Non-normal JIF data were described using median and interquartile range and analyzed using rank sum testing. Nonparametric trend testing evaluated the last decade's evidence using Cochrane-Armitage (dichotomous) or Cuzick (JIF) testing. RESULTS: Of an initial records of N = 5,179 (74 of which were reviewed as full text), we identified 21 studies for addition to HOARD. Longitudinal analysis revealed a significant (P < .001) annual trend toward increasing proportions of studies focusing on non-trauma; 2024 was the first time in a decade that the more than half of the year's outcomes studies focused on non-trauma. There was no indication of trend involving the proportion of studies emanating from the USA (P = .821) or from the combined countries of USA and Europe (P = .566). The 2024 JIF had a median of 2.11 and interquartile range of 1.25 to 2.60. There was no suggestion (P = .919) of longitudinal JIF trend in the past decade. CONCLUSION: This scoping review provides information on 21 HEMS outcomes studies new to the evidence base in 2024. The HOARD database, freely available, has been updated with these studies.
Predictive Value of Prehospital Point-of-Care Glucose Measurement and Shock Indices in Traumatically Injured Patients: A Retrospective Study.
Hill J, Norman J, Gothard MD … +4 more , McLean MM, Krajkowski D, Figg B, Marr J
Air Med J · 2025 · PMID 40571388 · Publisher ↗
OBJECTIVE: Stress-induced hyperglycemia is a well-established risk factor for mortality in critically ill trauma patients. Limited research exists on prehospital diagnostic tools for predicting hemorrhagic shock and mort...
OBJECTIVE: Stress-induced hyperglycemia is a well-established risk factor for mortality in critically ill trauma patients. Limited research exists on prehospital diagnostic tools for predicting hemorrhagic shock and mortality in this population. METHODS: A retrospective study involving 435 adult and pediatric trauma patients transported by air ambulance in 13 years aimed to assess the predictive value of prehospital point-of-care glucose (POCG), shock index (SI), Glasgow Coma Scale (GCS), fluid administration, and reverse SI multiplied by GCS (rSIG) for 24-hour and 30-day mortalities. RESULTS: Univariate analyses revealed that an elevated SI and lower GCS were associated with increased mortality, whereas POCG and crystalloid fluid administration were not significant predictors. Multivariate analysis confirmed SI and GCS as independent predictors of 30-day mortality. The rSIG emerged as the strongest predictor, with an Area Under the Receiver Operating Characteristic curve (AUROC) of 0.872. POCG alone did not demonstrate statistical significance in predicting mortality. CONCLUSION: Prehospital SI and GCS are valuable predictors of mortality, with rSIG offering the highest predictive accuracy. Despite limitations, this study suggests the potential impact of prehospital markers on trauma-related outcomes, emphasizing the need for further research validation.
Ventilators Currently Used in Emergency Neonatal Transport: Italian National Survey, Year 2025.
Perez CR, Bellini C, Gente M … +5 more , Minghetti D, Cavalleri E, Catani F, Risso FM, Neonatal Transport Study Group of the Italian Society of Neonatology
Air Med J · 2025 · PMID 40571387 · Publisher ↗
OBJECTIVE: Emergency neonatal transport is well established in many Western countries, with comprehensive frameworks and guidelines for the management of neonatal respiratory distress. The aim of this survey was to provi...
OBJECTIVE: Emergency neonatal transport is well established in many Western countries, with comprehensive frameworks and guidelines for the management of neonatal respiratory distress. The aim of this survey was to provide valuable insights into the ventilators currently used during neonatal transport in Italy. We hope that the results of this survey will help guide and inform future improvements in the quality of care provided during neonatal transport for newborns with respiratory distress. METHODS: Survey period: January 2025 (1-31). A simple questionnaire with 3 key questions was sent by e-mail to the directors of the 55 currently active Italian neonatal emergency transport services (NETS). The questions were as follows: Which ventilator model(s) are used? How many ventilators are mounted on each transport incubator in use? How many transport incubators are currently in use in your NETS? The last 2 questions have an additional query: Is it possible for your NETS to transport twins simultaneously, and if so, what is the current ventilation strategy? RESULTS: The survey, conducted among 55 Italian NETS, provides the following breakdown of the main results. Total ventilators used: 115; Hamilton T1: 61 of 115 (most used); Fabian without High Frequency Ventilation (HFV): 24 of 115; Stephan F 120: 18 of 115; Crossvent-2i+: 6 of 115; Leoni Plus with HFV: 2 of 115; MVP-10: 2 of 115; Bronchotron F00038-1: 1 of 115; pNeuton mini NEO: 1 of 115. CONCLUSION: This survey has revealed that there is great variability in Italy regarding the ventilators used in neonatal transport.
Optimizing Preoxygenation for Prehospital Emergency Anesthesia and Air Medical Transport: A Comparative Study of Bag Refill Valve and Reservoir Bag.
Lindsay HL, Humar MJ, Anderson DJ … +1 more , Meadley BN
Air Med J · 2025 · PMID 40571386 · Publisher ↗
OBJECTIVE: Oxygen desaturation is a complication of prehospital rapid sequence intubation before air medical transport. Preoxygenation with a self-inflating resuscitator (ie, bag-valve-mask [BVM]) device and a reservoir...
OBJECTIVE: Oxygen desaturation is a complication of prehospital rapid sequence intubation before air medical transport. Preoxygenation with a self-inflating resuscitator (ie, bag-valve-mask [BVM]) device and a reservoir bag at 15 L/min oxygen flow (BVM15) is effective at extending safe apnea time. The impact of a lightweight, oxygen-sparing bag refill valve (RV) connector on preoxygenation efficacy is unclear. The objective of this study was to compare preoxygenation with a BVM with a RV connector (BVM + RV) with a BVM with a reservoir bag at 15 L/min oxygen flow (BVM15). The primary outcome was percentage of end-tidal oxygen concentration (EtO) at 60 and 180 seconds. Secondary outcomes included EtO at 60 and 180 seconds when nasal cannula at 15 L/min oxygen flow (NC) was added to these preoxygenation methods (BVM + RV + NC and BVM15 + NC). METHOD: Healthy volunteers were recruited and randomly allocated to receive 3 minutes of preoxygenation using each of the 4 methods (BVM + RV, BVM15, BVM + RV + NC, BVM15 + NC). RESULTS: This pilot study found no significant difference in the EtO levels at 60 and 180 seconds between the BVM plus RV and BVM15. However, the addition of NC to the BVM15 setup significantly improved the rate of EtO rise. CONCLUSION: Preoxygenation using either a BVM plus RV or BVM15 achieves adequate EtO in healthy volunteers. The addition of NC further enhances rise in EtO levels. Although more research is needed, the RV may be an alternative device to facilitate preoxygenation in air medical services.
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