OBJECTIVE: In Japan, patients with inflammatory diseases are transported from the field by doctor helicopters (DHs). This study aimed to retrospectively investigate the relationship between early medical intervention and...OBJECTIVE: In Japan, patients with inflammatory diseases are transported from the field by doctor helicopters (DHs). This study aimed to retrospectively investigate the relationship between early medical intervention and outcomes in inflammatory diseases, such as respiratory, urinary tract, and gastrointestinal infections. METHODS: Using data collected by the Japanese Society for Aeromedical Services from DH base hospitals, cases with a discharge diagnosis of inflammatory diseases were selected. The study evaluated age, sex, request method, vital signs on DH staff contact, medical interventions, and final outcomes (cerebral performance category [CPC] at 1 month postinflammation and survival outcome). Exclusion criteria included cases of cardiac arrest at contact and those with unknown final outcomes. The cases were categorized into 2 groups based on survival or functional outcome (favorable: CPC 1-2; unfavorable: CPC 3-5), and a comparative analysis was conducted between the 2 groups. RESULTS: Of 41,592 cases in the data set, 785 cases met the inclusion criteria. The mean age was 73.8 years, with 491 male patients, 136 deaths, and 272 cases with poor outcomes. All cases were transported from the scene. Compared with the survival group, the fatal group was older and had poorer consciousness, lower blood pressure, higher rates of airway management, and higher use of vasopressors, glucose, and muscle relaxants, whereas the use of antiemetics was statistically lower. Similarly, compared with the favorable functional outcome group, the poor outcome group was older and had a higher proportion of female patients, poorer consciousness, faster respiratory rate and pulse, lower blood pressure, higher rates of airway management, and higher use of cardiopressors, glucose, and muscle relaxants, with a statistically lower use of antiemetics. CONCLUSION: In cases where the prehospital condition was severe, medical intervention rates increased, and the outcomes for such patients were poor. Conversely, the presence or absence of antiemetic use may have influenced the outcomes.
OBJECTIVE: Induction agent selection and dose are potentially modifiable risk factors to mitigate postintubation hypotension and hemodynamic collapse. Despite it being a common practice, minimal literature exists to supp...OBJECTIVE: Induction agent selection and dose are potentially modifiable risk factors to mitigate postintubation hypotension and hemodynamic collapse. Despite it being a common practice, minimal literature exists to support induction agent dose reduction. Our objective was to evaluate the rate of postintubation hemodynamic collapse with reduced-dose compared to full dose induction agents. METHODS: This is a retrospective chart review of adult patients who were endotracheally intubated by a critical care transport team and received etomidate or ketamine for induction. The primary outcome was association of reduced-dose induction agent use (etomidate <0.2 mg/kg or ketamine <1 mg/kg) with postintubation hemodynamic collapse. RESULTS: A total of 304 patients were included; 187 (61.5%) received etomidate and 117 (38.5%) received ketamine. Of these 304 patients, 64 (21.1%) received reduced-dose agents and 240 (78.9%) received full-dose agents. The initial systolic blood pressure and mean arterial blood pressure levels were lower in the reduced-dose arm. Shock index, hemodynamic collapse, and life-threatening hemodynamic collapse did not differ between the groups. CONCLUSION: In this analysis, there was no difference in rates of postintubation hemodynamic collapse with reduced-dose induction agents when compared with full-dose agents.
OBJECTIVE: Timely reperfusion is crucial for improving outcomes in patients with ST-elevation myocardial infarction (STEMI). The impact of transport mode on time to treatment for patients with STEMI over short distances...OBJECTIVE: Timely reperfusion is crucial for improving outcomes in patients with ST-elevation myocardial infarction (STEMI). The impact of transport mode on time to treatment for patients with STEMI over short distances (<10 miles) is not well studied. This study aimed to compare the time from transport request to percutaneous coronary intervention (PCI) suite arrival between helicopter emergency medical services (HEMS) and ground emergency medical services (GEMS) for patients with STEMI. METHODS: We conducted a retrospective cohort study involving 22 patients with STEMI transported by either HEMS or GEMS from a single referring hospital to a single receiving hospital PCI suite, located 8 miles apart, from January 2020 to January 2023. Data on transport times were collected from hospital records and Google Maps estimates. We analyzed the time intervals using descriptive and inferential statistics, including mean comparisons and regression analyses. RESULTS: Air transport (HEMS) was significantly faster than ground transport (GEMS) by a mean of 32 minutes (95% confidence interval: 21.1-42.9 minutes). This difference was clinically significant in 50% of the cases. Sensitivity analyses using longer HEMS transport times confirmed the robustness of the findings. No significant changes in transport times were observed over the study period. CONCLUSION: HEMS may offer time advantages compared with GEMS for short-distance transfers in STEMI cases, though the small sample size limits the robustness of these findings. Further research with larger samples and additional outcome measures is needed to confirm these results and assess the broader implications for emergency medical transport.
OBJECTIVE: Children with airway emergencies, such as aspirated foreign bodies (FBs), who present to community emergency departments usually require expeditious transfer to centers with pediatric expertise. In 2018, our h...OBJECTIVE: Children with airway emergencies, such as aspirated foreign bodies (FBs), who present to community emergency departments usually require expeditious transfer to centers with pediatric expertise. In 2018, our hospital's transport team implemented a multidisciplinary direct admission to the operating room (OR) protocol for children transferred for emergent surgical intervention, which bypassed typical hospital entry points. We aimed to assess its impact on time to definitive care and patient outcomes. METHODS: We performed a retrospective chart review of all patients aged ≤18 years with suspected aspirated FB transferred to our institution for emergent surgical intervention between July 1, 2013 and March 1, 2023. We determined whether they were taken to the OR post-transfer after first being evaluated in our pediatric emergency department/intensive care unit (Standard protocol) or transported directly to the OR by the transport team (OR Transport protocol). Demographics, transport/surgical times, and clinical data were compared between the groups using t-test and Mann-Whitney U test. RESULTS: Of the 27 children who met the inclusion criteria, 14 (51.9%) were transported via the Standard protocol and 13 (48.1%) via the OR Transport protocol. Demographics, referring hospital characteristics, time of transfer request, need for mechanical ventilation pretransport, and transport mode were not different; rates of critical care transports were higher for the OR Transport group than for the Standard group (P = .016). Compared with the Standard group, the OR Transport group had shorter median (interquartile range) times from transport arrival to start of surgery (8 [0-15.5] vs. 94.5 [25.75-148.75] minutes, P < .001) and from transport dispatch to surgery (103 [64.25-144] vs. 179 [115.5-265] minutes, P = .035). Although not statistically significant, the OR Transport group had a lower hospitalization rate after the surgery compared with the Standard group (38.5% vs. 64.3%). CONCLUSION: Implementation of a direct admission to the OR protocol seems to expedite definitive treatment and may be associated with a decreased need for hospitalization for children with airway FBs who require interhospital transport for emergent surgical intervention.
Critical care transport (CCT) education and training for health care providers are important for patient safety. In this study, a structured education and training program for CCT was implemented as a pilot in South Kore...Critical care transport (CCT) education and training for health care providers are important for patient safety. In this study, a structured education and training program for CCT was implemented as a pilot in South Korea, and the effects of improving knowledge and confidence among health care providers were evaluated. This retrospective observational study analyzed pre- and post-test scores and survey responses from participants in the education program. The education program consisted of a didactic lecture, skill practice, and simulation for 9 categories lasting 80 hours. The participants included nurses and emergency medical technicians with experience in emergency or critical care. The study consisted of 2 phases, with data collected through web-based evaluation forms and structured questionnaires. The program involved 20 participants across the 2 phases. Posteducation assessments revealed significant improvements in knowledge and confidence in CCT practices. The participants were especially satisfied with their skill in trauma management and advanced CCT simulations. The Korean Critical Care Transport Curriculum education program effectively enhanced the knowledge and confidence of health care providers in CCT. This standardized education model should be considered by policy makers and stakeholders to improve patient safety in emergency medical systems.
Nepal is a landlocked country in the heart of the Himalayan region. Its remote villages and mountainous terrain provide a unique set of challenges in health care. As a result, the last decade has seen major developments...Nepal is a landlocked country in the heart of the Himalayan region. Its remote villages and mountainous terrain provide a unique set of challenges in health care. As a result, the last decade has seen major developments in the use of helicopters in retrieval medicine. This has helped to improve accessibility to health care in even the most rural areas. Despite the assorted challenges, the helicopter emergency medical service in Nepal is a part of the medical system. This article provides a comprehensive overview of the history of helicopter and air medical services in Nepal.
Ambulance exchange points are preidentified sites where patients are transferred between evacuation platforms while en route to enhanced medical care. We propose a new capability for maritime medical evacuation, which in...Ambulance exchange points are preidentified sites where patients are transferred between evacuation platforms while en route to enhanced medical care. We propose a new capability for maritime medical evacuation, which involves co-opting underway watercraft as overwater ambulance exchange points to transfer patients between medical evacuation aircraft. We partnered with the US Army's 25th Combat Aviation Brigade to demonstrate the use of Army watercraft as overwater ambulance exchange points. A manikin was transferred between 2 HH-60M medical evacuation Black Hawk helicopters conducting hoist operations over Army Logistics Support Vessel 3, which was traveling south of Honolulu, HI. The demonstration was enabled by a decision support system for dispatching aircraft, hoist stabilization technology, commercial satellite internet, military geospatial infrastructure applications, and digital medical documentation tools, the benefits of which are all discussed. Three extensions of the overwater ambulance exchange point are introduced, and civilian applications are considered.
The Children's Mercy Hospital Critical Care Transport (CMCCT) team provides care to a sizable portion of the Midwest United States. CMCCT has seen an increased frequency of pediatric mental health transport requests for...The Children's Mercy Hospital Critical Care Transport (CMCCT) team provides care to a sizable portion of the Midwest United States. CMCCT has seen an increased frequency of pediatric mental health transport requests for patients who are aggressive or at risk of becoming aggressive during interfacility transport. These transport requests often involve long distances and require a medical flight to accomplish safely. CMCCT's multidisciplinary approach and process focus on crew and patient safety to provide compassionate and dignified care, ensuring that this very vulnerable patient population arrives safely at their mental health care institution. This paper describes our patient population, policy, systemic process, and barriers to completing the transport.
OBJECTIVE: Because of high-altitude operations, cold exposure is common for helicopter emergency medical services. However, drug emulsions such as propofol and etomidate are prone to degradation and the formation of lipi...OBJECTIVE: Because of high-altitude operations, cold exposure is common for helicopter emergency medical services. However, drug emulsions such as propofol and etomidate are prone to degradation and the formation of lipid droplets, possibly large enough to cause pulmonary embolism, when frozen. Amiodarone may be prone to crystallization, possibly causing phlebitis, when exposed to cold temperatures. The aim of this study was to microscopically identify physical changes in common emergency drugs under cold exposure. METHODS: Exposure time frames and temperature ranges were chosen according to real-world data collected on a rescue helicopter in Switzerland. Samples were stored in a laboratory freezer with a temperature range of -2.3°C (27.7°F) for 1 hour, 0.6°C to -3.6°C (33.1°F-25.5°F) for 12 hours, and -22°C (-7.6°F) for 1 hour and 12 hours. Analysis was performed under a light microscope. RESULTS: No physical changes in the form of large lipid droplets or crystallization were found in the samples stored at -2.3°C (27.7°F). Lipid droplets were found in the propofol samples stored at 0.6°C to -3.4°C (33.1°F-25.5°F) and -22°C (-7.6°F) over 12 hours. CONCLUSION: There was no observation of physical changes under temperature conditions commonly found in helicopter emergency medical services. However, lipid droplets could be observed in the propofol samples with long exposure times or under deep frozen temperature conditions. These findings highlight the need to establish a safe threshold for cold exposure of medications in the prehospital environment.
This case report describes the medical management for a 14-year-old female patient who suffered cardiac arrest following an acute asthma exacerbation. During air medical transport, the patient developed unilateral mydria...This case report describes the medical management for a 14-year-old female patient who suffered cardiac arrest following an acute asthma exacerbation. During air medical transport, the patient developed unilateral mydriasis, a concerning finding often associated with intracranial pathology such as cerebral herniation. Immediate interventions included the administration of hypertonic saline and targeted ventilation strategies to maintain end-tidal carbon dioxide levels within a therapeutic range. Subsequent diagnostic evaluation, including imaging, revealed no neurologic abnormalities, and the mydriasis resolved spontaneously without complications. Ophthalmic ipratropium exposure was suspected as the underlying cause. This case emphasizes the importance of understanding and recognizing pharmacologic causes, such as muscarinic receptor antagonism, in the differential diagnosis of mydriasis. It also underscores the need for continuous reassessment during transport and the potential for cognitive biases to influence decision-making.
This article describes the very first neonatal air transports in Italy. The historical documentation comes from the archive of the Italian Air Force and material collected by the Gente del 15° Association, which brings t...This article describes the very first neonatal air transports in Italy. The historical documentation comes from the archive of the Italian Air Force and material collected by the Gente del 15° Association, which brings together veterans and supporters of the glorious 15th Search and Rescue Squadron of the Italian Air Force. Four episodes are described, relating to the years 1953, 1955, 1971, and 1981.
OBJECTIVE: There is an increased mortality rate of patients residing in rural compared with urban communities. Helicopter emergency medical services (HEMS) decrease both the time to hospital arrival and trauma mortality...OBJECTIVE: There is an increased mortality rate of patients residing in rural compared with urban communities. Helicopter emergency medical services (HEMS) decrease both the time to hospital arrival and trauma mortality in patients originating from rural areas. An unreported number of urban residents are served by HEMS. Our objective was to quantify the fraction of urban residents who live in the adjoining city of a HEMS base and are transferred by helicopter while they are in rural areas. METHODS: This was a retrospective analysis of HEMS charts between 1985 and 2022. Records were assessed for patients' city and postal code. A secondary database was searched to assess mission location. RESULTS: Thirty-five thousand nine hundred seventy-one cases were analyzed; 3,871 (10.76%) cases involved patients residing within the urban area of an open HEMS base, and 32,100 (89.24%) did not. This contrasts with 2.04% of all missions conducted in urban areas. Cases flown with patients from outside of the 3 provinces were as follows: British Columbia (1,233/21,941; 5.3% of Alberta cases), international (988/35,971; 2.7% of total cases), Ontario (177/4,691; 3.6% of Manitoba cases), and other provinces combined (158/3,5971; 0.4% of total cases). CONCLUSION: We highlight the impact of HEMS, where it serves both rural residents and all people who work in, travel through, visit, or recreate across the areas that our HEMS supports.
The transport of intubated patients is a common but high-risk scenario for air medical transport crews. In the case presented, a physician-nurse HEMS crew responded for the interfacility transfer of a patient with severe...The transport of intubated patients is a common but high-risk scenario for air medical transport crews. In the case presented, a physician-nurse HEMS crew responded for the interfacility transfer of a patient with severe angioedema who had undergone awake fiberoptic nasotracheal intubation in the referring emergency department. The endotracheal tube had been damaged, however, and could not be adequately secured for transport. To facilitate tube securement, the crew elected to convert from nasotracheal to orotracheal intubation. Recognizing the high likelihood of anatomic difficulty and to minimize the risk of airway loss, the crew performed an airway exchange by passing a bougie adjacent to the existing endotracheal tube, while using the in situ tube to provide continued ventilation. This case highlights the importance of familiarity with airway exchange procedures and presents a novel technique of extraluminal bougie-assisted endotracheal tube exchange.
Cardiac arrest in pregnancy is a rare but serious complication, occurring at a rate of 1 in every 9,000 patients hospitalized for delivery. This review article provides a comprehensive overview of maternal cardiac arrest...Cardiac arrest in pregnancy is a rare but serious complication, occurring at a rate of 1 in every 9,000 patients hospitalized for delivery. This review article provides a comprehensive overview of maternal cardiac arrest for critical care transport providers. This article discusses the pertinent physiologic changes in pregnancy, common contributing factors, and special circumstances that can develop during a maternal cardiac arrest. We also provide current approaches to managing this population and special considerations for transport providers.
OBJECTIVE: Overseas Koreans face challenges in accessing adequate medical care abroad. Understanding the epidemiology and costs of international medical repatriation is important. METHODS: A retrospective analysis of ove...OBJECTIVE: Overseas Koreans face challenges in accessing adequate medical care abroad. Understanding the epidemiology and costs of international medical repatriation is important. METHODS: A retrospective analysis of overseas Korean patients who were repatriated to South Korea between 2019 and 2021 was conducted. The data collected from 121 countries included demographics, medical conditions, and costs. Variables from 9 continents (Southeast Asia, Northeast Asia, Southwest Asia-Pacific, Russia-Central Asia, North America, Central and South America, Europe, Middle East‒North Africa, and Sub-Saharan Africa) and the era of coronavirus disease 2019 (February 2020 and after) were analyzed and compared. Based on the available total cost data, stepwise extrapolation was conducted for the total cohort. RESULTS: A total of 428 overseas Korean patients who had undergone international medical repatriation via air transport were included in this study. The greatest number of repatriated patients were from Southeast Asia (108 patients), and 279 patients were transported within the coronavirus disease 2019 era. The average cost per patient exceeded $7,000, and the total cost estimated by extrapolation was over $8 million. CONCLUSION: International medical repatriation is significant for overseas Koreans. Standardized guidelines and system development are essential for effective air medical services.