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1.
BMC Emerg Med ; 24(1): 35, 2024 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-38429656

RESUMO

BACKGROUND: Physician-staffed helicopter emergency medical services (HEMS) are dispatched to a variety of incidents, ranging from less serious to life-threatening. The skillset of a physician may be important to provide appropriate care for the most critically ill and severely injured patients. A better understanding of these patients may therefore be important to optimize dispatch criteria, training, and equipment setups for HEMS units. The aim of this study was to describe the characteristics of patients with the national advisory committee on aeronautics (NACA) score 5 and 6, primarily by diagnostic group and interventions performed. METHODS: Retrospective cohort study on aggregated data from the HEMS-base in Trondheim, Norway. All patients with NACA score 5 and 6 in the 10-year period from 2013 to 2022 were included. Patients with return of spontaneous circulation (ROSC) after successful cardiopulmonary resuscitation were described separately from non-cardiac arrest patients. RESULTS: Out of 9546 patient encounters, 2598 patients were included, with 1640 in the NACA 5 and 958 in NACA 6 group. Patient age was median 63 (interquartile range 45-74) and 64% of the patients were male. Post-ROSC patients accounted for 24% of patients. Of the non-cardiac arrest patients, the most frequent aetiology was trauma (16%), cardiac (15%), neurologic (14%) and respiratory (11%). The most common physician-requiring advanced interventions were general anaesthesia (22%), intubation (21%), invasive blood pressure monitoring (21%) and ventilator treatment (18%). The mean number of advanced interventions per mission were consistent during the study period (1,78, SD 0,25). CONCLUSION: Twenty-seven percent of all HEMS dispatches were to NACA 5 and 6 patients. Twenty-four percent of these were post-ROSC patients. Sixty-three percent of all patients received at least one advanced physician-requiring intervention and the average number of interventions were consistent during the last 10 years. Hence, the competence a physician-staffed HEMS resource provide is utilized in a high number of critically ill and injured patients.


Assuntos
Resgate Aéreo , Serviços Médicos de Emergência , Humanos , Masculino , Feminino , Estudos Retrospectivos , Estado Terminal/terapia , Aeronaves , Noruega/epidemiologia
2.
Air Med J ; 43(2): 116-123, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38490774

RESUMO

OBJECTIVE: The epidemiology accompanying helicopter emergency medical services (HEMS) transport has evolved as agencies have matured and become integrated into regionalized health systems, as evidenced primarily by nationwide systems in Europe. System-level congruence between Europe and the United States, where HEMS is geographically fragmentary, is unclear. In this study, we provide a temporal, epidemiologic characterization of the largest standardized private, nonprofit HEMS system in the United States, STAT MedEvac. METHODS: We obtained comprehensive timing, procedure, and vital signs data from STAT MedEvac prehospital electronic patient care records for all adult patients transported to UPMC Health System hospitals in the period of January 2012 through October 2021. We linked these data with hospital electronic health records available through June 2018 to establish length of stay and vital status at discharge. RESULTS: We studied 90,960 transports and matched 62.8% (n = 57,128) to the electronic health record. The average patient age was 58.6 years ( 19 years), and most were male (57.9%). The majority of cases were interfacility transports (77.6%), and the most common general medical category was nontrauma (72.7%). Sixty-one percent of all patients received a prehospital intervention. Overall, hospital mortality was 15%, and the average hospital length of stay (LOS) was 8.8 days ( 10.0 days). Observed trends over time included increases in nontrauma transports, level of severity, and in-hospital mortality. In multivariable models, case severity and medical category correlated with the outcomes of mortality and LOS. CONCLUSION: In the largest standardized nonprofit HEMS system in the United States, patient mortality and hospital LOS increased over time, whereas the proportion of trauma patients and scene runs decreased.


Assuntos
Resgate Aéreo , Serviços Médicos de Emergência , Adulto , Humanos , Masculino , Estados Unidos/epidemiologia , Pessoa de Meia-Idade , Feminino , Estudos Retrospectivos , Aeronaves , Serviços Médicos de Emergência/métodos , Cuidados Críticos , Sorbitol , Escala de Gravidade do Ferimento
3.
Air Med J ; 43(2): 124-132, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38490775

RESUMO

OBJECTIVE: Helicopter emergency medical services (HEMS) is widely used for prehospital and interfacility transport, but there is a paucity of HEMS outcomes data from studies using randomized controlled trial designs. In the absence of robust randomized controlled trial evidence, judgments regarding HEMS potential benefit must be informed by observational data. Within the study design set of observational analyses, the natural experiment (NE) is notable for its high potential methodologic quality; NE designs are occasionally denoted "quasi-experimental." The aim of this study is to examine all NE outcomes studies in the HEMS literature and to discern what lessons can be learned from these potentially high-quality observational data. METHODS: HEMS NE studies were identified during the development of a new HEMS Outcomes Assessment Research Database (HOARD). HOARD was constructed using a broad-ranging search of published and gray literature resources (eg, PubMed, Embase, and Google Scholar) that used variations of the terms "helicopter EMS," "air ambulance," and "air medical transport." Among the 221 studies ultimately included in HOARD, 16 NE publications describing 13 sets of observational data comprising myriad diagnostic groups were identified. Of these 16 HEMS NEs, 4 HEMS NE studies assessing trauma outcomes were used in a meta-analysis. A meta-analysis was also performed of 4 HEMS NE studies. RESULTS: Although the disparity of studies (in terms of both case mix and end points) precluded the generation of a pooled effect estimate of an adjusted mortality benefit of HEMs versus ground emergency medical services, HEMS was found to be associated with outcomes improvement in 8 of the 13 cohorts. CONCLUSION: The weight of the NE evidence supports a conclusion of some form of HEMS-mediated outcomes improvement in a variety of patient types. Meta-analysis of 4 HEMS NE studies assessing trauma outcomes generated a model with acceptable heterogeneity (I2 = 43%, Q test: P = .16), which significantly (P < .01) favored HEMS use with a pooled HEMS survival odd ratio estimate of 1.66 (95% confidence interval, 1.23-2.22).


Assuntos
Resgate Aéreo , Serviços Médicos de Emergência , Humanos , Aeronaves , Avaliação de Resultados em Cuidados de Saúde , Bases de Dados Factuais , Estudos Retrospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Observacionais como Assunto
4.
Air Med J ; 43(2): 146-150, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38490778

RESUMO

OBJECTIVE: The MIRACLE2 score has been developed for use in a primary percutaneous coronary intervention center. It is unclear if it is feasible in the helicopter emergency medical service (HEMS) setting. METHODS: The computerized system at 1 UK HEMS was interrogated between December 1, 2020, and May 1, 2022, for the components of the MIRACLE2 score (recorded contemporaneously) plus demographics and outcomes in all post-return of spontaneous circulation patients conveyed to the hospital. pH was excluded because of no point-of-care testing resulting in a modified MIRACLE2 score (maximum score of 9). Data were analyzed using the chi-square test; P < .05 was statistically significant. RESULTS: Three hundred thirty patients (240 males) with out-of-hospital cardiac arrests were reviewed. Ninety-two adult patients with nontraumatic out-of-hospital cardiac arrests had sustained return of spontaneous circulation and a median MIRACLE2 score of 4 (range, 0-7). Forty-seven patients died before hospital discharge; the median MIRACLE2 score was higher in those who died (4) than those who survived (1.5, P < .01); 90.3% of those with a score ≥ 5 were triaged to an emergency department rather than directly to a catheterization laboratory. CONCLUSION: A modified MIRACLE2 score can be calculated in the HEMS setting. The benefit of point-of-care testing pH requires investigation. There may be a benefit in predicting outcomes in this nondifferentiated group, but additional research is required.


Assuntos
Resgate Aéreo , Serviços Médicos de Emergência , Parada Cardíaca Extra-Hospitalar , Adulto , Masculino , Humanos , Parada Cardíaca Extra-Hospitalar/terapia , Serviços Médicos de Emergência/métodos , Triagem , Aeronaves , Estudos Retrospectivos
5.
Air Med J ; 43(2): 106-110, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38490772

RESUMO

OBJECTIVE: Although a small proportion of helicopter emergency medical service (HEMS) missions are for pediatric patients, it is recognized that children do present unique challenges. This case series aims to evaluate the intubation first-pass success rate in HEMS pediatric patients for both medical and trauma patients in a UK semiurban environment. METHODS: A retrospective review of the computerized records system was performed from January 1, 2015, to July 31, 2022, at 1 UK HEMS. Anonymous data relating to advanced airway interventions in patients < 16 years of age were extracted. Primary analysis related to the first-pass success rate was performed; secondary analysis relating to the initial Glasgow Coma Scale (GCS) of the pediatric patients requiring prehospital anesthesia (rapid sequence induction with drugs) and first-pass success rates by clinician group was also performed. RESULTS: Of the pediatric patients, 15.8% required intubation. The overall first-pass success rate for intubation (including in cardiac arrest) was 83.5%; for prehospital anesthesia (drugs administered), it was 98.4%. First-pass success rates were lowest for those under 2 years of age (45.2% without drugs and 87.5% with drugs). There was no difference between physician background in the first-pass success rate. The median GCS for pediatric prehospital anesthesia was 7 versus 5 for adults (P = .012). No children with an initial GCS of 15 had prehospital anesthesia. CONCLUSION: The overall intubation first-pass success rates for pediatric patients is high at 83.5% and higher still for prehospital anesthesia (98.4%). However, it remains a rare intervention for clinicians, and children under 2 years of age require special consideration.


Assuntos
Resgate Aéreo , Serviços Médicos de Emergência , Medicina de Emergência , Adulto , Humanos , Criança , Lactente , Estudos Retrospectivos , Aeronaves , Intubação Intratraqueal
6.
Air Med J ; 43(2): 111-115, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38490773

RESUMO

OBJECTIVE: Interhospital transfer by air (IHTA) represents the majority of helicopter air ambulance transports in the United States, but the evaluation of what factors are associated with utilization has been limited. We aimed to assess the association of geographic distance and hospital characteristics (including patient volume) with the use of IHTA. METHODS: This was a multicenter, retrospective study of helicopter flight request data from 2018 provided by a convenience sample of 4 critical care transport medicine programs in 3 US census regions. Nonfederal referring hospitals located in the home state of the associated critical care transport medicine program and within 100 miles of the primary receiving facility in the region were included if complete data were available. We fit a Poisson principal component regression model incorporating geographic distance, the number of emergency department visits, the number of hospital discharges, case mix index, the number of intensive care unit beds, and the number of general beds and tested the association of the variables with helicopter emergency medical services utilization. RESULTS: A total of 106 referring hospitals were analyzed, 21 of which were hospitals identified as having a consistent request pattern. Using the hospitals with a consistent referral pattern, geographic distance had a significant positive association with flight request volume. Other variables, including emergency department visit volume, were not associated. Overall, the included variables offered poor explanatory power for the observed variation between referring facilities in the use of IHTA (r2 = 0.09). Predicted flights based on the principal component regression model for all referring hospitals suggested the majority of referring hospitals used multiple flight programs. CONCLUSION: Geographic distance is associated with the use of IHTA. Unexpectedly, most basic hospital characteristics are not associated with the use of IHTA, and the degree of variation between referring facilities that is explained by patient volume is limited. The evaluation of nonhospital factors, such as the density and availability of critical care or advanced life support ground emergency medical services resources, is needed.


Assuntos
Resgate Aéreo , Serviços Médicos de Emergência , Humanos , Estados Unidos , Estudos Retrospectivos , Hospitais , Aeronaves
7.
Air Med J ; 43(2): 177-182, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38490785

RESUMO

OBJECTIVE: Timely access to a lead trauma hospital (LTH) saves lives; however, the vast geography of Northern Ontario creates a barrier to equitable access to an LTH. Paramedics in Ontario follow the field trauma triage standard (FTTS) to identify which patients should be directly brought to an LTH. A pilot project was launched using a fixed wing modified scene response (MSR) to transport patients from Northern Ontario who met the FTTS directly to an LTH. This study aimed to 1) explore the impact of the fixed wing MSR pilot program on the time to LTH arrival for injured patients in Northern Ontario compared with the traditional interfacility transfer (IFT) process and 2) determine the frequency and specific FTTS criteria that were fulfilled. METHODS: This was a retrospective cohort study of injured patients in Northern Ontario who were emergently transported to an LTH by the provincial air ambulance service between January 2016 and October 2021. Electronic patient care records were manually reviewed, and patient cases were grouped by their sending and receiving facilities to evaluate time differences between MSR and IFT. RESULTS: For same-distance transports, the average time from injury to trauma center arrival was reduced with MSR (292.8 minutes) compared with IFT (507.8 minutes), with a mean difference of 130.3 minutes. All MSR cases and 90% of IFT cases met at least 1 FTTS criterion. CONCLUSION: Fixed wing MSR improves access to timely definitive care for injured patients in Northern Ontario, and all patients transported in this pilot project met the trauma bypass criteria.


Assuntos
Resgate Aéreo , Humanos , Projetos Piloto , Ontário , Estudos Retrospectivos , Triagem , Centros de Traumatologia
8.
Air Med J ; 43(2): 101-105, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38490771

RESUMO

OBJECTIVE: Overtriage (ie, delivering less severely injured patients via helicopter) is costly, raises safety concerns, and reduces efficiency of the trauma system. The Air Medical Prehospital Triage (AMPT) scoring system was developed to determine which trauma patients would gain a survival benefit by air transport. The objective of this study was to evaluate the AMPT scoring system as a method of reducing trauma overtriage when helicopter emergency medical services were used. METHODS: A retrospective study of all scene trauma transports delivered by helicopter to 1 of 2 level 1 trauma centers was evaluated for 1) hospital stay less than 1 day and 2) failure to meet 1 of the following criteria for resource utilization: intensive care unit admission, an operative procedure within the first 24 hours, the need for blood products, Injury Severity Score ≥ 16, or death during hospitalization. Helicopter emergency medical services personnel recorded specific criteria from the Centers for Disease Control and Prevention (CDC) field trauma triage guidelines and AMPT that were met by transported trauma patients. RESULTS: There were 244 patients in the study population. Eighty-one (33.2%) patients were discharged within 24 hours; 11 (13.5%) of these patients were positive using AMPT scoring, whereas 44 (54.3%) patients met 1 of the CDC criteria. Similarly, 141 (57.8%) patients failed to meet 1 of the level 1 resource criteria; 19 (13.5%) met the AMPT criteria for air medical transport, whereas 84 (59.6%) met 1 of the CDC criteria. Undertriage was 63.5% for AMPT and 20.2% for CDC based on resource utilization criteria. CONCLUSION: The AMPT score reduced the number of patients who were inappropriately transported to a trauma center. However, this appeared to be at the expense of undertriage. Future studies should focus on developing a refined air medical-specific triage tool that has both low overtriage rates as well as lower undertriage rates.


Assuntos
Resgate Aéreo , Serviços Médicos de Emergência , Ferimentos e Lesões , Humanos , Triagem , Centros de Traumatologia , Estudos Retrospectivos , Escala de Gravidade do Ferimento , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia
9.
Air Med J ; 43(2): 140-145, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38490777

RESUMO

OBJECTIVE: Hemorrhage remains the most common cause of preventable death after trauma. Prehospital blood product (PHBP) administration may improve outcomes. No data are available about PHBP use in Italian helicopter emergency medical services (HEMS). The primary aim of this survey was to establish the degree of PHBP used throughout Italy. The secondary aims were to evaluate the main indications for their use, the opinions about PHBPs, and users' experience. METHODS: The study group performed a telephone/e-mail survey of all 56 Italian HEMS bases. The questions concerned whether PHBPs were used in their HEMS bases, the frequency of transfusions, the PHBP used, and the perceived benefits. RESULTS: Four of 56 HEMS bases use PHBPs. Overall, 7% have prehospital access to packed red cells and only 1 to fresh plasma. In addition to blood product administration, 4 of 4 use tranexamic acid, and 3 of 4 also use fibrinogen. Seventy-five percent use PHBPs once a month and 25% once a week. The users' experience was that PHBPs are beneficial and lifesaving. CONCLUSION: Only 4 of 56 HEMS in Italy use PHBPs. There is an absolute consensus among providers on the benefit of PHBPs despite the lack of evidence on PHBP use.


Assuntos
Resgate Aéreo , Serviços Médicos de Emergência , Humanos , Aeronaves , Transfusão de Sangue , Itália , Estudos Retrospectivos
10.
Air Med J ; 43(2): 90-95, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38490791

RESUMO

OBJECTIVE: Recent systematic reviews of acute care medicine applications of artificial intelligence (AI) have focused on hospital and general prehospital uses. The purpose of this scoping review was to identify and describe the literature on AI use with a focus on applications in helicopter emergency medical services (HEMS). METHODS: A literature search was performed with specific inclusion and exclusion criteria. Articles were grouped by characteristics such as publication year and general subject matter with categoric and temporal trend analyses. RESULTS: We identified 21 records focused on the use of AI in HEMS. These applications included both clinical and triage uses and nonclinical uses. The earliest study appeared in 2006, but over one third of the identified studies have been published in 2021 or later. The passage of time has seen an increased likelihood of HEMS AI studies focusing on nonclinical issues; for each year, the likelihood of a nonclinical focus had an odds ratio of 1.3. CONCLUSION: This scoping review provides overview and hypothesis-generating information regarding AI applications specific to HEMS. HEMS AI may be ultimately deployed in nonclinical arenas as much as or more than for clinical decision support. Future studies will inform future decisions as to how AI may improve HEMS systems design, asset deployment, and clinical care.


Assuntos
Resgate Aéreo , Serviços Médicos de Emergência , Humanos , Inteligência Artificial , Aeronaves , Triagem
12.
Scand J Trauma Resusc Emerg Med ; 32(1): 21, 2024 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-38500142

RESUMO

BACKGROUND: Recently, the Norwegian Helicopter Emergency Medical Service (HEMS) has developed a procedure for a special type of static rope rescue operation, referred to as the offset technique. In this technique, the helicopter is offset from the accident site, and the HEMS technical crew member uses an offset throw line to gain access to the scene. Today, there is little practical experience of such operations, and a need has been identified for more knowledge on the potential hazards encountered during this type of operation. Such knowledge is of importance for further development of the procedure for the offset technique. OBJECTIVE: To identify potential hazards for helicopter rescue operations using the static rope offset technique and, thereby, to improve the procedure for such operations. This may lead to improved safety for patients and crew members during offset rescue operations. METHOD: A Safe Job Analysis was used to identify the hazards of offset rescue operations. Such operations are divided into tasks and sub-tasks. For each sub-task, we identified potential hazards and suggested ways of preventing these. RESULTS: Through the Safe Job Analysis, we suggest some changes in the existing procedure for the offset technique, to make it more robust against potential hazards. CONCLUSION: We have demonstrated the value of Safe Job Analysis for improving the static rope offset evacuation procedure. Our analysis has led to some changes in the procedure for offset rescue operations. This is the importance of having two throw lines and focusing on "why" in the procedure.


Assuntos
Resgate Aéreo , Serviços Médicos de Emergência , Humanos , Aeronaves , Serviços Médicos de Emergência/métodos , Noruega
13.
Scand J Trauma Resusc Emerg Med ; 32(1): 17, 2024 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-38448994

RESUMO

BACKGROUND: Improving oxygenation and ventilation in drowning patients early in the field is critical and may be lifesaving. The critical care interventions performed by physicians in drowning management are poorly described. The aim was to describe patient characteristics and critical care interventions with 30-day mortality as the primary outcome in drowning patients treated by the Danish Air Ambulance. METHODS: This retrospective cohort study with 30-day follow-up identified drowning patients treated by the Danish Air Ambulance from January 1, 2016, through December 31, 2021. Drowning patients were identified using a text-search algorithm (Danish Drowning Formula) followed by manual review and validation. Operational and medical data were extracted from the Danish Air Ambulance database. Descriptive analyses were performed comparing non-fatal and fatal drowning incidents with 30-day mortality as the primary outcome. RESULTS: Of 16,841 dispatches resulting in a patient encounter in the six years, the Danish Drowning Formula identified 138 potential drowning patients. After manual validation, 98 drowning patients were included in the analyses, and 82 completed 30-day follow-up. The prehospital and 30-day mortality rates were 33% and 67%, respectively. The National Advisory Committee for Aeronautics severity scores from 4 to 7, indicating a critical emergency, were observed in 90% of the total population. They were significantly higher in the fatal versus non-fatal group (p < 0.01). At least one critical care intervention was performed in 68% of all drowning patients, with endotracheal intubation (60%), use of an automated chest compression device (39%), and intraosseous cannulation (38%) as the most frequently performed interventions. More interventions were generally performed in the fatal group (p = 0.01), including intraosseous cannulation and automated chest compressions. CONCLUSIONS: The Danish Air Ambulance rarely treated drowning patients, but those treated were severely ill, with a 30-day mortality rate of 67% and frequently required critical care interventions. The most frequent interventions were endotracheal intubation, automated chest compressions, and intraosseous cannulation.


Assuntos
Resgate Aéreo , Afogamento , Humanos , Seguimentos , Estudos Retrospectivos , Cuidados Críticos , Dinamarca/epidemiologia
14.
Scand J Trauma Resusc Emerg Med ; 32(1): 20, 2024 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-38475832

RESUMO

BACKGROUND: Accurate haemodynamic monitoring in the prehospital setting is essential. Non-invasive blood pressure measurement is susceptible to vibration and motion artefact, especially at extremes of hypotension and hypertension: invasive arterial blood pressure (IABP) monitoring is a potential solution. This study describes the largest series to date of cases of IABP monitoring being initiated prehospital. METHODS: This retrospective observational study was conducted at East Anglian Air Ambulance (EAAA), a UK helicopter emergency medical service (HEMS). It included all patients attended by EAAA who underwent arterial catheterisation and initiation of IABP monitoring between 1st February 2015 and 20th April 2023. The following data were retrieved for all patients: sex; age; aetiology (medical cardiac arrest, other medical emergency, trauma); site of arterial cannulation; operator role (doctor/paramedic); time of insertion and, where applicable, times of pre-hospital emergency anaesthesia, and return of spontaneous circulation following cardiac arrest. Descriptive analyses were performed to characterise the sample. RESULTS: 13,556 patients were attended: IABP monitoring was initiated in 1083 (8.0%) cases, with a median age 59 years, of which 70.8% were male. 546 cases were of medical cardiac arrest: in 22.4% of these IABP monitoring was initiated during cardiopulmonary resuscitation. 322 were trauma cases, and the remaining 215 were medical emergencies. The patients were critically unwell: 981 required intubation, of which 789 underwent prehospital emergency anaesthesia; 609 received vasoactive medication. In 424 cases IABP monitoring was instituted en route to hospital. CONCLUSION: This study describes over 1000 cases of prehospital arterial catheterisation and IABP monitoring in a UK HEMS system and has demonstrated feasibility at scale. The high-fidelity of invasive arterial blood pressure monitoring with the additional benefit of arterial blood gas analysis presents an attractive translation of in-hospital critical care to the prehospital setting.


Assuntos
Resgate Aéreo , Serviços Médicos de Emergência , Parada Cardíaca , Monitorização Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Pressão Sanguínea , Pressão Arterial , Estudos Retrospectivos , Estado Terminal , Aeronaves , Reino Unido
15.
Crit Care Nurs Q ; 47(2): 126-142, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38419176

RESUMO

Air medical providers are responsible for the care of an incredibly diverse patient population. When it is time to transport a patient, providers must be prepared for complex situations, each requiring different skills, medications, and critical thinking. Scene flights will have providers landing and providing care in the prehospital setting where an interfacility transport requires the patient to be taken from one hospital to another. Specialty flights require special equipment, personnel, and aircraft preparedness to be completed. The case studies provided within this article highlight the complexity and diversity that is encountered each shift at Allegheny LifeFlight.


Assuntos
Resgate Aéreo , Serviços Médicos de Emergência , Humanos , Hospitais , Estudos Retrospectivos
16.
Crit Care Nurs Q ; 47(2): 102-110, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38419173

RESUMO

In Pittsburgh, Pennsylvania, the skies have become a battleground against time in a world where every second counts. Since its inception in 1978, a revolution has occurred in emergency medical services, with LifeFlight Helicopters soaring to new heights in emergency treatment and transport. This article will explore the transformation of helicopter emergency medical services through the decades, where every rotor blade spins with a mission to save lives and rewrite the rules of survival. Allegheny Health Network's LifeFlight is a rotor-wing (helicopter) aeromedical transport service that provides rapid emergent transport for critically ill and injured persons. The program hub of operations is primarily in Western Pennsylvania. Since its inception in 1978, the program has grown and transformed into the sophisticated, highly technical, expanded scope of practice, critical care transport service it is today. The crews spend a significant portion of clinical care focusing on preparing the patient to survive the transport and ensure stability during transit; this phase of transport is equally crucial as the patient care during the actual flight. This article introduces the evolution and innovations that LifeFlight's medical crews and aviation practices have undergone since the program started.


Assuntos
Resgate Aéreo , Serviços Médicos de Emergência , Humanos , Cuidados Críticos , Pennsylvania , Estado Terminal
17.
Crit Care Nurs Q ; 47(2): 143-151, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38419177

RESUMO

The air medical transport industry places a high value on developing and maintaining a culture of safety due to the higher risk nature of its operations. The dynamic nature of response and transport, inherent risks involved with flight, lack of supporting resources, weather conditions, and austere nature of the transport environment are all factors that highlight the need for enhanced safety. As such, the air medical transport industry has developed a robust and unique approach to provider and patient safety involving many tactics not otherwise used in other areas of health care. This article describes some of the unique safety features and approaches that are commonplace in the air medical transport industry and proposes a means for these initiatives to other areas of the health care system.


Assuntos
Resgate Aéreo , Segurança do Paciente , Humanos
18.
Pan Afr Med J ; 47: 41, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38371650

RESUMO

High blood pressure is a major cardiovascular risk factor closely linked to serious cardiovascular events. A real public health problem affecting more than one in three adults. Aircrew does not escape this pathology, despite very strict medical selection and rigorous and regular medical monitoring by the aircrew doctor during revision visits. We conducted a retrospective study at the medical expertise center for aircrew in Rabat which made it possible to collect 34 hypertensive civilian aircrew for 10 years, from January 2012 to December 2022. The median age at the time of the study was 56.5. The aeronautical specialties practiced by our aircrew population were dominated by class 1. The prevalence of hypertension in Moroccan civilian aircrew: out of 2000 monitored annually at the Aeromedical Expertise Center for 10 years, 34 cases were collected, i.e.: 1.7%. The average age of discovery was 49 years and in 23 cases the diagnosis was established by systematic screening during periodic fitness visits. More than 24 aircrews had no family history of hypertension. On the therapeutic level, lifestyle and dietary measures were systematically prescribed in all our aircrew, 18 patients were put on monotherapy, 11 on dual therapy, and 2 on triple therapy. Compared to fitness decisions, they were variable according to the grade of hypertension, the control of complications, and the aeronautical function. The discovery of hypertension in aircrew can jeopardize aviation safety with the risk of subtle or sudden incapacity in flight through neurological or cardiovascular complications, which could impact the fitness decision. However, advances in medicine and the management of hypertension made in recent years have prompted the medical and aeronautical authorities to revise the standards of aptitude.


Assuntos
Resgate Aéreo , Aviação , Hipertensão , Militares , Adulto , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Hipertensão/epidemiologia , Hipertensão/diagnóstico , Prevalência
19.
Scand J Trauma Resusc Emerg Med ; 32(1): 12, 2024 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-38347604

RESUMO

BACKGROUND: Pre-Hospital Emergency Anaesthesia (PHEA) has undergone significant developments since its inception. However, optimal drug dosing remains a challenge for both medical and trauma patients. Many prehospital teams have adopted a drug regimen of 3 mcg/kg fentanyl, 2 mg/kg ketamine and 1 mg/kg rocuronium ('3:2:1'). At Essex and Herts Air Ambulance Trust (EHAAT) a new standard dosing regimen was introduced in August 2021: 1 mcg/kg fentanyl, 2 mg/kg ketamine and 2 mg/kg rocuronium (up to a maximum dose of 150 mg) ('1:2:2'). The aim of this study was to evaluate the cardiorespiratory consequences of a new attenuated fentanyl and augmented rocuronium dosing regimen. METHODS: A retrospective study was conducted at EHAAT as a service evaluation. Anonymized records were reviewed from an electronic database to compare the original ('3:2:1') drug dosing regimen (December 2019-July 2021) and the new ('1:2:2') dosing regimen (September 2021-May 2023). The primary outcome was the incidence of absolute hypotension within ten minutes of induction. Secondary outcomes included immediate hypertension, immediate hypoxia and first pass success (FPS) rates. RESULTS: Following exclusions (n = 121), 720 PHEA cases were analysed (360 new vs. 360 original, no statistically significant difference in demographics). There was no difference in the rate of absolute hypotension (24.4% '1:2:2' v 23.8% '3:2:1', p = 0.93). In trauma patients, there was an increased first pass success (FPS) rate with the new regimen (95.1% v 86.5%, p = 0.01) and a reduced incidence of immediate hypoxia (7.9% v 14.8%, p = 0.05). There was no increase in immediate hypertensive episodes (22.7% vs. 24.2%, p = 0.73). No safety concerns were identified. CONCLUSION: An attenuated fentanyl and augmented rocuronium dosing regimen showed no difference in absolute hypotensive episodes in a mixed cohort of medical and trauma patients. In trauma patients, the new regimen was associated with an increased FPS rate and reduced episodes of immediate hypoxia. Further research is required to understand the impact of such drug dosing in the most critically ill and injured subpopulation.


Assuntos
Resgate Aéreo , Anestesia , Serviços Médicos de Emergência , Hipotensão , Ketamina , Poli-Hidroxietil Metacrilato/análogos & derivados , Humanos , Fentanila , Rocurônio , Ketamina/farmacologia , Estudos Retrospectivos , Hipóxia
20.
Sante Publique ; 35(5): 7-12, 2024 01 03.
Artigo em Francês | MEDLINE | ID: mdl-38172052

RESUMO

The main objective of this work was to develop a tool to assist the activation of a helicopter emergency medical service (HEMS) for the SAMU 14. We opted for a methodology based on "guidelines of good professional practice." Simple consensus was used. A multidisciplinary working group (pilots, medical regulation assistants, doctors) was created. Subgroup meetings (pilots, medical regulation assistants, doctors) developed subparts of the tool. The assembly of the tool's subparts was reviewed by the working group and then by an independent reading group. This work enabled the consensual creation of a tool to support the use of the helicopter emergency medical service (HEMS) for the SAMU 14. It is composed of maps, a protocol, and a written procedure of activation. This methodology by "simple consensus" allowed the development of a tool rationalizing the activation of the helicopter emergency medical service (HEMS) for the SAMU 14. It was the first work of this type within the SAMU 14. This simple and transposable methodology could be used in other emergency centers or for other multidisciplinary protocols.


L'objectif principal de ce travail était la création d'un outil d'aide au déclenchement d'un SMUR héliporté au SAMU 14. Nous avons opté pour une méthodologie type « recommandations de bonnes pratiques professionnelles ¼ (RBPP). Le consensus simple a été utilisé. Un groupe de travail multidisciplinaire (pilotes, assistant de régulation médicale [ARM], médecins) a été créé. Des réunions en sous-groupe (pilote, ARM et médecins) ont permis d'élaborer des sous-parties de l'outil. L'assemblage des sous-parties de l'outil a été relu par le groupe de travail puis par un groupe de lecture autonome et validé en réunion de service. Ce travail a permis la création consensuelle d'un outil d'aide à l'emploi du vecteur héliporté en SMUR primaire au sein du SAMU 14. Il est composé de cartes, d'une fiche réflexe et d'une procédure écrite de déclenchement. Cette méthodologie par consensus simple a permis la création d'un outil rationalisant le déclenchement du vecteur héliporté pour le SAMU 14. Il s'agissait du premier travail de ce type au SAMU 14. Cette méthodologie simple et transposable pourrait être utilisée dans d'autres centres 15 ou pour d'autres protocoles multidisciplinaires.


Assuntos
Resgate Aéreo , Serviços Médicos de Emergência , Humanos , Consenso , Aeronaves , Pessoal Técnico de Saúde
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