The Value of Physicians as Part of a Helicopter Emergency Medical Services Crew: A Review.

OBJECTIVE: The benefit and utility of a physician on a US-based air ambulance is an often-debated topic in the prehospital setting. There remains the question of what, if any, effect a physician crewmember has on patient outcome. Our goal was to assess the literature to date and determine if there exists a benefit to staffing air ambulances with physicians. METHODS: PubMed and Cochrane databases were searched for English language studies from 1980 to 2020 using the terms "flight physician" and "physician-staffed helicopter." Studies were chosen for inclusion based on the presence of a comparison of physician-staffed crews with non-physician-staffed crews. The included studies had their references reviewed for additional studies meeting the inclusion criteria. RESULTS: A total of 19 articles were included, and their overall opinion of the benefit of a physician was assessed. Ten studies demonstrated a benefit, 8 showed no benefit or favored a nonphysician crew, and 1 was equivocal. CONCLUSIONS: Although some studies showed a benefit to having physicians staff an air ambulance, some showed no benefit, leaving our findings inconclusive. More data are needed to determine if the inclusion of these crewmembers has a positive effect on patient outcomes.

Acute Alcohol Use and Injury Patterns in Young Adult Prehospital Patients.

The objective was to determine if acute alcohol consumption is associated with differences in injury pattern among young adult patients with traumatic injuries presenting to emergency medical services (EMS). A cross-sectional, retrospective review of prehospital patient care reports (PCRs) was conducted evaluating injured patients who presented to a collegiate EMS agency from January 1, 2011 to December 31, 2012. Included patients were age 18-24 y and sustained an injury within the previous 24 h. PCRs were reviewed independently by two abstractors to determine if the patient was documented to have acutely consumed alcohol proximate to his/her injury. Primary and secondary sites of regional body injury were recorded. Injury severity was recorded using the Revised Trauma Score (RTS). The association between primary injury site and acute alcohol use was assessed using a chi-square test. Multiple logistic regression was used to control for sex in predicting injury type. Of 440 injured patients, 135 (30.6%) had documented alcohol use prior to injury. Acute alcohol consumption altered the overall pattern of regional injury (p < 0.001). Alcohol users were more likely to present with injury secondary to assault, fall/trip, and unknown mechanism of injury (p < 0.001, all comparisons). RTS scores were statistically lower in the alcohol group (p < 0.001), although the clinical significance of this is unclear. Controlling for sex, acute alcohol consumption predicted increased risk of head/neck injury 5.59-fold (p < 0.001). Acute alcohol use in collegiate EMS patients appears to alter injury patterns in young adults and increases risk of head/neck injury. EMS providers in similar agencies should consider these trends when assessing and treating injured college-aged patients.

Online Medical Control for EMS: A Lecture and Case-Based Teaching Module.

Introduction: The provision of real-time medical direction to emergency medical services (EMS) providers is a core skill for the emergency physician, yet it is one with a wide variability of training received within residency. Methods: We developed a complete training module for providing online medical control to EMS providers, including two lectures, multiple case-based scenarios for practice via two-way radio, a survey of participants' self-perceived knowledge and comfort in this area, and a postmodule knowledge test. Participants completed the survey both before and after the module. The module was given during the regularly scheduled didactic conference series. There were 22 participants, some of whom were attendings and medical students. Results: The survey responses showed a statistically significant improvement after completion of the module for all questions, including improved self-perceived comfort with providing online medical control. Additionally, all participants passed the postmodule knowledge test with a mean score of 95%. Discussion: This module was well received and showed significant results in improving the participants' self-perceived and tested knowledge of EMS as well as their comfort with providing online medical control. The module offers an excellent baseline training experience for use by other residencies or agency medical directors.

Functional characterization of kurtz, a Drosophila non-visual arrestin, reveals conservation of GPCR desensitization mechanisms.

The arrestins are a family of molecules that terminate signaling from many different G protein-coupled receptors, by inhibiting the association between receptor and downstream effectors. We recently employed a human betaarrestin2-GFP fusion protein to explore the dynamics of different neuropeptide receptors in Drosophila and have previously used a betaarrestin translocation assay to identify ligands at orphan receptors. Here, we report that the Drosophila arrestin encoded by kurtz functions in a similar fashion and can be employed to investigate GPCR-arrestin associations. Specifically, a GFP-krz fusion protein, upon co-expression with various Drosophila peptide receptors, an amine receptor, and a mammalian peptide receptor translocates to the plasma membrane in specific response to ligand application. This molecular phenotype is exhibited in a mammalian cell line as well as in a Drosophila cell line. Notably, the details of receptor-arrestin associations in terms of endocytotic patterns are functionally conserved between the mammalian arrestins and kurtz. Furthermore, we report that kurtz mutants exhibit hypersensitivity to osmotic stress, implicating GPCR desensitization as an important feature of the endocrine events that shape this stress response.