Patients Air Medical Transport During the COVID-19 Pandemic: A Retrospective Cohort Study.

INTRODUCTION: Air medical transport during the coronavirus disease 2019 pandemic was essential for transferring critically ill patients. This study aimed to comparatively analyze air-transported patients with and without coronavirus disease 2019 according to their clinical condition and complications that occurred during the flight. METHODS: This was a retrospective cohort study that analyzed the digital records of adult patients transported by fixed-wing aircraft from the interior of the state of Amazonas to the state capital Manaus, Brazil, from June 2019 to May 2021. Pearson's chi-squared, Fisher exact, and Wilcoxon-Mann-Whitney tests were applied (significance level of P < .05). RESULTS: The sample consisted of 741 patients (60.59% men, median age 54 years). The incidence of complications during the flight was 7.28%, with emphasis on dyspnea, psychomotor agitation, and pain. There was a significant difference between patients with (n = 466) and without coronavirus disease 2019 (n = 275) regarding the variables age (P < .001), comorbidities (P < .001), body mass index (P < .001), impact (P < .001) and priority (P = .002) of the transfer, physiological severity (P < .001), use of vasoactive drugs when boarding the aircraft (P = .033), and occurrence of respiratory complications during air medical transport (P = .003). DISCUSSION: Patients with coronavirus disease 2019 were older, had more comorbidities and were severely ill, and had higher body mass index, frequency of vasoactive drug use, and respiratory complications. Although there are minimal differences among these patients, the role that interhospital transfer plays in reducing burden on local, less well-equipped hospitals is a primary role of medical transport, particularly during pandemics.

Noninferior Red Cell Concentrate Quality after Repeated Air Rescue Mission Transport for Prehospital Transfusion.

Background: Transfusion of red cell concentrates (RCCs) is an integral therapy after severe hemorrhage or trauma. Prehospital transfusion offers an immediate intervention in emergency cases. Air ambulance-based prehospital transfusion, already used in different countries, is currently established in Germany. Limited information is available for regulatory-compliant transport logistics of RCCs and their quality after repeated air rescue missions. Thus, the aim of this study was (i) to validate regulatory-compliant logistics and (ii) to assess product quality, analyzing biochemical parameters and RBC morphology. Study Design and Methods: Due to regulatory requirements, we adapted a rotation system of 1 day transport, 1 day quarantine storage and 1 day storage over the entire RCC shelf life. RCCs transported on air rescue missions (flight group) were compared against a control group, treated identically except for helicopter transport. RCCs were visually inspected, and their temperature was documented throughout the entire rotation cycles. RCCs at the end of shelf life (end point samples) were assessed for levels of hemoglobin, hematocrit, free hemoglobin, hemolysis, mean corpuscular volume, potassium and pH. In addition, morphological changes were assessed using flow morphometry. Results: In total 81 RCCs were assessed in the flight group and 50 in the control group. Within the flight group, 30 RCCs were transfused. RCCs were dispatched on average 11 times (7-13 times). The average flight time was 18.3 h (6.6-28.8 h). The rotation system ensured adherence to regulatory guidelines, especially compliance to storage conditions of +2 to +6°C of intermediate storage. Biochemical and morphological quality parameters did not exhibit any changes upon repeated air rescue missions. A correlation with respect to the flight time was not observed either. Discussion: The quality of RCCs after repeated air rescue missions is noninferior to control samples regarding biochemical and morphological parameters. The product quality is within German regulations for up to 42 days of storage. The logistics and maintenance of the thermal conditions are safe and feasible. Thus, a rotation system of RCCs offers a regulatory-compliant option to supply air rescue missions with RCCs to allow life-saving prehospital transfusions at the incident scene.

Air Rescue for Pediatric Trauma in a Metropolitan Region of Brazil: Profiles, Outcomes, and Overtriage Rates.

Besides ensuring a quick response and transport of trauma victims, helicopter support also involves risks to patients and professionals and has higher operational costs. Studying prehospital triage criteria and their relationship with patient overtriage and outcomes is important, particularly in newly established services and in developing countries with limited health budgets. This could help improve the use of the helicopter rescue and provide better management of the costs and risks related to it. The objective of this study was to determine the epidemiologic and severity profiles of pediatric victims of trauma attended by helicopter in a Brazilian Metropolitan Area to evaluate the outcomes and overtriage rates related to pediatric air rescue in the region. We conducted an observational and retrospective study using 49 hospital and prehospital records from victims of trauma aged <18 years old (yo) assisted by helicopter and then transferred to a tertiary University Hospital. Of the 49 patients, 39 (79.6%) individuals were male, and the mean age was 11.3 yo. Vehicular collisions accounted for 15 (30.6%) of the traumas, and traumatic brain injuries occurred in 28 (57.1%) cases. A total of 29 (59.1%) individuals had severe trauma (Injury Severity Score; ISS >15), and 34 (69.4%) required admission to the intensive care unit. Overtriage varied from 18.4 to 40.8% depending on the criteria used for its definition, being more frequent in individuals aged between 1 and 5 yo. Death occurred in 10 (20.4%) patients. On prehospital evaluation, we classified 29/32 (90.6%) patients with severe trauma according to the Pediatric Trauma Score (PTS ≤8) and 18/25 (72%) according to the Revised Trauma Score (RTS ≤11). Of these, 7/29 (24.1%) and 6/18 (33.3%), respectively, presented ISS <15 at in-hospital evaluation. None of the patients with PTS >8 and 3/7 (42.8%) of those with RTS >11 presented ISS >15. In conclusion, air rescue of pediatric trauma victims was used mainly for critically ill individuals, resulting in rates of overtriage compatible with that found in the literature. PTS showed the lowest rates of overtriage within excellent rates of undertriage.

Caracterização de vídeos no youtube sobre o transporte aeromédico do politraumatizado / Caracterización de videos en youtube sobre el traslado aeromédico del politraumatizado / Characterization of videos on youtube about the aeromedical transport of multiple trauma patients

Objetivo: caracterizar os vídeos do YouTube sobre o transporte aeromédico do politraumatizado. Método: estudo descritivo e quantitativo, realizado mediante acesso à plataforma de vídeos YouTube, entre julho e setembro de 2021, com utilização de instrumento composto por 13 variáveis que foram tabuladas e analisadas de maneira descritiva por software. Resultados: foram encontrados quatro vídeos, postados entre 2018 e 2021, dos quais a maioria foi postada em canais pessoais, em sua maior parte destinados aos profissionais da saúde, com predominância de médicos na narração. Os vídeos com mais inscritos nos canais e aqueles mais curtos obtiveram maior número de visualizações. Conclusão: os vídeos da plataforma YouTube sobre o transporte aeromédico do politraumatizado foram voltados aos profissionais da saúde, no entanto, há carência de citação de portarias, conselhos profissionais, legislações, além de atribuições dos profissionais que atuam no cuidado de saúde ao paciente com múltiplos traumas nesse tipo de transporte(AU)

Objective: to characterize YouTube videos about the aeromedical transport of polytraumatized patients. Method: descriptive and quantitative study, carried out through access to the YouTube video platform, between July and September 2021, using an instrument composed of 13 variables that were tabulated and analyzed in a descriptive way by software. Results: four videos were found, posted between 2018 and 2021, most of which were posted on personal channels, mostly aimed at health professionals, with a predominance of doctors in the narration. The videos with the most subscribers on the channels and the shortest ones got the most views. Conclusion: the videos on the YouTube platform about the aeromedical transport of polytraumatized patients were aimed at health professionals, however, there is a lack of citation of ordinances, professional advice, legislation, in addition to the attributions of professionals who work in health care for patients with multiple trauma in this type of transport(AU)

Objetivo: caracterizar videos de YouTube sobre el transporte aeromédico de pacientes politraumatizados. Método: estudio descriptivo y cuantitativo, realizado a través del acceso a la plataforma de videos YouTube, entre julio y septiembreVde 2021, utilizando un instrumento compuesto por 13 variables que fueron tabuladas y analizadas de forma descriptiva porVsoftware. Resultados: se encontraron cuatro videos, publicados entre 2018 y 2021, la mayoría de los cuales fueron publicadosVen canales personales, en su mayoría dirigidos a profesionales de la salud, con predominio de médicos en la narración. LosVvideos con más suscriptores en los canales y los que eran más cortos tenían la mayor cantidad de vistas. Conclusión: los videosVen la plataforma de YouTube sobre el transporte aeromédico de pacientes politraumatizados fueron dirigidos a los profesionalesVde la salud, sin embargo, falta la citación de ordenanzas, consejos profesionales, legislación, además de las atribuciones de losVprofesionales que actúan en la atención de la salud para pacientes politraumatizados en este tipo de transporte.(AU)

Categorização dos pontos estratégicos da fisiologia de voo para o transporte aeromédico / Categorización de puntos estratégicos de fisiología de vuelo para el transporte aeromédico / Categorization of strategic points of flight physiology for aeromedical transport

Objetivo: Categorizar os pontos estratégicos da fisiologia de voo que possam interferir no transporte aeromédico.Método: Trata-se de um estudo de revisão integrativa de literatura, realizada com base no modelo PRISMA - Preferred Reporting ltems for Systematic Reviews and Meta-Analyses. A busca dos artigos foi realizada nos meses de agosto e setembro de 2021 . Resultado: Foram utilizados 1 O trabalhos, elencadas seis categorias: (i) Altitude; (ii) Áreas comuns que precisam de atenção; (iii) Forças de Aceleração; (iv) Hipóxia, (v) Preparação para o voo do paciente; (vi) Umidade, Temperatura e Gravidade. Conclusão: O transporte em aeronaves de asa fixa necessita de um conhecimento de fisiologia de voo, potenciais alterações na altitude, recomendações específicas, equipe de saúde e tripulação capacitadas para reconhecer e intervir. Assim como, possuam práticas avançadas, compartilhem as informações, maximizem os processos de segurança e qualidade no ambiente hipobárico. (AU)

Objective: To categorize the strategic points of flight physiology that may interfere with aeromedical transport.Method: This is an integrative literature review study, based on the PRISMA model - Preferred Reporting ltems for Systematic Reviews and Meta-Analyses. The search for articles was carried out in August and September 2021. Result: 1 O works were used, listed in six categories: (i) Altitude; (ii) Common areas that need attention; (iii) Acceleration Forces; (iv) Hypoxia, (v) Preparation for the patient's flight; (vi) Humidity, Temperature and Gravity. Conclusion: Transportation in fixed-wing aircraft requires knowledge of flight physiology, potential changes in altitude, specific recommendations, health care team and crew trained to recognize and intervene. As well as having advanced practices, share information, maximize safety and quality processes in the hypobaric environment.(AU)

Objetivo: Categorizar los puntos estratégicos de la fisiología dei vuelo que pueden interferir con el transporteaeromédico. Método: Este es un estudio de revisión de literatura integradora, basado en el modelo PRISMA - ftems de reporte preferidos para revisiones sistemáticas y metaanálisis. La búsqueda de artículos se realizá en los meses de agosto y septiembre de 2021. Resultado: se utilizaron 1 O obras, clasificadas en seis categorías: (i) Altitud; (ii) Áreas comunes que necesitan atención; (iii) Fuerzas de Aceleración; (iv) Hipoxia, (v) Preparación para el vuelo dei paciente; (vi) Humedad, temperatura y gravedad. Conclusión: EI transporte en aeronaves requiere conocimientos de fisiología de vuelo, posibles cambias de altitud, recomendaciones específicas, equipo de atención médica y tripulación capacitados para reconocer e intervenir. Además de contar con prácticas avanzadas, compartir información, maximizar los procesos de seguridad y calidad en el ambiente hipobárico(AU)

Hormonal and Subjectively Perceived Stress of the Emergency Physicians of the Airborne Rescue Service.

Due to their work activities, emergency physicians are regularly exposed to exceptional mental and physical situations. In order to prevent stress-related illnesses, the triggers of hormonal and subjectively perceived stress must be understood better. On a sample of emergency physicians from two air rescue services (N = 80), the cortisol awakening response (CAR) was determined on flight rescue days, clinic days, and days off. Pearson correlations showed significant connections between the CAR on flight rescue days and individual scales of the Trier Inventory for Chronic Stress (TICS) and the Perceived Stress Scale (PSS). The results indicate that a lower subjective stress level is associated with higher levels of hormonal stress. Stepwise regression analyses showed a significant influence of the number of professional years, subjectively perceived stress, pressure to succeed, and social isolation. The results suggest that the hormonal stress burden of emergency physicians is in a complex relationship with perceived strain.

Segurança do paciente no cotidiano de trabalho da equipe multiprofissional do transporte aeromédico inter-hospitalar / Patient safety in the daily work of the multidisciplinary inter-hospital air medical transport team

O presente estudo objetivou analisar a segurança do paciente no cotidiano de trabalho da equipe multiprofissional do transporte aeromédico inter-hospitalar (TAI). Trata-se de um estudo de caso qualitativo, que utilizou o referencial teórico de Michel de Certeau, realizado em uma empresa de transporte aéreo inter-hospitalar na cidade de Belo Horizonte, Minas Gerais. Foram incluídos na pesquisa os profissionais que atuavam com mais de um ano em TAI, sendo 35 profissionais entrevistados: 12 (34,29%) enfermeiros; 14 (40%) médicos; e 9 (25,71%) pilotos. Sendo excluídos os profissionais que possuíam menos de ano de atuação. A coleta de dados foi realizada em por meio de entrevistas individuais guiadas por meio de um roteiro semiestruturado, no período de agosto a setembro de 2019. O estudo foi aprovado pelo Comitê de Ética e Pesquisa da UFMG (COEP/UFMG), sob Parecer nº: 3.368.996. As entrevistas foram agendadas, realizada em ambiente privativo após esclarecimento da pesquisa mediante o termo de consentimento livre esclarecido (TCLE). Após a gravação na íntegra, foram transcritas e submetidas à Análise de Conteúdo Temática e Análise Documental dos prontuários dos pacientes transportados de 2012 a 2017. Os resultados foram organizados em quatro categorias temáticas: os sujeitos da pesquisa e o perfil de atendimentos no TAI; o ambiente de voo e o fazer da equipe multidisciplinar; o controle e a imprevisibilidade no TAI: estratégias e táticas no cotidiano de trabalho; e os elementos que configuram o contexto do TAI. Os resultados mostraram que os atendimentos são, na sua maioria, de pacientes do sexo masculino e portadores de doenças cardiovasculares, neurológicos e trauma. O trabalho é dinâmico, imprevisível em ambiente restrito. No cotidiano, prevalecem às normas das áreas da saúde e da aviação, enfocando os riscos nas duas áreas e o rigor adotado no TAI. Conclui-se que, os profissionais adotam novas maneiras de fazer para tornar o ambiente seguro e as circunstâncias de risco podem ser mitigadas pela equipe.

The presente study aimed to analyze patient safety in the daily work of a multidisciplinar team of inter-hospital air medical transport (TAI). This is a qualitative case study, which used the theoretical framework of Michel de Certeau and it was carried out in an inter-hospital air transport company in Belo Horizonte, Minas Gerais. This study enrolled 35 professionals who had worked for more than one year in TAI: 12 nurses (34.29%); 14 physicians (40%); and 9 pilots (25.71%). Professionals who had less than one year of work were excluded. Data collection occurred between August and September 2019, and was obtained through individual interviews guided by a semi-structured script. This study was approved by the Ethics and Research Committee of UFMG (COEP/UFMG - No.: 3.368.996). Interviews were scheduled and held in a private environment after research explanation and signing of the free informed consent term (TCLE). After being recorded in full, the interviews were transcribed and submitted to Thematic Content Analysis and Document Analysis of the medical records of patients transported from 2012 to 2017. Results were organized into four thematic categories: the research subjects and the profile of assistance in TAI; the flight environment and the role of the multidisciplinary team; control and unpredictability in TAI; strategies and tactics in daily work; and the elements that configure the TAI context. Our results showed that the assistances are mostly for male patients and patients with cardiovascular, neurological and trauma diseases. We also observed that working in inter-hospital medical transport is dynamic and unpredictable in a restricted environment. In a daily basis, health and aviation standards prevail, focusing on the risks in both areas and the rigor adopted at work. We concluded that professionals adopt new ways to make the environment safe and that risky circumstances can be mitigated by the team.

[Transdermal intoxication through broken opioid ampules : Accidental intoxication in a paramedic]. / Transdermale Intoxikation durch zerbrochene Opioidampullen : Akzidentelle Intoxikation bei einem Rettungsdienstmitarbeiter.

This article presents the case of an accidental transdermal opioid intoxication in a paramedic. During an ambulance flight mission for patient repatriation several ampules containing opioids were broken unnoticed inside the ampule kit in the outside pocket of the work trousers of the paramedic. He developed the typical clinical picture of opioid intoxication with clouding of consciousness, miosis, and respiratory depression. This necessitated continuous monitoring of vital signs as well as repetitive administration of naloxone under the improvised circumstances of a mission abroad.

Injury severity in polytrauma patients is underestimated using the injury severity score: a single-center correlation study in air rescue.

PURPOSE: Prehospital estimation of injury severity is essential for prehospital therapy, deciding on the destination hospital and the associated emergency room care. The aim of this study was to compare prehospital estimates of the abbreviated injury scale (AIS) and the Injury Severity Score (ISS) by emergency physicians with the values of AIS and ISS of injury severity determined at the conclusion of diagnostics. METHODS: In this prospective study, the ISS was determined prehospital by emergency physicians. The validated AIS and ISS were analyzed based on final diagnoses. A Bland-Altman plot was used in analyzing the agreement between two different assays as well as sensitivity and specificity were determined. Confidence intervals were calculated for a Wilson score. Significance level was set at p ≤ 0.05. RESULTS: The prehospital ISS was estimated at 26.0 ± 13.0 and was 34.7 ± 16.3 (p < 0.001) after in-hospital validation. In addition, most of the AIS subgroups were significantly higher in the final calculation than preclinically estimated (p < 0.05). When analyzing subgroups of trauma patients (ISS < 16 vs. ISS ≥ 16), we were able to demonstrate a sensitivity of > 90% to identify a multiple-trauma patient. Diagnosing a higher injury severity group (ISS ≥ 25), sensitivity dropped to 61.1%. The Bland-Altman plot demonstrates that injury severity is underestimated in higher injury levels. CONCLUSION: Multiple-trauma patients can be identified using the ISS. Anatomic scores might be used for transport decisions; however, an accurate estimation of the injury severity should also be based on other criteria such as patient status, mechanism of injury, and other triage criteria.

Specialist advice may improve patient selection for decompression therapy following diving accidents: a retrospective observational study.

BACKGROUND: Even in a landlocked country like Switzerland recreational diving is becoming more and more popular. Smaller lakes in the Alps are located at an altitude of 2500 m above sea level. The incidence of diving accidents among all helicopter emergency service missions and the consecutive medical knowledge about decompression injuries is low. Thus, a collaboration between the Swiss Air-Ambulance (Rega) and the divers alert network (DAN) was initiated to improve patient treatment and identification of decompression injury and necessity of hyperbaric oxygen therapy (HBO). METHODS: Retrospective observational study that includes all patients treated by the Rega which have been classified to have had a diving accident from 2005 to 2014. Patient and diving epidemiology was assessed and the impact of DAN collaboration on patient selection and identification of patients needing transport to HBO facilities were analysed. RESULTS: In the 10-year observational period 116 patients with diving accidents were treated by Rega. Mean patient age was 40 (SD 11) years and 95 (82%) were male. If the Rega emergency physician suspected a decompression injury (DCI), without DAN contact 27/28 (96%) of these patients were transported directly to a HBO facility, whereas with DAN contact only 53/63 (84%) needed transport to a HBO facility. DAN was involved in 66/96 (69%) of the cases with suspected DCI on scene, with a significant increase over time (p = 0.001). Mean flight time to HBO facilities was significantly longer (28.9, SD 17.7 min.), compared to non-HBO facilities (7.1, SD 3.2 min., p < 0.001). Due to specialist advice, patients may have been selected who finally did not need a transport to a HBO facility, although DCI was primarily suspected by the emergency physician on the scene. These patients experienced a significantly reduced flight time to the (non-HBO) hospital of 25.6 (SD 6.5) min. (p < 0.001). DISCUSSION: Collaboration of DAN and Rega may allow a safe patient selection and a consecutive reduction of flight time and costs. Due to international collaborations, evacuation to HBO-facilities for acute recompression therapy can be provided by HEMS within less than 30 min all over Switzerland. CONCLUSIONS: For diving accidents among HEMS missions, specialist advice by diving medicine specialists (DAN) appears mandatory to accurately identify and transport patients with decompression injury, as exposure of emergency physicians towards diving accidents and the diagnosis of DCI is low.

[Medical Emergency Preparedness in offshore wind farms : New challenges in the german north and baltic seas]. / Notfallmedizinische Versorgung in Offshore-Windparks : Neue Herausforderungen in der deutschen Nord- und Ostsee.

BACKGROUND: Offshore windfarms are constructed in the German North and Baltic Seas. The off-coast remoteness of the windfarms, particular environmental conditions, limitations in offshore structure access, working in heights and depths, and the vast extent of the offshore windfarms cause significant challenges for offshore rescue. Emergency response systems comparable to onshore procedures are not fully established yet. Further, rescue from offshore windfarms is not part of the duty of the German Maritime Search and Rescue Organization or SAR-Services due to statute and mandate reasons. Scientific recommendations or guidelines for rescue from offshore windfarms are not available yet. The present article reflects the current state of medical care and rescue from German offshore windfarms and related questions. The extended therapy-free interval until arrival of the rescue helicopter requires advanced first-aid measures as well as improved first-aider qualification. Rescue helicopters need to be equipped with a winch system in order to dispose rescue personnel on the wind turbines, and to hoist-up patients. For redundancy reasons and for conducting rendezvous procedures, adequate sea-bound rescue units need to be provided. In the light of experiences from the offshore oil and gas industry and first offshore wind analyses, the availability of professional medical personnel in offshore windfarms seems advisible. Operational air medical rescue services and specific offshore emergency reaction teams have established a powerful rescue chain. Besides the present development of medical standards, more studies are necessary in order to place the rescue chain on a long-term, evidence-based groundwork. A central medical offshore registry may help to make a significant contribution at this point.

The strategy of training staff for a new type of helicopter as an element of raising the security level of flight operations.

In 2008, the Polish Medical Air Rescue started replacing its fleet with modern EC135 machines. To ensure the maximum possible safety of the missions performed both in the period of implementing the change and later on, the management prepared a strategy of training its crews to use the new type of helicopter. The analysis of incidents that occurred during 2006-2009 showed that both the human and the technical factors must be carefully considered. Moreover, a risk analysis was conducted to reduce the risk both during general crew training and in the course of particular flight operations. A four-stage strategy of training pilots and crew members was worked out by weighing up all the risks. The analysis of data from 2010 to 2013 confirmed that the risk connected with flying and with all the activities involved in direct support aircraft operations is under control and lowered to an acceptable level.

Mannitol dosing error during interfacility transfer for intracranial emergencies.

OBJECT: Mannitol is commonly used to treat elevated intracranial pressure (ICP). The authors analyzed mannitol dosing errors at peripheral hospitals prior to or during transport to tertiary care facilities for intracranial emergencies. They also investigated the appropriateness of mannitol use based on the 2007 Brain Trauma Foundation guidelines for severe traumatic brain injury. METHODS: The authors conducted a retrospective review of the Shock Trauma Air Rescue Society (STARS) electronic patient database of helicopter medical evacuations in Alberta, Canada, between 2004 and 2012, limited to patients receiving mannitol before transfer. They extracted data on mannitol administration and patient characteristics, including diagnosis, mechanism, Glasgow Coma Scale score, weight, age, and pupil status. RESULTS: A total of 120 patients with an intracranial emergency received a mannitol infusion initiated at a peripheral hospital (median Glasgow Coma Scale score 6; range 3-13). Overall, there was a 22% dosing error rate, which comprised an underdosing rate (<0.25 g/kg) of 8.3% (10 of 120 patients), an overdosing rate (>1.5 g/kg) of 7.5% (9 of 120), and a nonbolus administration rate (>1 hour) of 6.7% (8 of 120). Overall, 72% of patients had a clear indication to receive mannitol as defined by meeting at least one of the following criteria based on Brain Trauma Foundation guidelines: neurological deterioration (11%), severe traumatic brain injury (69%), or pupillary abnormality (25%). CONCLUSIONS: Mannitol administration at peripheral hospitals is prone to dosing error. Strategies such as a pretransport checklist may mitigate this risk.

Factors Associated with Failure of Non-invasive Positive Pressure Ventilation in a Critical Care Helicopter Emergency Medical Service.

INTRODUCTION: Non-invasive positive pressure ventilation (NIPPV) is used to treat severe acute respiratory distress. Prehospital NIPPV has been associated with a reduction in both in-hospital mortality and the need for invasive ventilation. HYPOTHESIS/PROBLEM: The authors of this study examined factors associated with NIPPV failure and evaluated the impact of NIPPV on scene times in a critical care helicopter Emergency Medical Service (HEMS). Non-invasive positive pressure ventilation failure was defined as the need for airway intervention or alternative means of ventilatory support. METHODS: A retrospective chart review of consecutive patients where NIPPV was completed in a critical care HEMS was conducted. Factors associated with NIPPV failure in univariate analyses and from published literature were included in a multivariable, logistic regression model. RESULTS: From a total of 44 patients, NIPPV failed in 14 (32%); a Glasgow Coma Scale (GCS)<15 at HEMS arrival was associated independently with NIPPV failure (adjusted odds ratio 13.9; 95% CI, 2.4-80.3; P=.003). Mean scene times were significantly longer in patients who failed NIPPV when compared with patients in whom NIPPV was successful (95 minutes vs 51 minutes; 39.4 minutes longer; 95% CI, 16.2-62.5; P=.001). CONCLUSION: Patients with a decreased level of consciousness were more likely to fail NIPPV. Furthermore, patients who failed NIPPV had significantly longer scene times. The benefits of NIPPV should be balanced against risks of long scene times by HEMS providers. Knowing risk factors of NIPPV failure could assist HEMS providers to make the safest decision for patients on whether to initiate NIPPV or proceed directly to endotracheal intubation prior to transport.

Injury severity and seating position in accidents with German EMS helicopters.

INTRODUCTION: Accident rates and fatality rates for Helicopter Emergency Medical Service (HEMS) missions have been investigated recently, but none of these studies considered the influence of the seating position in the helicopter. The aim of the present descriptive and observational study was to analyze injury severity depending on the seating position during HEMS accidents in Germany. MATERIAL AND METHODS: Data from the German Federal Agency for Flight Accident Investigation was gathered for a period of 40 years (from 1970 to 2009). The seating position in the aircraft during the accident and the resulting injury severity (i.e., 1=no; 2=slight; 3=severe; and 4=fatal) were recorded. Injury severity was compared using the Fisher's exact test. P values <0.05 were considered statistically significant. RESULTS: A total of n=99 accidents were investigated (n=61 accidents did not lead to any injuries in the occupants, n=7 accidents resulted in minor, and n=6 in severe injuries, and lethal injuries resulted from n=15 accidents). The occupant in the "patient" position was most likely to suffer from deadly injuries (44.9%), followed by the HEMS crew member rear seat (25.0%), compared to lower lethality rates in the other seating positions (9.4-11.2%). Sitting on the HEMS crew member rear seat also was associated with the highest percentage of severe and minor injuries (12.5% each). CONCLUSIONS: In HEMS accidents, the patients' position and the HEMS crew member rear seat were found to be at the highest risk for fatal or severe injuries. These results support the urgent requirement of a large international data base for HEMS accidents as a basis for further studies to improve the safety in HEMS missions.

Results of thoracic drainages placed in air rescue.

INTRODUCTION: horax injuries are to be found in approximately 78% amongst all accident victims. Moreover, they implicate an increase in mortality rate. Consequently, an adequate contemporary treatment has to begin preclinically, even if the conditions are less comfortable than in a clinical setting. Emergency doctors need to be familiar with the placement of chest tubes. MATERIALS AND METHODS: From January 1, 2007 to December 31, 2010, emergency doctors of the rescue helicopter site Christoph 20 had to place chest tubes directly at the scene of an accident in 49 patients. These patients were now reidentified, and their clinical course was reevaluated. By means of apparative diagnostics, it was possible to analyze the location of the tubes tip. Following a comparison of the patient, outcome versus the quality of preclinical thoracic discharge could be made. RESULTS: The preclinical placement of a chest tube became necessary mainly because of a blunt thoracic trauma. This was predominantly related to victims of traffic accidents, whereas male victims clearly dominated. Forty-two of those patients received further treatment at the Klinikum Bayreuth hospital, enabling an analysis of the tubes location by CAT (computed axial tomography) scan. Six patients had been discharged on both sides, contributing to 48 tube tips that could be examined concerning their location. Of the 48 chest tubes, 46 had been placed from a lateral approach. The ventral access by Monaldi had only been chosen in two cases. Altogether, nine incorrect placements, mainly within the right interlobe gap, had been detected. CONCLUSIONS: The study collective showed a significant preference to the lateral approach when placing a chest tube at the emergency scene of an accident. In total, a prevalence of 19% incorrect placements could be revealed, meaning the chest tube had either been placed within the lung parenchyma, the interlobe gap, or extrathoracically. Concerning the patient outcome, no statistically significant difference regarding the clinical course after incorrect chest tube placement could be identified.

The epidemiology of amputation injuries in the Austrian helicopter emergency medical service: a retrospective, nationwide cohort study.

PURPOSE: Data on the epidemiological characteristics of traumatic amputations in prehospital emergency care, especially in the context of air rescue, are scarce. Therefore, we aimed to describe the epidemiology of total and subtotal amputation injuries encountered by the OEAMTC helicopter emergency medical service (HEMS) in Austria, based on an almost nationwide sample. METHODS: We retrospectively reviewed all HEMS rescue missions flown for amputation injuries in 2009. Only primary missions were analyzed. RESULTS: In total, 149 out of 16,100 (0.9 %) primary HEMS rescue missions were for patients suffering from amputation injuries. Among these, HEMS physicians diagnosed 63.3 % (n = 94) total and 36.9 % (n = 55) subtotal amputations, with both groups showing a predominance of male victims (male:female ratios were 8:1 and 6:1, respectively).The highest rate occurred among adults between 45 and 64 years of age (35.6 %, n = 53). The most common causes were working with a circular saw (28.9 %, n = 43) and processing wood (16.8 %, n = 25). The majority of the cases included digital amputation injuries (77.2 %, n = 115) that were mainly related to the index finger (36.2 %, n = 54). One hundred forty patients (94.0 %) showed a total GCS of more than 12. Amputations were most prevalent in rural areas (84.6 %, n = 126) and between Thursday and Saturday (55.0 %, n = 82). The replantation rate after primary air transport was low (28 %). CONCLUSIONS: In the HEMS, amputation injuries are infrequent and mostly not life-threatening. However, HEMS crews need to maintain their focus on providing sufficient and fast primary care while facilitating rapid transport to a specialized hospital. The knowledge of the epidemiological characteristics of amputation injuries encountered in the HEMS gained in this study may be useful for educational and operational purposes.