Air Medical Transport of Patients Diagnosed With Confirmed Coronavirus Disease 2019 Infection Undergoing Extracorporeal Membrane Oxygenation: A Case Review and Lessons Learned.

The coronavirus disease 2019 pandemic disrupted health care delivery in every respect, including critical care resources and the transport of patients requiring extracorporeal membrane oxygenation. Innovative solutions allowing for safe helicopter air transport of these critical patients is needed because extracorporeal membrane oxygenation resources are only available in specialty centers. We present a case demonstrating the interfacility collaboration of care for a patient with coronavirus disease 2019 infection and the lessons learned from the air transport. Careful planning, coordination, communication, and teamwork contributed to the safe transport of this patient and several others subsequently.

Myocardial infarction complicated by ventricular septal rupture.

Transporting patients with an ST segment elevation myocardial infarction (STEMI) is a fairly common practice for most critical care transport teams. When a STEMI is complicated by ventricular septal rupture, the care can become more challenging, especially if the rupture is not yet diagnosed. This article describes such a transport and reviews the pathophysiology of the process along with treatment options.

Helmet use in Connecticut motorcycle crashes: a state without a universal helmet law.

OBJECTIVES: Assess the association of helmet use with motorcycle crash mortality and identify characteristics of riders who do not wear helmets in Connecticut crashes. METHODS: Police crash data for Connecticut motorcycle crashes 2001-2007 were analyzed. Bivariate analysis and multivariable logistic regressions were performed including age, gender, seating position, road type, season, time of day, and recklessness. RESULTS: Of the 9,214 crashes with helmet use data available, helmets were worn in 4072 (44.2%). Non-helmeted riders, age > or =18, riding interstate or state roads, in the evening or at night, and who were riding recklessly were associated with higher odds of fatality. Predictors of nonhelmet use included males, passengers, age <18 or 30 to 59, and riding in the summer, eveningor at night, and on U.S., state, and localroads. CONCLUSION: Current crash data affirm that helmets reduce fatal crashes in Connecticut. A set of factors help predict nonhelmeted riders to whom safety training could be targeted.

Air medical transport curriculum provides education for medical students.

INTRODUCTION: Increased regionalization of healthcare will most likely result in greater utilization of air medical transport (AMT). Education of providers regarding the utilization and capabilities of AMT will be important. This study was undertaken to determine whether our curriculum in AMT provided a useful and satisfying educational experience for medical students METHODS: The curriculum included three 6-hour fly-along sessions, 2 hours of lectures, 2 hours of case review, an 80-page syllabus listing articles and position papers, and a 3-page writing assignment. The study was a review of the participants' (1st- and 2nd-year medical students) test scores and postelective evaluation for 1 year. The setting was a two-helicopter AMT program based at an urban, university-affiliated level 1 trauma center. Twelve students (1/month) participated in the month-long elective. The students took a 20-item test before and after the elective and a 15-item postelective evaluation (5-point scale: very dissatisfied, dissatisfied, neutral, satisfied, very satisfied). A paired t-test was used to compare the mean pre-test and mean post-test scores. The evaluation data were analyzed descriptively. RESULTS: The mean number of correct responses on the post-test (M = 18.67, SD = 1.61) was significantly higher than the mean number of correct responses on the pretest (M = 13.83, SD = 2.17), P < .001. All students were either satisfied (56%) or very satisfied (44%) with the lectures and case review. Eleven (91%) were very satisfied with interaction with the crew, and nine (75%) were very satisfied overall (25% satisfied). Seven (58%) were very likely to use AMT in their career, two (16.7%) likely, two (16.7%) unsure, and one (8.3%) unlikely. CONCLUSIONS: Our curriculum in AMT provided a useful and satisfying educational opportunity for medical students. Their knowledge of AMT increased, and all were satisfied or very satisfied with the didactics and the crew interaction. Most thought that they would use AMT in their career.

Comparison of nitrile gloves and nitrile over Nomex gloves.

OBJECTIVES: Aeromedical flight crews must perform many tasks in flight requiring manual dexterity and fine precision. A common perception is that safety-enhancing fire-retardant gloves compromise patient care if worn during such tasks by providing added bulk and barrier to the hand. This study is a quantitative and qualitative analysis of this possible compromise to patient care. METHODS: Sixteen practicing flight nurses and respiratory therapists were asked to perform 10 different standard patient care tasks while wearing either nitrile gloves or a nitrile-Nomex glove pair. Tasks were timed, rated as completed successfully or not, and were subsequently judged subjectively by the participants. RESULTS: Whereas the time required to insert an intravenous catheter and to insert a central line while wearing only nitrile gloves was significantly faster than when wearing both gloves, the time to perform all other tasks was not significantly different. In subjective ratings, the nitrile glove alone was scored significantly better than the two-glove combination by the study participants. CONCLUSIONS: Comfort, dexterity, tactile discrimination, and ease of use were all adversely affected by wearing a Nomex glove under a nitrile glove. Although the differences in times for most tasks may not be clinically significant, the difference in the subjective parameters may be great enough to cause helicopter emergency medical services (HEMS) practitioners to not wear Nomex gloves under nitrile gloves while performing procedures.