Interhospital helicopter transport for stroke.

INTRODUCTION: The safety, cost efficacy, and time-to-treatment benefit of air transport of stroke patients have been acknowledged. We describe stroke patients transported to our facility by helicopter emergency medical services (HEMS) from a large rural area and compare 2 consecutive 3-year periods. METHODS: A retrospective chart review was conducted of all patients transferred by HEMS to our facility over 6 years. Data collected included patient demographics, pretransport imaging interpretation, final diagnosis, treatment, and outcomes. Trends between period 1 (January 1, 2003'December 31, 2005) and period 2 (January 1, 2006'December 31, 2008) were examined. RESULTS: A total of 347 acute stroke patients were transported by HEMS to our facility. The final diagnosis was intracerebral hemorrhage in 44%, subarachnoid hemorrhage in 24%, subdural hematoma in 14%, ischemic stroke or transient ischemic attack in 9%, and a nonstroke diagnosis in 7% of patients. Conventional cerebral angiography was performed in 28% of patients, and neurosurgical intervention, hematoma evacuation, or aneurysm clipping was performed in 32%. A final diagnosis of ischemic stroke or transient ischemic attack increased 3 times (4% vs. 12%, P < .05) from period 1 to 2. There was also a significant increase in the number of patients receiving intravenous tissue plasminogen activator before transport (0% vs. 3%, P < .01). CONCLUSIONS: The majority of our patients transported by HEMS for the management of acute stroke undergo urgent specialized diagnostics or interventions. This supports the role of interhospital HEMS transport in extending access to care in rural communities.

Blood administration in helicopter emergency medical services patients associated with hypothermia.

INTRODUCTION: The infusion of packed red blood cells (PRBCs) in the severely injured patient is not a new practice. It is a potentially lifesaving procedure although it is not without inherent risk. This practice in the helicopter emergency medical services (HEMS) has not been examined in the literature. We attempt to determine factors associated with hypothermia (ie, < 35°C), including the transfusion of O negative blood. METHODS: This was a retrospective review using our trauma registry on all patients who arrived at our rural level 1 trauma center by HEMS from January 1, 2005, through June 30, 2009. Patient temperature on arrival was compared for patients with and without hypothermia transported by our HEMS service. RESULTS: During the study period, there were 707 HEMS transports by our service. Sixty (8.5%) were hypothermic, and 30 (4.2%) received PRBCs. There was a high likelihood of PRBC patients with hypothermia (odds ratio = 6.27; 95% confidence interval, 2.47-14.89; P < .05). DISCUSSION: HEMS trauma patients who have received blood are more likely to arrive hypothermic (ie, < 35°C). The clinical impact of giving PRBCs in the HEMS prehospital setting was not determined.

The 2003 Air Medical Leadership Congress: findings and recommendations.

To address important concerns facing the air medical community, 149 air medical transport leaders, providers, consultants, and experts met September 4-6, 2003, in Salt Lake City, Utah, for a 3-day summit-the Air Medical Leadership Congress: Setting the Health Care Agenda for the Air Medical Community. Using data from a Web-based survey, top air medical transport issues were identified in four core areas: safety, medical care, cost/benefit, and regulatory/compliance. This report reviews the findings of previous congresses and summarizes the discussions, findings, recommendations, and proposed industry actions to address these issues as set forth by the 2003 congress participants.

The Air Medical Leadership Congress: setting the health care agenda for the air medical community.

BACKGROUND: Emergency air medical transport provides the means for critically ill or injured patients to rapidly access sophisticated medical flight teams and medical centers. However, issues such as surging emergency medical services helicopter accidents, expected pilot and nurse shortages, falling reimbursements, and new compliance regulations are now threatening these important but expensive transport services. Unless an industry strategy can be developed to address these and other threats, many medical flight programs may be forced to curtail the availability of these lifesaving services. PURPOSE: On September 4-6, 2003, air medical leaders, experts, program managers, providers, and users of emergency air medical services gathered in Salt Lake City, Utah, to discuss and formulate recommendations to address the top issues that threaten the future of air medical transport services. This congress was open to anyone engaged in the field of air medical transport. This historic meeting resulted in a plan to enhance transport safety, foster appropriate utilization, improve in-flight medical care, maximize cost and reimbursement effectiveness, and develop strategies to reduce the adverse effects of new regulatory and compliance mandates. OBJECTIVES: This article describes the significance of the Air Medical Leadership Congress and the 10-Point Plan method used to develop it.

Wilderness event medicine.

OBJECTIVES: Wilderness Event Medicine (WEM), that is, the care of large groups of people participating in events in remote areas, is a rapidly growing subspecialty of wilderness medicine. Our goals are to report the injury rates from one wilderness event and to suggest ways to advance this emerging field. METHODS: We describe a 1-day wilderness hike and compare the injury rates from this one event with rates from other urban and wilderness events. RESULTS: Of the total 350 hikers, 6 persons presented for medical evaluation (5 dehydration and 1 orthopedic), yielding a rate of 17 evaluations per 1000 person-days of exposure. Only 1 person (or 2.9 per 1000) required medical assistance beyond oral rehydration. These rates are comparable to rates reported for urban events and other wilderness activities. CONCLUSIONS: According to very limited reports, the rates of injuries in wilderness events are similar to those for urban events. We recommend defining a wilderness event as an event with more than 200 participants and where the time from injury to care at a medical facility is likely to be greater than 1 hour. We also suggest the creation of a database of wilderness events, including standardized terms for the descriptions of activities, terrain, injuries, and medical response. Such a database could be used to help event planners anticipate and perhaps prevent injuries and to prepare effectively for those injuries that do occur.