Characterizing Air Medical Transport Experiences in Emergency Medicine Residency Training Programs.

OBJECTIVE: Air medical transportation (AMT) of patients plays a critical role in the prehospital care of the ill patient. Despite its importance, there is no requirement in emergency medicine training programs to have direct experience or education on the topic, and data detailing current AMT experiences across programs are limited. METHODS: A survey detailing program characteristics, AMT experience characteristics, and curriculum factors relating to AMT experience was sent to all 275 credentialed emergency medicine residency training programs in the United States. Our outcomes were to describe the characteristics of AMT and non-AMT programs (proportions) and to evaluate associations (odds ratios with 95% confidence intervals) between program characteristics and 1) AMT experience opportunity and 2) level of resident participation among AMT programs. RESULTS: Two hundred (73%) programs responded, with 135 of 200 (68%) offering some type of AMT experience. The majority of programs offering AMT were 3 years (113 [84%]), university based (63 [47%]), and located in small urban areas (57 [42%]). When AMT was offered, most programs reported that the overall resident participation was low (≤ 20%). Programs that did not offer shift reduction or additional pay for participation in AMT were significantly more likely to have low participation than those with incentives (odds ratio = 4.8; 95% confidence interval, 1.8-15.3). Around one third of AMT experiences allowed for direct patient care. Less than half of the responding programs reported a dedicated AMT curriculum. CONCLUSION: The majority of emergency medicine residency training programs offer an AMT experience, but this experience is highly variable, and overall participation by residents is low. Given the importance of AMT in the care of emergency patients, standardization and increased access to AMT experience and education should be considered by emergency medicine training programs moving forward.

Annals of Emergency Medicine Journal Club. Is the golden hour tarnished? Registries and multivariable regression.

WHAT IS ALREADY KNOWN ON THIS TOPIC: The "golden hour" concept in trauma is pervasive despite little evidence to support it. WHAT QUESTION THIS STUDY ADDRESSED: Is there an association between various emergency medical services (EMS) intervals and in-hospital mortality in seriously injured adults? WHAT THIS STUDY ADDS TO OUR KNOWLEDGE: In 3,656 injured patients with substantial perturbations of vital signs or mental status, transported by 146 EMS agencies to 51 trauma centers across North America, no association was found among any EMS interval and mortality. HOW THIS MIGHT CHANGE CLINICAL PRACTICE: This study suggests that in our current out-of hospital and emergency care system time may be less crucial than once thought. Routine lights-and-sirens transport for trauma patients, with its inherent risks, may not be warranted.

Annals of Emergency Medicine Journal Club. Out-of-hospital continuous positive airway pressure ventilation versus usual care in acute respiratory failure: a randomized controlled trial.

WHAT IS ALREADY KNOWN ON THIS TOPIC: Application of continuous positive airway pressure (CPAP) for patients with acute respiratory distress reduces the need for tracheal intubation and mechanical ventilation. Case series have demonstrated CPAP's feasibility in out-of-hospital settings. WHAT QUESTION THIS STUDY ADDRESSED: Seventy-one out-of-hospital patients with severe respiratory distress, randomized to receive CPAP or usual care, were assessed to determine need for tracheal intubation and mortality. WHAT THIS STUDY ADDS TO OUR KNOWLEDGE: Within the CPAP group, the rate of intubation was 30% less than the usual care group, and mortality was 20% lower. HOW THIS MIGHT CHANGE CLINICAL PRACTICE: Emergency medical services systems and their medical directors should consider making CPAP available as part of the treatment for out-of-hospital severe respiratory distress patients, particularly in systems with long transport times.