Usefulness of a Simulated Helicopter Transport Experience for Medical Resident Training.

OBJECTIVE: This study evaluated the usefulness of a medical transport simulation to increase residents' understanding of medical transport. METHODS: Twenty-four medical residents participated in an intensive half-day medical transport simulation experience. Two questionnaires were administered, a pre/postsimulation questionnaire containing 11 questions that assessed the impact of the simulation training and a questionnaire that assessed realism of the flight simulator. RESULTS: There were statistically significant differences between the pre/postsimulation questions assessing perceived level of knowledge, experience, and training of transferring a patient in a helicopter with a mean change of 25 points on a 0 to 100 scale (P ≤ .001) and awareness of obstacles to treating patients during air transport exhibiting a mean change of 28 (P ≤ .001). The mean stress level for all participants increased from 32 (0-100 scale) before the start of the simulation to 47 during the simulation and decreased to 31 after the simulation (F2,46 = 20.67, P ≤ .001). CONCLUSION: The findings from this study provide evidence that the air medical simulation experience increases residents' perceived awareness of the context and difficulties of transferring a patient by helicopter and that the experience would influence their medical decision making in their future practice related to patient transfers.

Use of arterial catheters in the management of acute aortic dissection.

PURPOSE: The aim of this study was to investigate the relationship between the use of invasive arterial blood pressure (IBP) monitoring and reaching established aggressive medical management goals in acute aortic dissection. METHODS: Data were collected through a retrospective chart review of patients diagnosed with acute aortic syndromes of the thoracic cavity who required transport to tertiary care over a 28-month period. The 2010 American Heart Association medical management goals of thoracic aortic disease were used as hemodynamic end points. RESULTS: A total of 208 patients were included, with 113 (54%) diagnosed at least in part with acute Stanford Type A aortic dissections and the remaining 95 (46%) having isolated Stanford Type B dissections. Emergency departments made up 158 (76%) of transfer departments; 129 (62%) patients had IBP catheters placed. The highest mean systolic blood pressures (SBPs) recorded were 165 mm Hg in the IBP group versus 151 mm Hg when noninvasive blood pressure (NIBP) cuffs were used (P < .01). The mean decrease in SBP during transport was 51 mm Hg in the IBP group versus 34 mm Hg in the NIBP group (P < .001). The difference between the last reported NIBP and the first IBP was noted as 19 mm Hg higher. The IBP group met the SBP goal more frequently than the NIBP group (P < .05) when the SBP was noted as greater than 140 mm Hg during transport. Bedside time increased only 6 minutes with IBP placement (P < .007). CONCLUSION: Patients with IBP catheters were noted to be more aggressively managed with antihypertensive medications, met hemodynamic goals more frequently, and had only 6 minutes longer bedside times. These findings support the placement of IBP catheters by emergency departments and critical care transport (CCT) teams in patients with acute aortic syndromes requiring interfacility transport to definitive care.