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Publisher: Elsevier   (Total: 3181 journals)

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Showing 1 - 200 of 3181 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 39, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 26, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 105, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 42, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 7)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6)
Acta Astronautica     Hybrid Journal   (Followers: 444, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 30, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 11, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 5, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 320, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 26, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 7, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 8)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 18, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 11, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 23)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 188, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 12, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 17, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 30, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 12, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 15, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 34, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 5)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 14)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 29, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 11, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 20, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 13)
Advances in Digestive Medicine     Open Access   (Followers: 12)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 7)
Advances in Drug Research     Full-text available via subscription   (Followers: 26)
Advances in Ecological Research     Full-text available via subscription   (Followers: 44, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 29, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 8)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 52, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 67, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 21, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 7, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 26, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 3, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 37, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 9, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 21, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 15, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 8, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 25)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 5)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 18, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 27, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 19)
Advances in Pharmacology     Full-text available via subscription   (Followers: 17, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 6)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 68)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 2, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 6)
Advances in Space Research     Full-text available via subscription   (Followers: 425, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 13, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 38, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 20)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 54, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 385, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 12, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 483, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 18, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 32, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 45, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 58, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 8, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 12)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 2, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 11, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 54, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 6, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 6, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 58, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 66, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 47, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 13)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 37, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 29, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 36, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 50)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 267, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 66, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 32, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 28, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 39, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 67, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 25, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 44, SJR: 1.512, CiteScore: 5)
Analytica Chimica Acta : X     Open Access  
Analytical Biochemistry     Hybrid Journal   (Followers: 211, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 13, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 25, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 227, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 7, SJR: 0.937, CiteScore: 2)
Animal Reproduction Science     Hybrid Journal   (Followers: 7, SJR: 0.704, CiteScore: 2)

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Similar Journals
Journal Cover
Air Medical Journal
Journal Prestige (SJR): 0.26
Number of Followers: 8  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1067-991X
Published by Elsevier Homepage  [3181 journals]
  • Impact of Suction-Assisted Laryngoscopy and Airway Decontamination
           Technique on Intubation Quality Metrics in a Helicopter Emergency Medical
           Service: An Educational Intervention
    • Abstract: Publication date: Available online 7 November 2019Source: Air Medical JournalAuthor(s): Matthew Jensen, Benjamin Barmaan, Christine M. Orndahl, Amir LoukaAbstractObjectiveSuction-assisted laryngoscopy and airway decontamination (SALAD) was created to assist with the decontamination of a massively soiled airway. This study aims to investigate the usefulness of SALAD training to prehospital emergency providers to improve their ability to intubate a massively contaminated airway.MethodsThis was a prospective study conducted as a before and after teaching intervention. Participants were made up of prehospital providers who were present at regularly scheduled training sessions and were asked to intubate a high-fidelity mannequin simulating large-volume emesis before and after SALAD instruction. They were subsequently tested on 3-month skill retention. Twenty subjects participated in all stages of the study and were included in the analysis.ResultsThe median time to successful intubation for all study participants before instruction was 60.5 seconds (interquartile range [IQR] = 44.0-84.0); post-training was 43.0 seconds (IQR = 38.0-57.5); and at the 3-month follow-up, it was 29.5 seconds (IQR = 24.5-39.0). The greatest improvement was seen on subgroup analysis of the slowest 50th percentile where the median time before instruction was 84.0 seconds (IQR = 68.0-96.0); post-instruction was 41.5 seconds (IQR = 36.0-65.0); and at the 3-month follow-up, it was 29.5 seconds (IQR = 25.0-39.0).ConclusionThe implementation of the SALAD technique through a structured educational intervention improved time to intubation and the total number of attempts.
       
  • Thinking Out of the (Big) Box: A Wearable Near-Infrared Spectroscopy
           Monitor for the Helicopter Emergency Medical Service
    • Abstract: Publication date: Available online 6 November 2019Source: Air Medical JournalAuthor(s): Patrick Schober, Lothar A. SchwarteAbstractObjectiveIn prehospital helicopter emergency medical service (HEMS) settings, the medical team has limited monitoring options, usually restricted to systemic variables. Regional tissue oxygenation (rO2) can be assessed by near-infrared spectroscopy (NIRS), but clinical NIRS monitors are unpractical (“big boxes” and additional cables) in HEMS. As an alternative, we identified a wearable, athlete training NIRS device (Moxy; Idiag, Fehraltorf, Switzerland) and hypothesized that it would be applicable in our HEMS setting.MethodsThis feasibility study was performed at the Dutch HEMS Lifeliner 1. The Moxy sensor was tested in-flight and on ground. We tested various anatomic measurement spots, and multiple conditions and interventions were imposed to track rO2.ResultsThe rO2 measurements with the wearable Moxy NIRS device are both feasible and practical in an HEMS setting. Multiple conditions and interventions were tested successfully (eg, tourniquet placement [rO2↓], muscle compression [rO2↓], reperfusion [rO2↑], oxygen administration [rO2↑], hyperemia [rO2↑], and venous congestion [rO2↓]).ConclusionOur results suggest that rO2 measurements with the wearable Moxy NIRS device are both feasible and practical in HEMS, and Moxy allows the tracking of simulated pathophysiologic effects on rO2. Future studies will have to verify our preliminary data and elucidate if and how wearable NIRS monitoring may support treatment in HEMS and improve patient outcome.
       
  • Brain Emergency Management Initiative for Optimizing Hub–Helicopter
           Emergency Medical Systems–Spoke Transfer Networks
    • Abstract: Publication date: Available online 1 November 2019Source: Air Medical JournalAuthor(s): Royya Modir, Dawn Meyer, Morcel Hamidy, Teneille DeLima, Jeffrey Steinberg, Leslie Mukau, Dannielle Walls, Brandon Walls, Christian Sloane, Brett MeyerAbstractObjectiveEmbolectomy is standard for select occlusions up to 24 hours. Transfer patients may have worse outcomes than those originating in embolectomy centers. We developed the Brain Emergency Management Initiative (BEMI) protocol to streamline this transfer process and mimic the urgency that surrounds ST-elevation myocardial infarction cardiac evaluations.MethodsWe conducted an exploratory assessment of consecutive acute telestroke patients transferred for potential intervention in pre-BEMI versus BEMI periods. Times included spoke in, spoke out, hub in, and groin puncture. Outcomes included discharge destination and symptomatic intracranial hemorrhage.ResultsOverall, 68 transfers were assessed. There was a higher National Institute of Neurological Disorders and Stroke in BEMI (11 pre-BEMI vs. 20 B.M., P = .01). There were shorter spoke door in to door out (143 vs. 118 minutes, P = .01) and spoke door out to hub door in times (23 minutes pre-BEMI vs. 21 minutes BEMI, P = .001). For embolectomy patients, there was shorter hub door in to reperfusion (83 minutes pre-BEMI vs. 74 minutes BEMI, P = .04) and recombinant tissue plasminogen decision to groin puncture (155 minutes pre-BEMI vs. 130 minutes BEMI; P = .01). There were no symptomatic intracranial hemorrhage or discharge differences.ConclusionIn our hub–helicopter emergency medical services–spoke telestroke network, BEMI led to improved evaluation times. BEMI may serve as a model for future rapid stroke transfer pathways.
       
  • Intraosseous Insights: Tips and Tricks
    • Abstract: Publication date: Available online 31 October 2019Source: Air Medical JournalAuthor(s): Scott DeBoer, Jason Chancey, Michael Rushing, Lisa DeBoer, Michael Seaver
       
  • Cardiac Arrest Secondary to Accidental Hypothermia: Rewarming Strategies
           in the Field
    • Abstract: Publication date: Available online 31 October 2019Source: Air Medical JournalAuthor(s): Robert WillmoreAbstractHypothermic cardiac arrest is rare and poses a challenge to prehospital responders. Standard cardiac arrest protocols advise treating reversible causes of arrest; however, rewarming the cold casualty is not easily achieved in the field. This article aimed to review the literature on hypothermia in order to produce evidence-based recommendations on rewarming that could realistically be applied to hypothermic cardiac arrest patients.
       
  • Using Epidemiology and Pediatric Direction to Inform Air Medical Quality
           Improvement
    • Abstract: Publication date: Available online 31 October 2019Source: Air Medical JournalAuthor(s): Phyllis L. Hendry, Amanda Roycik, Raina Davidman, James Montgomery, David Ebler, Mark Hincapie, Caitlin BorkowskiAbstractIntroductionPediatric air transport research is limited, especially scene transport. Study purpose was to review transport epidemiology, outcomes, and documentation to inform development of a pediatric flight quality improvement (QI) program and outreach.MethodsStudy design was ongoing review and analysis of flight, ED, EMS and hospital records over 2 years from children ≤ 18 years transported by a regional flight program. Mission type included trauma, medical, scene and interfacility. Records were reviewed monthly by a pediatric medical director (PMD) with ongoing QI and educational initiatives. Peer review was added in year two. Demographic and outcome variables included weight, times, procedures, pain scales, Glasgow Coma Scale (GCS), medications, disposition, etc. Two QI focus areas were studied using QI Macros®: weight and pain documentation.ResultsChildren accounted for 8% of total flights (165/2076). Transport was 58% scene; 42% interfacility. Median dispatch to arrival time was 21 minutes. Saturday accounted for 24% of flights. Mean scene GCS was 12; 39 (24%) patients were intubated. Scene weight in kilograms improved 18% and pain documentation improved from 49% to 79% during the study.ConclusionAddition of PMD, peer and outcome review processes provided opportunities for improving pediatric transport QI initiatives and targeted outreach education.
       
  • Cardiac Arrest Secondary to Accidental Hypothermia: The Physiology Leading
           to Hypothermic Arrest
    • Abstract: Publication date: Available online 31 October 2019Source: Air Medical JournalAuthor(s): Robert WillmoreAbstractCardiac arrest secondary to accidental hypothermia is rare in the United Kingdom. However, some evidence suggests that it is under-reported; furthermore, recognizing hypothermia as the cause of death is difficult in the postmortem setting. Urban and rural residents are exposed to cold winter conditions both at home and while undertaking recreational activities. Understanding the physiology underpinning hypothermic cardiac arrest is crucial in order to make informed clinical decisions in regard to triage and management by air ambulance services and in prevention of this rare presentation. This article discusses the epidemiology and pathophysiology of accidental hypothermic to explain how personnel can survive after 8 hours 40 minutes of cardiac arrest.
       
  • Experience of the Usage of a Portable X-ray System
    • Abstract: Publication date: Available online 31 October 2019Source: Air Medical JournalAuthor(s): Kazuhiko Omori, Ken-ichi Muramatsu, Hiroki Nagasawa, Ikuto Takeuchi, Yoshihiro Kushida, Hiromichi Ohsaka, Kei Jitsuiki, Yasumsa Oode, Youichi YanagawaAbstractObjectiveThe purpose of this study was to introduce the use of a portable X-ray system by the staff members of a doctor helicopter (DH).MethodsFrom January 11 to 18, 2019, we were given temporary access to a portable X-ray system. This period is defined as the investigation term. During the investigation term, a medical chart review was retrospectively performed for all patients who were transported by the DH. We investigated the variables between cases in which an X-ray study had been performed (X-ray group) and had not been performed (control group).ResultsThirteen subjects were classified into the X-ray group, and 17 were classified into the control group. No X-ray studies were performed for patients who underwent interhospital transportation, and the proportion of cases involving patients with exogenous disease in the X-ray group was greater than that in the control group.ConclusionWe reported our experience of DH staff performing X-ray studies at the scene. Further studies are required to determine the indications for using portable X-ray systems in the prehospital setting.
       
  • Extracorporeal Membrane Oxygenation in Transport Part 1: Extracorporeal
           Membrane Oxygenation Configurations and Physiology
    • Abstract: Publication date: Available online 31 October 2019Source: Air Medical JournalAuthor(s): Jennifer Vieira, Michael Frakes, Jason Cohen, Susan WilcoxAbstractExtracorporeal membrane oxygenation (ECMO), a term used to describe oxygenation that occurs outside of the body, is an increasingly common means of supporting the most critically ill patients. Because of the invasiveness and high probability of serious complications during ECMO, ECMO is typically indicated only when there is a high likelihood of death with conventional treatment. With continued improvements in technology and increasing clinical experience, transport clinicians are increasingly likely to be called on to transport patients on ECMO. ECMO can be initiated in 2 distinct forms, venovenous or venoarterial, and can primarily support the respiratory system or the cardiac and respiratory systems concurrently. This review will cover the basic physiology and components of ECMO as well as the preparation for ECMO transport for adults.
       
  • The Case for Bougie Use on Every Intubation
    • Abstract: Publication date: Available online 30 October 2019Source: Air Medical JournalAuthor(s): Andrew H. MerelmanAbstractDespite its value in emergency airway management, the endotracheal tube introducer, commonly known as the bougie, has traditionally been a point of disagreement between providers. It is typically viewed as a “rescue” device and not a primary airway tool. However, its value as a primary device during plan A has recently been recognized. Two studies have shown increased first-pass success using a bougie on the initial attempt. Additionally, bougie use on every intubation increases provider comfort with the device so that, on a truly difficult intubation, the skills and mechanics are instilled. In the out-of-hospital and critical care transport settings, intubation is often inherently more difficult because of varying environments. For these reasons, the bougie should be integrated into the first intubation attempt in emergent intubation.
       
  • NeoSTRESS: Study of Transfer and Retrieval Environmental StressorS Upon
           Neonates via a Smartphone Application–Light
    • Abstract: Publication date: Available online 25 October 2019Source: Air Medical JournalAuthor(s): Deborah Gilmour, Khoi M. Duong, Ian J. Gilmour, Mark W. DaviesAbstractObjectiveThis study aimed to measure the light levels neonates would be exposed to during retrieval, determine whether this varied with transport mode, and compare them with recommended light exposure in neonatal intensive care units. We also aimed to determine the ease of use and acceptability of using the smartphone application.SettingA neonatal retrieval service in Brisbane, Australia.MethodsThis prospective study used the calibrated smartphone application Physics Toolbox Sensor Suite (Vieyra Software, Washington, DC). Data were collected during the outbound, nonpatient leg of 45 retrievals (25 road, 11 fixed wing aircraft, and 9 rotary aircraft journeys). Data were saved to Cloud storage and then analyzed using the PostgreSQL database.ResultsThe median illuminance was 6 lux (interquartile range [IQR], 1-58). The maximum recorded was 93,842 lux. The median illuminance during daytime journeys was 15 lux (IQR, 2-77). The median light level for night journeys was 1 lux (IQR, 0.5-8). Illuminance exceeded the recommended level (600 lux) for 2.1% of all journey time.ConclusionRetrieved neonates can be exposed to light in excess of recommended neonatal intensive care unit levels, including extremely bright light. It is feasible, with good staff acceptability, for a calibrated smartphone application to be used in place of a light meter.
       
  • A 4-Year-Old With Altered Mental Status and Bradycardia After Clonidine
           Overdose
    • Abstract: Publication date: Available online 24 October 2019Source: Air Medical JournalAuthor(s): Thomas L. Pietrantonio, Doug SwansonAbstractThis case presentation describes the clinical management of a pediatric patient during transport after a single-drug overdose of clonidine. Clonidine overdose closely resembles opiate intoxication, and treatment is largely supportive; however, the patient in this case presentation had a declining altered mental status with evidence of airway compromise within 1 to 2 hours after ingestion, which warranted protective airway management. The patient was extubated the following day with a successful outcome.
       
  • Cardiac Arrest Secondary to Accidental Hypothermia: Who Should We
           Resuscitate'
    • Abstract: Publication date: Available online 22 October 2019Source: Air Medical JournalAuthor(s): Robert WillmoreAbstractCardiac arrest with a degree of concurrent hypothermia is not a rare presentation. This presentation, often in remote areas, poses a challenge for the prehospital physician because the cause of the arrest will significantly alter decision making and prognostication. Survival from cardiac arrest secondary to accidental hypothermia is significantly greater than that of normothermic arrests when appropriate triage and management decisions are made. The complexity of this decision benefits from a specific algorithm to follow in the event of such a casualty presenting. This article systematically reviews the literature on cardiac arrest secondary to accidental hypothermia and provides recommendations in addition to a novel algorithm to aid the responding prehospital clinician in deciding if a hypothermic resuscitation standard operating procedure should be implemented.
       
  • A Program Profile of Air Medical Transport in Regional Central Queensland,
           Australia
    • Abstract: Publication date: Available online 21 October 2019Source: Air Medical JournalAuthor(s): Kristin H. Edwards, Richard C. Franklin, Peter Aitken, Mark Elcock, Mark Terrell EdwardsAbstractObjectiveThe purpose of this study was to investigate the epidemiology of air medical patients and referral patterns in Central Queensland Hospital and Health Service (CQHHS).MethodsAnalysis of air medical transport from January 2010 to December 2014. Air medical tasks within the local health service boundary were included. All patients transported on rotor or fixed wing aircraft for medical purposes were included. Patterns of air medical tasks in and out of the region by referring and receiving location, aircraft type, flight priority, time of day, month, sex, age, illness, and referral indexes were analyzed.ResultsThere were 11,456 air ambulance tasks in CQHHS region during the study period, an average of 2,291 retrievals per annum or 191 per month. Frequent referrals were to a tertiary facility, located 800 km across economic and political boundaries. Referral pattern indexes highlight a net patient flow of 1.2 to 1. Cardiology was the largest illness category (24%). Males represented 59% overall as well as patients 66 years and older (33%). Fixed wing aircraft carried out 87% of the tasks with a frequent response time of 6 to 24 hours.ConclusionAir medical transports are an integral part of the health system in Central Queensland communities with vast geographic distances. Identifying regional referral pattern rates and ratios aid in the planning of resource allocation.
       
  • Postpartum Hemorrhage With Cardiorespiratory Collapse Transported From a
           Rural Hospital
    • Abstract: Publication date: Available online 19 October 2019Source: Air Medical JournalAuthor(s): Chad L. Ulrich, Richard B. Utarnachitt, Kyle Danielson, Alexa Pieri, Steven Whitley, Andrew J. Latimer
       
  • Forum November/December 2019
    • Abstract: Publication date: Available online 19 October 2019Source: Air Medical JournalAuthor(s):
       
  • Extracorporeal Membrane Oxygenation in Transport Part 2: Complications and
           Troubleshooting
    • Abstract: Publication date: Available online 19 October 2019Source: Air Medical JournalAuthor(s): Jennifer Vieira, Michael Frakes, Jason Cohen, Susan WilcoxAbstractFactors taken for granted while the extracorporeal membrane oxygenation (ECMO) patient is maintained in a hospital setting can become critical when planning for transport. These issues include but are not limited to positioning of patients on a small transport stretcher, positioning of cannulas and equipment, ensuring adequate power sources and supply, inefficient temperature control, and a much higher risk of decannulation. It is paramount to be comfortable with the management strategies required to handle common complications of ECMO with limited resources in a relatively austere environment. Coagulopathy and bleeding are the most common complications occurring in up to 50% of ECMO patients. Loss of flow and hypotension from loss of volume or profound vasodilation after ECMO initiation need to be managed accordingly. Oxygenator malfunction can occur, and clinicians must be able to recognize the indicators of this complication promptly. Loss of pulsatility, low end-tidal carbon dioxide (ETCO2), and differential hypoxia are common complications in venoarterial ECMO. In addition, an air embolism is life-threatening on venoarterial ECMO but may be better tolerated in the setting of venovenous ECMO. Recirculation in venovenous ECMO leads to circulation of poorly oxygenated blood and must be recognized and addressed. Lastly, pump failure, circuit rupture, and decannulation are devastating complications.Over the last decade, the use of extracorporeal membrane oxygenation (ECMO) has accelerated rapidly,1, 2, 3 providing support for patients in severe respiratory or cardiac failure. With ongoing clinical experience and improvements in technology, the indications for ECMO are increasing.4 Many areas are developing centralized ECMO centers to serve their surrounding communities.5, 6, 7 To use a centralized ECMO referral model, patients need access to effective, safe critical care transport, but transporting a patient on ECMO carries a significant risk of adverse events.8, 9, 10, 11, 12, 13 The purpose of this review is to highlight some of the most common adverse events in ECMO transports and provide management suggestions. Note that these recommendations are not a substitution for close collaboration with medical control, and all adverse events should be promptly reported per organizational protocols.
       
  • Mechanical Ventilation: Finer Points
    • Abstract: Publication date: Available online 19 October 2019Source: Air Medical JournalAuthor(s): David J. Dries
       
  • Infrastructure
    • Abstract: Publication date: Available online 18 October 2019Source: Air Medical JournalAuthor(s): Eileen Frazer
       
  • The Neonatal Transporter's Brain
    • Abstract: Publication date: Available online 18 October 2019Source: Air Medical JournalAuthor(s): Carlo Bellini
       
  • CAMTS Quality Management Process
    • Abstract: Publication date: Available online 17 October 2019Source: Air Medical JournalAuthor(s): Eileen Frazer
       
  • Articles That May Change Your Practice: Dexmedetomidine
    • Abstract: Publication date: Available online 16 October 2019Source: Air Medical JournalAuthor(s): Russell D. MacDonald, Adam Greene
       
  • A Blended Prehospital Ultrasound Curriculum for Critical Care Paramedics
    • Abstract: Publication date: Available online 2 October 2019Source: Air Medical JournalAuthor(s): Andrew Guy, Anthony Bryson, Stephen Wheeler, Neilson McLean, Hussein D. KanjiAbstractObjectivePoint-of-care ultrasound is a nascent and growing area of prehospital care. Most previously described ultrasound curricula for paramedics examine a single type of ultrasound scan. Here, we describe the implementation and evaluation of a prehospital ultrasound curriculum using a blended model of traditional didactics and hands-on experience with online prereading.MethodsWe recruited a prospective convenience sample of critical care paramedics without prior ultrasound experience to take part in a 2-day ultrasound course. All participants completed prereading modules built from online resources followed by a didactic review of the material and hands-on practice. Ultrasound examinations included extended focused abdominal sonography in trauma, cardiac ultrasound, thoracic ultrasound, and vascular ultrasound. A written examination evaluated ultrasound theory and image interpretation, and a practical examination evaluated image acquisition.ResultsSeventeen critical care paramedics completed the course with a mean grade on the written examination of 76%, with 76% of paramedics achieving the predetermined passing mark of 70% or greater. All paramedics passed the practical examination.ConclusionThe implementation of a prehospital critical care ultrasound program is feasible in our provincial emergency medical services system. Further assessment is necessary to determine future knowledge and skill retention as well as clinical application and utility in real-world settings.
       
  • The SHOCK of Sepsis
    • Abstract: Publication date: September–October 2019Source: Air Medical Journal, Volume 38, Issue 5Author(s): Penny Amsden, Carol Yocom-BakerIntroductionThis poster presentation discusses facts and statistics regarding sepsis, as well as the importance of early recognition including signs and symptoms, and the importance of early treatment for decreased mortality in the pediatric populationMethodsThe poster highlights several statistics regarding sepsis in the pediatric population. The poster also stresses the importance of early recognition and predisposition of sepsis. Early treatment is of utmost importance to decrease mortality in the pediatric population.ResultsThe attendee will be able to understand that early recognition and treatment is of the utmost importance in decreasing the mortality in pediatric population. The attendee will also be able to identify several predisposition factors that may contribute to the development of sepsis.ConclusionIn conclusion, the attendee will have a better understanding of the signs and symptoms of sepsis, the importance of early recognition and timely treatment to decrease the mortality due to sepsis in the pediatric population.
       
  • General Information
    • Abstract: Publication date: September–October 2019Source: Air Medical Journal, Volume 38, Issue 5Author(s):
       
  • Effect of Suction Assisted Laryngoscopy Airway Decontamination (SALAD)
           Training on Intubation Quality Metrics
    • Abstract: Publication date: September–October 2019Source: Air Medical Journal, Volume 38, Issue 5Author(s): Matt Jensen, Amir Louka, Benjamin BarmaanIntroductionVCU Health Critical Care Transport Network paramedics and nurses staff three rotary-wing aircraft and one ground ambulance that provide scene response and interfacility transports throughout Virginia. Prehospital rapid sequence induction and intubation are among the highest risk procedures employed by these providers, particularly when the airway is massively contaminated with blood or vomit. A quality assurance review of attempted prehospital intubations determined issues with suction to be a key factor in those requiring more than one attempt. A targeted training session introducing Suction Assisted Laryngoscopy and Airway Decontamination (SALAD) was implemented and quality improvement data collected.MethodsSALAD was introduced during scheduled quarterly training. In attendance were 15 nurses and 10 paramedics for a total of 25 participants. With no prior notice, training or cognitive priming each participant attempted intubation using videolaryngoscopy on a custom high fidelity training mannequin designed to emit 650 ml per minute of simulated vomit into the airway. Following their first attempt, participants were instructed on SALAD technique by an EMS-fellowship trained emergency physician. Participants then had another opportunity to intubate the mannequin using SALAD technique. Data was collected on number of attempts and time to successful intubation before and after training.ResultsMean time to successful intubation improved from 68.28 seconds to 49.76 seconds (95% confidence interval [CI], -34.976 to -2.064; P = 0.0282). There was a trend toward improvement in mean number of intubation attempts overall from 1.12 per participant to 1.0 (CI, -0.0135 to 0.2535; P = 
       
  • An Apple a Day: Modern Atrial Fibrillation Detection
    • Abstract: Publication date: Available online 27 September 2019Source: Air Medical JournalAuthor(s): Joseph Hill, Peter Tilney
       
  • Prove It
    • Abstract: Publication date: Available online 17 August 2019Source: Air Medical JournalAuthor(s): John R. Clark
       
  • Articles That May Change Your Practice: Sugammadex
    • Abstract: Publication date: Available online 9 August 2019Source: Air Medical JournalAuthor(s): Russell D. MacDonald
       
  • Renal Injuries, Markers, and Therapy
    • Abstract: Publication date: Available online 9 August 2019Source: Air Medical JournalAuthor(s): Anna Rauzi, David J. Dries
       
  • Forum September/October 2019
    • Abstract: Publication date: Available online 7 August 2019Source: Air Medical JournalAuthor(s):
       
  • 2019 Air Medical Transport Conference Preview
    • Abstract: Publication date: Available online 2 August 2019Source: Air Medical JournalAuthor(s): Natasha J. Ross
       
  • 2019 Air Medical Transport Conference Scientific Assembly Abstracts
    • Abstract: Publication date: Available online 2 August 2019Source: Air Medical JournalAuthor(s):
       
  • Pericardiocentesis in an Ambulance: A Case Report and Lessons Learned
    • Abstract: Publication date: Available online 27 July 2019Source: Air Medical JournalAuthor(s): David M. KanieckiAbstractThere are few procedures performed in the prehospital setting as intimidating as pericardiocentesis. We report a case in which lifesaving pericardiocentesis was performed in the back of an ambulance after temporizing measures of volume resuscitation and vasopressor therapy failed.Fluid accumulation within the pericardial sac can increase pressures around the heart and lead to cardiac tamponade. Helicopter emergency medical service crews may be called to transport patients with cardiac tamponade physiology to definitive care where removal of the pericardial fluid can be achieved. Pericardiocentesis is indicated as an emergency procedure in patients with hemodynamic compromise secondary to cardiac tamponade.1 Because most HEMS crews do not routinely perform pericardiocentesis because of the rare need or crew scope of practice limitations, the general approach to management in the prehospital setting is volume resuscitation, to overcome decreased preload, and vasopressor support. Here, we report a case in which lifesaving pericardiocentesis was performed in a ground ambulance after temporizing measures of volume resuscitation and vasopressor therapy failed.
       
  • Controlled Substances Compliance for Transport Programs
    • Abstract: Publication date: Available online 18 July 2019Source: Air Medical JournalAuthor(s): Joseph P. Santiago, Patrick B. LickissAbstractTransport programs are highly regulated health care organizations. Of the many imposers of regulations, those controlled by the Drug Enforcement Administration are some of the least understood by transport programs. This article serves to lift the regulatory fog surrounding controlled substances and to provide clear and actionable guidance to transport programs. Storage, security, and recordkeeping requirements for emergency medical service organizations can be confusing given that there are no specific regulations for emergency medical services. Transport programs are subject to all the current regulations, and nonadherence can result in significant fines and loss of public trust for any transport program found to be in violation.
       
  • First Reported Helicopter In-flight Serratus Plane Block for Rib Fractures
    • Abstract: Publication date: Available online 17 July 2019Source: Air Medical JournalAuthor(s): Justin McLean, Sean Cooke, Brian Burns, Cliff Reid
       
  • Medical Protocols
    • Abstract: Publication date: Available online 16 July 2019Source: Air Medical JournalAuthor(s): Eileen Frazer
       
  • Prehospital Airway Management in Severe Traumatic Brain Injury
    • Abstract: Publication date: Available online 12 July 2019Source: Air Medical JournalAuthor(s): Lorenzo Gamberini, Marzia Baldazzi, Carlo Coniglio, Giovanni Gordini, Tommaso BardiAbstractObjectiveTraumatic brain injury (TBI) is a leading cause of death and disability among trauma patients. The final outcome of TBI results from a complex interaction between primary and secondary mechanisms of injury that begin immediately after the traumatic event. The aim of this review was to evaluate the latest evidence regarding the impact of prehospital airway management and the outcome after traumatic brain injury.MethodsPubMed, Embase, and Cochrane searches were conducted using the MeSH database. Airway management, traumatic brain injury, pneumonia, and the subheadings of these Medical Subject Headings were combined.ResultsThe review is structured into 4 major topics: airway management devices, prehospital pharmacologic management, mortality and neurologic outcomes, and early respiratory infections. The available literature shows a shift toward a more comprehensive view of prehospital airway management, taking into account not only the location where airway management is attempted but also the drugs administered, the airway management devices used, and the skills of the main professional figures attending the scene.ConclusionsLiterature about this topic is still inconclusive; however, new evidence taking into consideration more complex aspects of airway management rather than orotracheal intubation per se shows improved outcomes with aggressive prehospital airway management.
       
  • Neonatal Transport Clinician Performed Ultrasound Evaluation of Cardiac
           Function
    • Abstract: Publication date: Available online 10 July 2019Source: Air Medical JournalAuthor(s): Amelie Stritzke, Amuchou Soraisham, Prashanth Murthy, Derek Kowal, Renee Paul, Majeeda Kamaluddeen, Khorshid Mohammad, Essa Hamdan Al Awad, Sumesh ThomasAbstractBackgroundLimited point-of-care ultrasound skills for ultrasound-naïve neonatal transport clinicians could enhance clinical evaluation and decision making. Teaching Respiratory Therapists and Nurses to assess cardiac filling and contractility may be feasible.MethodsProspective educational study using educational materials, didactic theoretical, and hands-on practical sessions, followed by assessment of practical and theoretical skills.ResultsA total of 18 participants completed the study meeting the predefined standard, proving feasibility. Nine (50%) participants had ≤ 10 years of NICU experience. The mean time required for complete training was 8.6 ± 2.1 hours. Time was spent on average on 269 ± 104 minutes for hands-on practice, 171 ± 96 minutes on didactic training, and 76 ± 16 minutes on testing sessions. The median number of hands-on sessions per participant was 5 [Interquartile range (IQR) 5, 7]. The median number of infants required to complete training was 9 infants (IQR 7, 11). RRTs required less time than RNs. Evaluations and feedback from participants on the training program was positive.ConclusionNeonatal RNs and RTs can be trained to perform focused cardiac ultrasound examinations with average time of 8.6 hours. This skill could enhance clinical care on neonatal transport with appropriate interventions to manage suspected hypotension or shock.
       
  • Factors Affecting Stabilization Times in Neonatal Transport
    • Abstract: Publication date: Available online 9 July 2019Source: Air Medical JournalAuthor(s): Muzafar Gani Abdul Wahab, Sumesh Thomas, Prashanth Murthy, Aravanan Anbu ChakkarapaniAbstractObjectiveDuring transport, the time spent in stabilizing sick infants before repatriation is crucial in optimizing the outcome and effective use of resources. The study aim was to assess individual components of neonatal transport time to identify opportunities to minimize delay, optimize care, and improve the overall efficiency of transport.MethodsA single-center prospective observational study conducted at McMaster Children's Hospital, Hamilton, Ontario, Canada, with a dedicated transport team for over 12 months. The stabilization time was defined as the time interval between arrival and departure from the referring hospital.ResultsOf 223 neonatal transfers, 67 required no procedural or therapeutic intervention before mobilization to the receiving unit, with a mean stabilization time of 113 ± 52 minutes. In 156 transport events, 1 or more interventions were required, with a significantly higher mean stabilization time of 165 ± 89 minutes (P < .0001).ConclusionThis study found that the local stabilization time was more than 1.5 times that of the comparable published data. The reasons identified for this delay were mostly because of waiting times for vehicle mobilization, waiting for blood and radiology results, and bed availability. Modifying these factors could save up to 28% of the stabilization time.
       
  • Abstract 1: Analysis of the Usage of a Portable X-Ray System Transported
           to the Scene by a Physician-Staffed Helicopter
    • Abstract: Publication date: July–August 2019Source: Air Medical Journal, Volume 38, Issue 4Author(s): ObjectiveWe had the opportunity to use a portable X-ray system. The purpose of this study was to investigate the influence of the use of a portable X-ray system by the staff members of a physician-staffed helicopter (called a doctor helicopter [DH] in Japan) on the activities of the DH staff and the indications for its use in the prehospital setting.MethodsFrom January 11, 2019 to January 18, 2019 we had temporary access to a portable X-ray system. This period is defined as the investigation time. During the investigation time, a medical chart review was retrospectively performed for all patients who were transported by a DH in Japan. These patients were included as subjects in the present study. We collected data on each subject's sex, age, details of dispatch (to the scene or interhospital transportation), endogenous or exogenous disease status, clinical diagnosis, contents of treatment, whether or not an X-ray study was performed, region of X-ray, treatment at scene, time at the scene, and outcome (survival or death). In addition, we the compared age, sex, details of dispatch, endogenous or exogenous disease status, cardiac status (cardiac arrest or no cardiac arrest), treatment, time at the scene (minutes) and outcomes between cases in which an X-ray study was performed (X-ray group) and those in which an X-ray study was not performed (Control group).ResultsDuring investigation period, 30 patients were transported by DH. Thirteen subjects were classified into the X-ray group and 17 were classified into the Control group. There were no significant differences in the sex, age, cardiac status, time at the scene, or outcomes of the two groups. The proportions of patients with exogenous disease and female patients in the X-ray group tended to be greater than those in the Control group; however, neither of these differences was statistically significant. The proportion of cases in which the DH was dispatched to the scene in the X-ray group was significantly greater than that in the Control group.ConclusionThis is the first study to demonstrate that the performance of X-ray studies at the scene did not significant influence the activities of DH staff and to demonstrate that X-ray studies were performed significantly more frequently when a DH was dispatched to the scene. Future prospective studies involving a greater number of patients and a comparison of the final outcomes are needed.
       
  • Abstract 4: Predictors of Definitive Airway sans Hypoxia/Hypotension on
           First Attempt (DASH 1A) Success in Traumatically Injured Patients
           Undergoing Prehospital Intubation
    • Abstract: Publication date: July–August 2019Source: Air Medical Journal, Volume 38, Issue 4Author(s): Elizabeth K. Powell, William R. Hinckley, Uwe Stolz, Andrew J. Golden, Amanda Ventura, Jaston T. McMullanObjectivePrehospital intubation success is routinely treated as a dichotomous outcome based on an endotracheal tube passing through vocal cords regardless of number of attempts or occurrence of hypoxia, or hypotension, which are associated with worse outcomes. We explore patient, provider, and procedure-related variables associated with successful definitive airway sans hypoxia/hypotension on first attempt (DASH-1A) in traumatically injured subjects undergoing endotracheal intubation at the scene of injury by a helicopter EMS system.MethodsThis single-center retrospective chart review included patients with traumatic injuries and at least one attempted intubation by helicopter EMS at the scene of injury. Demographic and clinical variables were tested for association with DASH-1A and overall first-attempt success using univariate comparisons and multivariable logistic regression to produce adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Purposeful backwards stepwise elimination was used to develop logistic regression models for outcomes. Initial inclusion of covariates in multivariable models was based on clinical judgement, known or suspected risk factors and confounders for intubation success, and univariate associations.ResultsOf 419 subjects screened, 263 met inclusion criteria. Median age was 34 years and the majority of subjects were Caucasian (95%), male (76%), and suffered blunt trauma (90%). A total of 142 (55.3%) subjects had a successful DASH-1A airway, 198 (75%) had a successful first attempt non-DASH-1A airway, and overall, 246 (94%) had an endotracheal tube passed successfully before hospital arrival. Factors significantly associated with successful DASH-1A were no ground EMS intubation attempt prior to arrival (aOR 2.2), lack of airway secretions (1.9), Cormack-Lehane Score of I and II (12.3 & 3.2, respectively), and bougie use (5.4). For endotracheal tube passing only, the following were significantly associated with first pass success: grade of view I and II (87.3 & 6.8, respectively), lack of secretions (4.9), bougie use (7.8), direct laryngoscopy (5.1) and not using apneic oxygenation through a nasal cannula (2.5).ConclusionsIn our helicopter EMS system, successful endotracheal intubation on the first attempt and without an episode of hypoxia was associated with no ground EMS intubation attempt prior to flight crew arrival, lack of airway secretions, Cormack-Lehane Score, and bougie use.
       
  • Abstract 3: Comparison of Flight Physician operated Hyper-Angulated and
           Standard Geometry Video Laryngoscopy Tracheal Intubation on a Helicopter
           in a Manikin
    • Abstract: Publication date: July–August 2019Source: Air Medical Journal, Volume 38, Issue 4Author(s): Kevin Emmerich, Michael Steuerwald, Nick Lepa, Louis Scrattish, Ryan Wubben, Brian Jennett, Richard Galgon, Matthew HollanderObjectiveTo investigate the efficacy of hyper-angulated video laryngoscopy (HAVL) versus standard-geometry video laryngoscopy (SGVL) during a simulated mid-flight helicopter intubation.IntroductionPrehospital intubation is often complicated by poor conditions including bad lighting, poor patient positioning, excessive noise, and restricted cervical spine mobility – some of which are known predictors of a difficult airway. These factors are magnified in the setting of a mid-flight helicopter intubation. The specific aim of our investigation was to evaluate if use of a specific video laryngoscopy technique offers advantage in this situation. The SGVL technique requires the creation of nearly a direct line between the oropharynx and glottis in order for endotracheal tube placement. The line must be created by manipulation of the patient's airway by the operator with a laryngoscope. Due to poor operator and patient positioning in a helicopter, this process was hypothesized to be more difficult than HAVL, which allows the operator to pass an endotracheal tube around the natural curvature of the patient's upper airway. There are no studies to date comparing these two distinct techniques by board-certified emergency medicine physicians in a simulated mid-flight environment.MethodsA single center, randomized crossover trial was performed using attending physician helicopter EMS providers in a simulated environment. After IRB approval and informed consent, physicians were randomized to perform five HAVL or SGVL intubations, followed by the subsequent technique. Intubations were performed in a grounded EC-135 helicopter with an AirsimTM airway management trainer restrained on the cot. Time to intubation (primary outcome) as well as first pass success (FPS) and Cormack-Lehane views were recorded for each attempt. Qualitative data was also obtained for physician preference and perceived difficulty.ResultsFifteen physicians participated in the study. There was no statistically significant difference in time to intubation with HAVL versus SGVL (16.14 seconds vs. 16.12 seconds; p-value 0.97). FPS was 100% for both techniques. Ninety-seven percent of Cormack-Lehane views were grade one for HAVL versus 88% for SGVL. Despite no statistical significance in time to intubation, participants subjectively reported that SGVL required more physical force to perform intubation. The majority also qualitatively prefer HAVL over SGVL after performing the study for future flight intubations.Conclusions/LimitationsOur results suggest that both SAVL and HAVL are efficacious techniques to perform intubations in an EC-135 helicopter, should this somewhat rare, but likely difficult procedure, be necessary. Providers did, however, prefer HAVL over SGVL in our group. The discordant quantitative and qualitative results in this study may be due to the static nature and highly favorable anatomy of a manikin, versus the varying anatomy of individual patients.
       
  • General Information
    • Abstract: Publication date: July–August 2019Source: Air Medical Journal, Volume 38, Issue 4Author(s):
       
  • Cognitive Appraisal and Stress Performance: The Threat/Challenge Matrix
           and Its Implications on Performance
    • Abstract: Publication date: Available online 13 June 2019Source: Air Medical JournalAuthor(s): John vonRosenbergAbstractBackgroundStress has the potential to improve performance through increased focus and strength or negatively impact performance through distraction and decreased fine motor control. The first step in the distinction between success or failure in a stressful situation is making the decision to engage in the process or withdraw. Cognitive appraisal describes the process of evaluating a stimulus as either a challenge to be met or an overwhelming obstacle from which to retreat.ObjectiveProviders in the air medical community are required to perform in inherently stressful and unpredictable situations that may threaten to devastate personal resources. This paper is a literary meta-analysis of existing literature on stress performance, threat assessment, and cognitive appraisal in the medical environment.FindingsPreparing for stressful situations is not only accomplished through the practice of skills and rehearsal of knowledge, but also cognitive readiness, mindfulness, and encouragement of team members. Positive cognitive appraisals is practiced through simulation, case study, and purposeful mental practice. Deciding to actively engage in problem solving through the lens of overcoming obstacles and meeting challenges with confidence provides the mental framework that recruits the inevitable sympathetic surge for benefit rather than impairment.ImplicationCognitive appraisal describes the decision to focus on the challenge rather than threat of the situation based on the skills, knowledge, and experience of the team. Establishing a positive narrative and actively engaging in challenges increased confidence and improves performance of medical providers.
       
  • Resilience During Times of Change
    • Abstract: Publication date: Available online 3 June 2019Source: Air Medical JournalAuthor(s): Eileen Frazer
       
  • Forum July/August 2019
    • Abstract: Publication date: Available online 3 June 2019Source: Air Medical JournalAuthor(s):
       
  • The Concept of Overcommitment in Rescue Operations: Some Theoretical
           Aspects Based on Empirical Data
    • Abstract: Publication date: Available online 25 May 2019Source: Air Medical JournalAuthor(s): Albert Lunde, Geir Sverre BrautAbstractObjectiveStudies on Norwegian avalanche rescue operations have indicated high-stake searching of avalanches during elevated risk conditions. We perceive these characteristics as a sign of overcommitment. The purpose of this study is to explore the concept of overcommitment in Norwegian medical evacuation and rescue operations. How can overcommitment be described and understood as a uniform concept in rescue operations based on empirical data'MethodsIn a qualitative, exploratory study, 9 focus group interviews were conducted with a total of 30 crewmembers from the Norwegian air ambulance service.ResultsIn this first in a series of 2 articles, crewmembers’ reflections on the concept of overcommitment, important factors to consider when balancing risk and benefit in every mission, and a number of causal factors are presented. A definition of overcommitment in the context of rescue activities is presented.ConclusionAir ambulance personnel recognize overcommitment in a variety of situations. They broaden the concept to include both regular, everyday actions and hazardous rescue attempts in extraordinary incidents. The causal factors form recognizable constellations that may offer useful starting points for systems-based counteracting measures. The definition of overcommitment could provide a background for evaluation and learning in the rescue service.
       
  • Interfacility Critical Care Transport of an Elderly Patient With Confirmed
           Tricyclic Antidepressant Toxicity and Hemodynamic Collapse
    • Abstract: Publication date: Available online 24 May 2019Source: Air Medical JournalAuthor(s): Benjamin J. Lawner, Nsehniitooh Mbah, Stephanie Bailey, Heather Erickson, Matthew Poremba
       
  • A Physician-Based Helicopter Emergency Medical Services Was Associated
           With an Additional 2.5 Lives Saved per 100 Dispatches of Severely Injured
           Pediatric Patients
    • Abstract: Publication date: Available online 23 May 2019Source: Air Medical JournalAuthor(s): Xavier R.J. Moors, Esther M.M. Van Lieshout, Michael H.J. Verhofstad, Robert Jan Stolker, Dennis Den HartogAbstractObjectivePhysician-based helicopter emergency medical services (HEMS) provide specialist medical care to the accident scene in order to improve the survival of severely injured patients. Studies that focus on the role of physician-based HEMS in pediatric trauma are scarce. The aim of this retrospective, observational study was to determine the effect of physician-based HEMS assistance on the survival of severely injured pediatric patients.MethodsAll consecutive severely injured pediatric patients (age < 18 years and Injury Severity Score> 15) treated between October 1, 2000, and February 28, 2013, were included. The survival of patients who received medical care of physician-based HEMS was compared with the survival of patients treated by an ambulance paramedic crew (ie, emergency medical services group) only. A regression model was developed for calculating the survival benefit in the physician-based HEMS group.ResultsA total of 308 patients were included; 112 (36%) were primarily treated by emergency medical services, and 196 (64%) patients received additional physician-based HEMS assistance on scene. The model with the best diagnostic properties and fit contained physician-based HEMS assistance, 3 components of the Glasgow Coma Scale (eye, motor, and verbal) scored prehospitally (before intubation), ordinal values for the Injury Severity Scale, systolic blood pressure, and respiratory rate. This model predicted that 5 additional patients survived because of physician-based HEMS assistance. This corresponds with 2.5 additional lives saved per 100 physician-based HEMS dispatches for severely injured pediatric patients.ConclusionThe data suggest that an additional 2.5 lives might be saved per 100 physician-based HEMS dispatches for severely injured pediatric patients.
       
  • Clinical Examination of the Pelvic Ring in the Prehospital Phase
    • Abstract: Publication date: Available online 22 May 2019Source: Air Medical JournalAuthor(s): Eelco A.P. van Leent, Bas van Wageningen, Özcan Sir, Erik Hermans, Jan BiertAbstractIntroductionInstable pelvic fractures are associated with significant hemorrhage and shock. Instability of the pelvic ring should be tested with the manual compression test (MCT) and instable pelvic ring fractures should prompt mechanical stabilization. However, the accuracy of the prehospital MCT in patients, that sustained a high energetic trauma, is still unknown.SettingRadboudumc Nijmegen, level 1 trauma center, the Netherlands.MethodsThis prospective blind observational study included all patients after a high impact blunt trauma treated by an experienced Helicopter Emergency Medical Service (HEMS) physician. Nominal arranged questionnaires were filled in by the HEMS physician prior to the radiological examination of the patient.ResultsWe included 56 patients of which 11 sustained a pelvic ring fracture. 13 patients were treated with pelvic compression devices, of which only five patients had a pelvic ring fracture. Prehospital performed clinical examination by the HEMS physicians had an overall sensitivity of 0.45 (95% CI 0.16-0.75) and a specificity of 0.93 (95% CI 0.29-0.96).ConclusionPelvic ring instability cannot accurately be diagnosed in the prehospital setting, based on the MCT. The use of the pelvic binder should standard in high impact blunt trauma patients, independently of the MCT or trauma mechanism.
       
  • Efficacy and Safety of Nasal High-Flow Therapy for Neonatal Transport
    • Abstract: Publication date: Available online 22 May 2019Source: Air Medical JournalAuthor(s): Bhanu Muniyappa, Gina Honey, Bradley A. YoderAbstractObjectiveNoninvasive ventilation, including nasal high-flow therapy (nHFT), provides effective neonatal respiratory support. There are limited data on nHFT use during neonatal transport. Our objective was to assess the efficacy and safety of nHFT during neonatal transport.MethodsOne hundred ninety-five neonates transported on nHFT via a Neo-Pod “T” system (Westmed Inc, Tucson, AZ) were identified from Life Flight transport data. Data included demographics, transport location, distance, indication, and mode as well as pretransport and intratransport respiratory support data. We compared neonates who successfully tolerated nHFT transport with those who required support escalation (defined as increase in flow ≥2 L/min or fraction of inspired oxygen [FiO2] ≥20%).ResultsEighty-seven percent of neonates (170/195) were effectively transported on nHFT. Infants requiring escalation of nHFT support had a significantly higher pretransport FiO2 (median = 0.60 [interquartile range, 0.36-1.00] vs. 0.36 [0.23-0.56]; P < .05) and a longer ground time for stabilization (56 ± 25 vs. 39 ± 18 minutes, P < .05) and were more frequently transported by air.ConclusionNasal HFT can be an effective mode of respiratory support in the transport of selected neonates. FiO2 at the time of transport may be a key parameter to aid in determining neonates who can be safely transported on nHFT.
       
  • Portable Blood (Gas) Analyzer in a Helicopter Emergency Medical Service
    • Abstract: Publication date: Available online 18 May 2019Source: Air Medical JournalAuthor(s): Patrick Schober, Sebastiaan M. Bossers, Ralf Krage, Marcel A. De Leeuw, Lothar A. SchwarteAbstractIntroductionIn prehospital helicopter emergency medical services (HEMS), the medical team frequently manages critical patients with only limited, noninvasive monitoring options on-site and during HEMS transport. To gain deeper insight into the patient's pathology and to track prehospital treatment effects, a point-of-care blood (gas) analyzer appears desirable also in HEMS. Thus, we hypothesized that prehospital blood (gas) analysis is feasible in the HEMS setting.MethodsA prehospital evaluation of a portable blood (gas) analyzer (i-Stat 1; Abbott, Chicago, IL) with appropriate laboratory cartridges was performed within the Dutch HEMS Lifeliner 1, serving a region of ∼4.5 million inhabitants. Venous blood (gas) measurements were performed in our HEMS collective in both trauma and nontrauma cases.ResultsThe HEMS team identified benefits (eg, portability and speed) and limitations (eg, a narrow operational temperature range) regarding the tested blood (gas) analyzer. Regarding the actual blood (gas) results, the team collected results without major abnormalities but also cases identifying major pathologies, including several cases of marked acidosis, refractory hypoglycemia, or severe anemia.ConclusionIn conclusion, portable blood (gas) analysis proved feasible in an HEMS operation but with relevant limitations. Future studies will have to show how these limitations can be overcome and how the implementation of portable blood (gas) analyzers may support improved patient outcome.
       
  • Articles That May Change Your Practice: Inhaled Epoprostenol
    • Abstract: Publication date: Available online 25 April 2019Source: Air Medical JournalAuthor(s): Russell D. MacDonald
       
  • Handheld Tissue Oximetry for the Prehospital Detection of Shock and Need
           for Lifesaving Interventions: Technology in Search of an Indication'
    • Abstract: Publication date: Available online 25 April 2019Source: Air Medical JournalAuthor(s): Jason S. Radowsky, Joseph J. DuBose, Thomas M. Scalea, Catriona Miller, Douglas J. Floccare, Robert A. Sikorski, Colin F. MacKenzie, Peter Hu, Peter Rock, Samuel M. GalvagnoAbstractImproved prehospital methods for assessing the need for lifesaving interventions (LSIs) are needed to gain critical lead time in the care of the injured. We hypothesized that threshold values using prehospital handheld tissue oximetry would detect occult shock and predict LSI requirements. This was a prospective observational study of adult trauma patients emergently transported by helicopter. Patients were monitored with a handheld tissue oximeter (InSpectra Spot Check; Hutchinson Technology Inc, Hutchinson, MN), continuous vital signs, and 21 laboratory measurements obtained both in the field with a portable analyzer and at the time of admission. Shock was defined as base excess ≥ 4 or lactate> 3 mmol/L. Eighty-eight patients were enrolled with a median Injury Severity Score of 16 (interquartile range, 5-29). The median hemoglobin saturation in the capillaries, venules, and arterioles (StO2) value for all patients was 82% (interquartile range, 76%-87%; range, 42%-98%). StO2 was abnormal (< 75%) in 18 patients (20%). Eight were hypotensive (9%) and had laboratory-confirmed evidence of occult shock. StO2 correlated poorly with shock threshold laboratory values (r = −0.17; 95% confidence interval, −0.33 to 1.0; P = .94). The area under the receiver operating curve was 0.51 (95% confidence interval, 0.39-0.63) for StO2 < 75% and laboratory-confirmed shock. StO2 was not associated with LSI need on admission when adjusted for multiple covariates, nor was it independently associated with death. Handheld tissue oximetry was not sensitive or specific for identifying patients with prehospital occult shock. These results do not support prehospital StO2 monitoring despite its inclusion in several published guidelines.
       
  • Defining a Theory-Driven Ultrasound Curriculum for Prehospital Providers
    • Abstract: Publication date: Available online 22 April 2019Source: Air Medical JournalAuthor(s): Daniel Micheller, William J. Peterson, Michael Cover, Graham Smith, Matthew Chapman, Nik Theyyunni, Ross Kessler, Mark J. Lowell, Robert D. HuangAbstractAdvances in point-of-care ultrasound technology have allowed for the extension of emergency medicine ultrasound beyond the walls of the emergency department. Emergency medical system providers may benefit from the use of ultrasound. It has previously been shown that with a brief introductory course, novices can obtain and correctly interpret focused ultrasound examinations. The purpose of this study was to design a theory-driven point-of-care ultrasound curriculum to assess and develop ultrasound skill in prehospital providers. The resultant curriculum outlined in this paper encompasses a large array of skills that may be useful for different prehospital services to use to develop curriculum for their own needs.
       
  • A 63-Year-Old Man With Frostbite
    • Abstract: Publication date: Available online 19 April 2019Source: Air Medical JournalAuthor(s): Peter Tilney, Michael Choate, Patrick Perrault
       
  • There Isn't Enough Narcan to Fix This
    • Abstract: Publication date: Available online 16 April 2019Source: Air Medical JournalAuthor(s): John R. Clark
       
  • The Efficacy of Chest Compressions in the Bell 407
    • Abstract: Publication date: Available online 12 April 2019Source: Air Medical JournalAuthor(s): Dean V Hoffman, Alejandra Figueroa, Matthew Shaw, Paula McAllisterAbstractObjectiveThe Air Medical industry is fraught with obstacles to patient care and providers can recognize that several sub-groups of patients can provide very challenging scenarios while in flight. However, the patient experiencing cardiac arrest in flight is, by its very nature, one that poses the most severe risk to the patient and provider. This study seeks to explore the capability of a highly trained emergency medical provider to provide adequate chest compressions while in a Bell 407 helicopter.Methods59 participants were evaluated in two separate scenarios. Scenario A consisted of 2 rounds of of 200 chest compressions performed on a flat, uncrowded surface. Scenario B consisted of 200 chest compressions performed in the cabin of a Bell 407. Participants performed 2 rounds of 200 chest compressions. The results were then compared to each other and to the AHA 2010 CPR guidelines.ResultsThe findings of the study show that compressions performed in the aircraft do not meet AHA guidelines for chest compressions in regard to depth and duration of compressions. The deviation from guideline in regard to rate was found to be not statistically significant.ConclusionChest compressions performed in a Bell 407 helicopter do not meet AHA guidelines.
       
  • Creation of a Flight Nurse Critical Care Ultrasound Program
    • Abstract: Publication date: Available online 10 April 2019Source: Air Medical JournalAuthor(s): Michael Cover, Chelsea Tafoya, Benjamin Long, James Cranford, John Burkhardt, Robert Huang, Nik Theyyunni, Benjamin Bassin, Mark Lowell, Ross KesslerAbstractObjectiveOur objectives were 2-fold: to describe the creation of a flight nurse (FN) ultrasound (US) program and to evaluate whether critical care US performed by nonphysician providers in the prehospital setting can clarify patient assessment.MethodsTwenty FNs completed a didactic and hands-on US curriculum focusing on critical care modalities. FNs displayed competency by successful completion of an objective-structured clinical examination. Portable US devices were used during patient transports when deemed clinically indicated by the FN. If US was subsequently performed, the FN was asked if US use prompted a change in assessment. Associations were evaluated with chi-square and bivariate logistic regression analyses.ResultsFNs reported US use during 102 (12.3%) patient transports, of which intensive care unit (ICU) to ICU (58.8%) constituted the majority of cases followed by emergency department (ED) to ED (28.4%), ED to ICU (4.9%), and scene to ED (2.9%). FNs agreed or strongly agreed that US use clarified the cause of patient symptoms in 67.4% of transports.ConclusionFNs were more likely to perform US when they expressed lower confidence in their initial patient assessment. FNs reported that US helped to clarify patient assessments.
       
  • Helicopter Emergency Medical Services Utilization
    • Abstract: Publication date: Available online 10 April 2019Source: Air Medical JournalAuthor(s): Timothy J. Lenz, Elena A. Kossyreva, M. Riccardo ColellaAbstractBackgroundThe decision to utilize HEMS is a complex process that involves many considerations. Professional associations and agencies have published guidelines to assist providers with decision making for the utilization of helicopter transport.Study ObjectiveDetermine if requests for HEMS align with recently published utilization guidelines.Study DesignA retrospective chart review was performed during a six-month period. Reviewers versed in Wisconsin HEMS Utilization, NAEMSP, and CAMTS guidelines determined if transport criteria were met. Charts were categorized according to whether or not criteria for each set of recommendations were followed.Results514 charts were reviewed; 439 consisted of completed patient transports. CAMTS, NAEMSP, and WI HEMS guidelines satisfied 85.4%, 83.4%, and 53.1% of requests, respectively. Statistically significant differences existed when comparing rates meeting criteria between WI HEMS and CAMTS and between WI HEMS and NAEMSP guidelines (p-value
       
 
 
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