Publisher: Elsevier   (Total: 3148 journals)

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Showing 1 - 200 of 3148 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: 106, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 44, 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: 446, 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: 2)
Acta Ecologica Sinica     Open Access   (Followers: 12, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 5, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 324, 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 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   (Followers: 1)
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: 13, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 190, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 13, 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: 1, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 35, 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: 11, 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: 21, 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: 16)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 14)
Advances in Digestive Medicine     Open Access   (Followers: 13)
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: 30, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 9)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 51, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 2)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 68, 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: 8, 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: 4, 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: 17, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 9, 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: 26)
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: 6, 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: 10, 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: 11)
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: 69)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 3, 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: 7)
Advances in Space Research     Full-text available via subscription   (Followers: 430, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 6)
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: 37, 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: 57, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 394, 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: 489, 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: 47, 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: 55, 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: 67, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 48, 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: 15, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 40, 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: 37, 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: 266, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 67, 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: 30, 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: 6, 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: 216, 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: 236, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 8, SJR: 0.937, CiteScore: 2)
Animal Reproduction Science     Hybrid Journal   (Followers: 7, SJR: 0.704, CiteScore: 2)
Annales d'Endocrinologie     Full-text available via subscription   (Followers: 3, SJR: 0.451, CiteScore: 1)

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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  [3148 journals]
  • Articles That May Change Your Practice: Prone Position Ventilation
    • Abstract: Publication date: Available online 21 January 2020Source: Air Medical JournalAuthor(s): Russell D. MacDonald, Yuen Chin Leong
       
  • A Tribute to N. Genell Lee
    • Abstract: Publication date: Available online 14 January 2020Source: Air Medical JournalAuthor(s): Denise Treadwell
       
  • The Use of Point-of-Care Ultrasound to Accurately Measure Cardiac Output
           in Flight
    • Abstract: Publication date: Available online 14 January 2020Source: Air Medical JournalAuthor(s): Alexandra Murray, Heidi Hutchison, Madalyn Popil, William Krebs
       
  • “Flight Nurses,” or “Nurses Who Fly”' An International
           Perspective on the Role of Flight Nurses
    • Abstract: Publication date: Available online 10 January 2020Source: Air Medical JournalAuthor(s): Ian Braithwaite, Ann-marie SteeleAbstractObjectiveDiscovering how transport nurses around the world are prepared and supported for a flight role may illuminate areas of best practice. This article reviews the flight nursing research, exploring what the international literature tells us about the role of flight nurses and discovering lessons from their experiences that may have particular relevance for the UK context.MethodsThe results of a literature search and thematic synthesis for flight nursing research are described.ResultsThirteen research articles were obtained covering a broad range of countries. The scope of practice encompasses primary and secondary transport services and both civilian and military personnel. In an attempt to distill the role, work, and purpose of a flight nurse, a list of all the themes and categories that could be identified within the literature was assembled. These were inductively refined into 8 cluster themes, seeking to capture a broad description of the role of a nurse who flies. The definition of a “flight nurse” in the international context is debated. Thoughts related to training and education and, in particular, the nontechnical challenges of the role are discussed.ConclusionThis reflection provides insights that will influence the ongoing conversation around future air medical service development.
       
  • Comment on: Cardiac Arrest Secondary to Accidental Hypothermia: Who Should
           We Resuscitate'
    • Abstract: Publication date: Available online 6 January 2020Source: Air Medical JournalAuthor(s): Mathieu Pasquier, Oliver Hugli, Adam-Scott Feiner, Tomasz Darocha
       
  • On Their Own Terms
    • Abstract: Publication date: Available online 3 January 2020Source: Air Medical JournalAuthor(s): Janie Kofford Ford
       
  • A 19-Year-Old Man With Vaping-Associated Lung Injury
    • Abstract: Publication date: Available online 28 December 2019Source: Air Medical JournalAuthor(s): Jacob Gutsche, Racheal Pasternak, Doug Campbell, Joseph L. Schili, Patrick J. Boyle, Peter Tilney
       
  • AMTC 2019
    • Abstract: Publication date: Available online 28 December 2019Source: Air Medical JournalAuthor(s): Eileen Frazer
       
  • The Call
    • Abstract: Publication date: Available online 28 December 2019Source: Air Medical JournalAuthor(s): Michel Hall
       
  • Forum January/February 2020
    • Abstract: Publication date: Available online 25 December 2019Source: Air Medical JournalAuthor(s):
       
  • The Use of Ketamine for Air Medical Rapid Sequence Intubation Was Not
           Associated With a Decrease in Hypotension or Cardiopulmonary Arrest
    • Abstract: Publication date: Available online 19 December 2019Source: Air Medical JournalAuthor(s): Melanie A. Pollack, Gregory M. Fenati, Troy W. Pennington, David J. Olvera, Allen Wolfe, Michelle Owens, Daniel P. DavisAbstractObjectiveRapid sequence intubation (RSI) is associated with a number of complications that can increase morbidity and mortality. Among RSI agents used to blunt awareness of the procedure and produce amnesia, ketamine is unique in its classification as a dissociative agent rather than a central nervous system depressant. Thus, ketamine should have a lower risk of peri-RSI hypotension because of the minimal sympatholysis compared with other agents. Recent recommendations include the use of ketamine for RSI in hemodynamically unstable patients. The main goal of this analysis was to explore the incidence of hypotension and/or cardiopulmonary arrest in patients receiving ketamine, etomidate, midazolam, and fentanyl during air medical RSI. We hypothesized that ketamine would be associated with a lower risk of hemodynamic complications, particularly after adjusting for covariables reflecting patient acuity. In addition, we anticipated that an increased prevalence of ketamine use would be associated with a decreased incidence of peri-RSI hypotension and/or arrest.MethodsThis was a retrospective, observational study using a large air medical airway database. A waiver of informed consent was granted by our institutional review board. Descriptive statistics were used to present demographic and clinical data. The incidence rates of hypotension and cardiopulmonary arrest were calculated for each sedative/dissociative agent. Multivariable logistic regression was used to calculate the odds ratios of both hypotension and arrest for each of the sedative/dissociative agents. The prevalence of use for each agent and the incidence of hemodynamic complications (hypotension and arrest) were determined over time.ResultsA total of 7,466 RSI patients were included in this analysis. The use of ketamine increased over the duration of the study. Ketamine was associated with a higher incidence of both hypotension and arrest compared with other agents, even after adjustment for multiple covariables. The overall incidence of hypotension, desaturation, and cardiopulmonary arrest did not change over the study period.ConclusionsAlthough the incidence of hemodynamic complications was higher in patients receiving ketamine, this may reflect a selection bias toward more hemodynamically unstable patients in the ketamine cohort. The incidence of hypotension and arrest did not change over time despite an increase in the prevalence of ketamine use for air medical RSI. These data do not support a safer hemodynamic profile for ketamine.
       
  • Bhutan's First Emergency Air Medical Retrieval Service: The First Year of
           Operations
    • Abstract: Publication date: Available online 9 December 2019Source: Air Medical JournalAuthor(s): Sweta Giri, Urvashi Sharma, Jangchu Choden, Kiran Biswa Diyali, Lhab Dorji, Cheki WangchukAbstractObjectiveThe Bhutan Emergency Aeromedical Retrieval (BEAR) Team is the only helicopter emergency medical service in Bhutan. This study was performed to review the clinical cases cared for by the BEAR Team, ascertain the types of interventions that were performed, and determine the outcomes of patients evacuated in its first year of operations.MethodsThis is a retrospective observational study in which medical evacuations performed in the first year of operations were analyzed. The number of airlifts activated during the study period determined the sample size (171). Data were obtained from case logs and trip sheets.ResultsThe BEAR Team provided services to all regions of the country in its first year. The overall survival rate was 73.1%. The most common intervention required was securing a definitive airway (n = 24). The top 3 conditions requiring air medical retrieval were sepsis, acute mountain sickness, and trauma.ConclusionHelicopter emergency medical services are known to decrease the time to definitive treatment. This is particularly pertinent in Bhutan, given the scattered population distribution, long transport times, and distribution of medical resources and specialty care. This study is the first of its kind in Bhutan, and this can pave way to conduct more studies involving patients transported by air ambulance.
       
  • Ketamine Sedation of the Pregnant Patient With Acute Suicidal Ideation
           During Air Medical Transfer
    • Abstract: Publication date: Available online 4 December 2019Source: Air Medical JournalAuthor(s): Minh Le Cong, Susan Markwell, Liza RobertsonAbstractAeromedical retrieval of acutely suicidal pregnant patient can be facilitated by novel use of ketamine and it's rapid antidepressant property.
       
  • General Information
    • Abstract: Publication date: November–December 2019Source: Air Medical Journal, Volume 38, Issue 6Author(s):
       
  • Resuscitation Part 2: Trauma and Burn Injury
    • Abstract: Publication date: November–December 2019Source: Air Medical Journal, Volume 38, Issue 6Author(s): David J. Dries
       
  • 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.
       
  • 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):
       
  • Infrastructure
    • Abstract: Publication date: Available online 18 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.
       
  • 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.
       
  • 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
       
 
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