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Publisher: Elsevier   (Total: 3184 journals)

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Showing 1 - 200 of 3184 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 37, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 26, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 100, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 39, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 6)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 435, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 28, 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: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 308, 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: 1, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 25, 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: 183, 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: 29, 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: 11, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, 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: 33, 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: 10, 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: 43, 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: 51, 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: 65, 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: 10, 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: 24)
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: 36, 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: 12, 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: 24)
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: 18)
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: 66)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 1, 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: 421, 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: 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: 5, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 53, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 383, 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: 473, 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: 31, 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: 7, 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: 11)
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: 10, 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: 63, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 46, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 12)
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: 249, 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: 66, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 24, 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: 210, 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: 221, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 6, 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: 7  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1067-991X
Published by Elsevier Homepage  [3184 journals]
  • Resuscitation Part 2: Trauma and Burn Injury
    • Abstract: Publication date: Available online 24 August 2019Source: Air Medical JournalAuthor(s): David J. Dries
       
  • 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):
       
  • Hot Loading Reduces Time to Intervention for ST-segment Elevation
           Myocardial Infarction Patients Being Transferred by Helicopter
    • Abstract: Publication date: May–June 2019Source: Air Medical Journal, Volume 38, Issue 3Author(s): Jeffrey S. Lubin, Keane E. McCullumAbstractObjectiveThe aim of this study was to quantify the effect of helicopter hot loading on the time to percutaneous intervention (time-to-PCI) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing interhospital transfer.MethodsWe performed a retrospective cohort study using data from 2009 to 2014, looking at all patients who had an STEMI, were transferred from a single non-PCI hospital by helicopter emergency medical services, and who received PCI intervention at the PCI-capable hospital. Differences in loading method, flight details, and patient demographics were analyzed to measure the effectiveness of the intervention.ResultsDuring the 5-year study period, 134 STEMI patients were transferred. Sixty-four were hot loaded (47.7%), and 70 were cold loaded. Patients who were hot loaded had a median reduction in interhospital transfer and time-to-PCI of 22.3 minutes from 91.0 minutes (interquartile range, 65-117 minutes) by cold load to 69.5 minutes (interquartile range, 47.5-91.5 minutes) by hot load. There was no increase in reported safety-related events during the hot load process. The median length of hospital stay was equivalent for both groups at 3 days.ConclusionsThis protocol of helicopter hot loading STEMI patients presenting to a non-PCI hospital significantly reduced the median time of interhospital transfer and time-to-PCI without an increase in reported safety events.
       
  • 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.
       
  • General Information
    • Abstract: Publication date: May–June 2019Source: Air Medical Journal, Volume 38, Issue 3Author(s):
       
  • Responsible “Helicopter Shopping” Through Selective Resource
           Management
    • Abstract: Publication date: May–June 2019Source: Air Medical Journal, Volume 38, Issue 3Author(s): Nikole Regina Good, Air & Surface Transport Nurses Association, Emergency Nurses Association and International Association of Flight and Critical Care Paramedics
       
  • 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
       
  • Overcommitment: Management in Helicopter Emergency Medical Services in
           Norway
    • Abstract: Publication date: Available online 4 April 2019Source: Air Medical JournalAuthor(s): Albert Lunde, Geir Sverre BrautAbstractObjectiveOvercommitment in demanding rescue situations may put both rescuers and patients in danger. This study aimed at identifying individual approaches and organizational strategies that counteract instances in which rescuers commit more than is feasible, desirable, expected, recommended, or compellingly necessary. How is overcommitment managed by professional frontline rescuers during hazardous medical evacuation and rescue situations'MethodsIn a qualitative, exploratory study, 9 focus group interviews were conducted with a total of 30 crewmembers from the Norwegian Helicopter Emergency Medical Service.ResultsIn this second article in a series of 2 articles on overcommitment, 12 commitment-moderating factors are presented. Air ambulance personnel pointed at sociological, cognitive, and organizational elements that may influence their degree of commitment in challenging and hazardous rescue situations.ConclusionAir ambulance personnel describe a team-based approach to adjust their level of commitment in medical evacuation and rescue missions. They rely on known, however important, nontechnical skills and organizational measures to combat overcommitment in demanding rescue situations. Some of their approaches to safe performance should be adoptable by other rescue units and less experienced voluntary, not-for-profit, rescue organizations.
       
  • Near-infrared Spectroscopy in Transport With a Patient in Multi-factorial
           Shock
    • Abstract: Publication date: Available online 3 April 2019Source: Air Medical JournalAuthor(s): Jeff Parker, Tanya Walenta, Kim Turner-NelsonAbstractA 14-year-old male with a history of repaired truncus arteriosus presented to an outside hospital emergency room in respiratory distress. The triage report to the transport referral center included the following vital signs: temperature of 36.6°C, respiratory rate (RR) of 26breaths/min, heart rate (HR) of 144beats/min, and blood pressure (BP) of 113/52mm Hg with peripheral capillary oxygen saturation (SpO2) of 95% on 4 L via an OxyMask (SouthMedic, Barrie, Ontario, Canada). Additional information indicated severe right ventricle to pulmonary artery conduit stenosis; anuria for 2 days; and cool, mottled extremities. The transport team was dispatched via helicopter. The vital signs upon arrival were as follows: temperature of 36.5°C, HR of 153beats/min, RR of 48breaths/min, BP of 81/52, mean arterial pressure of 62, and SpO2 of 96% on 8 L via an OxyMask. Physical assessment revealed the patient was alert and oriented, tachypneic, tachycardic, and displaying poor perfusion. An epinephrine drip was initiated while the patient was being prepared for transport. Near-infrared spectroscopy (NIRS) was initiated with cerebral NIRS of 71% and renal NIRS of 39%. The epinephrine drip was escalated, and norepinephrine was initiated and titrated up for continued poor perfusion and low renal NIRS. Vitals at the transfer of care at the receiving facility were HR of 142beats/min, BP of 91/51mm Hg, RR of 56breaths/min, SpO2 of 99%, and cerebral NIRS of 75% and renal NIRS of 53%. The patient required mechanical circulatory support shortly after admission. NIRS monitoring was used to help measure perfusion and reassess interventions made during transport.
       
  • Forum May/June 2019
    • Abstract: Publication date: Available online 2 April 2019Source: Air Medical JournalAuthor(s):
       
  • Incomplete Spinal Cord Injury With Concurrent Hypertrophic Obstructive
           Cardiomyopathy
    • Abstract: Publication date: Available online 1 April 2019Source: Air Medical JournalAuthor(s): Matthew Jensen, Robert Brown, David Trueman, Katherine Rodman, Harinder DhindsaAbstractTraumatic spinal cord injuries are significant contributors to the morbidity and mortality burden of trauma patients worldwide, and consume significant resources in both their acute and rehabilitative care. Another cause of mortality and morbidity is hypertrophic obstructive cardiomyopathy, which can cause syncope or sudden cardiac death in patients with no known prior cardiac disease. This case report describes a unique combination of these two high-risk pathologies in a scene trauma patient, and provides an overview of the pathophysiology and treatment of these high-risk disease processes.
       
  • Long-Distance Transportation of Carbon Monoxide–Poisoned Patients on
           Extracorporeal Membrane Oxygenation Seems Possible: A Porcine Feasibility
           Study
    • Abstract: Publication date: Available online 30 March 2019Source: Air Medical JournalAuthor(s): Carsten Simonsen, Sigridur O. Magnusdottir, Jan J. Andreasen, René C. Bleeg, Claus Lie, Benedict KjærgaardAbstractObjectiveExtracorporeal membrane oxygenation (ECMO) has been widely used to stabilize patients with impairment of cardiac/respiratory function, and ECMO has been used to stabilize cardiopulmonary insufficiency caused by carbon monoxide (CO) poisoning in a porcine model. Airborne transportation in fixed wing aircraft of patients suffering from CO poisoning is challenging because as the air pressure drops, the oxygen content falls correspondingly.The aim of this study was to show the feasibility of cannulating and establishing ECMO therapy during airborne transportation after severe CO poisoning in a porcine model.MethodsAn anesthetized pig was subjected to severe CO poisoning and loaded onto a Hercules aircraft. Cardiac arrest was induced at an altitude of 8,000 feet, after which cannulation and the establishment of venoarterial (VA) ECMO were performed. Vital signs were monitored, and arterial blood samples were analyzed while airborne.ResultsCO poisoning was induced with carboxyhemoglobin at 58% before takeoff. We successfully cannulated the animal in-flight during cardiac arrest and initiated VA ECMO. The animal regained spontaneous circulation and was successfully weaned from ECMO. During VA ECMO, PaO2 was maintained at high levels (420-615mm Hg).ConclusionIt is possible to cannulate and initiate VA ECMO treatment as airborne en route therapy for cardiac arrest and severe CO intoxication in a porcine model.
       
  • Ask the CAMTS
    • Abstract: Publication date: Available online 28 March 2019Source: Air Medical JournalAuthor(s): Eileen Frazer
       
  • Articles That May Change Your Practice: Prehospital Antibiotics
    • Abstract: Publication date: Available online 28 March 2019Source: Air Medical JournalAuthor(s): Russell D. MacDonald
       
  • Faces of Terrorism
    • Abstract: Publication date: Available online 28 March 2019Source: Air Medical JournalAuthor(s): David J. Dries
       
  • Effect of Intravenous Versus Intraosseous Access in Prehospital Cardiac
           Arrest
    • Abstract: Publication date: Available online 12 March 2019Source: Air Medical JournalAuthor(s): Linh Nguyen, Stephen Suarez, Jessica Daniels, Cristina Sanchez, Kim Landry, Colby RedfieldAbstractObjectiveThe prevailing standard of care in prehospital emergency medical services (EMS) is that either intravenous (IV) or intraosseous (IO) access is an acceptable route for obtaining vascular access and delivery of resuscitation medications and volume expanders in cardiac arrest patients. The aim of this study was to evaluate the effectiveness of IV access versus IO access in terms of return of spontaneous circulation (ROSC) for patients suffering from cardiac arrest.MethodsA retrospective chart review examining cardiac arrest data with a single advanced life support EMS agency over a 4-year period was performed. Cardiac arrest patients were identified from a quality assurance database. Exclusion criteria included trauma arrest, pediatrics, pregnancy, and obvious signs of death.ResultsA total of 795 patients remained after applying the exclusion criteria. A total of 183 (45.1%) out of 406 cardiac arrest patients achieved ROSC who had an IV placed. A total of 389 cardiac arrest patients had an IO placed with ROSC in 100 (25.7%).ConclusionsHigher ROSC rates were achieved with IV access versus IO access. Limitations include the small sample size, a single EMS agency, and the retrospective nature of the study. Future studies should further evaluate the effectiveness of IO versus IV access in cardiac arrest and other low perfusion states.
       
  • Ebola, Airborne Medical Evacuation . . . The Danish way
    • Abstract: Publication date: Available online 8 March 2019Source: Air Medical JournalAuthor(s): René Christian Bleeg
       
  • Troubleshooting Hypoxemia After Placement of an Extraglottic Airway
    • Abstract: Publication date: Available online 7 March 2019Source: Air Medical JournalAuthor(s): J. Britton Hopkins, Matthew A. Roginski, Darren A. Braude, Andrew D. Cathers, Trevor Johnson, Michael T. SteuerwaldAbstractThe case presented here highlights the feasibility of using an extraglottic airway device as a conduit for delivering high levels of lifesaving positive end expiratory pressure (PEEP), as well as other means of combating recalcitrant hypoxia. The case also highlights the merit of an approach to the hypoxic patient with an in-situ extraglottic airway device based not only on deciding if the device is functioning to maintain a patent airway, but also, simultaneously considering the patient's physiology. A 71 year old male suffered an out-of-hospital cardiac arrest. Part of his resuscitation included placement of a dual-balloon extraglottic airway device by EMS. He was hypoxic, but the device seemed to be providing for a patent airway without an air leak. There was also a favorable end-tidal carbon dioxide waveform. The flight team chose to the leave the device in place. PEEP was up-titrated to 17 cmH20 without issue. Sigh breaths, as well as breath holds, were also able to be delivered. The patient's hypoxia improved over the course of the patient's transport, and he ultimately did well.
       
  • The Rapid Emergency Medicine Score: A Critical Appraisal of Its
           
    • Abstract: Publication date: Available online 7 March 2019Source: Air Medical JournalAuthor(s): Brodie Nolan, Homer Tien, Barbara Haas, Refik Saskin, Avery NathensAbstractObjectiveThe Rapid Emergency Medicine Score (REMS) was designed to predict in-hospital mortality using variables that are available in the prehospital setting. The objective of this article is to critically appraise the development and summarize the evidence regarding the measurement properties (sensitivity, reliability and validity) of the REMS.MethodsA literature search was performed identifying all studies describing the REMS. The original validation study was critically appraised for its development. All other studies that reported any measurement properties of the REMS were also appraised for evidence of calibration, reliability, and validity.ResultsIn total, 26 studies reported on the measurement properties of the REMS. Overall, the REMS was developed with robust methodology and has good sensibility with adequate content and face validity. It is easy to understand and feasible to be calculated within minutes of patient assessment. The REMS has the necessary measurement properties to be both a predictive and evaluative clinical index to measure prehospital severity of illness; however, no studies have adequately addressed the intra or inter-rater reliability of the score.ConclusionsThere is evidence to support the use of the REMS as a predictive or evaluative instrument. In most studies, it performed as well or better than other illness severity scores in predicting mortality.
       
  • Teaching Flight Nurses Ultrasonographic Evaluation of Esophageal
           Intubation and Pneumothorax
    • Abstract: Publication date: Available online 2 March 2019Source: Air Medical JournalAuthor(s): Ryan Mason, Andrew Latimer, Michael Vrablik, Rich UtarnachittAbstractAeromedical prehospital care has seen an increase in the use of point-of-care-ultrasound (POCUS) in recent years. Prior research has focused on abdominal trauma exams by physician or advanced practice providers. In this study, we describe the implementation of an ultrasound curriculum designed for Flight Nurse assessment of pneumothorax and esophageal intubation.The study team conducted three one-hour training sessions over two months. The training curriculum included didactic and hands-on components. We enrolled twelve flight nurses with no prior ultrasound experience. A pre- and post-test was administered consisting of fifteen questions.The median pre-test score was seven correct for an average of 45.0%. After the training session, the median post-test score was fourteen correct for an average of 90.6%. The training intervention resulted in an average improvement in score of 45.6%.While not examining skill acquisition, we are encouraged by the implementation of this curriculum for future ultrasound education in esophageal intubation and pneumothorax.
       
  • It's Just the Flu
    • Abstract: Publication date: Available online 1 March 2019Source: Air Medical JournalAuthor(s): Sarah Fabiano, Matt Bicknell
       
  • The Utility of a Portable X-ray System
    • Abstract: Publication date: Available online 26 February 2019Source: Air Medical JournalAuthor(s): Kazuhiko Omori, Ken-ichi Muramatsu, Hiroki Nagasawa, Ikuto Takeuchi, Shunsuke Madokoro, Kei Jitsuiki, Hiromichi Ohsaka, Kouhei Ishikawa, Youichi YanagawaAbstractFujifilm (Tokyo, Japan) developed a portable X-ray system called the CALNEO Xair. We herein report our experience in using this portable X-ray system at the scene after transportation by a doctor helicopter (DH). An explosion suddenly occurred while a 42-year-old man was handling toluene in a factory, causing his clothes to catch on fire. When the staff of a physician-staffed helicopter (DH) equipped with a portable X-ray system checked the man at the rendezvous point, he had second- and third-degree flame burns to> 70% of his total body surface area. A chest X-ray obtained using the portable X-ray system showed clear lung fields. A noninvasive carboxyhemoglobin monitor indicated a carboxyhemoglobin value of 6%. He was transferred to a special burn center by the DH. This is the first reported case in which a portable X-ray system was used to evaluate blast injuries in the prehospital setting. This system may be useful for performing prehospital medical treatment for blast injury victims.
       
  • Long-term Effectiveness of the Airway Registry at Sydney Helicopter
           Emergency Medical Service
    • Abstract: Publication date: Available online 22 February 2019Source: Air Medical JournalAuthor(s): Floris R.W. Oud, Fabian O. Kooij, Brian J. BurnsAbstractObjectivePrehospital rapid sequence intubation (RSI) is prone to suboptimal documentation. The Greater Sydney Area Helicopter Emergency Medical Service (GSA-HEMS) uses a dedicated Airway Registry (AR) to aid documentation. The AR was only evaluated shortly after its introduction. This first evaluation is followed up to assess the long-term effectiveness of the AR. The secondary objective was to compare the AR with templates in the literature.MethodsA retrospective review of electronic records was undertaken to compare completeness of documentation between an immediate postintroduction and a long-term postintroduction cohort. Differences between the two cohorts were tested for significance.ResultsThere was no significant difference in documentation for Cormack-Lehane laryngoscopy grade at the first intubation attempt (P = .552) and confirmation of end-tidal carbon dioxide (P = .258). A significant improvement in the documentation of laryngoscopy grade for the second attempt (P = 0) was found. The documentation of intubator details remained at 100% (165/165). The variables collected by GSA-HEMS corresponded well to the literature, but some definitions differ (eg, desaturation).ConclusionThere was no significant change in completeness of documentation for most key intubation variables eight years after the introduction of the AR. GSA-HEMS performs well in registering variables as proposed in the literature; however, variable definitions need to be synchronized.
       
  • Transportation of Temperature-sensitive Medications in an Air Medical
           Setting
    • Abstract: Publication date: Available online 10 February 2019Source: Air Medical JournalAuthor(s): Timothy WallaceAbstractIntroductionThis article describes an effective system for the transportation of temperature-sensitive medications within acceptable temperature ranges in the air medical setting.MethodA temperature audit using data logging thermometers of drug bags used to transport temperature-sensitive medications revealed that temperature excursions above the accepted maximums (8°C) occurred frequently. An experimental methodology was developed using a commercially available shipping container that was subject to a rapid conditioning regimen. Through a series of experimental trials, it was determined that with the devised conditioning regimen the system would maintain a consistent 2°C to 8°C. This system was implemented, and data were collected over a series of air medical missions (5) over a 90-day period.ResultsThe average mission duration was 10 hours with temperature-sensitive medications spending an average of 15.3 hours out of the pharmacy fridge. Temperature data showed temperature-sensitive medications remained within the 2°C to 8°C range for the duration of all missions in which the shipping container was prepared appropriately.ConclusionThis proof of concept study showed a system that can maintain acceptable storage conditions for temperature-sensitive medications.
       
  • Evaluation of a New Helicopter Crew Transport Fatigue Assessment
    • Abstract: Publication date: Available online 5 February 2019Source: Air Medical JournalAuthor(s): Ryan Bushmaker, Katherine Corey, Julie Dunn, Trent Lalonde, Samantha EstradaAbstractFatigue in air ambulance crews leads to decrements in performance and situational awareness that may contribute to aircraft accidents and patient care mistakes. Fatigue assessments completed by flight crews can give early warning when fatigue is accumulating. Countermeasures can then be implemented to improve performance and increase safety. No validated air ambulance fatigue assessment currently exists that incorporates transport-specific factors. The objective of this study was to validate a flight fatigue assessment that accounts for air transport–specific factors. Flight crewmembers from multiple air ambulance programs participated and completed assessments. Results were analyzed to determine if the assessment captured or predicted fatigue levels of crewmembers. When used to measure crewmember fatigue, the assessment was shown to consistently and reliably confirm accumulating fatigue and correlated with crew-reported levels of fatigue. A predicted fatigue scale was created to help crewmembers objectively identify their fatigue level. Used consistently, the transport fatigue assessment should increase awareness of accumulating fatigue. With awareness, crewmembers are better equipped to justify and take advantage of opportunities to mitigate their fatigue, increase crew coordination, enhance safety, and improve patient care.
       
  • Investigation of Stethoscope Technology for En Route Care
    • Abstract: Publication date: Available online 31 January 2019Source: Air Medical JournalAuthor(s): Melissa A. Wilson, Brittany L. Fouts, Charles J. Harding
       
 
 
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