Feasibility of 10-Minute Arrival Time to Departure Time Metric for STEMI Patients.

Objectives: Delays in reperfusion treatment in ST-elevation myocardial infarction (STEMI) patients leads to higher morbidity and mortality. Previous reports for Helicopter Emergency Medical Services (HEMS) suggests a 10-minute skid-to-skid (arrival to departure) time to achieve appropriate reperfusion times. However, there is no published data on whether this goal is achievable for a HEMS service.

Acute Non-ST Segment Elevation Myocardial Infarction Following Intravenous Injection of Sublingual Suboxone.

Non-ST segment elevation myocardial infarction (NSTEMI) is a relatively unknown complication of injecting sublingual Suboxone (buprenorphine/naloxone). Buprenorphine/naloxone should be taken as a sublingual tablet or a buccal film and not injected, so its effects from this mode of administration are not well known. While the differential diagnosis for chest pain is very broad, many practitioners do not associate chest pain with the use of buprenorphine/naloxone.

The Effect of Coronavirus Disease 2019 on Adverse Events in Health Care: A Retrospective Study in Ground and Helicopter Emergency Medical Services.

Objective: The coronavirus disease 2019 (COVID-19) pandemic has proven to be a significant hardship for the entire world. Health care systems and their workers have been stretched to their limits. Research regarding whether this increased strain has affected patient safety has not been sufficient, especially in emergency medical services.

Comparing Intubation Success Between Flight Nurses and Flight Paramedics in Helicopter Emergency Medical Services.

Objective: Intubation is a vital skill performed by flight nurses and paramedics. Before flight training, nurses do not routinely intubate and must be trained in proper techniques. Flight paramedics universally train in intubation before flight training and are the primary managers of in-flight airways.

Do EMS Physicians Delay On-Scene Times for HEMS Crews?

Objectives: Helicopter emergency services (HEMS) serve a crucial role in the triage and transport of critically ill patients. Rapid transport to definitive care has become the goal of all prehospital EMS as shorter scene intervals have been associated with decreased mortality. Over the past several years, we have seen a rise in physicians trained in emergency medicine and EMS responding in the prehospital setting in our HEMS region.

Predictive Factors for the Application of Pelvic Binders in the Prehospital Setting.

Objectives: Early pelvic binder placement in the field stabilizes pelvic fractures and tamponades potential hemorrhage within the pelvis. Despite known risk factors for pelvic fracture, it remains challenging to quickly triage and correctly apply a pelvic binder. We aim to develop a prediction model that exclusively uses prehospital criteria to inform the decision to place a pelvic binder.

Out-of-pocket payments made by patients transported by Helicopter Emergency Medical Services (HEMS).

Objective: Recent news media have reported that Helicopter Emergency Medical Service (HEMS) programs use the practice of balanced billing, resulting in exorbitant charges not covered by insurance companies and financially burdening patients. To date, no study has described the billing practices of HEMS programs. We look to provide transparent billing practices and average patient payment of one midwestern non-profit HEMS program and report the reimbursement data of both federal and private insurance policies for transports.

Hemodynamics in Helicopter Emergency Medical Services (HEMS) Patients Undergoing Rapid Sequence Intubation With Etomidate or Ketamine.

Background: Rapid sequence intubation (RSI) is performed by helicopter emergency medical services (HEMS) providers to establish airway control. Common induction agents are etomidate and ketamine, both touted to have relatively stable hemodynamic profiles. Limited data comparing these medications in the air medical setting exist.

Direct Versus Video Laryngoscopy in a Helicopter Emergency Medical Services Setting: A Retrospective Comparison.

Objective: Since the introduction of video laryngoscopy (VL) as a technique for orotracheal intubation, its use has become widespread among prehospital providers. However, little information is available about the efficacy and success of VL compared with direct laryngoscopy (DL) in the helicopter emergency medical services (HEMS) setting. The objective of this study was to investigate whether VL or DL increased successful first-pass orotracheal intubations and overall intubation success by HEMS providers.

Determining a Need for Point-of-Care Ultrasound in Helicopter Emergency Medical Services Transport.

Objective: Point-of care-ultrasound (PoCUS) is useful in evaluating unstable emergency department patients. The portability of this technology increases its potential use in prehospital settings, including helicopter emergency medical services (HEMS) programs. Identifying useful applications may support implementing a PoCUS program that develops sonography skills for prehospital providers.

The Safety and Utility of Ground Transport of Traumatic Cardiopulmonary Arrest Patients by Helicopter Emergency Medical Services Crews.

Objective: Patients suffering from traumatic cardiopulmonary arrest (TCPA) typically demonstrate dismal survival rates. Some helicopter emergency medical services (HEMS) systems transport TCPA patients via ground with a referring agency when cardiopulmonary pulmonary resuscitation is in progress. With expanding research on the inherent risk of ground emergency medical services (GEMS) transport with the use of lights and sirens to both crew and the general public, the benefits may not outweigh the risks of transporting these patients by GEMS.

Factors That Contribute to Provider Decision Between Direct and Video Laryngoscopy in a Helicopter Emergency Medical Services System: A Survey.

Objective: In caring for critically ill patients in the prehospital setting, rapid, definitive airway management is a high-risk, crucial procedure. All helicopter emergency medical services (HEMS) providers must proficiently and safely perform this procedure. Little information is available about the preference and efficacy of video laryngoscopy (VL) compared with direct laryngoscopy (DL).

Complications from Needle Thoracostomy: Penetration of the Myocardium.

We report a rare but serious complication of needle thoracostomy, penetration of the myocardium. Needle thoracostomy is typically performed in the prehospital setting or upon arrival in the emergency department for suspected tension pneumothorax. Needle decompression is generally taught and done anteriorly, in the 2 intercostal space on the midclavicular line (MCL).

Effectiveness of Manual Ventilation in Intubated Helicopter Emergency Services-Transported Trauma Patients.

Background: Helicopter Emergency Medical Services agencies frequently transport intubated patients to definitive care. No evidence exists to determine the type of ventilation in this population. Practice varies amongst programs from bag-valve-mask to mechanical ventilation.

Helicopter Emergency Medical Services Utilization.

Background: The 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 Objective: Determine if requests for HEMS align with recently published utilization guidelines.

Multiple prebiotic metals mediate translation.

Today, Mg is an essential cofactor with diverse structural and functional roles in life's oldest macromolecular machine, the translation system. We tested whether ancient Earth conditions (low O, high Fe, and high Mn) can revert the ribosome to a functional ancestral state. First, SHAPE (selective 2'-hydroxyl acylation analyzed by primer extension) was used to compare the effect of Mg, Fe, and Mn on the tertiary structure of rRNA.

Molecular paleontology: a biochemical model of the ancestral ribosome.

Ancient components of the ribosome, inferred from a consensus of previous work, were constructed in silico, in vitro and in vivo. The resulting model of the ancestral ribosome presented here incorporates ∼20% of the extant 23S rRNA and fragments of five ribosomal proteins. We test hypotheses that ancestral rRNA can: (i) assume canonical 23S rRNA-like secondary structure, (ii) assume canonical tertiary structure and (iii) form native complexes with ribosomal protein fragments.

Preparation of long templates for RNA in vitro transcription by recursive PCR.

Preparing conventional DNA templates for in vitro RNA transcription involves PCR amplification of the DNA gene coding for the RNA of interest from plasmid or genomic DNA, subsequent amplification with primers containing a 5' T7 promoter region, and confirmation of the amplified DNA sequence. Complications arise in applications where long, nonnative sequences are desired in the final RNA transcript. Here we describe a ligase-independent method for the preparation of long synthetic DNA templates for in vitro RNA transcription.

Gaucher disease: successful treatment of myoclonic status epilepticus with levetiracetam.

We present the first reported case of a rapid clinical and electroencephalographic response to intravenous levetiracetam infusion of myoclonic status epilepticus in a patient with progressive myoclonus epilepsy due to Gaucher disease. Under continuous video-EEG monitoring, the clinical myoclonic status and the electrographic ictal discharges resolved within 10 minutes after the infusion was initiated. The patient tolerated the treatment well without any reported side effects.