Validation of Air Medical Prehospital Triage Score in Determining Resource Utilization at Level 1 Trauma Centers.

Objective: Overtriage (ie, delivering less severely injured patients via helicopter) is costly, raises safety concerns, and reduces efficiency of the trauma system. The Air Medical Prehospital Triage (AMPT) scoring system was developed to determine which trauma patients would gain a survival benefit by air transport. The objective of this study was to evaluate the AMPT scoring system as a method of reducing trauma overtriage when helicopter emergency medical services were used.

Correlation of Preflight Risk Assessment Scores With First-Pass Intubation Success in a Critical Care Transport Environment.

Objective: The purpose of this study was to examine the impact of crew fatigue on the performance of a high-risk clinical skill in a clinical setting.

Methods: This was a retrospective analysis of first-pass intubation success comparing critical care providers with self-reported fatigue and those without fatigue in a transport environment.

Results: No statistical difference was found in first-pass intubation between fatigued and nonfatigued practitioners.

Prehospital Ketamine Use for Rapid Sequence Intubation: Are Higher Doses Associated With Adverse Events?

Objective: Ketamine for rapid sequence intubation (RSI) is typically dosed at 1 to 2 mg/kg intravenously. The need to ensure dissociation during RSI led some to administer ketamine at doses greater than 2 mg/kg. This study assessed associations between ketamine dose and adverse events.

Characteristics of scene trauma patients discharged within 24-hours of air medical transport.

Introduction: Helicopters play an important role in trauma; however, this service comes with safety risks, high transport costs, and downstream care charges.

Objective: Our objective was to determine the characteristics of early discharged trauma patients (<24 h length of stay) in order to reduce overtriage.

Methodology: Data were obtained from the trauma registries at one of two Level 1 trauma centers.

Are there Field Triage Criteria that Can Predict Low-Yield Air Medical Transports?

Introduction: Air medical transport of trauma patients from the scene of injury plays a critical role in the delivery of severely injured patients to trauma centers. Over-triage of patients to trauma centers reduces the system efficiency and jeopardizes safety of air medical crews.

Hypothesis: The objective of this study was to determine which triage factors utilized by Emergency Medical Services (EMS) providers are strong predictors of early discharge for trauma patients transported by helicopter to a trauma center.

Impact of shift duration on alertness among air-medical emergency care clinician shift workers.

Background: Greater than half of Emergency Medical Services (EMS) shift workers report fatigue at work and most work long duration shifts. We sought to compare the alertness level of EMS shift workers by shift duration.

Methods: We used a multi-site, 14-day prospective observational cohort study design of EMS clinician shift workers at four air-medical EMS organizations.

Impact of Paralytic Agent on Postintubation Sedation.

Objective: The aim of this study was to evaluate the difference in the time to postintubation sedation between patients receiving etomidate and either succinylcholine or rocuronium in the prehospital setting.

Setting: Patients who received rapid sequence intubation medications from transport service personnel and were subsequently intubated were included. The critical care transport agency operates 8 helicopter- and 3 ground-based emergency medical service units.

Real-Time Fatigue Mitigation with Air-Medical Personnel: The SleepTrackTXT2 Randomized Trial.

The aims of this study were: 1) to determine the short-term impact of the SleepTrackTXT2 intervention on air-medical clinician fatigue during work shifts and 2) determine the longer-term impact on sleep quality over 120 days. We used a multi-site randomized controlled trial study design with a targeted enrollment of 100 (ClinicalTrials.gov NCT02783027).

Botulism Outbreak in a Regional Community Hospital: Lessons Learned in Transfer and Transport Considerations.

Botulism is a potentially lethal disease caused by a toxin released by Clostridium botulinum. Outbreaks of botulism from food sources can lead to a Mass Casualty Incident (MCI) involving sometimes hundreds of individuals. We report on a recent outbreak of botulism treated at a regional community hospital with a focus on emergency medical services (EMS) response and transport considerations.

Fatigue mitigation with SleepTrackTXT2 in air medical emergency care systems: study protocol for a randomized controlled trial.

Background: Most air medical Emergency Medical Services (EMS) clinicians work extended duration shifts, and more than 50% report inadequate sleep, poor sleep quality, and/or poor recovery between shifts. The SleepTrackTXT pilot trial (ClinicalTrials.gov, NCT02063737) showed that use of mobile phone text messages could impact EMS clinician self-reported fatigue and sleepiness during long duration shifts.

Do Trauma Patients Aged 55 and Older Benefit from Air Medical Transport?

Introduction: A recent analysis of the National Sample Project demonstrated that the mortality benefits of air medical transport do not extend to patients age 55 or older. The purpose of the current investigation was to evaluate mortality benefits of air transport in adult trauma patients ≥ 55 years of age.

Methods: A retrospective analysis of all adult patients greater than age 55 years directly transported from a trauma scene to a Level I or II facility was conducted.

Limb Replantation in Air-Transported Patients: A 4-Year Study.

Objective: Patients who require extremity reimplantation represent a population in whom rapid transport could provide potential benefit. Only 1 previous report has described the use of air transport in patients with these injuries. We describe our experience in air medical transport of limb reimplantation candidates.

Ambulance Diversion: Ethical Dilema and Necessary Evil.

Ambulance diversion presents a dilemma pitting the ethical principles of patient autonomy and beneficence against the principles of justice and nonmaleficence. The guiding priority in requesting ambulance diversion is to maintain the safety of all patients in the emergency department as well as those waiting to be seen. Policies and procedures can be developed that maintain the best possible outcome for patients transported by ambulance during periods of diversion.

Characteristics of nontrauma scene flights for air medical transport.

Introduction: Little is known about the use of air medical transport for patients with medical, rather than traumatic, emergencies. This study describes the practices of air transport programs, with respect to nontrauma scene responses, in several areas throughout the United States and Canada.

Methods: A descriptive, retrospective study was conducted of all nontrauma scene flights from 2008 and 2009.

Survivors Perceptions of Recovery following Air Medical Transport Accidents.

Abstract Objective: Air medical transport (AMT) teams play an essential role in the care of the critically ill and injured. Their work, however, is not without risk. Since the inception of the industry numerous AMT accidents have been reported.

Assessing satisfaction and quality in the EMS/HEMS working relationship.

Background/objective: Treatment provided to critically ill and injured patients during air medical transport bridges initial local emergency medical service (EMS) treatment and the care provided upon arrival to the emergency department. Transition of care from EMS to air medical service includes multiple elements, many of which have been previously undefined. These include operational details surrounding the handoff and attention to issues of continuity in patient care.

A framework for analysis of sentinel events in medical student education.

Problem: Although previous studies have addressed student factors contributing to dismissal or withdrawal from medical school for academic reasons, little information is available regarding institutional factors that may hinder student progress.

Approach: The authors describe the development and application of a framework for sentinel event (SE) root cause analysis to evaluate cases in which students are dismissed or withdraw because of failure to progress in the medical school curriculum. The SE in medical student education (MSE) framework was piloted at the Ohio State University College of Medicine (OSUCOM) during 2010-2012.

A blueprint for critical care transport research.

Introduction: An estimated 500,000 critical care patient transports occur annually in the United States. Little research exists to inform optimal practices, promote safety, or encourage responsible, cost-effective use of this resource. Previous efforts to develop a research agenda have not yielded significant progress in producing much-needed scientific study.

Two cases of thenar compartment syndrome from blunt trauma.

Background: Compartment syndrome is a limb-threatening complication associated with extremity trauma. The existence of compartment syndrome involving the thenar space is considered controversial and has not been reported in association with blunt traumatic injury of the hand.

Objective: We report two cases involving compartment syndrome of the thenar space in association with blunt trauma to the hand.

Brightness mode quality ultrasound imaging examination technique (B-QUIET): quantifying quality in ultrasound imaging.

Objectives: Ultrasound image interpretation and education relies on obtaining a high-quality ultrasound image; however, no literature exists to date attempting to define a high-quality ultrasound image. The purpose of this study was to design and perform a pilot reliability study of the Brightness Mode Quality Ultrasound Imaging Examination Technique (B-QUIET) method for ultrasound quality image assessment.

Methods: A single sonologist performed a Trinity hypotensive ultrasound protocol on 3 participants of varying body types.

Development of statewide geriatric patients trauma triage criteria.

Introduction: The geriatric population is unique in the type of traumatic injuries sustained, physiological responses to those injuries, and an overall higher mortality when compared to younger adults. No published, evidence-based, geriatric-specific field destination criteria exist as part of a statewide trauma system. The Trauma Committee of the Ohio Emergency Medical Services (EMS) Board sought to develop specific criteria for geriatric trauma victims.

Prehospital factors associated with mortality in injured air medical patients.

Background: Air medical transport provides rapid transport to definitive care. Overtriage and the expense and risk of transport may offset survival benefits.

Objective: We assessed the ability of prehospital factors to predict resource need for helicopter-transported patients.