UK Triage the validation of a new tool to counter an evolving threat.

Introduction: Major Incidents (MI) occur frequently and their unpredictable nature makes prospective research difficult and largely unethical. A key step in MI management is triage; the identification of the critically injured. Within a MI environment this is commonly performed using simple physiological ‘tools’, such as the Triage Sieve (TS).

Air medical retrieval of acute psychiatric patients.

Background: The aim of this study is to review the characteristics of acute psychiatric patients requiring air medical retrieval across the Northern Territory (NT) of Australia, to assess the sedation requirements and incidence of in-flight complications when retrieving such patients, and to review the optimal flight crew composition required for safe retrieval.

Methods: Retrospective data were collected for all psychiatric patients retrieved by an air medical retrieval service of the NT of Australia over a 12-month period between February 1, 2012, and January 31, 2013.

Results: Two hundred sixty-two patients were retrieved using fixed wing transport; 90% were indigenous.

Placement of a central venous catheter in the antecubital vein using a modified seldinger technique.

Purpose: To describe a case of a patient requiring inotropic support without central venous access in which the central venous catheter (CVC) was placed in the antecubital vein using a modified seldinger technique.

Background: Placement of CVC in the field in retrieval medicine can be time consuming and is not without risk of complication. Minimizing time in the field can lead to better outcomes for patients who are seriously medically ill or traumatically injured.

Study protocol for the PHANTOM study: prehospital assessment of noninvasive tissue oximetry monitoring.

Background: Traumatic brain injury is a major cause of mortality and morbidity worldwide. It can be worsened by secondary injury particularly with hypoxia or hypotension. Current prehospital guidelines emphasise regular measurement of peripheral oxygen saturation and blood pressure but there is no monitor in use to provide direct information relating to blood flow or oxygen delivery to the brain tissue.

Patient perceptions of emergency department fast track: a prospective pilot study comparing two models of care.

Background: Emergency department (ED) fast track has been shown to improve patient flow for low complexity presentations.(1) The optimal model of care and service delivery for fast track patients has not been established.

Aims: The objective of this pilot study was to compare patient satisfaction using two models of ED fast track - one in a tertiary hospital emergency department staffed by doctors and the other in a nearby urban district hospital staffed by nurse practitioners.

Intraosseous access in trauma by air medical retrieval teams.

Trauma accounts for a significant portion of overall mortality globally. Hemorrhage is the second major cause of mortality in the prehospital environment. Air medical retrieval services throughout the world have been developed to help improve the outcomes of patients suffering from a broad range of medical conditions, including trauma.

Paediatric aeromedical retrievals in the 'Top End' of the Northern Territory.

Objective: The primary objective of this study was to describe the remote paediatric aeromedical population of the 'Top End' of the Northern Territory. The secondary objective was to identify children requiring high-dependency care by the transport team.

Design: Retrospective case review.

Obstetric air medical retrievals in the Australian outback.

Introduction: Women in labor or with complications of pregnancy in the remote, outback region of Australia's Northern Territory are transported to the hospital by air. The objective of this study was to describe the interventions required by obstetric and newborn patients during air medical transport and to evaluate how often these were beyond the scope of practice of a team consisting of an experienced midwife with or without a general flight doctor.

Methods: A retrospective cohort analysis of 200 consecutive women between 20 weeks gestation up to 24 hours postpartum and newborns transferred during the same time period.

The study protocol for the Head Injury Retrieval Trial (HIRT): a single centre randomised controlled trial of physician prehospital management of severe blunt head injury compared with management by paramedics.

Background: The utility of advanced prehospital interventions for severe blunt traumatic brain injury (BTI) remains controversial. Of all trauma patient subgroups it has been anticipated that this patient group would most benefit from advanced prehospital interventions as hypoxia and hypotension have been demonstrated to be associated with poor outcomes and these factors may be amenable to prehospital intervention. Supporting evidence is largely lacking however.

Prehospital paediatric emergencies treated by an Australian helicopter emergency medical service.

Objectives: The aim of this study was to describe the mechanism and severity of injuries in the paediatric population treated by an Australian helicopter emergency medical service and to examine the frequency and nature of interventions performed. This information is important for planning education and continuing professional development in prehospital medicine.

Methods: The study is a retrospective cohort analysis of 349 patients under the age of 16 treated by CareFlight in Sydney, Australia, between April 2007 and April 2012.

Head-to-head comparison of disaster triage methods in pediatric, adult, and geriatric patients.

Study Objective: A variety of methods have been proposed and used in disaster triage situations, but there is little more than expert opinion to support most of them. Anecdotal disaster experiences often report mediocre real-world triage accuracy. The study objective was to determine the accuracy of several disaster triage methods when predicting clinically important outcomes in a large cohort of trauma victims.

Practical management of the shocked neonate.

The shocked neonate often causes anxiety in the ED. This article aims to provide a systematic, practical approach to recognition and initial management of these patients. Their resuscitation should follow a pattern of provision of oxygen, fluid resuscitation, blood glucose correction, inotropic support and ventilation.

Physician staffed helicopter emergency medical service dispatch via centralised control or directly by crew - case identification rates and effect on the Sydney paediatric trauma system.

Background: Severe paediatric trauma patients benefit from direct transport to dedicated Paediatric Trauma Centres (PTC). Parallel case identification systems utilising paramedics from a centralised dispatch centre versus the crew of a physician staffed Helicopter Emergency Medical Service (HEMS) allowed comparison of the two systems for case identification rates and subsequent timeliness of direct transfer to a PTC.

Methods: Paediatric trauma patients over a two year period from the Sydney region with an Injury Severity Score (ISS) > 15 were retrospectively identified from a state wide trauma registry.

Major incident triage: comparative validation using data from 7th July bombings.

Introduction: The importance of health service planning for major incident management has been recognised since the World Trade Centre attacks of September 2001 and is highly relevant to planning for the 2012 Olympics. UK national Major Incident guidance stipulates the use of a system of triage for casualties to prioritise treatment and ensure "the greatest good for the greatest number". However, at least three triage systems are in use worldwide and no evidence exists to demonstrate their relative efficacy.

Feasibility of cerebral near-infrared spectroscopy monitoring in the pre-hospital environment.

Background: Traumatic brain injury (TBI) is a significant cause of death and severe disability from trauma. Pre-hospital care of patients with TBI may be aided by non-invasive monitoring of cerebral tissue oxygenation. This pilot observational study was designed to assess if cerebral tissue oximetry using near-infrared spectroscopy (NIRS) is feasible in the pre-hospital and transport environment.

Letter to the editors: the potential role for prehospital thrombolysis and time-critical stroke transfers in the northern Norway aeromedical retrieval system; In response to: Norum J, Elsbak TM: Air ambulance services in the Arctic: a Norwegian study. Int J Emerg Med 2011, 4:1.

The role for prehospital thrombolysis for ST-elevation acute myocardial infarction and time-critical stroke transfers in the northern Norway aeromedical retrieval system as well as the aero-evacuation impact of increased Arctic expedition tourism could benefit from further discussion by Norum and Elsbak. Close ECG surveillance for ST elevation and retrieval thrombolysis en route to the accepting hospital could be of benefit for acute coronary syndrome patients in northern Norway who require prolonged aeromedical transfer. For patients who remain within a reasonable time frame for stroke thrombolysis (up to 4.

Respiratory function in hoist rescue: comparing slings, stretcher, and rescue basket.

Introduction: Some types of equipment used in helicopter hoist rescue have the potential to cause respiratory embarrassment due to chest compression and/or body positioning. This study compared the respiratory effects of four commonly used devices.

Methods: A randomized crossover trial was undertaken in 27 healthy adults while suspended in single sling (SSling), double sling (DSling), supine in a rescue stretcher, and in a rescue basket (RB) of the type used by the U.

A prehospital paediatric tension viscerothorax presenting as a tension pneumothorax: a diagnostic dilemma.

This article reports a case of a paediatric pre-hospital tension viscerothorax, and it subsequent management. It also discusses the difficulty in diagnosing this condition in the pre-hospital arena.

Defining a standard medication kit for prehospital and retrieval physicians: a comprehensive review.

Background: There is little consolidated evidence for which prehospital and retrieval drugs a given service should carry.

Objectives: To suggest a core group of drugs based on the best evidence currently available.

Methods: This paper has reviewed documents from recognised evidence-based sources and put together an initial skeleton for an evidence-based drug pack.

Emergency intubation: a prospective multicentre descriptive audit in an Australian helicopter emergency medical service.

Objective: To describe the safety profile of emergency airway management when performed by a prehospital team consisting of a doctor and a paramedic. Success rates, the incidence of difficult airways and the ability of prehospital doctors to determine a difficult airway are reported.

Methods: A prospective audit and descriptive study of three Australian helicopter emergency medical service (HEMS) bases, over a 9-month period.

A comparison of tape-tying versus a tube-holding device for securing endotracheal tubes in adults.

During the transfer of intubated patients, endotracheal tube security is paramount. This study aims to compare two methods of securing an endotracheal tube in adults: tying with a cloth tape versus the Thomas Endotracheal Tube Holder (Laerdal). A manikin-based study was performed using paramedics and critical care doctors (consultants and senior trainees) as participants.