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Wend CM, Fransman RB, Haut ER. Prehospital Trauma Care. Surg Clin North Am 2024; 104:267-277. [PMID: 38453301 DOI: 10.1016/j.suc.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Prehospital trauma evaluation begins with the primary assessment of airway, breathing, circulation, disability, and exposure. This is closely followed by vital signs and a secondary assessment. Key prehospital interventions include management and resuscitation according to the aforementioned principles with a focus on major hemorrhage control, airway compromise, and invasive management of tension pneumothorax. Determining the appropriate time and method for transportation (eg, ground ambulance, helicopter, police, private vehicle) to the hospital or when to terminate resuscitation are also important decisions to be made by emergency medical services clinicians.
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Affiliation(s)
- Christopher M Wend
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street Suite 6-100, Baltimore, MD 21287, USA
| | - Ryan B Fransman
- Department of Trauma, Acute Care Surgery, and Surgical Critical Care, Emory University School of Medicine, Grady Memorial Hospital, 80 Jesse Hill Jr. Drive, SE, Atlanta, GA 30303, USA
| | - Elliott R Haut
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street Suite 6-100, Baltimore, MD 21287, USA; Department of Surgery, Division of Acute Care Surgery, Johns Hopkins University School of Medicine, Sheikh Zayed 6107C, 1800 Orleans Street, Baltimore, MD 21287, USA; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Engelsen PC, Heyerdahl F, Maddali DD, Akhavi MS, Undseth RM, Elle OJ, Brun H. Ascending with ultrasound: telementored eFAST in flight-a feasibility study. Emerg Radiol 2024; 31:25-31. [PMID: 38066242 PMCID: PMC10830595 DOI: 10.1007/s10140-023-02186-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/02/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE Teleultrasound uses telecommunication technologies to transmit ultrasound images from a remote location to an expert who guides the acquisition of images and interprets them in real time. Multiple studies have demonstrated the feasibility of teleultrasound. However, its application during helicopter flight using long-term evolution (LTE) for streaming has not been studied. Therefore, we conducted a study to examine the feasibility of teleultrasound in an Airbus H145 helicopter. METHODS Four anesthesiologists and one military physician were recruited to perform telementored extended Focused Assessment with Sonography in Trauma (eFAST) during nine helicopter flights, each with a unique healthy volunteer. A radiologist was recruited as a remote expert, guiding the physicians in their examinations. The examining physicians reported the user experience of telementored eFAST on a questionnaire, while the remote expert rated the diagnostic quality of the images on a 1-5 Likert scale. In addition, we measured the duration of the examinations and key LTE network parameters including signal strength, quality, and continuity. RESULTS The images were rated to an average of 4.9 by the remote expert, corresponding to good diagnostic quality. The average duration of telementored eFAST was 05:54 min. LTE coverage was negatively affected by proximity to urban areas and ceased above 2000 ft altitude. Occasional audio problems were addressed by using the Voice over LTE network for communication. The examining physicians unanimously reported on the questionnaire that they would use telementored eFAST on patients. CONCLUSION Telementored eFAST is feasible in ambulance helicopters and can produce images of good diagnostic quality. However, it relies on stable LTE coverage, which is influenced by many factors, including the helicopter's altitude and flight path. Furthermore, its benefit on patient outcomes remains to be proven.
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Affiliation(s)
| | - Fridtjof Heyerdahl
- The Air Ambulance Department, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | | | - Ole Jakob Elle
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Henrik Brun
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
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Gunaltili E, Ekici S, Kalkan A, Gocmen FE, Kale U, Yilmazoglu Z, Karakoc TH. Conceptual design and optimization of a sustainable and environmentally friendly archetypal helicopter within the selection criteria and limitations. Heliyon 2023; 9:e17369. [PMID: 37408911 PMCID: PMC10319214 DOI: 10.1016/j.heliyon.2023.e17369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/28/2023] [Accepted: 06/14/2023] [Indexed: 07/07/2023] Open
Abstract
The design and mission requirements of aero vehicles, which vary on a day-to-day basis, have become major study concerns in the burgeoning aviation sector. In addition to the design and mission criteria that must be met in an aero vehicle design, the designers' primary goals are to construct original, innovative, environmentally friendly, fuel-efficient, and sustainable designs. In this study, a detailed conceptual design of a helicopter that does not need a notable runway for operation and is limited by mission and design requirements is offered. Within the scope of this research, a competitor analysis study was undertaken in accordance with the defined criteria, and design approaches were chosen based on the outcomes of competitor analysis. In addition, this research, which looks for an environmentally friendly and sustainable design, was developed with the aviation industry's demands in mind by analyzing the International Helicopter Safety Team's (IHST) data. As a result of the reports analyzed and considering the causes and consequences of accidents that have happened, the objective of the design research was to achieve a sustainable, ecologically friendly, and fuel-efficient design by reducing the number of accidents and damage. The planning and design processes as a result of this examination are essential as a step towards the helicopter being an original design and in the context of solution methodologies. This archetypal design aims to shed light on helicopter design studies and serve as a roadmap for future research.
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Affiliation(s)
- Enes Gunaltili
- Department of Astronautical Engineering, Konya Necmettin Erbakan University, Konya, Turkey
| | - Selcuk Ekici
- Department of Aviation, Iğdır University, Iğdır, Turkey
| | | | | | - Utku Kale
- Department of Aeronautics and Naval Architecture, Faculty of Transportation Engineering and Vehicle Engineering, Budapest University of Technology and Economics, Budapest, Hungary
- Faculty of Technology, Aviation Academy, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Zeki Yilmazoglu
- Department of Mechanical Engineering, Gazi University, Ankara, Turkey
| | - T. Hikmet Karakoc
- Faculty of Aeronautics and Astronautics, Eskisehir Technical University, Eskisehir, Turkey
- Information Technology Research and Application Center, Istanbul Ticaret University, Istanbul, Turkey
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Amadasi L, Amadasi A, Buschmann CT, Tsokos M. Fatal injuries due to direct helicopter propeller strike. Forensic Sci Med Pathol 2022; 18:545-8. [PMID: 35930214 DOI: 10.1007/s12024-022-00509-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 12/14/2022]
Abstract
During a helicopter exercise, due to the scarce visibility caused by the presence of snow, a collision between a landing helicopter and one already on the ground occurred. The 40-year-old pilot of the already landed aircraft was killed as a result of a direct propeller impact in the right side of the pilot's cockpit, while the co-pilot remained uninjured. At autopsy, the macroscopic characteristic findings in the form of cut injuries and amputations along the axis of the rotor blade impact as well as a 3D reconstruction through CT-Scan were analyzed and discussed for a thorough reconstruction of the injuries and the dynamics.
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Wright AHB, Freshwater ES, Crouch R. Resource utilisation for patients brought to a major trauma centre by helicopter. Int Emerg Nurs 2021; 59:101072. [PMID: 34597867 DOI: 10.1016/j.ienj.2021.101072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/31/2021] [Accepted: 08/11/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Helicopter Emergency Medical Services (HEMS) allow critical care personnel to attend incidents alongside transporting patients to hospital. The study site is a UK based emergency department and major trauma centre, accepting flights from a wide geographical area. AIMS To characterise the impact of HEMS on a major trauma centre clinical resources and the impact of the UK regional trauma network launch on HEMS asset provision. METHODS Flight case-mix data were obtained from Emergency Department (ED) records (non-trauma patients) and from the Trauma Audit and Research Network database (trauma patients). Statistical analysis was in Excel. RESULTS 432 flights landed at the site between August 2018 and July 2019. 178 flights originated from the incident scene (145 trauma, 26 non-trauma), 107 from other hospitals, and 5 to other hospitals. Hospitalisation was reduced to a median of 6 days. CONCLUSIONS Primary HEMS trauma patients utilised significant clinical resources but had shorter hospitalisations than those without HEMS intervention. The regional trauma network improved HEMS tasking and utilised critical car cars to provide advanced pre-hospital care locally. Further work should compare HEMS versus ground ambulance to determine the impact of HEMS on patient outcomes and cost implications to both HEMS operators and receiving hospital.
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Affiliation(s)
- Alexander H B Wright
- Faculty of Medicine, University of Southampton, Building 85, Highfield Campus, Southampton, Hampshire SO17 1BJ, United Kingdom.
| | - Eleanor S Freshwater
- Emergency Department, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD, United Kingdom.
| | - Robert Crouch
- Emergency Department, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD, United Kingdom.
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Schober P, Bossers SM, Koolwijk J, Terra M, Schwarte LA. Prehospital coagulation measurement by a portable blood analyzer in a helicopter emergency medical service (HEMS). Am J Emerg Med 2021; 46:137-140. [PMID: 33906029 DOI: 10.1016/j.ajem.2021.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/03/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022] Open
Abstract
In helicopter emergency medical services, HEMS, coagulopathy presents both in trauma (e.g. consumption of coagulation factors) and non-trauma cases (e.g. anticoagulant use). Therefore, in HEMS coagulation measurements appear promising and Prothrombin Time (PT) and derived INR are attractive variables herein. We tested the feasibility of prehospital PT/INR coagulation measurements in HEMS. This study was performed at the Dutch HEMS, using a portable blood analyzer (i-Stat®1, Abbott). PT/INR measurements were performed on (hemodiluted) author's blood, and both trauma- and non-trauma HEMS patients. Device-related benefits of the i-Stat PT/INR system were portability, speed and ease of handling. Limitations included a rather narrow operational temperature range (16-30 °C). PT/INR measurements (n = 15) were performed on hemodiluted blood, and both trauma and non-trauma patients. The PT/INR results confirmed effects of hemodilution and anticoagulation, however, most measurement results were in the normal INR-range (0.9-1.2). We conclude that prehospital PT/INR measurements, although with limitations, are feasible in HEMS operations.
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Affiliation(s)
- Patrick Schober
- Department of Anesthesiology, Amsterdam University Medical Center, Amsterdam, Netherlands; HEMS Life Liner 1, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Sebastiaan M Bossers
- Department of Anesthesiology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Jasper Koolwijk
- Department of Anesthesiology, Amsterdam University Medical Center, Amsterdam, Netherlands.
| | - Maartje Terra
- HEMS Life Liner 1, Amsterdam University Medical Center, Amsterdam, Netherlands; Department of Traumatology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Lothar A Schwarte
- Department of Anesthesiology, Amsterdam University Medical Center, Amsterdam, Netherlands; HEMS Life Liner 1, Amsterdam University Medical Center, Amsterdam, Netherlands
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Hubert GJ, Kraus F, Maegerlein C, Platen S, Friedrich B, Kain HU, Witton-Davies T, Hubert ND, Zimmer C, Bath PM, Audebert HJ, Haberl RL. The "Flying Intervention Team": A Novel Stroke Care Concept for Rural Areas. Cerebrovasc Dis 2021; 50:375-382. [PMID: 33849042 DOI: 10.1159/000514845] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/02/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Endovascular treatment of large vessel occlusion in acute ischemic stroke patients is difficult to establish in remote areas, and time dependency of treatment effect increases the urge to develop health care concepts for this population. SUMMARY Current strategies include direct transportation of patients to a comprehensive stroke center (CSC) ("mothership model") or transportation to the nearest primary stroke center (PSC) and secondary transfer to the CSC ("drip-and-ship model"). Both have disadvantages. We propose the model "flying intervention team." Patients will be transported to the nearest PSC; if telemedically identified as eligible for thrombectomy, an intervention team will be acutely transported via helicopter to the PSC and endovascular treatment will be performed on site. Patients stay at the PSC for further stroke unit care. This model was implemented at a telestroke network in Germany. Fifteen remote hospitals participated in the project, covering 14,000 km2 and a population of 2 million. All have well established telemedically supported stroke units, an angiography suite, and a helicopter pad. Processes were defined individually for each hospital and training sessions were implemented for all stroke teams. An exclusive project helicopter was installed to be available from 8 a.m. to 10 p.m. during 26 weeks per year. Key Messages: The model of the flying intervention team is likely to reduce time delays since processes will be performed in parallel, rather than consecutively, and since it is quicker to move a medical team rather than a patient. This project is currently under evaluation (clinicaltrials NCT04270513).
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Affiliation(s)
- Gordian Jan Hubert
- Department of Neurology, TEMPiS Telemedical Stroke Center, München Klinik Harlaching, Academic Teaching Hospital of the University of Munich, Munich, Germany
| | - Frank Kraus
- Department of Neurology, TEMPiS Telemedical Stroke Center, München Klinik Harlaching, Academic Teaching Hospital of the University of Munich, Munich, Germany
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sabine Platen
- Department of Neurology, TEMPiS Telemedical Stroke Center, University of Regensburg, Bezirksklinikum Regensburg, Regensburg, Germany
| | - Benjamin Friedrich
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Thomas Witton-Davies
- Department of Diagnostic and Interventional Radiology and Neuroradiology, München Klinik Harlaching, Munich, Germany
| | - Nikolai Dominik Hubert
- Department of Neurology, TEMPiS Telemedical Stroke Center, München Klinik Harlaching, Academic Teaching Hospital of the University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Philip M Bath
- Division of Clinical Neuroscience, Stroke Trials Unit, University of Nottingham, Nottingham, United Kingdom
| | - Heinrich J Audebert
- Center for Stroke Research Berlin, Charite-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Roman L Haberl
- Department of Neurology, TEMPiS Telemedical Stroke Center, München Klinik Harlaching, Academic Teaching Hospital of the University of Munich, Munich, Germany
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Shinozaki RM, Schwingshackl A, Srivastava N, Grogan T, Kelly RB. Pediatric interfacility transport effects on mortality and length of stay. World J Pediatr 2021; 17:400-408. [PMID: 34319538 PMCID: PMC8363522 DOI: 10.1007/s12519-021-00445-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/13/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND We aimed to evaluate the effects of interfacility pediatric critical care transport response time, physician presence during transport, and mode of transport on mortality and length of stay (LOS) among pediatric patients. We hypothesized that a shorter response time and helicopter transports, but not physician presence, are associated with lower mortality and a shorter LOS. METHODS Retrospective, single-center, cohort study of 841 patients (< 19 years) transported to a quaternary pediatric intensive care unit and cardiovascular intensive care unit between 2014 and 2018 utilizing patient charts and transport records. Multivariate linear and logistic regression analyses adjusted for age, diagnosis, mode of transport, response time, stabilization time, return duration, mortality risk (pediatric index of mortality-2 and pediatric risk of mortality-3), and inotrope, vasopressor, or mechanical ventilation presence on admission. RESULTS Four hundred and twenty-eight (50.9%) patients were transported by helicopter, and 413 (49.1%) were transported by ambulance. Physicians accompanied 239 (28.4%) transports. The median response time was 2.0 (interquartile range 1.4-2.9) hours. Although physician presence increased the median response time by 0.26 hours (P = 0.020), neither physician presence nor response time significantly affected mortality, ICU length of stay (ILOS) or hospital length of stay (HLOS). Helicopter transports were not significantly associated with mortality or ILOS, but were associated with a longer HLOS (3.24 days, 95% confidence interval 0.59-5.90) than ambulance transports (P = 0.017). CONCLUSIONS These results suggest response time and physician presence do not significantly affect mortality or LOS. This may reflect the quality of pre-transport care and medical control communication. Helicopter transports were only associated with a longer HLOS. Our analysis provides a framework for examining transport workforce needs and associated costs.
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Affiliation(s)
- Rod M. Shinozaki
- grid.19006.3e0000 0000 9632 6718David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Andreas Schwingshackl
- grid.19006.3e0000 0000 9632 6718David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Neeraj Srivastava
- grid.19006.3e0000 0000 9632 6718David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Tristan Grogan
- grid.19006.3e0000 0000 9632 6718David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Robert B. Kelly
- grid.266093.80000 0001 0668 7243University of California, Irvine, Irvine, CA USA ,grid.414164.20000 0004 0442 4003Children’s Hospital of Orange County, 1201 West La Veta Avenue, Orange, CA 92868 USA
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Yeoman K, O'Connor MB, Sochor S, Poplin G. Characterization of fatal injuries in oil and gas industry-related helicopter accidents in the Gulf of Mexico, 2004-2014. Inj Epidemiol 2020; 7:64. [PMID: 33280614 PMCID: PMC7720596 DOI: 10.1186/s40621-020-00288-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/19/2020] [Indexed: 11/19/2022] Open
Abstract
Background Transportation events are the most common cause of offshore fatalities in the oil and gas industry, of which helicopter accidents comprise the majority. Little is known about injury distributions in civilian helicopter crashes, and knowledge of injury distributions could focus research and recommendations for enhanced injury prevention and post-crash survival. This study describes the distribution of injuries among fatalities in Gulf of Mexico oil and gas industry-related helicopter accidents, provides a detailed injury classification to identify potential areas of enhanced safety design, and describes relevant safety features for mitigation of common injuries. Methods Decedents of accidents during 2004–2014 were identified, and autopsy reports were requested from responsible jurisdictions. Documented injuries were coded using the Abbreviated Injury Scale (AIS), and frequency and proportion of injuries by AIS body region and severity were calculated. Injuries were categorized into detailed body regions to target areas for prevention. Results A total of 35 autopsies were coded, with 568 injuries documented. Of these, 23.4% were lower extremity, 22.0% were thorax, 13.6% were upper extremity, and 13.4% were face injuries. Minor injuries were most prevalent in the face, neck, upper and lower extremities, and abdomen. Serious or worse injuries were most prevalent in the thorax (53.6%), spine (50.0%), head (41.7%), and external/other regions (75.0%). The most frequent injuries by detailed body regions were thoracic organ (23.0%), thoracic skeletal (13.3%), abdominal organ (9.6%), and leg injuries (7.4%). Drowning occurred in 13 (37.1%) of victims, and drowning victims had a higher proportion of moderate brain injuries (7.8%) and lower number of documented injuries (3.8) compared with non-drowning victims (2.9 and 9.4%, respectively). Conclusions Knowledge of injury distributions focuses and prioritizes the need for additional safety features not routinely used in helicopters. The most frequent injuries occurred in the thorax and lower extremity regions. Future research requires improved and expanded data, including collection of detailed data to allow characterization of both injury mechanism and distribution. Improved safety systems including airbags and helmets should be implemented and evaluated for their impact on injuries and fatalities.
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Affiliation(s)
- Kristin Yeoman
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 315 E. Montgomery Ave., Spokane, WA, 99207, USA.
| | - Mary B O'Connor
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 315 E. Montgomery Ave., Spokane, WA, 99207, USA
| | - Sara Sochor
- University of Virginia Center for Applied Biomechanics, 404 Lewis & Clark Drive, Charlottesville, VA, 22911, USA
| | - Gerald Poplin
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 315 E. Montgomery Ave., Spokane, WA, 99207, USA
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Huang Y, Zhu M, Zheng Z. Output-constrained fixed-time control for autonomous ship landing of helicopters. ISA Trans 2020; 106:221-232. [PMID: 32768134 DOI: 10.1016/j.isatra.2020.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 06/11/2023]
Abstract
In this paper, we consider a fixed-time autonomous ship landing control design for helicopters subject to asymmetric output constraints, model uncertainties and external perturbations. By incorporating a universal barrier function into the backstepping design, an output-constrained fixed-time control algorithm is proposed, where a new adaptive estimation method is introduced to compensate the effects resulting from uncertainties and disturbances. To avoid crash and overcome the limitation of the helicopter's under-actuated property, the whole landing operation is completed in a dual-phase landing sequence with two controllers, which are both designed based on the output-constrained fixed-time control algorithm. The proposed control strategy guarantees that the tracking and landing errors converge into a small neighborhood of zero in a fixed settling time without violating the constraint requirement. Numerical comparative simulations are executed to further verify the prominent control performance.
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Affiliation(s)
- Yanting Huang
- School of Aeronautic Science and Engineering, Beihang University, Beijing 100191, PR China
| | - Ming Zhu
- Institute of Unmanned System, Beihang University, Beijing 100191, PR China
| | - Zewei Zheng
- The Seventh Research Division, School of Automation Science and Electrical Engineering, Beihang University, Beijing, 100191, PR China.
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Smedley WA, Killian J, Stone KL, Stephens SW, Griffin RL, Cox DB, Kerby JD, Jansen JO. How Does Mission Ground Time Impact on Population Coverage of Aeromedical Retrieval Systems? J Surg Res 2021; 258:362-9. [PMID: 33069390 DOI: 10.1016/j.jss.2020.08.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/17/2020] [Accepted: 08/25/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Aeromedical retrieval is an essential component of contemporary emergency care systems. However, in many locations, ground emergency medical services are dispatched to the scene of an incident first to assess the patient and then call for a helicopter if needed. The time to definitive care therefore includes the helicopter's flight to the scene, flight to the trauma center, and nonflying time. Mission ground time (MGT) includes the time required to get the helicopter airborne, as well as time spent at the scene, packaging and loading the casualty into the aircraft. Estimates of MGT typically vary from 10 to 30 min. The impact of MGT duration on population coverage-the number of residents that could be taken to a trauma center within a set time-is not known. The aim of this study was to compare population coverage for different durations of MGT in a single state. METHODS Coverage was calculated using elliptical coverage areas ("isochrones") based on the location of helicopter bases and Level I and Level II trauma centers. The calculations were performed using Microsoft Excel, assuming a cruising speed of 133 knots (246 km/h), and mapped using arcGIS. The access time threshold was set at 60 min, and we evaluated MGTs of 10, 15, 20, 25, and 30 min. RESULTS MGT has a marked impact on population coverage. The effect is, furthermore, not linear. When considering the state's three Level I trauma centers, decreasing MGT from 30 to 10 min increased population coverage from 61.2% to 84.2%. When also considering Level II centers, decreasing MGT from 30 min to 10 min increased coverage by 20%. CONCLUSIONS Elliptical isochrones, with allowance for MGT, provide realistic estimates of population coverage. MGT significantly impacts the proportion of the population that can be taken to a Level I and/or Level II Trauma Center within a set time. The impact is not linear, reflecting the uneven distribution of the population. Consideration should be given to minimizing MGT to preserve the benefits of aeromedical retrieval.
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Hilbert-Carius P, Braun J, Abu-Zidan F, Adler J, Knapp J, Dandrifosse D, Braun D, Pietsch U, Adamczuk P, Rognås L, Albrecht R. Pre-hospital care & interfacility transport of 385 COVID-19 emergency patients: an air ambulance perspective. Scand J Trauma Resusc Emerg Med 2020; 28:94. [PMID: 32962739 PMCID: PMC7506825 DOI: 10.1186/s13049-020-00789-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/10/2020] [Indexed: 12/17/2022] Open
Abstract
Background COVID-19, the pandemic caused by the severe acute respiratory syndrome coronavirus-2, is challenging healthcare systems worldwide. Little is known about problems faced by emergency medical services—particularly helicopter services—caring for suspected or confirmed COVID-19 patients. We aimed to describe the issues faced by air ambulance services in Europe as they transport potential COVID-19 patients. Methods Nine different HEMS providers in seven different countries across Europe were invited to share their experiences and to report their data regarding the care, transport, and safety measures in suspected or confirmed COVID-19 missions. Six air ambulance providers in six countries agreed and reported their data regarding development of special procedures and safety instructions in preparation for the COVID-19 pandemic. Four providers agreed to provide mission related data. Three hundred eighty-five COVID-19-related missions were analysed, including 119 primary transport missions and 266 interfacility transport missions. Results All providers had developed special procedures and safety instructions in preparation for COVID-19. Ground transport was the preferred mode of transport in primary missions, whereas air transport was preferred for interfacility transport. In some countries the transport of COVID-19 patients by regular air ambulance services was avoided. Patients in interfacility transport missions had a significantly higher median (range) NACA Score 4 (2-5) compared with 3 (1-7), needed significantly more medical interventions, were significantly younger (59.6 ± 16 vs 65 ± 21 years), and were significantly more often male (73% vs 60.5%). Conclusions All participating air ambulance providers were prepared for COVID-19. Safe care and transport of suspected or confirmed COVID-19 patients is achievable. Most patients on primary missions were transported by ground. These patients were less sick than interfacility transport patients, for whom air transport was the preferred method.
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Affiliation(s)
- Peter Hilbert-Carius
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, Pain Therapy, BG-Klinikum Bergmannstrost Halle (Saale), Merseburgerstr 165, 06112, Halle (Saale), Germany. .,DRF-Luftrettung (German Air Rescue), HEMS Christoph 84 and Christoph 85 Halle (Saale), Halle (Saale), Germany.
| | - Jörg Braun
- Faculty of Medicine -Wissenschaftlicher Arbeitskreis der DRF Stiftung Luftrettung (German Air Rescue) gemeinnützige AG, Filderstadt, Germany
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Science, UAE University, Al-Ain, United Arab Emirates
| | - Jörn Adler
- LAR-Luxembourg Air Rescue, Sandweiler, Luxembourg
| | - Jürgen Knapp
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Désirée Braun
- Faculty of Medicine -Wissenschaftlicher Arbeitskreis der DRF Stiftung Luftrettung (German Air Rescue) gemeinnützige AG, Filderstadt, Germany
| | - Urs Pietsch
- Swiss Air Rescue Rega, Zürich, Switzerland.,Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | | | - Leif Rognås
- Department of Anaesthesia, Aarhus University Hospital, Aarhus, Denmark.,Den Landsdækkende Akutlægehelikopterording (Danish Air Ambulance), Aarhus, Denmark
| | - Roland Albrecht
- Swiss Air Rescue Rega, Zürich, Switzerland.,Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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13
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Kushida Y, Jitsuiki K, Muramatsu KI, Ikegami S, Nagasawa H, Takeuchi I, Ohsaka H, Oode Y, Omori K, Yanagawa Y. A comparison of physician-staffed helicopters and ground ambulances transport for the outcome of severe thoracic trauma patients. Am J Emerg Med 2020; 45:358-360. [PMID: 33039240 DOI: 10.1016/j.ajem.2020.08.088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/22/2020] [Accepted: 08/27/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE We retrospectively investigated prognostic factors for severe thoracic trauma patients evacuated by a physician-staffed helicopter emergency medical service (HEMS) and ground ambulance using the Japan Trauma Data Bank (JTDB). METHODS This study was a retrospective analysis of the JTDB database. The study period was from January 2004 to May 2019. The subjects were divided into two groups, according to the type of transportation: the Heli group included cases transported by the HEMS, while the Ambulance group included cases transported by ground ambulance. RESULTS During the investigation period, a total of 57,872 patients were enrolled as subjects, including 7238 in the Heli group and 50,634 in the Ambulance group. The average age, male ratio, average injury severity score (ISS), average revised trauma score (RTS) and survival ratio were significantly greater in the Heli group than in the Ambulance group. After performing a propensity score-matched analysis, there were no statistical differences concerning the age, sex, ISS, RTS between the two groups. However, the survival ratio in the Heli group remained greater than that in the Ambulance group. When variables that showed statistical significance in the univariate analysis were included in a multivariate analysis, the RTS, transport by the HEMS, age, ISS and female gender were identified as significant predictors of a survival outcome. The HEMS was significantly associated with an increased survival ratio (odds ratio: 1.69; 95% confidence interval: 1.51-1.88) compared with a ground ambulance. CONCLUSION The present study showed that transport by the HEMS improved the survival rate compared to that by a ground ambulance for patients with severe thoracic trauma.
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Affiliation(s)
- Yoshihiro Kushida
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Kei Jitsuiki
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Ken-Ichi Muramatsu
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Saya Ikegami
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Ikuto Takeuchi
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Yasumasa Oode
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan.
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14
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Ageron FX, Debaty G, Savary D, Champly F, Albasini F, Usseglio P, Vallot C, Galvagno S, Bouzat P. Association of helicopter transportation and improved mortality for patients with major trauma in the northern French Alps trauma system: an observational study based on the TRENAU registry. Scand J Trauma Resusc Emerg Med 2020; 28:35. [PMID: 32398058 PMCID: PMC7218509 DOI: 10.1186/s13049-020-00730-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 04/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prompt prehospital triage and transportation are essential in an organised trauma system. The benefits of helicopter transportation on mortality in a physician-staffed pre-hospital trauma system remains unknown. The aim of the study was to assess the impact of helicopter transportation on mortality and prehospital triage. METHODS Data collection was based on trauma registry for all consecutive major trauma patients transported by helicopter or ground ambulance in the Northern French Alps Trauma system between 2009 and 2017. The primary endpoint was in-hospital death. We performed multivariate logistic regression to compare death between helicopter and ground ambulance. RESULTS Overall, 9458 major trauma patients were included. 37% (n = 3524) were transported by helicopter, and 56% (n = 5253) by ground ambulance. Prehospital time from the first call to the arrival at hospital was longer in the helicopter group compared to the ground ambulance group, respectively median time 95 [72-124] minutes and 85 [63-113] minutes (P < 0.001). Median transport time was similar between groups, 20 min [13-30] for helicopter and 21 min [14-32] for ground ambulance. Using multivariate logistic regression, helicopter was associated with reduced mortality compared to ground ambulance (adjusted OR 0.70; 95% CI, 0.53-0.92; P = 0.01) and with reduced undertriage (OR 0.69 95% CI, 0.60-0.80; P < 0.001). CONCLUSION Helicopter was associated with reduced in-hospital death and undertriage by one third. It did not decrease prehospital and transport times in a system with the same crew using both helicopter or ground ambulance. The mortality and undertriage benefits observed suggest that the helicopter is the proper mode for long-distant transport to a regional trauma centre.
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Affiliation(s)
- Francois-Xavier Ageron
- Northern French Alp Emergency Network, Centre Hospitalier Annecy Genevois, 1, avenue de l'hopital - BP 90074, F-74374, Pringy, France. .,Emergency Department, Lausanne University Hospital, CHUV, Lausanne, Switzerland.
| | - Guillaume Debaty
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Dominique Savary
- Emergency Department, Centre Hospitalier Annecy Genevois, Pringy, France
| | - Frederic Champly
- Emergency Department, Hôpitaux du Pays du Mont-Blanc, Sallanches, France
| | - Francois Albasini
- Emergency Department, Centre Hospitalier de Saint-Jean de Maurienne, Saint-Jean de Maurienne, France
| | - Pascal Usseglio
- Emergency Department, Centre Hospitalier Metropole de Savoie, Chambery, France
| | - Cécile Vallot
- Northern French Alp Emergency Network, Centre Hospitalier Annecy Genevois, 1, avenue de l'hopital - BP 90074, F-74374, Pringy, France.,Emergency Department, Centre Hospitalier Annecy Genevois, Pringy, France
| | - Samuel Galvagno
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, USA
| | - Pierre Bouzat
- Northern French Alp Emergency Network, Centre Hospitalier Annecy Genevois, 1, avenue de l'hopital - BP 90074, F-74374, Pringy, France.,Department of Anaesthesiology and Critical Care, Grenoble Alpes University Hospital, 38000, Grenoble, France
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15
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Wu MY, Li CJ, Hou YT, Chen YL, Chang FW, Yiang GT. Analysis of emergency air medical services over 9 years in the Penghu archipelago of Taiwan. Tzu Chi Med J 2020; 32:82-87. [PMID: 32110526 PMCID: PMC7015014 DOI: 10.4103/tcmj.tcmj_216_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/16/2018] [Accepted: 11/21/2018] [Indexed: 11/16/2022] Open
Abstract
Objective: Emergency air medical services (EAMS) share a common helicopter system for prehospital care and transfer in several countries. In Penghu, two systems are involved in EAMS: the helicopter and C130 systems. Given their features and limitations, patients using the two systems have significantly different characteristics. Materials and Methods: To clearly understand the disease patterns and dynamic changes in transferred patients, we studied 1228 patients transported from Penghu to Taiwan between January 2009 and December 2017. Results: Our findings show that the helicopter group had more acute diseases, while the C130 system group had more chronic diseases. Cardiovascular disease was the most common diagnosis (328 patients, 26.71%), followed by cerebrovascular disease (263 patients, 21.41%) and gastrointestinal disease (221 patients, 17.99%). Following interventions to support local medicine by Tri-Service General Hospital and the establishment of a cardiac catheterization laboratory, the annual number of transported patients decreased, especially those with cardiovascular diseases. The disease pattern also shifted from acute to chronic disease. Conclusion: Current data indicate that the local medical system is developing the ability to manage chronic diseases and care problems. This article analyzes dynamic changes in the disease patterns of transferred patients in both EAMS groups, providing a strong foundation for developing local medical systems.
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Affiliation(s)
- Meng-Yu Wu
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chia-Jung Li
- Research Assistant Center, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Yueh-Tseng Hou
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yu-Long Chen
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Fung-Wei Chang
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Office of Superintendent, Tri-Service General Hospital Penghu Branch, National Defence Medical Center, Peghu, Taiwan
| | - Giou-Teng Yiang
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
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16
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Langkamp-Wedde T, Rautmann D, von Hörsten D, Wegener JK. Comparison of the drift potential of two application methods for the control of oak processionary moths with biocidal products in an oak avenue. Sci Total Environ 2020; 704:135313. [PMID: 31787302 DOI: 10.1016/j.scitotenv.2019.135313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/29/2019] [Accepted: 10/29/2019] [Indexed: 06/10/2023]
Abstract
The control of oak processionary moths (OPM; Thaumetopoea processionea) with biocidal products has become more important to protect humans from its urticating hairs. Two important application methods are cannon sprayers and helicopters. However, drift of insecticides to non-target areas might occur during the treatment resulting in potential risks for non-target organisms. Until now, information about the direct drift resulting from the applications are missing because equipment for the application of biocidal products is not tested or regulated within Europe. The aim of this work is to measure the direct drift in up to 100 m distance resulting from the application of biocidal products using a cannon sprayer and helicopter in an oak avenue. Furthermore, two different nozzles were tested for the helicopter application. The results show high drift potential with decreasing concentrations in relation to the distance to the treated area. Considering the 50th percentile of the results, the cannon sprayer produced generally more drift than the helicopter. Considering the 90th percentile at near distance, the helicopter equipped with ID-120-05 POM nozzles showed a significantly lower drift than both other tested techniques, the helicopter equipped with the Airmix 110 05 nozzles and the cannon sprayer. Hundred m away from the treated area, both nozzles installed at the helicopter showed a lower drift than the cannon sprayer. For the first time, this study shows the drift potential of applications of biocidal products and shows the possibilities to reduce drift into non-target areas by choosing appropriate equipment. This leads to a reduction of risks for non-target organisms in the vicinity of treated avenues.
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Affiliation(s)
- Tina Langkamp-Wedde
- Institute for Application Techniques in Plant Protection, Julius Kühn-Institute, Braunschweig, Germany.
| | - Dirk Rautmann
- Institute for Application Techniques in Plant Protection, Julius Kühn-Institute, Braunschweig, Germany
| | - Dieter von Hörsten
- Institute for Application Techniques in Plant Protection, Julius Kühn-Institute, Braunschweig, Germany
| | - Jens Karl Wegener
- Institute for Application Techniques in Plant Protection, Julius Kühn-Institute, Braunschweig, Germany
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17
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Stone KL, Smedley WA, Killian J, Stephens SW, Griffin RL, Cox DB, Kerby JD, Jansen JO. Aeromedical retrieval of trauma patients: Impact of flight path model on estimates of population coverage. Am J Surg 2020; 220:765-772. [PMID: 32037046 DOI: 10.1016/j.amjsurg.2020.01.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 01/16/2020] [Accepted: 01/31/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of this study was to compare the impact of different flight path models on the calculated population coverage of aeromedical retrieval systems, using the state of Alabama as a case study. METHODS Geospatial analysis of U.S. Census Bureau population data using helicopter bases and trauma centers as foci of either circular or elliptical coverage areas. RESULTS Circular isochrone models around helicopter bases or trauma centers suggest that the entire population of Alabama could reach a level I or II trauma center within 60 min. Elliptical isochrones, incorporating outbound and inbound flights, suggest that only 78.8% of the population have ready access to level I or II trauma centers. CONCLUSION While all three flight path models described have some validity and utility, simplistic circular flight time isochrones around trauma centers and helicopter bases provide overly optimistic estimates of population coverage. The elliptical model provides a more realistic evaluation.
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Affiliation(s)
- K Lorraine Stone
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - W Andrew Smedley
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - John Killian
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Shannon W Stephens
- Center for Injury Sciences, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Russell L Griffin
- Center for Injury Sciences, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Daniel B Cox
- Center for Injury Sciences, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Jeffrey D Kerby
- Center for Injury Sciences, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Jan O Jansen
- Center for Injury Sciences, University of Alabama at Birmingham, Birmingham, AL, USA.
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18
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Caldeira JMA, Goffi-Gomez MVS, Imamura R, Bento RF. Speech Recognition of Cochlear Implant Users Inside a Noisy Helicopter Environment. Audiol Neurootol 2019; 24:32-37. [PMID: 30955013 DOI: 10.1159/000497031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 01/16/2019] [Indexed: 11/19/2022] Open
Abstract
In this study, we tested whether the speech recognition, through radio communications, of cochlear implant (CI) users inside a noisy helicopter cockpit is adequate for safe flight. METHOD Speech recognition tests (sentences, numbers and disyllables) through a very-high-frequency radio were administered to 12 CI users in a soundproof booth, inside a helicopter with the engine turned off and turned on. RESULTS In quiet environments, radio communications were impacted only for disyllable intelligibility, but in noisy situations, all tests were affected. CONCLUSIONS CI subjects did not achieve the auditory levels recommended by the International Civil Aviation Organization.
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Affiliation(s)
| | - Maria Valéria Schmidt Goffi-Gomez
- Cochlear Implant Group, Department of Otorhinolaryngology, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Rui Imamura
- Department of Otorhinolaryngology, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Ricardo Ferreira Bento
- Department of Otorhinolaryngology, University of São Paulo School of Medicine, São Paulo, Brazil
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19
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Rasmussen K, Langdalen H, Sollid SJM, Abrahamsen EB, Sørskår LIK, Bondevik GT, Abrahamsen HB. Training and assessment of non-technical skills in Norwegian helicopter emergency services: a cross-sectional and longitudinal study. Scand J Trauma Resusc Emerg Med 2019; 27:1. [PMID: 30616604 DOI: 10.1186/s13049-018-0583-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 12/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Deficient non-technical skills (NTS) among providers of critical care in helicopter emergency medical services (HEMS) is a threat to patient and operational safety. Skills can be improved through simulation-based training and assessment. A previous study indicated that physicians underwent less frequent training compared to pilots and HEMS crew members (HCM) and that all professional groups in Norwegian HEMS received limited training in how to cope with fatigue. Since then, training initiatives and a fatigue risk management project has been initiated. Our study aimed to explore if the frequency of simulation-based training and assessment of NTS in Norwegian HEMS has changed since 2011 following these measures. Methods A cross-sectional web-based survey from October through December 2016, of physicians, HCM and pilots from all civilian Norwegian HEMS-bases reporting the overall extent of simulation-based training and assessment of NTS. Results Of 214 invited, 109 responses were eligible for analysis. The frequency of simulation-based training and assessment of NTS has increased significantly for all professional groups in Norwegian HEMS, most prominently for the physicians. For all groups, the frequency of assessment is generally lower than the frequency of training. Conclusions Physicians in Norwegian HEMS seem to have adjusted to the NTS training culture of the other crew member groups. This might be a consequence of improved NTS training programs. The use of behavioural marker systems systematically in HEMS should be emphasized. Electronic supplementary material The online version of this article (10.1186/s13049-018-0583-1) contains supplementary material, which is available to authorized users.
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20
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Langdalen H, Abrahamsen EB, Sollid SJM, Sørskår LIK, Abrahamsen HB. A comparative study on the frequency of simulation-based training and assessment of non-technical skills in the Norwegian ground ambulance services and helicopter emergency medical services. BMC Health Serv Res 2018; 18:509. [PMID: 29970079 PMCID: PMC6029269 DOI: 10.1186/s12913-018-3325-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inadequate non-technical skills (NTSs) among employees in the Norwegian prehospital emergency medical services (EMSs) are a risk for patient and operational safety. Simulation-based training and assessment is promising with respect to improving NTSs. The frequency of simulation-based training in and assessment of NTSs among crewmembers in the Norwegian helicopter emergency medical service (HEMS) has gained increased attention over recent years, whereas there has been much less focus on the Norwegian ground emergency medical service (GEMS). The aim of the study was to compare and document the frequencies of simulation-based training in and assessment of seven NTSs between the Norwegian HEMS and GEMS, conditional on workplace and occupation. METHOD A comparative study of the results from cross-sectional questionnaires responded to by employees in the Norwegian prehospital EMSs in 2016 regarding training in and assessment of NTSs during 2015, with a focus on the Norwegian GEMS and HEMS. Professional groups of interest are: pilots, HEMS crew members (HCMs), physicians, paramedics, emergency medical technicians (EMTs), EMT apprentices, nurses and nurses with an EMT licence. RESULTS The frequency of simulation-based training in and assessment of seven generic NTSs was statistically significantly greater for HEMS than for GEMS during 2015. Compared with pilots and HCMs, other health care providers in GEMS and HEMS undergo statistically significantly less frequent simulation-based training in and assessment of NTSs. Physicians working in the HEMS appear to be undergoing training and assessment more frequently than the rest of the health trust employees. The study indicates a tendency for lesser focus on the assessment of NTSs compared to simulation-based training. CONCLUSION HEMS has become superior to GEMS, in terms of frequency of training in and assessment of NTSs. The low frequency of training in and assessment of NTSs in GEMS suggests that there is a great potential to learn from HEMS and to strengthen the focus on NTSs. Increased frequency of assessment of NTSs in both HEMS and GEMS is called for.
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Affiliation(s)
- Henrik Langdalen
- Department of Safety, Economics and Planning, University of Stavanger, Faculty of Science and Technology, Stavanger, Norway
| | - Eirik B. Abrahamsen
- Department of Safety, Economics and Planning, University of Stavanger, Faculty of Science and Technology, Stavanger, Norway
| | - Stephen J. M. Sollid
- Department of Quality and Health Technology, University of Stavanger, Faculty of Health Sciences, Stavanger, Norway
- Prehospital Division, Stavanger University Hospital, Stavanger, Norway
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
| | - Leif Inge K. Sørskår
- Department of Safety, Economics and Planning, University of Stavanger, Faculty of Science and Technology, Stavanger, Norway
| | - Håkon B. Abrahamsen
- Department of Safety, Economics and Planning, University of Stavanger, Faculty of Science and Technology, Stavanger, Norway
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
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21
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Nakajima M, Aso S, Yasunaga H, Shirokawa M, Nakano T, Miyakuni Y, Goto H, Yamaguchi Y. Body temperature change and outcomes in patients undergoing long-distance air medical transport. Am J Emerg Med 2018; 37:89-93. [PMID: 29730095 DOI: 10.1016/j.ajem.2018.04.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/27/2018] [Accepted: 04/27/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Short-distance air medical transport for adult emergency patients does not significantly affect patients' body temperature and outcomes. This study aimed to examine the influence of long-distance air medical transport on patients' body temperatures and the relationship between body temperature change and mortality. METHODS We retrospectively enrolled consecutive patients transferred via helicopter or plane from isolated islands to an emergency medical center in Tokyo, Japan between April 2010 and December 2016. Patients' average body temperature was compared before and after air transport using a paired t-test, and corrections between body temperature change and flight duration were calculated using Pearson's correlation coefficient. Multivariable logistic regression models were then used to examine the association between body temperature change and in-hospital mortality. RESULTS Of 1253 patients, the median age was 72 years (interquartile range, 60-82 years) and median flight duration was 71 min (interquartile range, 54-93 min). In-hospital mortality was 8.5%, and average body temperature was significantly different before and after air transport (36.7 °C versus 36.3 °C; difference: -0.36 °C; 95% confidence interval, -0.30 to -0.42; p < 0.001). There was no correlation between body temperature change and flight duration (r = 0.025, p = 0.371). In-hospital death was significantly associated with (i) hyperthermia (>38.0 °C) or normothermia (36.0-37.9 °C) before air transport and hypothermia after air transport (odds ratio, 2.08; 95% confidence interval, 1.20-3.63; p = 0.009), and (ii) winter season (odds ratio, 2.15; 95% confidence interval, 1.08-4.27; p = 0.030). CONCLUSION Physicians should consider body temperature change during long-distance air transport in patients with not only hypothermia but also normothermia or hyperthermia before air transport, especially in winter.
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Affiliation(s)
- Mikio Nakajima
- Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo 150-0013, Japan; Department of Trauma and Critical Care Medicine, School of Medicine, Kyorin University, 6-20-2, Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan.
| | - Shotaro Aso
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Masamitsu Shirokawa
- Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo 150-0013, Japan
| | - Tomotsugu Nakano
- Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo 150-0013, Japan
| | - Yasuhiko Miyakuni
- Department of Trauma and Critical Care Medicine, School of Medicine, Kyorin University, 6-20-2, Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
| | - Hideaki Goto
- Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo 150-0013, Japan.
| | - Yoshihiro Yamaguchi
- Department of Trauma and Critical Care Medicine, School of Medicine, Kyorin University, 6-20-2, Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan.
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Hansen MCT, Schmidt JH, Brøchner AC, Johansen JK, Zwisler S, Mikkelsen S. Noise exposure during prehospital emergency physicians work on Mobile Emergency Care Units and Helicopter Emergency Medical Services. Scand J Trauma Resusc Emerg Med 2017; 25:119. [PMID: 29208018 PMCID: PMC5717803 DOI: 10.1186/s13049-017-0459-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 11/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prehospital personnel are at risk of occupational hearing loss due to high noise exposure. The aim of the study was to establish an overview of noise exposure during emergency responses in Mobile Emergency Care Units (MECU), ambulances and Helicopter Emergency Medical Services (HEMS). A second objective was to identify any occupational hearing loss amongst prehospital personnel. METHODS Noise exposure during work in the MECU and HEMS was measured using miniature microphones worn laterally to the auditory canals or within the earmuffs of the helmet. All recorded sounds were analysed in proportion to a known tone of 94 dB. Before and after episodes of noise exposure, the physicians underwent a hearing test indicating whether the noise had had any impact on the function of the outer sensory hair cells. This was accomplished by measuring the amplitude level shifts of the Distortion Product Otoacoustic Emissions. Furthermore, the prehospital personnels' hearing was investigated using pure-tone audiometry to reveal any occupational hearing loss. All prehospital personnel were compared to ten in-hospital controls. RESULTS Our results indicate high-noise exposure levels of ≥80 dB(A) during use of sirens on the MECU and during HEMS operations compared to in-hospital controls (70 dB(A)). We measured an exposure up to ≥90 dB(A) under the helmet for HEMS crew. No occupational hearing loss was identified with audiometry. A significant level shift of the Distortion Product Otoacoustic Emissions at 4 kHz for HEMS crew compared to MECU physicians was found indicating that noise affected the outer hair cell function of the inner ear, thus potentially reducing the hearing ability of the HEMS crew. DISCUSSION Further initiatives to prevent noise exposure should be taken, such as active noise reduction or custom-made in-ear protection with communication system for HEMS personnel. Furthermore, better insulation of MECU and ambulances is warranted. CONCLUSION We found that the exposure levels exceeded the recommendations described in the European Regulative for Noise, which requires further protective initiatives. Although no hearing loss was demonstrated in the personnel of the ground-based units, a reduced function of the outer sensory hair cells was found in the HEMS group following missions.
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Affiliation(s)
| | - Jesper Hvass Schmidt
- Department of Audiology, Odense University Hospital, Odense C, 5000, DK, Denmark.,Department of ENT, Head and Neck Surgery, Odense University Hospital, Odense C, 5000, DK, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense M, 5230, DK, Denmark
| | - Anne C Brøchner
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense C, 5000, DK, Denmark.,Mobile Emergency Care Unit, Odense University Hospital, Odense C, 5000, DK, Denmark
| | - Jakob Kjersgaard Johansen
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense C, 5000, DK, Denmark.,National Helicopter Emergency Medical Services, Pre-hospital Center Region of Central Denmark, Aarhus C, 8200, DK, Denmark
| | - Stine Zwisler
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense C, 5000, DK, Denmark.,Mobile Emergency Care Unit, Odense University Hospital, Odense C, 5000, DK, Denmark
| | - Søren Mikkelsen
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense C, 5000, DK, Denmark.,Mobile Emergency Care Unit, Odense University Hospital, Odense C, 5000, DK, Denmark
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Garner AA, van den Berg PL. Locating helicopter emergency medical service bases to optimise population coverage versus average response time. BMC Emerg Med 2017; 17:31. [PMID: 29037168 PMCID: PMC5644058 DOI: 10.1186/s12873-017-0142-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 10/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background New South Wales (NSW), Australia has a network of multirole retrieval physician staffed helicopter emergency medical services (HEMS) with seven bases servicing a jurisdiction with population concentrated along the eastern seaboard. The aim of this study was to estimate optimal HEMS base locations within NSW using advanced mathematical modelling techniques. Methods We used high resolution census population data for NSW from 2011 which divides the state into areas containing 200–800 people. Optimal HEMS base locations were estimated using the maximal covering location problem facility location optimization model and the average response time model, exploring the number of bases needed to cover various fractions of the population for a 45 min response time threshold or minimizing the overall average response time to all persons, both in green field scenarios and conditioning on the current base structure. We also developed a hybrid mathematical model where average response time was optimised based on minimum population coverage thresholds. Results Seven bases could cover 98% of the population within 45mins when optimised for coverage or reach the entire population of the state within an average of 21mins if optimised for response time. Given the existing bases, adding two bases could either increase the 45 min coverage from 91% to 97% or decrease the average response time from 21mins to 19mins. Adding a single specialist prehospital rapid response HEMS to the area of greatest population concentration decreased the average state wide response time by 4mins. The optimum seven base hybrid model that was able to cover 97.75% of the population within 45mins, and all of the population in an average response time of 18 mins included the rapid response HEMS model. Conclusions HEMS base locations can be optimised based on either percentage of the population covered, or average response time to the entire population. We have also demonstrated a hybrid technique that optimizes response time for a given number of bases and minimum defined threshold of population coverage. Addition of specialized rapid response HEMS services to a system of multirole retrieval HEMS may reduce overall average response times by improving access in large urban areas. Electronic supplementary material The online version of this article (10.1186/s12873-017-0142-5) contains supplementary material, which is available to authorized users.
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Østerås Ø, Heltne JK, Vikenes BC, Assmus J, Brattebø G. Factors influencing on-scene time in a rural Norwegian helicopter emergency medical service: a retrospective observational study. Scand J Trauma Resusc Emerg Med 2017; 25:97. [PMID: 28934985 PMCID: PMC5609050 DOI: 10.1186/s13049-017-0442-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 09/13/2017] [Indexed: 11/29/2022] Open
Abstract
Background Critically ill patients need to be immediately identified, properly managed, and rapidly transported to definitive care. Extensive prehospital times may increase mortality in selected patient groups. The on-scene time is a part of the prehospital interval that can be decreased, as transport times are determined mostly by the distance to the hospital. Identifying factors that affect on-scene time can improve training, protocols, and decision making. Our objectives were to assess on-scene time in the Helicopter Emergency Medical Service (HEMS) in our region and selected factors that may affect it in specific and severe conditions. Methods This retrospective cohort study evaluated on-scene time and factors that may affect it for 9757 emergency primary missions by the three HEMSs in western Norway between 2009 and 2013, using graphics and descriptive statistics. Results The overall median on-scene time was 10 minutes (IQR 5–16). The median on-scene time in patients with penetrating torso injuries was 5 minutes (IQR 3–10), whereas in cardiac arrest patients it was 20 minutes (IQR 13–28). Based on multivariate linear regression analysis, the severity of the patient’s condition, advanced interventions performed, mode of transport, and trauma missions increased the on-scene time. Endotracheal intubation increased the OST by almost 10 minutes. Treatment prior to HEMS arrival reduced the on-scene time in patients suffering from acute myocardial infarction. Discussion We found a short OST in preselected conditions compared to other studies. For the various patient subgroups, the strength of association between factors and OST varied. The time spent on-scene and its influencing factors were dependent on the patient’s condition. Our results provide a basis for efforts to improve decision making and reduce OST for selected patient groups. Conclusions The most important factors associated with increased on-scene time were the severity of the patient’s condition, the need for intubation or intravenous analgesic, helicopter transport, and trauma missions. Electronic supplementary material The online version of this article (10.1186/s13049-017-0442-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Øyvind Østerås
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, PO Box 1400, 5021, Bergen, Norway. .,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, PO Box 7804, 5020, Bergen, Norway.
| | - Jon-Kenneth Heltne
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, PO Box 1400, 5021, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, PO Box 7804, 5020, Bergen, Norway
| | - Bjørn-Christian Vikenes
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, PO Box 1400, 5021, Bergen, Norway
| | - Jörg Assmus
- Centre for Clinical Research, Haukeland University Hospital, PO Box 1400, 5021, Bergen, Norway
| | - Guttorm Brattebø
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, PO Box 1400, 5021, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, PO Box 7804, 5020, Bergen, Norway.,Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, PO Box 4950 Nydalen, 0424, Oslo, Norway
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Ausserer J, Moritz E, Stroehle M, Brugger H, Strapazzon G, Rauch S, Mair P. Physician staffed helicopter emergency medical systems can provide advanced trauma life support in mountainous and remote areas. Injury 2017; 48:20-25. [PMID: 27650943 DOI: 10.1016/j.injury.2016.09.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/17/2016] [Accepted: 09/02/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In remote and mountainous areas, helicopter emergency medical systems (HEMS) are used to expedite evacuation and provide pre-hospital advanced trauma life support (ATLS) in major trauma victims. Aim of the study was to investigate feasibility of ATLS in HEMS mountain rescue missions and its influence on patient condition at hospital admission. PATIENTS 58 major trauma victims (Injury Severity Score ≥16), evacuated by physician staffed HEMS from remote and mountainous areas in the State of Tyrol, Austria between 1.1.2011 and 31.12.2013. RESULTS Pre-hospital time exceeded 90min in 24 (44%) cases. 31 (53%) patients suffered critical impairment of at least one vital function (systolic blood pressure <90mmHg, GCS <10, or respiratory rate <10 or >30). 4 (6.9%) of 58 patients died prior to hospital admission. Volume resuscitation was restrictive: 18 (72%) of 25 hypotensive patients received ≤500ml fluids and blood pressure was increased >90mmHg at hospital admission in only 9 (36%) of these 25 patients. 8 (50%) of 16 brain trauma patients with a blood pressure <90mmHg remained hypotensive at hospital admission. Endotracheal intubation was accomplished without major complications in 15 (79%) of 19 patients with a Glasgow Coma Scale score <10. Rope operations were necessary in 40 (69%) of 58 cases and ATLS was started before hoist evacuation in 30 (75%) of them. CONCLUSIONS The frequent combination of prolonged pre-hospital times, with critical impairment of vital functions, supports the need for early ATLS in HEMS mountain rescue missions. Pre-hospital endotracheal intubation is possible with a high success and low complication rate also in a mountain rescue scenario. Pre-hospital volume resuscitation is restrictive and hypotension is reversed at hospital admission in only one third of patients. Prolonged pre-hospital hypotension remains an unresolved problem in half of all brain trauma patients and indicates the difficulties to increase blood pressure to a desired level in a mountain rescue scenario. Despite technical considerations, on-site ATLS is feasible for an experienced emergency physician in the majority of rope rescue operations.
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Affiliation(s)
- Julia Ausserer
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Elizabeth Moritz
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Matthias Stroehle
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Hermann Brugger
- EURAC Institute of Mountain Emergency Medicine, Drususallee 1, 39100 Bolzano, Italy
| | - Giacomo Strapazzon
- EURAC Institute of Mountain Emergency Medicine, Drususallee 1, 39100 Bolzano, Italy
| | - Simon Rauch
- EURAC Institute of Mountain Emergency Medicine, Drususallee 1, 39100 Bolzano, Italy
| | - Peter Mair
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
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Murray M, Lange B, Chreiteh SS, Olsen HB, Nørnberg BR, Boyle E, Søgaard K, Sjøgaard G. Neck and shoulder muscle activity and posture among helicopter pilots and crew-members during military helicopter flight. J Electromyogr Kinesiol 2016; 27:10-7. [PMID: 26852114 DOI: 10.1016/j.jelekin.2015.12.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 12/16/2015] [Accepted: 12/19/2015] [Indexed: 11/17/2022] Open
Abstract
Neck pain among helicopter pilots and crew-members is common. This study quantified the physical workload on neck and shoulder muscles using electromyography (EMG) measures during helicopter flight. Nine standardized sorties were performed, encompassing: cruising from location A to location B (AB) and performing search and rescue (SAR). SAR was performed with Night Vision Goggles (NVG), while AB was performed with (AB+NVG) and without NVG (AB-NVG). EMG was recorded for: trapezius (TRA), upper neck extensors (UNE), and sternocleido-mastoid (SCM). Maximal voluntary contractions (MVC) were performed for normalization of EMG (MVE). Neck posture of pilots and crew-members was monitored and pain intensity of neck, shoulder, and back was recorded. Mean muscle activity for UNE was ∼10% MVE and significantly higher than TRA and SCM, and SCM was significantly lower than TRA. There was no significant difference between AB-NVG and AB+NVG. Muscle activity in the UNE was significantly higher during SAR+NVG than AB-NVG. Sortie time (%) with non-neutral neck posture for SAR+NVG and AB-NVG was: 80.4%, 74.5% (flexed), 55.5%, 47.9% (rotated), 4.5%, 3.7% (lateral flexed). Neck pain intensity increased significantly from pre- (0.7±1.3) to post-sortie (1.6±1.9) for pilots (p=0.028). If sustained, UNE activity of ∼10% MVE is high, and implies a risk for neck disorders.
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Affiliation(s)
- Mike Murray
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark.
| | - Britt Lange
- Department of Anesthesia and Intensive Care Medicine, Odense University Hospital, Denmark
| | - Shadi Samir Chreiteh
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Henrik Baare Olsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | | | - Eleanor Boyle
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark; Dalla Lana School of Public Health, University of Toronto, Canada
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Gisela Sjøgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
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O'Dochartaigh D, Douma M. Prehospital ultrasound of the abdomen and thorax changes trauma patient management: A systematic review. Injury 2015; 46:2093-102. [PMID: 26264879 DOI: 10.1016/j.injury.2015.07.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/01/2015] [Accepted: 07/02/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ultrasound examination of trauma patients is increasingly performed in prehospital services. It is unclear if prehospital sonographic assessments change patient management: providing prehospital diagnosis and treatment, determining choice of destination hospital, or treatment at the receiving hospital. OBJECTIVE This review aims to assess and grade the evidence that specifically examines whether prehospital ultrasound (PHUS) of the thorax and/or abdomen changes management of the trauma patient. METHODS A systematic review was conducted of trauma patients who had an ultrasound of the thorax or abdomen performed in the prehospital setting. PubMed, MEDLINE, Web of Science (CINAHL, EMBASE, Cochrane Central Register of Controlled Trials) and the reference lists of included studies were searched. Methodological quality was checked and risk of bias analysis performed, a level of evidence grade was assigned, and descriptive data analysis performed. RESULTS 992 unique citations were identified, which included eight studies that met inclusion criteria with a total of 925 patients. There are no reports of randomised controlled trials. Heterogeneity exists between the included studies which ranged from a case series to retrospective and prospective non-randomised observational studies. Three studies achieved a 2+ Scottish Intercollegiate Guidelines Networks grade for quality of evidence and the remainder demonstrated a high risk of bias. The three best studies each provided examples of prehospital ultrasound positively changing patient management. CONCLUSION There is moderate evidence that supports prehospital physician use of ultrasound for trauma patients. For some patients, management was changed based on the results of the PHUS. The benefit of ultrasound use in non-physician services is unclear.
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Affiliation(s)
- D O'Dochartaigh
- Air Medical Crew, Shock Trauma Air Rescue Society, Suite 100, 1519 35 Ave E, Edmonton Int'l Airport, Alberta T9E 0V6, Canada.
| | - M Douma
- Clinical Nurse Educator, Emergency Services, Royal Alexandra Hospital, 10240 Kingsway Avenue NW, Edmonton, Alberta T5H 3V9, Canada.
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Di Stasi LL, McCamy MB, Martinez-Conde S, Gayles E, Hoare C, Foster M, Catena A, Macknik SL. Effects of long and short simulated flights on the saccadic eye movement velocity of aviators. Physiol Behav 2016; 153:91-6. [PMID: 26597121 DOI: 10.1016/j.physbeh.2015.10.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 11/20/2022]
Abstract
Aircrew fatigue is a major contributor to operational errors in civil and military aviation. Objective detection of pilot fatigue is thus critical to prevent aviation catastrophes. Previous work has linked fatigue to changes in oculomotor dynamics, but few studies have studied this relationship in critical safety environments. Here we measured the eye movements of US Marine Corps combat helicopter pilots before and after simulated flight missions of different durations.We found a decrease in saccadic velocities after long simulated flights compared to short simulated flights. These results suggest that saccadic velocity could serve as a biomarker of aviator fatigue.
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Michailidou M, Goldstein SD, Salazar J, Aboagye J, Stewart D, Efron D, Abdullah F, Haut ER. Helicopter overtriage in pediatric trauma. J Pediatr Surg 2014; 49:1673-7. [PMID: 25475816 DOI: 10.1016/j.jpedsurg.2014.08.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 08/12/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Helicopter Emergency Medical Services (HEMS) have been designed to provide faster access to trauma center care in cases of life-threatening injury. However, the ideal recipient population is not fully characterized, and indications for helicopter transport in pediatric trauma vary dramatically by county, state, and region. Overtriage, or unnecessary utilization, can lead to additional patient risk and expense. In this study we perform a nationwide descriptive analysis of HEMS for pediatric trauma and assess the incidence of overtriage in this group. METHODS We reviewed records from the American College of Surgeons National Trauma Data Bank (2008-11) and included patients less than 16 years of age who were transferred from the scene of injury to a trauma center via HEMS. Overtriage was defined as patients meeting all of the following criteria: Glasgow Coma Scale (GCS) equal to 15, absence of hypotension, an Injury Severity Score (ISS) less than 9, no need for procedure or critical care, and a hospital length of stay of less than 24 hours. RESULTS A total of 19,725 patients were identified with a mean age of 10.5 years. The majority of injuries were blunt (95.6%) and resulted from motor vehicle crashes (48%) and falls (15%). HEMS transported patients were predominately normotensive (96%), had a GCS of 15 (67%), and presented with minor injuries (ISS<9, 41%). Overall, 28 % of patients stayed in the hospital for less than 24 hours, and the incidence of overtriage was 17%. CONCLUSIONS Helicopter overtriage is prevalent among pediatric trauma patients nationwide. The ideal model to predict need for HEMS must consider clinical outcomes in the context of judicious resource utilization. The development of guidelines for HEMS use in pediatric trauma could potentially limit unnecessary transfers while still identifying children who require trauma center care in a timely fashion.
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Affiliation(s)
- Maria Michailidou
- Center for Pediatric Surgical Trials & Outcomes Research, Department of Surgery, Division of Pediatric Surgery, Johns Hopkins University School of Medicine.
| | - Seth D Goldstein
- Center for Pediatric Surgical Trials & Outcomes Research, Department of Surgery, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
| | - Jose Salazar
- Center for Pediatric Surgical Trials & Outcomes Research, Department of Surgery, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
| | - Jonathan Aboagye
- Center for Pediatric Surgical Trials & Outcomes Research, Department of Surgery, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
| | - Dylan Stewart
- Center for Pediatric Surgical Trials & Outcomes Research, Department of Surgery, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
| | - David Efron
- Center for Pediatric Surgical Trials & Outcomes Research, Department of Surgery, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
| | - Fizan Abdullah
- Center for Pediatric Surgical Trials & Outcomes Research, Department of Surgery, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
| | - Elliot R Haut
- Center for Pediatric Surgical Trials & Outcomes Research, Department of Surgery, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
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Abstract
INTRODUCTION The TraumaRegister DGU(®) has been founded 20 years ago. Although initially supported by larger hospitals and universities, it has recently become a representative registry for the care of severely injured patients in Germany. Based on the registry data some important trends and developments of the recent decades are presented. PATIENTS AND METHODS German trauma patients with an Injury Severity Score (ISS)≥ 16 were eligible if primary admitted from the scene. All cases documented between 1993 and 2012 (20 years) were eligible. For selected variables, an average change per years was calculated using linear regression analysis. RESULTS A total of 49,801 patients was analysed. The mean age was 46.3 years, and 72% were males. The following relevant trends could be observed: The average age increased dramatically from 38 to 50 years. Pre-hospital intubation rate was halfed in patients with Glasgow Coma Scale (GCS)>8 but remained constant in unconscious patients (GCS ≤ 8; 90% intubation rate). Pre-hospital volume administration decreased as well, which led to less blood transfusions (from 45% to 16%). The use of helicopters for transportation into a trauma centre decreased as well but today still 27% of all cases are transported by air. Whole-body CT was performed in about 80% of patients; this value is stable in the last four years. Hospital mortality could be reduced and was 2-3% lower than expected in recent years. The Revised Injury Severity Classification (RISC) score used as a reference here was based on TR-DGU data from the 1990s. CONCLUSION Standardised prospective registration of severely injured patients over 20years allows to empirically monitor trends and developments in acute trauma care.
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Andruszkow H, Hildebrand F, Lefering R, Pape HC, Hoffmann R, Schweigkofler U. Ten years of helicopter emergency medical services in Germany: do we still need the helicopter rescue in multiple traumatised patients? Injury 2014; 45 Suppl 3:S53-8. [PMID: 25284235 DOI: 10.1016/j.injury.2014.08.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Helicopter emergency medical service (HEMS) has been established in the preclinical treatment of multiple traumatised patients despite an ongoing controversy towards the potential benefit. Celebrating the 20th anniversary of TraumaRegister DGU(®) of the German Trauma Society (DGU) the presented study intended to provide an overview of HEMS rescue in Germany over the last 10 years analysing the potential beneficial impact of a nationwide helicopter rescue in multiple traumatised patients. PATIENTS AND METHODS We analysed TraumaRegister DGU(®) including multiple traumatised patients (ISS ≥ 16) between 2002 and 2012. In-hospital mortality was defined as main outcome. An adjusted, multivariate regression with 13 confounders was performed to evaluate the potential survival benefit. RESULTS 42,788 patients were included in the present study. 14,275 (33.4%) patients were rescued by HEMS and 28,513 (66.6%) by GEMS. Overall, 66.8% (n=28,569) patients were transported to a level I trauma centre and 28.2% (n=12,052) to a level II trauma centre. Patients rescued by HEMS sustained a higher injury severity compared to GEMS (ISS HEMS: 29.5 ± 12.6 vs. ISS GEMS 27.5 ± 11.8). Helicopter rescue teams performed more on-scene interventions, and mission times were increased in HEMS rescue (HEMS: 77.2 ± 28.7 min. vs. GEMS: 60.9 ± 26.9 min.). Linear regression analysis revealed that the frequency of HEMS rescue has decreased significantly between 2002 and 2012. In case of transportation to level I trauma centres a decrease of 1.7% per year was noted (p<0.001) while a decline of 1.6% per year (p<0.001) was measured for level II trauma centre admissions. According to multivariate logistic regression HEMS was proven a positive independent survival predictor between 2002 and 2012 (OR 0.863; 95%-CI 0.800-0.930; Nagelkerkes-R(2) 0.539) with only little differences between each year. CONCLUSIONS This study was able to prove an independent survival benefit of HEMS in multiple traumatised patients during the last 10 years. Despite this fact, a constant decline of HEMS rescue missions was found in multiple trauma patients due to unknown reasons. We concluded that HEMS should be used more often in case of trauma in order to guarantee the proven benefit for multiple traumatised patients.
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Affiliation(s)
- Hagen Andruszkow
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - Frank Hildebrand
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Ostmerheimer Str. 200, 51109 Cologne, Germany.
| | - Hans-Christoph Pape
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - Reinhard Hoffmann
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik, Frankfurt, Germany.
| | - Uwe Schweigkofler
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik, Frankfurt, Germany.
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Moradian MJ, Rastegarfar B, Salahi R, Abbasi HR, Paydar Sh, Rastegar MR, Dehghani M, Mousavi S, Shirzad E, Khorrami M, Esnaashar M, Bolandparvaz Sh. Helicopter emergency medical service in fars province: the referral trauma center of South of iran. Iran Red Crescent Med J 2012; 14:300-4. [PMID: 22829990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 01/10/2012] [Indexed: 12/04/2022]
Abstract
BACKGROUND Considering the limited available resources, high cost of the helicopter emergency medical service (HEMS), and high load of trauma patients especially in our centers, a careful assessment of HEMS in our center seemed to be necessary for trauma patients. METHODS From April 2001 to September 2007, the data of all patients transferred by HEMS were extracted including: Annual number of services, clinical category, number of proper or improper services, and rescue time for HEMS and ground ambulance. The criteria for the properly transferred group included: Death or being operated in the first 24 hours of admission, admission in ICU care units, and transfer of more than three patients in one mission. Others were considered as improper group. RESULTS In this period through 185 flights, 225 victims were transferred. The most common reason of HEMS dispatching was trauma. The most difference of rescue time between ground ambulance and HEMS was recorded in Lamerd that was transferring patients with HEMS needed 3 hours less than ground ambulance. However, in Sarvestan, Dashte-Arjan, and Marvdasht, transferred patients with ground ambulance needed less time than air transfer. Most of transferred patients were from Kazeroon, Nourabad and Lamerd respectively while 46.3% of patients were in the proper group, and the rest were considered as improper group. CONCLUSION Our study revealed that helicopter dispatch to the cities like Lamerd, Lar, Khonj, Abadeh can be more effective, whereas, for the towns like Marvdasht, Dashte-Arjan, Sarvestan, Sepidan, Saadatshar, Tang Abolhayat use of HEMS should be limited to specific conditions. Our study showed inclusion of physicians in the decision making team increased the number of transferred cases.
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