Search

Objective: Aeromedical services are an essential part of the healthcare system. Centralised coordination of aeromedical retrieval tasking offers benefits for safety, timeliness and efficiency in service delivery. The aim of the present study is to review aeromedical retrievals in Queensland exploring patient demographics, temporal patterns and usage characteristics. Methods: This is a retrospective cases series for the period 1 January 2010 to 31 December 2014 incorporating data from Retrieval Services Queensland and Queensland Newborn Emergency Transport Service. Ethics approval was obtained (JCU‐HREC H6137 and Public Health Act #RD005673). Descriptive analysis of the de‐identified data was undertaken included patient demographics, referral and receiving locations, retrieval platform and acuity of transport request. Results: There were 73 042 aeromedical retrievals undertaken during the period, with an average of 40 cases per day (range 16–89). The majority (95%) of retrievals were for Queensland residents. Overall 23.1% of cases were cardiology‐related and 12.7% were injury‐related. Older adults aged 75–84 years had the highest rate of retrievals relative to the population with a crude rate of 942.4 per 100 000 per annum. Overall 14.9% of cases were Priority 1, which represents the tasking with the highest acuity but majority were Priority 4 (41.6%). One third (37.6%) of all patients were from inner regional locations. Conclusions: Potential investments in health service planning may alleviate the burden on aeromedical services, particularly related to cardiology services in inner and outer regional Queensland. Aeromedical services are pivotal in enabling all sick and injured residents' access to the highest quality of care regardless of the remoteness of their residence. [ABSTRACT FROM AUTHOR]

Primary aeromedical retrievals are a direct scene response to patients with a critical injury or illness using a medically equipped aircraft. They are often high‐acuity taskings. In Australia, information on primary retrieval taskings is housed by service providers, of which there are many across the country. This exploratory literature review aims to explore the contemporary peer‐reviewed literature on primary aeromedical retrievals in Australia. The focus is on adult primary aeromedical retrievals undertaken in Australia and clinical tools used in this pre‐hospital setting. Included articles were reviewed for research theme (clinical and equipment, systems and/or outcomes), data coverage and appraisal of the evidence. Of the 37 articles included, majority explored helicopter retrievals (n = 32), retrieval systems (n = 21), compared outcomes within a service (n = 10) and explored retrievals in the state of New South Wales (n = 19). Major topics of focus included retrieval of trauma patients and airway management. Overall, the publications had a lower strength of evidence because of the preponderance of cross‐sectional and case‐study methodology. This review provides some preliminary but piecemeal insight into primary retrievals in Australia through a localised systems lens. However, there are several areas for research action and service outcome improvements suggested, all of which would be facilitated through the creation of a national pre‐hospital and retrieval registry. The creation of a registry would enable consideration of the frequency and context of retrievals, comparison across services, more sophisticated data interrogation. Most importantly, it can lead to service and pre‐hospital and retrieval system strengthening. [ABSTRACT FROM AUTHOR]

Objective: We sought to identify out‐of‐hospital cardiac arrest (OOHCA) patients who might benefit from a future prehospital extracorporeal cardiopulmonary resuscitation (ECPR) programme in a moderately sized city. We described the 2014 OOHCA data and identified those who fulfilled hypothetical prehospital ECPR eligibility criteria. Methods: We identified patients aged 18–65 years in cardiac arrest, where CPR was commenced by paramedics on arrival. Traumatic cardiac arrest and end‐of‐life needs were patient exclusions. Patients were then included in one of three hypothetical 'ECPR eligible' groups. Patients were included in an 'ECPR eligible' group if they met author agreed criteria. Select patients in refractory VT/VF; pulseless electrical activity (PEA); and non‐refractory VT/VF, or asystole with subsequent VT/VF or transient return of spontaneous circulation (ROSC), were assigned to three separate groups. Descriptive statistics were applied to each group. Outcomes of ECPR eligible patients who developed sustained ROSC after 20 min of conventional CPR were characterised. Results: A total of 206 patients were included. A significant positive association between initial shockable rhythm (odds ratio [OR] 15.32, confidence interval [CI] 5.4–43.2) and sustained ROSC, and PEA (OR 6.93, CI 2.4–19.8) and sustained ROSC, versus asystole was identified (P < 0.001). Sixty‐eight (33%) patients were eligible for one of the hypothetical ECPR groups. Twelve (17.6%) of the 68 ECPR eligible patients developed sustained ROSC after 20 min of conventional CPR, with only two surviving neurologically intact to hospital discharge. Conclusion: Sixty‐three (30.6%) patients could have derived benefit from a prehospital ECPR programme. Further analyses of prehospital ECPR logistics and economics are necessary to ensure that any future prehospital ECPR programme is effective and efficient. [ABSTRACT FROM AUTHOR]

Objectives: To report on the safety and efficacy of transvenous cardiac pacing wire insertion outside a tertiary hospital by a medical retrieval service. Methods: SAAS MedSTAR Emergency Medical Retrieval Service transports symptomatic bradycardic patients in rural South Australia to Adelaide on transvenous pacing for ongoing management. This is a retrospective case review of all transvenous cardiac pacing wires inserted by SAAS MedSTAR between January 2015 and October 2017. Results: This study demonstrated successful insertion of cardiac transvenous pacing wires and cardiac capture in 10 of 11 cases (91%) by pre‐hospital and retrieval doctors. There were no immediate or long‐term complications from insertion. All of the patients were successfully transferred by helicopter or fixed wing to their receiving facility, with nine of the 11 patients (82%) surviving to hospital discharge. Conclusion: This paper demonstrates that transvenous cardiac pacing can be safely and successfully implemented for symptomatic patients by pre‐hospital and retrieval physicians in the aeromedical retrieval setting. [ABSTRACT FROM AUTHOR]

Pre-hospital medicine is developing rapidly. Increasingly, specialist pre-hospital medical practitioners are working in this environment and paramedics are advancing their skill base. Tools traditionally associated with hospital care are now used pre-hospital to improve diagnosis and intervention. In this paper, we assess the developing role of ultrasound in improving trauma care in the pre-hospital arena. Focused ultrasound is used to facilitate early diagnosis of pneumothorax and intraperitoneal/pericardial haemorrhage in trauma victims. Ultrasound may have a role in assessing the circulating blood volume, fracture diagnosis and triage in mass casualty scenarios. Information obtained using ultrasound may change diagnoses and consequently alter therapy, as well as patient disposition by highlighting injuries not identified on physical examination. Receiving hospitals can be alerted to injuries requiring intervention upon arrival. Ultrasound is also used to reduce complications and improve performance in numerous procedures such as obtaining vascular and intra-osseous access, paracentesis and tracheal tube placement. There is emerging evidence that ultrasound may be used safely pre-hospital without increasing on-scene times and with results comparable to use in hospital. [ABSTRACT FROM AUTHOR]

Background: Whether prehospital administration of tranexamic acid increases the likelihood of survival with a favorable functional outcome among patients with major trauma and suspected trauma-induced coagulopathy who are being treated in advanced trauma systems is uncertain., Methods: We randomly assigned adults with major trauma who were at risk for trauma-induced coagulopathy to receive tranexamic acid (administered intravenously as a bolus dose of 1 g before hospital admission, followed by a 1-g infusion over a period of 8 hours after arrival at the hospital) or matched placebo. The primary outcome was survival with a favorable functional outcome at 6 months after injury, as assessed with the use of the Glasgow Outcome Scale-Extended (GOS-E). Levels on the GOS-E range from 1 (death) to 8 ("upper good recovery" [no injury-related problems]). We defined survival with a favorable functional outcome as a GOS-E level of 5 ("lower moderate disability") or higher. Secondary outcomes included death from any cause within 28 days and within 6 months after injury., Results: A total of 1310 patients were recruited by 15 emergency medical services in Australia, New Zealand, and Germany. Of these patients, 661 were assigned to receive tranexamic acid, and 646 were assigned to receive placebo; the trial-group assignment was unknown for 3 patients. Survival with a favorable functional outcome at 6 months occurred in 307 of 572 patients (53.7%) in the tranexamic acid group and in 299 of 559 (53.5%) in the placebo group (risk ratio, 1.00; 95% confidence interval [CI], 0.90 to 1.12; P = 0.95). At 28 days after injury, 113 of 653 patients (17.3%) in the tranexamic acid group and 139 of 637 (21.8%) in the placebo group had died (risk ratio, 0.79; 95% CI, 0.63 to 0.99). By 6 months, 123 of 648 patients (19.0%) in the tranexamic acid group and 144 of 629 (22.9%) in the placebo group had died (risk ratio, 0.83; 95% CI, 0.67 to 1.03). The number of serious adverse events, including vascular occlusive events, did not differ meaningfully between the groups., Conclusions: Among adults with major trauma and suspected trauma-induced coagulopathy who were being treated in advanced trauma systems, prehospital administration of tranexamic acid followed by an infusion over 8 hours did not result in a greater number of patients surviving with a favorable functional outcome at 6 months than placebo. (Funded by the Australian National Health and Medical Research Council and others; PATCH-Trauma ClinicalTrials.gov number, NCT02187120.)., (Copyright © 2023 Massachusetts Medical Society.)