Search

Objective We retrospectively investigated the actual conditions of burn patients evacuated by helicopter in comparison to those evacuated by ground ambulance using the Japan Trauma Data Bank. Methods This study was a retrospective analysis of the data recorded in the Japan Trauma Data Bank between January 2004 and May 2019. After propensity score matching for the method of transportation, the survival rate was compared between the 2 groups. Results During the investigation period, there were 4,627 burn patients (helicopter group, n = 276; ambulance group, n = 4,351). After propensity score matching, there were no significant differences between the 2 groups in any of the assessed variables, and the survival rate did not differ to a statistically significant extent. Conclusion After propensity score matching, the survival rate of the helicopter group did not appear to be superior to the ambulance group. Further prospective studies are needed to explore the proper indications for air transportation of burn patients, which could potentially improve outcomes.

Introduction:Emergency departments are 24-hour open health services. Patients can register to the emergency departments by their own or via emergency ambulance services (EAS). In this study, we aimed to examine the characteristics of patients who were admitted to a pediatric emergency department via EAS and to evaluate clinical and laboratory data of the patients as well as their managements during hospital stay .Methods:Patients brought to the emergency department via EAS between 1 June 2017 and 30 December 2017 were retrospectively analyzed. Data on demographic characteristic and presenting complaints of the patients and resources used were collected.Results:A total of 1234 patients (631 males, 51.1%) were included in the study. The median age of the patients was 75 months (Interquartile range 24-162 months). The majority of patients (n=514, %42) were admitted to the emergency department between the hours 16.01 and 23.59. The most common complaints were convulsion in 231 patients (18.7%), fever in 139 (11.3%), abdominal pain in 129 (10.4%), and intoxication in 86 (6.97%). We noticed that patients used EAS for non-urgent complaints such as constipation, toothache, red eye, nasal discharge, leg pain, leg tenderness, sore throat, and skin rashes and eruptions. No laboratory tests were necessary for 207 patients (17.8%), and 690 patients (56%) did not require hospitalization.Conclusion:There were various reasons for calling ambulances but it was found that families called ambulances for non-urgent complaints such as constipation, toothache, redness in eye and nasal discharge. For this reason, it is necessary to improve the public awareness of the role of ambulance services in order to minimize unnecessary use of ambulance transportation.

Background: The positive effects of Kangaroo mother care in NICU’s are well documented but, to a lesser extent, explored during inter-hospital neonatal transport. Inter-hospital transport, with the infant placed in a transport incubator, increases the risk of separation while infants in Kangaroo mother care position implies that the parents accompany the transport. There exists limited knowledge if physiological stability differs when transported in Kangaroo mother care position compared to transport in a transport incubator. Aims: The aim of this study was to compare physiological stability of infants transported via ground ambulance in either Kangaroo mother care position or positioned in a transport incubator. Method: In total, 24 infants were recruited to be transported between hospitals in either a Kangaroo mother care position (n = 16) or in a transport incubator (n = 8). Inclusion criteria were; current weight >1500 g; current gestational age above 31 +0 weeks; no central catheter; no respiratory support and no planed painful or distressing interventions during the 48-h follow-up period post-transport. Exclusion criteria were; infants whose parents did not speak or understand Swedish or English and infants with a current weight above 4500 g for the KMC group. Physiological stability was obtained during transport and for a 48-h follow-up period by measuring body temperature, respiratory and heart rate, oxygen saturation, pain score, transport risk assessment and number of interventions during transport and 48-h post-transport. Cost-effectiveness and adverse events were also evaluated. Results: Both groups had comparable background characteristics and physiological stability during transport and for the 48-h follow-up period after transport. Transporting in Kangaroo mother care position was more cost-effective. Study limitation: A small sample size in both groups. Conclusion: Transporting an infant in Kangaroo mother care position can be regarded as a choice of transport mode when the infant fulfils the set criteria. (Less)

IntroOn August 14, a magnitude 7.2 earthquake occurred in the South of Haiti, killing over 2,200 people and leaving at least 12,000 injured. On August 17th, a joint task force coordinated the triage, treatment, and transport for patients arriving at the Port-au-Prince airport from the South.MethodsFrom August 17th-27th, approximately 243 patients were encountered at the Port-au-Prince airport. For the first three days of operations, written notes, reports, and various chat logs from WhatsApp were used to compile this data.Results243 patents were encountered at the airport Triage and Treatment from August 17 to August 27. Orthopedic injuries were the most common presenting injury with 20% of patients having a pelvis fracture (the most prevalent injury). Of the 174 with known transfer destinations, 118 (68%) were transported to one of three tertiary care hospitals, with 99 going via ground ambulance to the two in Port au Prince, and 19 going via HAA helicopter to Mirebalais. Once treatment operations were initiated, 106 patients received some form of treatment at the airport while awaiting transport.DiscussionInteragency coordination was the key to rapid scale up. To address the most prevalent patient issues, a treatment bundle was conceptualized a few days into operations that consisted of IV fluids, analgesia, IV antibiotics, wound debridement and cleaning, and tetanus prophylaxis.

Background Ambulance accidents are an unfortunate indirect result of ambulance emergency calls, which create hazardous environments for personnel, patients, and bystanders. However, in European German-speaking countries, factors contributing to ambulance accidents have not been optimally researched and analyzed. Objective The objective of this study was to extract, analyze, and compare data from online newspaper articles on ambulance accidents for Austria, Germany, and Switzerland. We hope to highlight future strategies to offset the deficit in research data and official registers for prevention of ambulance and emergency vehicle accidents. Methods Ambulance accident data were collected from Austrian, German, and Swiss free web-based daily newspapers, as listed in Wikipedia, for the period between January 2014 and January 2019. All included newspapers were searched for articles reporting ambulance accidents using German terms representing “ambulance” and “ambulance accident.” Characteristics of the accidents were compiled and analyzed. Only ground ambulance accidents were covered. Results In Germany, a total of 597 ambulance accidents were recorded, corresponding to 0.719 (95% CI 0.663-0.779) per 100,000 inhabitants; 453 of these accidents left 1170 people injured, corresponding to 1.409 (95% CI 1.330-1.492) per 100,000 inhabitants, and 28 of these accidents caused 31 fatalities, corresponding to 0.037 (95% CI 0.025-0.053) per 100,000 inhabitants. In Austria, a total of 62 ambulance accidents were recorded, corresponding to 0.698 (95% CI 0.535-0.894) per 100,000 inhabitants; 47 of these accidents left 115 people injured, corresponding to 1.294 (95% CI 1.068-1.553) per 100,000 inhabitants, and 6 of these accidents caused 7 fatalities, corresponding to 0.079 (95% CI 0.032-0.162) per 100,000 inhabitants. In Switzerland, a total of 25 ambulance accidents were recorded, corresponding to 0.293 (95% CI 0.189-0.432) per 100,000 inhabitants; 11 of these accidents left 18 people injured, corresponding to 0.211(95% CI 0.113-0.308) per 100,000 inhabitants. There were no fatalities. In each of the three countries, the majority of the accidents involved another car (77%-81%). In Germany and Switzerland, most accidents occurred at an intersection. In Germany, Austria, and Switzerland, 38.7%, 26%, and 4%, respectively, of ambulance accidents occurred at intersections for which the ambulance had a red light (P Conclusions This study draws attention to much needed auxiliary sources of data that may allow for creation of a contemporary registry of all ambulance accidents in Austria, Germany, and Switzerland. To improve risk management and set European standards, it should be mandatory to collect standardized goal-directed and representative information using various sources (including the wide range presented by the press and social media), which should then be made available for audit, analysis, and research.

Purpose The purpose of this paper is to evaluate the time, place and ambulance types specified on the ambulance patient registry forms for cases transferred through 112 EMS in the Bozcaada and Gökçeada island districts of the province of Çanakkale. Design/methodology/approach The universe of the descriptive – cross-sectional epidemiological study was composed of the ambulance patient registration forms of the cases which were transferred from Bozcaada and Gökçeada islands between January 1, 2009 and December 31, 2013. Findings Of the transfers made, 28.1 percent were in the year 2012, 39.5 percent were in summer, 16.6 percent were in July, 17.9 percent were on Monday, 37.1 percent were between 12.00 and 17.59 h and 61.5 percent were from Gökçeada island. Ground ambulances were more common in the transfers from Bozcaada island, while ambulance boat and helicopter ambulance were more common for transfers from Gökçeada island. Helicopter-Emergency Medical Service (HEMS) (ppp Practical implications This study reveals the current state of the various referral routes from the islands. Originality/value This paper is the first study to demonstrate the characteristics of patients referred from the island belongs to Turkey.

On August 30, 2017, the wet-bulb globe temperature was 30°C. Three female military personnel fell unconscious almost simultaneously around noon after a long-distance march that had started at 6 am . The fire department in Gotenba received a 119 call [at 1:16 PM] and requested dispatch of the eastern Shizuoka doctor helicopter (DH) because it would take about 1 hour from the scene to arrive at our hospital by ground ambulance. At that time, the DH of eastern Shizuoka was transporting an injured patient to Kanagawa Prefecture, so the flight dispatcher of the DH of eastern Shizuoka decided to request support DHs from Kanagawa Prefectures based on an agreement concerning collaboration using the DH. The DH of Kanagawa Prefecture met 1 of the patients and transported her to its base hospital. The remaining 2 patients were then transported by the DH of eastern Shizuoka to its base hospital after completing the previous mission. All patients obtained a survival discharge without major complications after receiving proper treatment and rehabilitation. The agreement concerning collaboration using multiple DHs was important in this case, and dispersion transportation was successfully achieved.

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.

Objective We aim to report intra-arterial thrombectomy transfer metrics for ischemic stroke patients that were transferred to hub hospitals for possible intra-arterial thrombectomy in multiple geographic regions throughout the state of Texas and to identify potential barriers and delays in the intra-arterial thrombectomy transfer process. Method We prospectively collected data from 8 participating Texas comprehensive stroke/thrombectomy capable centers from 7 major regions in the State of Texas. We collected baseline clinical and imaging data related to the pre-transfer evaluation, transfer metrics, and post-transfer clinical and imaging data. Results A total of 103 acute ischemic stroke patients suspected/confirmed to have large vessel occlusions between December 2016 to May 2019 that were transferred to hubs as possible intra-arterial thrombectomy candidates were enrolled. A total of 56 (54%) patients were sent from the spoke to the hub via ground ambulance with 47 (46%) patients traveling via air ambulance. The median spoke arrival to hub arrival time was 174 min, median spoke arrival to departure from spoke was 131 min, and median travel time was 39 min. The spoke arrival time to transfer initiation was 68 min. CT-perfusion obtained at the spoke and earlier initiation of transfer were statistically associated with shorter transfer times. Conclusion Transfer of intra-arterial thrombectomy patients in Texas may take over 4 h from spoke arrival to hub arrival. This time may be shortened by earlier transfer initiation and acceptance.

Aim We aimed to establish a telestroke system for general physicians in areas without a nearby stroke center and investigate its usefulness for recombinant tissue plasminogen activator (rt‐PA) therapy for patients with acute cerebral infarction. Methods We used a hub and spoke model, in which a hub hospital provided telestroke support to the spoke hospitals in rural areas that were not nearby a stroke center. The telestroke support device enabled the sharing of images and real‐time face‐to‐face discussion with a stroke specialist for diagnosis and treatment. We evaluated the effect of this telestroke system on shortening time to start rt‐PA therapy. Result One hub and three spoke hospitals were selected. From May 2017 to November 2018, seven patients (77.2 ± 6.3 years old) suspected to have acute cerebral infarction were treated at the spoke hospitals via this system, three of whom received intravenous rt‐PA administration by a general physician under telestroke support. If these patients would have been sent via ground ambulance to the nearby stroke center, it would have taken approximately 48 min more to administer rt‐PA. Conclusion Establishment of a telestroke support system for general physicians in areas without a nearby stroke center was useful for promptly performing rt‐PA therapy., Telemedicine device. We used iPad mini installed with a thin client viewer system and the video call system, which allowed specialists in the “hub” hospital to review computed tomography images, assess the patient, and make recommendations face‐to‐face in real time.

Introduction:In October 2017, the American Association of Blood Bankers (AABB; Bethesda, Maryland USA) approved a petition to allow low-titer group O whole blood as a standard product without the need for a waiver. Around that time, a few Texas, USA-based Emergency Medical Services (EMS) systems incorporated whole blood into their ground ambulances. The purpose of this project was to describe the epidemiology of ground ambulance patients that received a prehospital whole blood transfusion. The secondary aim of this project was to report an accounting analysis of these ground ambulance prehospital whole blood programs.Methods:The dataset came from the Harris County Emergency Service District 48 Fire Department (HCESD 48; Harris County, Texas USA) and San Antonio Fire Department (SAFD; San Antonio, Texas USA) whole blood Quality Assurance/Quality Improvement (QA/QI) databases from September 2017 through December 2018. The primary outcome of this study was the prehospital transfusion indication. The secondary outcome was the projected cost per life saved during the first 10 years of the prehospital whole blood initiative.Results:Of 58 consecutive prehospital whole blood administrations, the team included all 58 cases. Hemorrhagic shock from a non-traumatic etiology accounted for 46.5% (95% CI, 34.3%-59.2%) of prehospital whole blood recipients. In the non-traumatic hemorrhagic shock cohort, gastrointestinal hemorrhage was the underlying etiology of hemorrhagic shock in 66.7% (95% CI, 47.8%-81.4%) of prehospital whole blood transfusion recipients. The projected average cost to save a life in Year 10 was US$5,136.51 for the combined cohort, US$4,512.69 for HCESD 48, and US$5,243.72 for SAFD EMS.Conclusion:This retrospective analysis of ground ambulance patients that receive prehospital whole blood transfusion found that non-traumatic etiology accounted for 46.5% (95% CI, 34.3%-59.2%) of prehospital whole blood recipients. Additionally, the accounting analysis suggests that by Year 10 of a ground ambulance whole blood transfusion program, the average cost to save a life will be approximately US$5,136.51.

Background Few studies have investigated the patient compartment temperatures during ambulance missions or its relation to admission hypothermia. Still hypothermia is a known risk factor for increased mortality and morbidity in both trauma and disease. This has special relevance to our sub-arctic region’s pre-hospital services, and we prospectively studied the environmental temperature in the patient transport compartment in both ground and air ambulances. Methods We recorded cabin temperature during patient transport in two ground ambulances and one ambulance helicopter in the catchment area of the University Hospital of North Norway using automatic temperature loggers. The data were collected for one month in each of the four seasons. We calculated the sum of degrees Celsius below 18 min by minute to describe the patient exposure to unfavourably low cabin temperature, and present the data as box plots. The statistical differences between transport mode and season were analysed with ANCOVA. Results The recorded cabin temperatures were higher during the summer than the other three seasons. However, we also found that helicopter transports were performed at lower cabin temperatures and with significantly more exposure to unfavourably low temperatures than the ground ambulance transports. Furthermore, the helicopter cabin reached the final temperature much slower than the ground ambulance cabins did or remained at a lower than comfortable temperature. Conclusions Helicopter cabin temperature during ambulance missions should be monitored closer, particularly for patients at risk for developing admission hypothermia.

Emergency calls may lead to the dispatch of either ground ambulances or helicopter emergency medical services (HEMS). For residents on isolated islands, the HEMS can reduce the time to hospital admission and lead to improved outcomes. This study investigated the emergency care for residents on isolated islands with a focus on the role of a physician-staffed helicopter. The data were obtained from Danish national registries and databases. We included data on emergency calls from isolated islands from the time of emergency call to discharge. We identified 1130 emergency calls from which 775 patients were registered with a hospital admission. Of these, 41% were transported by the HEMS and 36% by a ground ambulance. The median time to admission was 83 min (IQR 66–104) and 90 min (IQR 45–144) for the HEMS and ground ambulance, respectively (p = 0.26). The overall 30-day mortality was 6.2% (95% CI: 4.6–8.1%), and 37% of all the patients were admitted to the hospital with an unspecified diagnosis. The emergency calls from isolated islands led to the dispatch of the HEMS in 41% of the cases. The use of the HEMS did not significantly reduce the time to admission but was used in a greater proportion of patients with an acute cardiac disease (66%) or stroke (67%).

Introduction: There are multiple factors from injury spot till patient reach trauma unit, which affect their outcome. The literature of same from developing country is mere. The present study investigates primary care, mode of transportation and emergency management among TBI patients visiting a tertiary institute. Methods: The data of 337 patients was selected from a trauma registry. The data of TBI patients visiting emergency were entered in standard computer interface after obtaining their consent. The standard proforma was developed by FileMaker Pro Advanced 13 (Copyright © 1994-2015, FileMaker, Inc) and web data entry interface Drupal CMS. Data was analyzed using Stats Direct version 3.0.150. Results: Seventy five percent of patients were from rural setup. About 67% of patients visiting emergency had undergone first aid from both rural and urban setup. Forty percent of patients came directly, only about 5% were referred from other hospitals. Majority of patients were accompanied by relatives (87%) followed by spouse (8.6%). Non ambulance mode (31%) was more than ground ambulance (25%) to reach emergency setup. Emergency management of airway, breathing and circulation was significant with outcome at discharge (p Conclusion: The study reports that majority of patients had undergone first aid before reaching trauma unit. Non ambulance mode of transportation is more. The study emphasis for detail study on pre hospital care variables with larger sample size.

Objectives This article describes the detailed project aimed to realize a dedicated ground ambulance for neonatal emergency transport service (NETS). To date, the European Community rules specify requirements for the design, testing, performance, and equipping of road ambulance used for transport and care of adult injured or ill patients, completely ignoring neonatal transport. Methods The project consisted of electric and gas supply planning, interior design taking into account ergonomic and occupant protection principles, both during travel and during medical care performances. Results A detailed project is presented. Main differences between European Type C ambulance and the new proposed Type D neonatal ground ambulance are the presence on board of air compressed cylinder, iNO cylinders and delivery system, phototheraphy, shock adsorbing stretcher support, cooling device, patient’s placenta (refrigeration box), and transcutaneous gas analyzer. Conclusion The European Community rules specify requirements for road ambulance used for transport and care of adult injured or ill patients, completely ignoring neonatal transport. This study describes the detailed project aimed to realize a dedicated ground ambulance for neonatal emergency transport service. This study demonstrated that it is not possible simply to adapt the currently dedicated ambulance for mobile intensive care and resuscitation services (actual type C European Community) in a modern dedicated NETS ambulance; it is of paramount importance suggesting to European Community to introduce a further ambulance type, to be identified type D, strictly reserved to neonatal transport activities.

We read with interest the impressive study by Michaels et al on helicopter versus ground transport survival in trauma patients. We commend the authors for their work but have some concerns. Our first issue is semantic, the authors’ state in the title that “Helicopter vs ground ambulance; review of… transferre d trauma patients…” However, in the methods section the authors’ state, “All transferred patients…were excluded.” Italics and underline added for emphasis. Instead, it may be more appropriate to use the word “transported” instead of transferred as a description of the mode of arrival for the …

In injuries reducing ambulance response time (time from injury to hospital arrival) is an important factor for saving people’s lives. Helicopter emergency medical services can reduce out-of-hospital transport times because of their high speed and their ability to travel in straight paths unlike ground ambulance which are restricted to road network paths, as well as the ability toaccess rural or remote area injuries that are difficult to reach by ground ambulance. GIS technology aids air ambulance movement planning to reduce out-of-hospital response time based on mathematical and geographic models to support decision making which is necessary from out-of-hospital care providers. The goal of this study is to use GIS to develop an efficient DSS to outline where air ambulance can reduce response times, by using spatial analysis tools to create Euclidean distance and direction zones around receiving hospitals. The study concludes that GIS technology can be used to develop an efficient DSS to outline where air ambulance can reduce response times, by creating surfaces of Euclidean allocation, direction, and distance that can be used to improve initial response times for the civil defense air rescue and air ambulance services.

Objective The identification of serious injury is critical to the tasking of air ambulances. London’s Air Ambulance (LAA) is dispatched by a flight paramedic based on mechanism of injury (MOI), paramedical interrogation of caller (INT) or land ambulance crew request (REQ).This study aimed to demonstrate which of the dispatch methods was most effective (in accuracy and time) in identifying patients with serious injury. Methods A retrospective review of 3 years of data (to December 2010) was undertaken. Appropriate dispatch was defined as the requirement for LAA to escort the patient to hospital or for resuscitation on-scene. Inaccurate dispatch was where LAA was cancelled or left the patient in the care of the land ambulance crew. The χ 2 test was used to calculate p values; with significance adjusted to account for multiple testing. Results There were 2203 helicopter activations analysed: MOI 18.9% (n=417), INT 62.4% (n=1375) and REQ 18.7% (n=411). Appropriate dispatch rates were MOI 58.7% (245/417), INT 69.7% (959/1375) and REQ 72.2% (297/411). INT and REQ were both significantly more accurate than MOI (p Conclusions Telephone interrogation of the caller by a flight paramedic is as accurate as ground ambulance crew requests, and both are significantly better than MOI in identifying serious injury. Overtriage remains an issue with all methods.

Background and Purpose— We examine whether the proportion of the US population with ≤60 minute access to Primary Stroke Centers (PSCs) varies based on geographic and demographic factors. Methods— Population level access to PSCs within 60 minutes was estimated using validated models of prehospital time accounting for critical prehospital time intervals and existing road networks. We examined the association between geographic factors, demographic factors, and access to care. Multivariable models quantified the association between demographics and PSC access for the entire United States and then stratified by urbanicity. Results— Of the 309 million people in the United States, 65.8% had ≤60 minute PSC access by ground ambulance (87% major cities, 59% minor cities, 9% suburbs, and 1% rural). PSC access was lower in stroke belt states (44% versus 69%). Non-whites were more likely to have access than whites (77% versus 62%), and Hispanics were more likely to have access than non-Hispanics (78% versus 64%). Demographics were not meaningfully associated with access in major cities or suburbs. In smaller cities, there was less access in areas with lower income, less education, more uninsured, more Medicare and Medicaid eligibles, lower healthcare utilization, and healthcare resources. Conclusions— There are significant geographic disparities in access to PSCs. Access is limited in nonurban areas. Despite the higher burden of cerebrovascular disease in stroke belt states, access to care is lower in these areas. Selecting demographic and healthcare factors is strongly associated with access to care in smaller cities, but not in other areas, including major cities.

Aim Since 2014, HEMS (Helicopter Emergency Medical System) has been an integrated part of the emergency medical system, providing fast and high-competence helicopter transport of patients to highly specialised care. Different heliport solutions at the receiving hospitals may have an impact on the time delay from landing to treatment (LTT). In this study, we compared the time delay from landing to arrival at the catheterization laboratory in patients with ST Elevation Myocardial Infarction (STEMI) accepted for primary Percutaneous Coronary Intervention (pPCI) at one of the four centres in Denmark. We hypothesised that heliport proximity strongly influence the LTT. Methods We prospectively recorded the time from the landing at the heliport to arrival at the catheterization laboratory from October 1st 2014 to December 31st 2016 in all STEMI patients transported by HEMS Denmark. LTT was compared between two centres with heliports at the hospital, and two centres with heliport located outside the hospital, necessitating ground transportation in ambulance. Results 1163 patients were included in the study. 310 were excluded due to missing data. The two hospitals with hospital based heliports showed shorter LTT compared to the two hospitals with heliport outside the hospital (5±2.18 and 6±2.94 vs. 9±3.94 and 12±3.49, p Conclusion Hospital based heliports ensure shorter time delay from landing to pPCI in patients with STEMI. We strongly recommend that heliports are located close to the treating facility. Transfer from landing site to hospital by ground ambulance seems unfeasible in time critical patients. Conflict of interest None declared. Funding None declared.

Introduction:The management of chemical and explosive events is critical to reducing morbidity and mortality. However, initial patient care considerations and protective actions for staff are unfamiliar to most frontline clinicians.Methods:This study evaluated an Incident report.Results:On December 1, 2017, a factory of chemical industries in Japan exploded. Dust forming as a byproduct from the crushing and packing process of the resin for ink exploded at the facility. A local fire department requested the dispatch of two physician-staffed helicopters (known as a doctor helicopter [DH] in Japan). The first party of emergency services established a headquarters and first-aid station. However, this area was feared to be at risk of a second explosion. Physicians performed re-triage for all 11 burned patients. Three severely injured patients were transported to emergency medical service centers either by ground ambulance or the DH without undergoing any decontamination. The physician who escorted the patient by ground ambulance complained of a headache. One of the severely injured patients was treated at a local hospital and then transported to an emergency medical service center after undergoing decontamination and intubation. Fortunately, all patients who were transported to medical facilities obtained a survival outcome.Discussion:Chemical, biological, radiological, nuclear, and explosive incidents are rare, but can be fatal for responders to this kind disaster. As such, all who work at such scenes should be prepared and train adequately to ensure they have the knowledge and skill to both manage patients and protect themselves from harm.

This paper presents minisum and minimax location problems for helicopter emergency medical service (HEMS) systems. Given demand points (origins) and hospitals (destinations), the locations of rendezvous points and helicopter stations are selected to minimize the total demand-weighted transport time (minisum objective) and the maximum transport time (minimax objective) to a hospital. Rendezvous points are required for a helicopter to meet with an ambulance. In minimizing these objectives, each demand is allocated to either an already-available ground ambulance or a newly-introduced helicopter. We provide 0-1 integer formulations of the minisum and minimax problems, and develop a variable reduction procedure that reduces the size of the problem. Some optimal solutions of the proposed models tested for an idealized square city are analyzed. We also apply the models to the case study of Japan using geographical and population data, and the locations of the actual emergency medical centers. The proposed variable reduction procedure is shown to be effective for both examples. Results show that the proposed problems tend to focus on low-accessibility locations and that accessibility to a hospital is greatly improved.

Purpose The role of helicopter emergency medical services (HEMS) in pediatric trauma remains controversial. We examined its use in pediatric trauma and its effectiveness in children with moderate/severe injuries. Methods All blunt/penetrating trauma patients ≤18years old in the National Trauma Data Bank were evaluated for use of HEMS and in-hospital mortality. In a comparative effectiveness study, only patients treated at level I/II pediatric centers with injury severity score (ISS)≥9 were included. Results Of 127,489 included patients, 18,291 (14%) arrived via HEMS, compared to 56% by ground ambulance and 29% by private vehicle/walk-in. HEMS patients had more severe injuries (ISS≥25; 28% vs. 14%) and altered mental status (GCS≤8; 29% vs. 11%), but also contained many patients with only minor injuries or no major physiologic derangements. In unadjusted analysis, HEMS was associated with increased mortality (OR: 1.6; 95% CI: 1.4–1.7). However, it had decreased mortality by regression (0.5; 0.4–0.6) and propensity analysis (0.7; 0.6–0.8) to adjust for confounders. Conclusion We found multiple indicators for overuse of HEMS, with nearly 40% of children having only minor injuries. In moderate/severe injuries, HEMS is associated with decreased mortality, potentially saving one life for every 47 flights. Research is needed to determine appropriate criteria for helicopter triage. Comparative Study/Level of evidence III

Purpose We investigated the changes in the vital signs and the final outcomes subarachnoid hemorrhage (SAH) patients who were evacuated from the scene using the doctor-helicopter (Dr. Heli) service and those who only underwent interhospital transportation using the doctor-helicopter Dr. Heli service to investigate safety of this system. Methods We retrospectively investigated all of the patients with non-traumatic SAH who were transported by a Dr. Heli between January 2010 and March 2016. The subjects were divided into two groups: the Scene group included subjects who were evacuated from the scene by a Dr. Heli, while the Interhospital group included subjects who were transported by a ground ambulance to a nearby medical facility and then transported by a Dr. Heli to a single tertiary center. Results The systolic blood pressure, ratio of cardiac arrest, and Fisher classification values of the patients in the Scene group were significantly greater than those in the Interhospital group. The Glasgow Coma Scale in the Scene group was significantly lower than that in the Interhospital group. After excluding the patients with cardiac arrest, the Glasgow Coma Scale scores of the patients in the two groups did not differ to a statistically significant extent during, before or after transportation. There were no significant differences in Glasgow Outcome Scores or the survival ratio of the two groups, even when cardiac arrest patients were included. Conclusion The present study indirectly suggests the safety of using a Dr. Heli to evacuate SAH patients from the scene.

OBJECTIVES To describe the epidemiology of acute hand injuries and hand infections and to describe the factors associated with the transfer of these patients to a level 1 trauma center. In addition, we sought to understand management before transfer. DESIGN Retrospective review of patients with hand trauma or hand infection transferred to our level 1 trauma center from May 2009 to August 2011. We also identified hospitals with emergency departments (EDs) in our region and surveyed ED providers in these hospitals with regard to acute hand care. SETTING A level 1 trauma center in the United States. PATIENTS Four hundred sixty consecutive transfers for acute hand care. RESULTS The average patient age was 38. Most were male (84%), uninsured (51%), and from another county (59%). The average distance of transfer was 51 miles, and 80% were transferred by ground ambulance. The most common reasons for transfer were amputations (24%), infections (21%), lacerations (17%), and fractures/dislocations (16%). Of the 345 hospitals with an ED surveyed, 71% never had hand surgery coverage. CONCLUSIONS Patients transferred for acute hand care were young and male, and traveled an average 51 miles to get to our center. More than half of these patients were treated and discharged from our ED. This indicates that a majority may have been managed in a clinic setting. Most EDs in our region do not have a hand surgeon available. Most emergency physicians surveyed had received little training in management of acute hand injuries and hand infections. Further research is needed to identify methods to remove barriers to provision of care for patients with hand trauma. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

This paper discusses the principles of medical evacuation planning and execution with specific consideration of the command and control arrangements for Forward medical evacuation. The current operational context has focussed efforts on helicopter medical evacuation as the main evacuation element of the pre-hospital military medical care system rather than the ground ambulance. This paper complements the significant number of papers recently published by RAMC clinical staff on pre-hospital care.

Objectives This study was undertaken to assess concurrent mechanical stresses from shock, vibration, and noise to which a critically ill neonate is exposed during emergency transfer. Methods For neonates transported by a French specialized emergency medical service, we measured and analyzed 27 physical parameters recorded during typical transport by ambulance and by helicopter. The noninvasive sensors were placed to allow better representation of the exposure of the newborn to the physical constraints. Results Based on 10 hours of transport by ambulance and 2 hours by helicopter, noise, whole body vibration, rate of turn, acceleration, and pitch were extracted as the five most representative dynamic harshness indicators. A helicopter produces a higher-level but more stable (lower relative dispersion) whole body dynamic exposure than an ambulance, with a mean noise level of 86 ± 1 dBA versus 67 ± 3 dBA, mean whole body vibration of 1 ± 0.1 meter per second squared (m/s 2 ) versus 0.4 6 0.2 m/s 2 , and acceleration of 1 6 0.05 m/s 2 versus 0.4 6 0.1 m/s 2 . A ground ambulance has many more dynamic effects in terms of braking, shock, and impulsive noise than a helicopter (1 impulsive event per 2 minutes vs. 1 per 11 minutes). Conclusions Our results show significant exposure of the sick neonate to both stationary and impulsive dynamic physical stressors during transportation, particularly in a ground ambulance. The study suggests opportunities to reduce physical stressors during neonatal transport.

Many referring facilities and transport teams function under the assumption that faster is better. However, data on the benefits of air ambulance (AA) use in neonatal transport are sparse. At our referral hospital in northwest Ohio, we compared the total time from telephone request for transport to arrival in the referral nursery by ground ambulance vs AA for each of our referring facilities and evaluated if this had an impact on patient outcomes. Time from transport call to arrival at the referring hospital was 72 ± 17 minutes by AA and 95 ± 23 minutes by ground ambulance. We demonstrated that although it was approximately 25% faster to fly to a referring hospital compared with traveling by ground, the time saved had no impact on outcome. On the basis of these data, we continue to encourage ground transport whenever possible and reserve the use of the AA for the sickest neonates located in the furthest referring hospitals.

AbstrastThe purpose of this article is to address the question of helipad location for hospitals using helicopter emergency medical services (HEMS). A helipad is defined as off-site, or remote, if a ground ambulance is required for patient transport between the helicopter and the hospital's patient care area. On-site helipads are those for which no ground ambulance transport is required between the hospital and the helicopter. The article describes the attributes of on-site helipads, which include elimination of the inherent risks of additional patient transfers, enhanced availability of emergency medical services (EMS) resources that would otherwise be used for extra transfer, and decreased time to arrival at the receiving treatment site. It is acknowledged that helipad placement decisions are informed by non–patient care issues and a paucity of research. Nevertheless, when the choice is viewed from a patient care perspective, there is a clear preference for on-site helipad location.

The purpose of this study was to determine whether use of an air ambulance service using a helicopter with a critical care physician and nurse on board (doctor helicopter service; DHS) could shorten the prehospital delay. We evaluated the initial treatment time and the transport time in 30 patients transported by DHS and 30 patients transported by ground ambulance service (GAS). The initial treatment time was significantly shorter in the DHS group (11.3+/-5.4 min) than in the GAS group (29.5+/-15.3 min). But the transport time in the DHS group (26.1+/-8.6 min) was not different from that in the GAS group. The difference in the initial treatment time was remarkable for patients transported from distant areas (12.7+/-5.6 min for DHS, and 42.1+/-13.8 min for GAS) and DHS shortened the initial treatment time by 30 min compared with GAS. The transport time was shorter for DHS (30.5+/-9.9 min) than for GAS (42.1+/-13.8 min) for patients transported from distant areas, but it was not significantly different for patients transported from nearby areas (22.3+/-5.0 min for DHS, and 18.4+/-2.4 min for GAS). In conclusion, DHS is important in the management of life-threatening cardiovascular diseases, and has a significant impact when GAS cannot transport a patient to the hospital within 20 min.

In an era of concern over the rising cost of health care, cost-effectiveness of auxiliary services merits careful evaluation. We compared costs and benefits of Helicopter Emergency Medical Service (HEMS) with Ground Emergency Medical Service (GEMS) in patients with an isolated ankle fracture. A medical record review was conducted for patients with an isolated ankle fracture who had been transported to a level 1 trauma center by either HEMS or GEMS from January 1, 2000 to December 31, 2010. We abstracted demographic data, fracture grade, complications, and transportation mode. Transportation costs were obtained by examining medical center financial records. A total of 303 patients was included in the analysis. Of 87 (28.71%) HEMS patients, 53 (60.92%) had sustained closed injuries and 34 (39.08%) had open injuries. Of the 216 (71.29%) GEMS patients, 156 (72.22%) had closed injuries and 60 (27.78%) had open injuries. No significant difference was seen between the groups regarding the percentage of patients with open fractures or the grade of the open fracture (p = .07). No significant difference in the rate of complications was found between the 2 groups (p = 18). The mean baseline cost to transport a patient via HEMS was $10,220 + a $108/mile surcharge, whereas the mean transport cost using GEMS was $976 per patient + $16/mile. Because the HEMS mode of emergency transport did not significantly improve patient outcomes, health systems should reconsider the use of HEMS for patients with isolated ankle fractures.

Introduction: In Sweden, several ambulance helicopter programs have been used during the past 3 decades. This article describes one of these programs. Setting: The catchment area of the helicopter system under study was a typical rural setting with a population density of less than 5 people per square kilometer. Methods: We describe in detail, with special reference to medical aspects, the activities of an helicopter ambulance program in 1997. Results: A total of 288 missions, including 328 patients (204 men), were analyzed. Trauma cases (29%) and patients with cardiovascular (24%) and neurologic problems (13%) dominated the missions. One-sixth of the cases occurred at night. The median response time was 12 minutes, and the median on-scene time was 28 minutes. The medical interventions performed included intubations; central venous catheter, arterial needle, and duodenal tube insertions; and medication administered intravenously, orally, and intrabronchially. Conclusion: We detected a higher rate of trauma cases than in previously published investigations, probably related to the outdoor activities of the area. We believe that the rapid institution of thrombolytic treatment in suspected acute myocardial infarction and a more rapid and flexible transport of trauma cases in a rural area are important. We estimate that, in most cases, the helicopter service could provide a quicker transport than a ground ambulance; however, for short distance transports, ground ambulance is faster than helicopter ambulance.

Parental accompaniment can be a positive experience for the parent and the patient, as perceived by the parent. It can also be accomplished effectively without hindering the delivery of intratransport medical care by a nurse/nurse or nurse/physician transport team. This survey, along with the responses from other parents, led our team to adopt the position that a parent is welcome and encouraged to accompany the transport team if he or she wishes to. The team has recognized the importance of the family unit during the stressful period surrounding an acute medical issue and interfacility transport. The transport team reserves the option to ask that a parent not ride along if they suspect the parent might not function as a supportive team member (ie, the parent is belligerent, inebriated, or hostile). The parent normally rides in the passenger seat of the ambulance, and we encourage him or her to interact with the patient as much as possible. Occasionally parents ride in the back of the ambulance if the patient's situation allows for that option (ie, no anticipated need for potential interventions, number of team personnel, etc.).

Despite the sophistication of the ICU, not all patient care can be performed there. Patients must be transferred to radiology, to the operating room, and to other places away from the unit to have special tests or procedures performed. More importantly, patients may require transport from outlying clinics and hospitals to medical centers with critical care facilities for more specialized care. In the past decade, an increasing number of transports have been brought about by changes in methods of reimbursement to hospitals and increasing fiscal restraints on health care. Significant advances in therapeutic and diagnostic techniques for the critically ill patient have occurred. Some of these advances require qualified technical personnel and staggering financial outlays, which severely limit their availability beyond the largest medical centers. Thus, critically ill patients may be transported by air or ground ambulance to such facilities. 6 As the problem of transporting the critically ill patient is considered, it behooves us to understand the transport environment, the personnel, the equipment, the vehicles, and the constraints that apply to this arena. Transport of patients includes both organized transport within the hospital (intrahospital) and transports out of the hospital environment (external). External transports may be accomplished by a number of vehicle types; however, it is convenient to consider two broad groups of external transports: ground and air.

The purpose of this study was to review whether air ambulance transportation of trauma patients to the Brooke Army Medical Center (BAMC) level I trauma center contributed to maintaining national mortality standards in the trauma care of these patients. Aeromedical transportation is considered a standard-of-care component of regional trauma systems throughout the United States. Pooled trauma database information from 792 consecutive ambulance-transported trauma patients received at BAMC during the fiscal year from October 1, 1995, to September 30, 1996, were reviewed. The 792 trauma patients were composed of 687 patients transported by ground ambulance and 105 patients who received helicopter aeromedical evacuation. Aeromedical evacuation was associated with increased levels of prehospital medical care and faster transportation than ground ambulance service. The mortality rates (immediate, early, and late deaths) of both ambulance groups were compared with national mortality standards using the internationally recognized Trauma and Injury Severity Score methodology, based on the Major Trauma Outcome Study in 1986 and validated in 1992. The Z test for independent populations demonstrated no statistically significant difference between BAMC trauma mortality rates for either ambulance group compared with national trauma mortality rates. The results suggest that aeromedical evacuation of the more severely injured patients farthest from the BAMC trauma center resulted in mortality rates that met national standards.

BACKGROUND: Helicopters provide rapid interfacility transport, but the effect on patients is largely unknown. METHODS: Patients requested to be transported between facilities by helicopter were followed prospectively to determine survival, disability, health status, and health care utilization. A total of 1,234 patients were transported by the primary aeromedical company; 153 patients were transported by ground and 25 patients were transported by other aeromedical services because of weather or unavailability of aircraft. RESULTS: There were no differences at 30 days for survivors in disability, health status, or health care utilization. Nineteen percent of helicopter-transported patients died compared with 15% of those transported by ground (p=0.21). CONCLUSION: The patients transported by helicopter did not have improved outcomes compared with patients transported by ground. These data argue against a large advantage of helicopters for interfacility transport. A randomized trial is needed to address these issues conclusively. Language: en

As the flight nurse stepped into the relative darkness of the ground ambulance's interior, one of the emergency medical technicians said to him, “You've got to take both of them.” Quickly assessing the husband and wife patients, the flight nurse answered, “If I take both of them, they'll both die.” In the moment of sobering silence that followed, a thin voice climbed up out of the two broken bodies and somehow made it to the flight nurse's ear: “Take my husband.”

Introduction Critically ill patients can be subject to prolonged stays in the emergency department following receipt of an order to admit to an intensive care unit. The purpose of this study was to explore patient and organizational influences on the duration of boarding times for intensive care bound patients. Methods This exploratory descriptive study was situated in a Canadian hospital in northern Ontario. Through a six-month retrospective review of three data sources, information was collected pertaining to 16 patient and organizational variables detailing the emergency department boarding time of adults awaiting transfer to the intensive care unit. Data analysis involved descriptive and non-parametric methods. Results The majority of the 122 critically ill patients boarded in the ED were male, 55years of age or older, arriving by ground ambulance on a weekday, and had an admitting diagnosis of trauma. The median boarding time was 34min, with a range of 0–1549min. Patients designated as most acute, intubated, and undergoing multiple diagnostic procedures had statistically significantly shorter boarding times. Discussion The study results provide a profile that may assist clinicians in understanding the complex and site-specific interplay of variables contributing to boarding of critically ill patients.

In 2011, Alberta Health Services (AHS) standardized the design of their new ground ambulances to improve provider safety in the event of a collision. Human Factors methods and design principles were used to examine the new ambulances and provide recommendations to further improve the workspace, functionality, and design for the next generation of ambulances. Human Factors consultants participated in ride-alongs within the urban Calgary area, observing patient care, staff interactions, and workflow. A total of 32 recommendations were suggested for future design iterations of the ambulance. Next steps include utilizing simulations and usability testing to ensure their feasibility and effectiveness.

The sprung stretcher of a ground ambulance litter as the space conducting mechanism with three degrees of freedom. The first degree is determined to compensate the vertical translations of a carriage, the second and third to compensate both horizontal rotations (so called pitching and rolling). The first degree is realized with scissor or with parallelogram, on the upper base on which the double Cardane suspension is placed (as the second and third degree). The second Cardane frame is connected with an own stretcher. The vibration isolation is realized with controlled pneumatic springs. Their control has two sensing units: sensor of the relative position of the upper and lower base and sensor of the absolute angle deflection of the second Cardane frame from an horizontal plane (double electrolytic level). This level is modeled as a spherical pendulum (on the base of its identified characteristics). There was analyzed this dynamic system with five degrees of freedom. The analyze of two conceptions demonstrates that the scissor mechanism is for the complete space mechanism more useful than the parallelogram.

The economic model created in this paper replaces the existing University of Massachusetts Medical Center's New England Life Flight (NELF) helicopter ambulance service with a ground ambulance system to investigate comparative costs. The model is based on a less than 30-minute response time to the patient, similar medical team staffing and equal service area. The annual budgetary cost of the replacement ground network is $3,804,000 while the helicopter ambulance costs are $1,686,500 (based on 1991 dollars). The cost per patient transported is $4,475 for the ground system and $2,811 for the helicopter system. The comparison finds that the commonly held notion that condemns helicopters as an excessively expensive technology for patient transport is incorrect. Future research to address intermediate alternatives using similar analytical technology assessment techniques is recommended.

Hypothesis:Paramedics accurately estimate the closest trauma hospital for ground transport.Population:Ground ambulance scene transports of trauma system patients to six participating trauma hospitals in Multnomah County, Oregon from 1 January 1986 to 1 January 1987 were studied. Transports involving multiple patients or pediatric patients were excluded.Methods:A retrospective analysis was performed on consecutive patient transports to be taken to the closest trauma hospital as required by protocol. The availability of each hospital to receive trauma patients was monitored continuously by a central communications facility. Paramedics were provided hospital availability data at the time of patient system entry. When several hospitals were available, the paramedics were required by protocol to select the “closest” hospital. Subsequently, the vector distance from the trauma site to each of the available hospitals was measured using a grid map. This method was validated by odometer measurement (r2 = 0.924). Chisquare analysis was used to analyze hospital bypasses to specific hospitals.Results:Of the 1193 eligible patients entered into the trauma system, 160 (13%; 95% CI = 11–15%) transports bypassed the closest available hospital for a receiving hospital ≥1 mile more distant. There were 11 (1%; 0–2%) patients transported to a hospital more than five miles more distant. Of the 132 patients with a trauma score (TS) Conclusion:While paramedics generally can identify the closest hospital for trauma patient transport, some systematic hospital bypass errors occur. If a community wants assurance of an equitable patient distribution among participating trauma hospitals and assignment of the closest geographic hospital for injured patients, then map vector distance determination to identify the closest available hospital should supplement paramedic dispatching.

Helicopter transport is often considered in an effort to minimize time to critical interventions, such as cardiac catheterization or arterial thrombolysis in stroke patients. However, for interfacility transports, the extra time considerations for helicopter preparation, takeoff, and time to get to the transferring hospital may not offset the slower transport times for local ground ambulances. The purpose of this study was to compare transport times for helicopter with traditional ground ambulance for interfacility transfers within a regional referral system.All patients transported from an outside hospital to the intensive care unit of the University of Wisconsin were eligible for this study. Equal numbers of patients transferred by ground and by helicopter from each facility were sequentially selected. The following intervals were compared: time from call to dispatch, time from dispatch to arrival at the referring hospital, time at the referring hospital, transport time to the receiving hospital, and total transport time.One hundred forty-five patients were included in this study, transferred from 20 hospitals within the UW referral system. Dispatch times and time at the referring hospital were location independent, and each was shorter for ground transport. Ground dispatch times were 5+/-6 minutes, whereas for helicopter transport dispatch times were 17+/-8 (P.001). Times at the referral hospital were on average longer for helicopter transport (31+/-11 minutes for air ambulance, 25+/-13 for ground; P=.008). Other intervals were location dependent. Arrivals were much more variable for ground transport, reflecting the fact that private ambulance services may have to travel some distance to reach the referring hospital (helicopter 18+/-8 minutes, ground 19+/-18 minutes). As expected, transport time from the referring hospital was shorter for helicopter transport. From each of the hospitals, average helicopter transport was as fast as the best ground transport.Helicopter transport was faster than ground transport for interfacility transfer of patients from all hospitals studied in our referral system. Under optimal dispatch and transport conditions, the time difference from several hospitals was minimal. For stable patients for whom the only issue is time to critical procedure, it may be reasonable for those hospitals to try ground transport first if timely service is available to transport in that way. Even for those hospitals, helicopter transport should be considered for these patients if ground transport is not optimally available, as well as for patients in whom minimizing time outside of the hospital is a significant consideration, or when transport of such patients impacts emergency medical services availability to the community for a significant time.

How does an air medical transport program measure success? By the number of lives saved? An increase in transport requests and completed flights? Additional aircraft or an added ground ambulance service? Conversely, how do we measure failure or setbacks? By experiencing a flat or decreasing trend in transport numbers? By "downsizing" the number of aircraft or closing satellite operations?

A simple algorithm has been produced to assist front line ground ambulance personnel, air ambulance crews, and immediate care doctors attending trauma patients in selecting the most appropriate mode of transport from the incident scene to hospital.

MEDEVAC encompasses all movement of the movement of patients: from the point of injury to the nearest medical facility, between medical facilities at different echelon levels, and finally to the site of embarkation out of the theater. A key component of MEDEVAC is the provision of ongoing casualty care. To assure the success of what is one of the most important missions of military medicine, all military medical providers need to be familiar with the basic concepts and components of tactical MEDEVAC.