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Background Pregnant laboring patients sometimes require interfacility transfer to a higher level of care. There is a paucity of evidence to inform when it is safe to transfer a laboring patient and when delivery may be too imminent to transfer. Methods This is a retrospective study of pregnant patients undergoing interfacility transfer with a specialized obstetric transport team deployed from a large Midwest regional healthcare system. The primary outcome was delivery prior to or within one hour of arrival at the receiving institution due to progression of labor. Data collected included basic demographics, vital signs, gravidity, parity, gestational age, contraction frequency if contractions were present, and cervical dilation. We sought to define the association between these variables and the primary outcome to inform risk assessment for precipitous delivery among patients being considered for interfacility transfer. Results Of the 370 pregnant patients for whom the specialized transfer team was requested, 11 (3%) met the primary outcome. Those with more advanced cervical dilation and those who did not receive regular prenatal care were more likely to meet the criteria for the primary outcome. For every centimeter of cervical dilation, the odds of meeting the primary outcome increased 2.3-fold (95% CI: 1.5-3.4). Conclusions We identified risk factors for early delivery among pregnant patients for whom an interfacility transfer was requested and described patients who were high-risk for obstetric interfacility transport due to the progression of labor. Our results can help inform risk assessments for transferring potentially high-risk laboring patients., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Indiana University Institutional Review Board issued approval 20146. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Lardaro et al.)

Introduction: Medical drones have potential for improving the response times to out-of-hospital emergencies. However, widespread adoption is hindered by unanswered questions surrounding medical dispatch and bystander safety. This study evaluated the impact of novel drone-specific dispatch instructions (DSDI) on bystanders' ability to interact effectively with a medical drone and provide prompt, safe, and high-quality treatment in a simulated emergency scenario. We hypothesized DSDI would improve bystanders' performance and facilitate safer bystander-drone interactions., Methods: Twenty-four volunteers were randomized to receive either DSDI and standard Medical Priority Dispatch (MPD) instructions or MPD alone in a simulated out-of-hospital cardiac arrest (OHCA) or pediatric anaphylaxis., 3 Participants in the DSDI group received detailed instructions on locating and interacting with the drone and its enclosed medical kit. The simulations were video recorded. Participants completed a semi-structured interview and survey., Results: The addition of DSDI did not lead to statistically significant changes to the overall time to provide care in either the anaphylaxis or OHCA simulations. However, DSDI did have an impact on bystander safety. In the MPD only group, 50% (6/12) of participants ignored the audio and visual safety cues from the drone instead of waiting for it to be declared safe compared to no DSDI participants ignoring these safety cues., Conclusions: All participants successfully provided patient care. However, this study indicates that DSDI may be useful to ensure bystander safety and should be incorporated in the continued development of emergency medical drones., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Christine M. Brent reports financial support was provided by Toyota Motor Corporation. James M. Pribble reports financial support was provided by Toyota Motor Corporation. Laura R. Hopson reports financial support was provided by Toyota Motor Corporation. Emily J. Mathias reports financial support was provided by Toyota Motor Corporation. Nathaniel Hunt reports financial support was provided by Toyota Motor Corporation. Christine M. Brent reports a relationship with the Medical Control Authority of Michigan that includes: board membership. Co-author employed by Emergent Health Partners − E.E.D. Co-author employed by Emergent Health Partners − I.G.S. Co-author employed by Emergent Health Partners − N.K.M. Corresponding author employed as EMS Medical Director − C.M.B. Co-author employed as EMS Medical Director − N.H. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Intro: Medical drones are an emerging technology which may facilitate rapid treatment in time-sensitive emergencies. However, drones rely on lay rescuers, whose interactions with multipurpose medical drones have not been studied, and the optimal drone design remains unclear., Methods: We conducted 24 simulations of adult out-of-hospital cardiac arrest (OHCA) and pediatric anaphylaxis with a prototype drone equipped with spoken and visual cues and a multipurpose medical kit. 24 layperson volunteers encountered one of the two scenarios and were supported through administering treatment by a simulated 911 dispatcher. Bystander-drone interactions were evaluated via a convergent parallel mixed methods approach using surveys, video event review, and semi-structured interviews., Results: 83% (20/24) of participants voiced comfort interacting with the drone. 96% (23/24) were interested in future interaction. Participants appreciated the drone's spoken instructions but found visual cues confusing. Participants retrieved the medical kit from the drone in a mean of 5 seconds (range 2-14) of drone contact; 79% (19/24) found this step easy or very easy. The medical kit's layered design caused difficulty in retrieving appropriate equipment. Participants expressed a wide range of reactions to the unique drone design., Conclusions: Laypeople can effectively and comfortably interact with a medical drone with a novel design. Feedback on design elements will result in further refinements and valuable insights for other drone designers. A multipurpose medical kit created more challenges and indicates the need for further refinement to facilitate use of the equipment., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: ‘Dr. Brent, Dr. Hopson, Dr. Pribble, Dr. Mathias and Dr. Hunt report funding support from Toyota Motors North America Research and Development for this study. Ms. Davidson, Ms. Majhail and Ms. Scott report employment, during one or more phases of the study, with Huron Valley Ambulance of Emergent Health Partners, a licensed transporting advanced life support agency (ALS) that serves as a regional provider of BLS/ALS medical transport and 9–1-1 dispatched emergency response in southern Michigan. Dr. Brent and Dr. Hunt report a leadership role as co-deputy medical director for the Washtenaw/Livingston Medical Control Authority, a regional EMS oversight body. All other authors report no relevant interests.’., (© 2024 The Authors.)

Critical care transport medicine (CCTM) teams are playing an increasing role in the care of patients in cardiogenic shock requiring mechanical circulatory support devices. Hence, it is important that CCTM providers are familiar with the pathophysiology of cardiogenic shock, the role of mechanical circulatory support, and the management of these devices in the transport environment. The intra-aortic balloon pump is a widely used and accessible cardiac support device capable of increasing cardiac output and reducing work on the left ventricle through diastolic augmentation and counterpulsation. This article reviews essential CCTM-based considerations for patients supported by intra-aortic balloon pump, including indications for placement, mechanics and physiology, potential issues during transport, and associated complications., (© 2024 The Author(s).)

Objective: Intranasal medications have been proposed as adjuncts to out-of-hospital cardiac arrest (OHCA) care. We sought to quantify the effects of intranasal medication administration (INMA) in OHCA workflows., Methods: We conducted separate randomized OHCA simulation trials with lay rescuers (LRs) and first responders (FRs). Participants were randomized to groups performing hands-only cardiopulmonary resuscitation (CPR)/automated external defibrillator with or without INMA during the second analysis phase. Time to compression following the second shock (CPR2) was the primary outcome and compression quality (chest compression rate (CCR) and fraction (CCF)) was the secondary outcome. We fit linear regression models adjusted for CPR training in the LR group and service years in the FR group., Results: Among LRs, INMA was associated with a significant increase in CPR2 (mean diff. 44.1 s, 95% CI: 14.9, 73.3), which persisted after adjustment ( p  = 0.005). We observed a significant decrease in CCR (INMA 95.1 compressions per min (cpm) vs control 104.2 cpm, mean diff. -9.1 cpm, 95% CI -16.6, -1.6) and CCF (INMA 62.4% vs control 69.8%, mean diff. -7.5%, 95% CI -12.0, -2.9). Among FRs, we found no significant CPR2 delays (mean diff. -2.1 s, 95% CI -15.9, 11.7), which persisted after adjustment ( p  = 0.704), or difference in quality (CCR INMA 115.5 cpm vs control 120.8 cpm, mean diff. -5.3 cpm, 95% CI -12.6, 2.0; CCF INMA 79.6% vs control 81.2% mean diff. -1.6%, 95% CI -7.4, 4.3%)., Conclusions: INMA in LR resuscitation was associated with diminished resuscitation performance. INMA by FR did not impede key times or quality., Competing Interests: Mr. Dowker reports grant‐funding from the National Institutes of Health (grant R01‐HL137964), travel support from National Association of EMS Physicians (NAEMSP)/GMR Foundation, and concurrent employment as a firefighter/EMT with the Green Oak Charter Township Fire Department a licensed nontransporting Basic Life Support (BLS) agency in Michigan. Ms. Majhail and Ms. Scott report employment, during one or more phases of the study, with Emergent Health Partners, a licensed transporting Advanced Life Support (ALS) agency that serves as a regional provider of BLS/ALS medical transport and 911 dispatched emergency response in southern Michigan. Dr. Brent reports a leadership position for the Washtenaw/Livingston Medical Control Authority, she is an Air Medical Physician Association Board Member, NAEMSP Air Medical Committee Vice Chair, NAEMSP Council of EMS Fellowship Directors Vice Chair, and grant funding CMB Toyota Grant on Prehospital Medical Drones, and travel support from Air Medical Physician Association. Dr. Smith reports effort as associate medical director for the Washtenaw/Livingston Medical Control Authority, a regional EMS oversight body. Dr. Berger reports grant funding from AHRQ R01 HS025411‐02BCBSM Foundation, Dr. Neumar reports the following grant support National Institutes of Health: K12HL133304, R01HL133129, R34HL130738 ‐ Institution; Laerdal Foundation‐Institution, and he is SaveMiHeart President and Board Chair, ILCOR cochair. All other authors report no relevant interests., (© 2024 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.)

Introduction: Millions of out-of-hospital cardiac arrests (OHCA) occur globally each year. Survival after OHCA can be improved with the use of automated external defibrillators (AED). The main strategy for facilitating bystander defibrillation has been fixed-location public access defibrillators (PADs). New strategies of mobile AEDs depart from the model of static PADs and have the potential to address known barriers to early defibrillation and improve outcomes., Methods: Mobile AEDs was one of six focus topics for the Wolf Creek XVII Conference held on June 14-17, 2023, in Ann Arbor, Michigan, USA. Conference invitees included international thought leaders and scientists in the field of cardiac arrest resuscitation from academia and industry. Participants submitted via online survey knowledge gaps, barriers to translation and research priorities for each focus topic. Expert panels used the survey results and their own perspectives and insights to create and present a preliminary unranked list for each category that was debated, revised, and ranked by all attendees to identify the top 5 for each category., Results: Top knowledge gaps center around understanding the impact of mobile AEDs on OHCA outcomes in various settings and the impact of novel AED technologies. Top barriers to translation include questionable public comfort/acceptance, financial/regulatory constraints, and a lack of centralized accountability. Top research priorities focus on understanding the impact of the mobile AED strategies and technologies on time to defibrillation and OHCA outcomes., Conclusion: This work informs research agendas, funding priorities and policy decisions around using mobile AEDs to optimize prehospital response to OHCA., Competing Interests: Dr. Brent has received grant funding from Toyota Motors North America for research into drone delivery of multimodal medical kits for bystander interventions in prehospital emergencies. Dr. Brooks is the Chief Medical Officer for Rapid Response Revival, a defibrillator manufacturer that makes the CellAED. He is also a shareholder in this company. Dr. Brooks has received in-kind support for research from GoodSAM and SaveStation. He receives funding from the Canadian Institutes for Health Research for research on the PulsePoint mobile device app. He also receives funding from the Ontario Ministry of Health for the study of a community volunteer responder program. This study is also supported by Action First Aid, an AED distributor in Canada, through in-kind supply of refurbished defibrillators. The GoodSAM app provided discounted services for use in this study. Dr. Cheskes sits on the Advisory Board of Drone Delivery Canada and has received grant funding from Zoll Medical Inc. for research on the use of drones for time sensitive medical emergencies. Dr. Cheskes has also received grant funding from the Cardiovascular Network of Canada for research into the use of drones in rural and remote cardiac arrest. All other authors report no current relevant financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

This update to the 2013 joint position statement, Appropriate and Safe Utilization of Helicopter Emergency Medical Services , provides guidance for air medical services utilization based on currently available evidence. Air medical services utilization considerations fall into three major categories: clinical considerations, safety considerations, and system integration and quality assurance.Clinically, air medical services should accomplish one or more of three primary patient-centered goals: initiation or continuation of locally unavailable advanced or specialty care; expedited delivery to definitive care for time-sensitive interventions; and/or extraction from physically remote or otherwise inaccessible locations that limit timely access to necessary care. Ground-EMS (GEMS) transport is preferred when it is able to provide the necessary level of care and timely transport to definitive care.Risk identification and safety of both the patient and crew must be uniformly balanced against the anticipated degree of patient medical benefit. While auto-ready and auto-launch practices may increase access to air medical services, they also risk over-use, and so must be rigorously reviewed. Safety is enhanced during multi-agency emergency responses by coordinated interagency communication, ideally through centralized communication centers. Helicopter shopping and reverse helicopter shopping both create significant safety risks and their use is discouraged.Regional EMS systems must integrate air medical services to facilitate appropriate utilization in alignment with the primary patient goals while being cognizant of local indications, resources, and needs. To maximize consistent, informed air medical services utilization decisions, specific indications for and limitations to air medical services utilization that align with local and regional system and patient needs should be identified, and requests routed through centralized coordinating centers supported by EMS physicians.To limit risk and promote appropriate utilization of air medical services, GEMS clinicians should be encouraged to cancel an air medical services response if it is not aligned with at least one of the three primary patient-centered goals. Similarly, air medical services clinicians should be empowered to redirect patient transport to GEMS. Air medical services should not routinely be used solely to allow GEMS to remain in their primary service area.