scholarly journals Implementing new advanced airway management standards in the Hungarian physician staffed Helicopter Emergency Medical Service

2015 ◽  
Vol 23 (1) ◽  
Author(s):  
Akos Soti ◽  
Peter Temesvari ◽  
Laszlo Hetzman ◽  
Attila Eross ◽  
Andras Petroczy
Keyword(s):  
Airway Management ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Helicopter Emergency Medical Service ◽  
Management Standards ◽  
Emergency Medical ◽  
Advanced Airway

scholarly journals Airway Management Difficulties in a Helicopter Emergency Medical Service (HEMS): A Retrospective Observational Study of 676 Out-of-Hospital Intubations

2021 ◽  
Author(s):  
Urs Pietsch ◽  
Raphael Müllner ◽  
Lorenz Theiler ◽  
Volker Wenzel ◽  
Lorenz Meuli ◽  
...  
Keyword(s):  
Airway Management ◽  
Emergency Medical Services ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Ventilatory Support ◽  
Helicopter Emergency Medical Service ◽  
Medical Services ◽  
Emergency Medical ◽  
Advanced Airway ◽  
Number Of Patients

Abstract Background: Airway management is a key skill in any helicopter emergency medical service (HEMS). Successful intubation is less often than in the hospital, and alternative forms of airway management are needed more often. Methods: Retrospective observational cohort study in an anaesthesiologist-staffed HEMS in Switzerland. Patients charts from all scene calls (n=9035) that took place between June 2016 and May 2017 (12 months) were analysed. The primary outcome parameter was intubation success rate. Secondary parameters included number of patients intubated by ground-based emergency medical services, alternative devices used, and comparison of patients with and without difficulties in airway management. Results: A total of 676 patients with invasive ventilatory support were identified. Difficulties in airway management were rare, occurring in 44 (6.5%) patients, and trauma was significantly more common (59.1% vs. 38.6%, p<0.001). In 335 (49.6%) patients, advanced airway management had already been initiated by Ground emergency medical services upon arrival of the HEMS. Paramedics had significantly more exposure to patients needing prehospital anaesthesia than the HEMS physicians; median 12 (IQR 9 to 17.5) versus 3 (IQR 2 to 6), p<0.001.Conclusion: Despite overall high success rates for endotracheal intubation in the physician-staffed service, each physician gets little real-life experience with advanced airway management in the field, highlighting the importance of a solid basic competence such as anaesthesiology and additional training. Direct laryngoscopy is still a valuable skill and an important Plan B in difficult airway situations in which factors such as fogging, blood, bright radiation on the video laryngoscopes screen, impaired the success of video laryngoscopes intubation.

scholarly journals Intubation during a medevac flight: safety and effect on total prehospital time in the helicopter emergency medical service system

2020 ◽  
Vol 28 (1) ◽  
Author(s):  
Hiroki Maeyama ◽  
Hiromichi Naito ◽  
Francis X. Guyette ◽  
Takashi Yorifuji ◽  
Yuki Banshotani ◽  
...  
Keyword(s):  
Emergency Medical Service ◽  
Medical Service ◽  
Helicopter Emergency Medical Service ◽  
Emergency Medical Service System ◽  
Success Rates ◽  
Emergency Medical ◽  
Advanced Airway ◽  
Intubation Success Rate ◽  
Prehospital Time ◽  
Improve Patient

Abstract Introduction The Helicopter Emergency Medical Service (HEMS) commonly intubates patients who require advanced airway support prior to takeoff. In-flight intubation (IFI) is avoided because it is considered difficult due to limited space, difficulty communicating, and vibration in flight. However, IFI may shorten the total prehospital time. We tested whether IFI can be performed safely by the HEMS. Methods We conducted a retrospective cohort study in adult patients transported from 2010 to 2017 who received prehospital, non-emergent intubation from a single HEMS. We divided the cohort in two groups, patients intubated during flight (flight group, FG) and patients intubated before takeoff (ground group, GG). The primary outcome was the proportion of successful intubations. Secondary outcomes included total prehospital time and the incidence of complications. Results We analyzed 376 patients transported during the study period, 192 patients in the FG and 184 patients in the GG. The intubation success rate did not differ between the two groups (FG 189/192 [98.4%] vs. GG 179/184 [97.3%], p = 0.50). There were also no differences in hypoxia (FG 4/117 [3.4%] vs. GG 4/95 [4.2%], p = 1.00) or hypotension (FG 6/117 [5.1%] vs. GG 5/95 [5.3%], p = 1.00) between the two groups. Scene time and total prehospital time were shorter in the FG (scene time 7 min vs. 14 min, p <  0.001; total prehospital time 33.5 min vs. 40.0 min, p <  0.001). Conclusions IFI was safely performed with high success rates, similar to intubation on the ground, without increasing the risk of hypoxia or hypotension. IFI by experienced providers shortened transportation time, which may improve patient outcomes.

Location of arrest and effect of prehospital advanced airway management after emergency medical service-witnessed out-of-hospital cardiac arrest: nationwide observational study

2019 ◽  
Vol 36 (9) ◽  
pp. 541-547
Author(s):  
Jeong Ho Park ◽  
Kyoung Jun Song ◽  
Sang Do Shin ◽  
Young Sun Ro ◽  
Ki Jeong Hong ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Cerebral Performance Category ◽  
Neurological Recovery ◽  
Multivariable Logistic Regression Analysis ◽  
Emergency Medical ◽  
Advanced Airway ◽  
Hospital Cardiac Arrest

ObjectivesTo investigate the association of prehospital advanced airway management (AAM) on outcomes of emergency medical service (EMS)-witnessed out-of-hospital cardiac arrest (OHCA) according to the location of arrest.MethodsWe evaluated a Korean national OHCA database from 2012 to 2016. Adults with EMS-witnessed, non-traumatic OHCA were included. Patients were categorised into four groups according to whether prehospital AAM was conducted (yes/no) and location of arrest (‘at scene’ or ‘in the ambulance’). The primary outcome was discharge with good neurological recovery (cerebral performance category 1 or 2). Multivariable logistic regression analysis was conducted to evaluate the association between AAM and outcome according to the location of arrest.ResultsAmong 6620 cases, 1425 (21.5%) cases of arrest occurred ‘at the scene’, and 5195 (78.5%) cases of arrest occurred ‘in an ambulance’. Prehospital AAM was performed in 272 (19.1%) OHCAs occurring ‘at the scene’ and 645 (12.4%) OHCAs occurring ‘in an ambulance’. Patients with OHCA in the ambulance who had prehospital AAM showed the lowest good neurological recovery rate (6.0%) compared with OHCAs in the ambulance with no AAM (8.9%), OHCA at scene with AAM (10.7%) and OHCA at scene with no AAM (7.7%). For OHCAs occurring in the ambulance, the use of AAM had an adjusted OR of 0.67 (95% CI 0.45 to 0.98) for good neurological recovery.ConclusionOur data show no benefit of AAM in patients with EMS-witnessed OHCA. For patients with OHCA occurring in the ambulance, AAM was associated with worse clinical outcome.

Intubation Performance of Advanced Airway Devices in a Helicopter Emergency Medical Service Setting

2016 ◽  
Vol 35 (3) ◽  
pp. 132-137
Author(s):  
John W. Hafner ◽  
Blake W. Perkins ◽  
Joshua D. Korosac ◽  
Alayna K. Bucher ◽  
Jean C. Aldag ◽  
...  
Keyword(s):  
Emergency Medical Service ◽  
Medical Service ◽  
Helicopter Emergency Medical Service ◽  
Emergency Medical ◽  
Service Setting ◽  
Advanced Airway ◽  
Airway Devices

scholarly journals Intubation during A Medevac Flight: Safety and Effect on The Total Prehospital Time in Helicopter Emergency Medical Service System

2020 ◽  
Author(s):  
Hiroki Maeyama ◽  
Hiromichi Naito ◽  
Francis X Guyette ◽  
Takashi Yorifuji ◽  
Yuki Banshotani ◽  
...  
Keyword(s):  
Emergency Medical Service ◽  
Medical Service ◽  
Helicopter Emergency Medical Service ◽  
Emergency Medical Service System ◽  
Safe Procedure ◽  
Transportation Time ◽  
Emergency Medical ◽  
Advanced Airway ◽  
Intubation Success Rate ◽  
Prehospital Time

Abstract Introduction: Endotracheal intubation is an essential skill in emergency medicine requiring technical proficiency and sufficient preparation for a safe procedure. In the Helicopter Emergency Medical Service (HEMS), it is common to intubate the patient who needs an advanced airway prior to take-off. In-flight-intubation (IFI) is avoided because it is considered difficult due to environmental limitations of space, communication, and vibration. In contrast, IFI may shorten the total prehospital time since the procedure is conducted during the flight. We tested whether IFI can be performed safely and shorten transportation time. Methods: We conducted a retrospective cohort study with patients transported from Apr 2010 to Mar 2017 in a single center. We included patients ≥ 18 years who received prehospital intubation and excluded patients with emergent intubation at the scene. We divided the observational cohort into two groups. The Flight group (FG): included patients intubated during the flight. The Ground group (GG): included patients intubated prior to take-off. HEMS crews transported both groups. The primary outcome was the proportion of successful intubations. Secondary outcomes included total prehospital time and the incidence of complications such as hypoxia and hypotension. Result: We analyzed 376 patients during the study period. There were 192 cases in FG and 184 cases in GG. Intubation success rate did not differ between the two groups (FG vs GG: 98.4% vs 97.3%, p = 0.50). There were no differences in hypoxia (FG vs GG: 3.4% vs 4.2%, p = 1.00) or hypotension (FG vs GG: 5.1% vs 5.3%, p = 1.00) between two groups. Scene time was shorter in FG (FG vs GG: 7 min vs 14 min, p < 0.001), as was total prehospital time (FG vs GG: 33.5 min vs 40.0 min, p < 0.001). Conclusions: In-flight-intubation during HEMS could be safely performed without additional hypoxia or hypotension. In-flight-intubation by experienced providers shortened transportation time by an average of 7 minutes.

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