Abstract Advances in technology and decreasing costs have led to an increased use of unmanned aerial vehicles (UAVs) by the military and civilian sectors. The use of UAVs in commerce is restricted by US Federal Aviation Administration (FAA) regulations, but the FAA is drafting new regulations that are expected to expand commercial applications. Currently, the transportation of medical goods in times of critical need is limited to wheeled motor vehicles and manned aircraft, options that can be costly and slow. This article explores the demand for, feasibility of, and risks associated with the use of UAVs to deliver medical products, including blood derivatives and pharmaceuticals, to hospitals, mass casualty scenes, and offshore vessels in times of critical demand.
The medical support of military operations over a 5 million km area in the Sahel-Saharan strip has justified the use of a medical fixed wing aircraft. Two CASA CN 235 aircraft currently perform medical evacuation (medevac) from the point of injury to forward surgical structures and then to the international airport before strategic medevac to France. A retrospective observational study including all flights performed from January 2013 to December 2017 by the medical CASA located in Mali. Three thousand three flight hours were achieved. Four hundred twenty-four medevacs were performed for 898 patients. Seventy-five percent were evacuated from forward surgical structures. Their initial categorization included 10% Alpha, 23% Bravo, and 67% Charlie. Mechanical ventilation was performed for 5%; 34.5% had common medical or surgical pathologies, 34.2% were combat casualties mostly by explosion, and 18.7% were nonbattle injuries. No difficulties related to the aeronautical environment were reported by the teams. Tactical medevac with fixed wing aircraft has become a crucial link in the French medical evacuation chain in remote areas. Military emergency medical teams were able to provide in-flight intensive care before and after damage control surgery. Discussions are underway to consider possible doctrinal and logistical evolutions.
In emergency medicine, endotracheal intubation is the gold standard for airway management. First-pass intubation success is beneficial because it secures the patient airway more quickly and avoids complications associated with repeated attempts, such as bleeding and swelling of soft tissue. The key to first-pass success is the ability to visualize the laryngeal inlet. Visualization can be accomplished using traditional direct laryngoscopy or video laryngoscopy. The purpose of our study was to compare the rate of successful first-pass endotracheal intubations using a video laryngoscope with that using a direct visualization laryngoscope in a prehospital emergency setting. We retrospectively reviewed data that had been prospectively collected in our emergency department regarding patients who underwent endotracheal intubation performed by personnel from a single local ambulance service from January 1, 2014, through December 31, 2015. One hundred eighty-one patients were intubated using video laryngoscopy and 115 using direct visualization laryngoscopy. The first-pass endotracheal intubation success rate using video laryngoscopy was 12.6% higher than with direct laryngoscopy. This retrospective study shows that video laryngoscopy had a higher first-pass success rate than direct laryngoscopy. This is promising because decreasing failure rates provide better patient outcomes.
Traumatic brain injury (TBI) is a leading cause of death and disability among trauma patients. The final outcome of TBI results from a complex interaction between primary and secondary mechanisms of injury that begin immediately after the traumatic event. The aim of this review was to evaluate the latest evidence regarding the impact of prehospital airway management and the outcome after traumatic brain injury. PubMed, Embase, and Cochrane searches were conducted using the MeSH database. Airway management, traumatic brain injury, pneumonia, and the subheadings of these Medical Subject Headings were combined. The review is structured into 4 major topics: airway management devices, prehospital pharmacologic management, mortality and neurologic outcomes, and early respiratory infections. The available literature shows a shift toward a more comprehensive view of prehospital airway management, taking into account not only the location where airway management is attempted but also the drugs administered, the airway management devices used, and the skills of the main professional figures attending the scene. Literature about this topic is still inconclusive; however, new evidence taking into consideration more complex aspects of airway management rather than orotracheal intubation per se shows improved outcomes with aggressive prehospital airway management.
Studies on Norwegian avalanche rescue operations have indicated high-stake searching of avalanches during elevated risk conditions. We perceive these characteristics as a sign of overcommitment. The purpose of this study is to explore the concept of overcommitment in Norwegian medical evacuation and rescue operations. How can overcommitment be described and understood as a uniform concept in rescue operations based on empirical data? In a qualitative, exploratory study, 9 focus group interviews were conducted with a total of 30 crewmembers from the Norwegian air ambulance service. In this first in a series of 2 articles, crewmembers’ reflections on the concept of overcommitment, important factors to consider when balancing risk and benefit in every mission, and a number of causal factors are presented. A definition of overcommitment in the context of rescue activities is presented. Air ambulance personnel recognize overcommitment in a variety of situations. They broaden the concept to include both regular, everyday actions and hazardous rescue attempts in extraordinary incidents. The causal factors form recognizable constellations that may offer useful starting points for systems-based counteracting measures. The definition of overcommitment could provide a background for evaluation and learning in the rescue service.
Stress has the potential to improve performance through increased focus and strength or negatively impact performance through distraction and decreased fine motor control. The first step in the distinction between success or failure in a stressful situation is making the decision to engage in the process or withdraw. Cognitive appraisal describes the process of evaluating a stimulus as either a challenge to be met or an overwhelming obstacle from which to retreat. Providers in the air medical community are required to perform in inherently stressful and unpredictable situations that may threaten to devastate personal resources. This paper is a literary meta-analysis of existing literature on stress performance, threat assessment, and cognitive appraisal in the medical environment. Preparing for stressful situations is not only accomplished through the practice of skills and rehearsal of knowledge, but also cognitive readiness, mindfulness, and encouragement of team members. Positive cognitive appraisals is practiced through simulation, case study, and purposeful mental practice. Deciding to actively engage in problem solving through the lens of overcoming obstacles and meeting challenges with confidence provides the mental framework that recruits the inevitable sympathetic surge for benefit rather than impairment. Cognitive appraisal describes the decision to focus on the challenge rather than threat of the situation based on the skills, knowledge, and experience of the team. Establishing a positive narrative and actively engaging in challenges increased confidence and improves performance of medical providers.
Transport programs are highly regulated health care organizations. Of the many imposers of regulations, those controlled by the Drug Enforcement Administration are some of the least understood by transport programs. This article serves to lift the regulatory fog surrounding controlled substances and to provide clear and actionable guidance to transport programs. Storage, security, and recordkeeping requirements for emergency medical service organizations can be confusing given that there are no specific regulations for emergency medical services. Transport programs are subject to all the current regulations, and nonadherence can result in significant fines and loss of public trust for any transport program found to be in violation.
During transport, the time spent in stabilizing sick infants before repatriation is crucial in optimizing the outcome and effective use of resources. The study aim was to assess individual components of neonatal transport time to identify opportunities to minimize delay, optimize care, and improve the overall efficiency of transport. A single-center prospective observational study conducted at McMaster Children's Hospital, Hamilton, Ontario, Canada, with a dedicated transport team for over 12 months. The stabilization time was defined as the time interval between arrival and departure from the referring hospital. Of 223 neonatal transfers, 67 required no procedural or therapeutic intervention before mobilization to the receiving unit, with a mean stabilization time of 113 ± 52 minutes. In 156 transport events, 1 or more interventions were required, with a significantly higher mean stabilization time of 165 ± 89 minutes ( < .0001). This study found that the local stabilization time was more than 1.5 times that of the comparable published data. The reasons identified for this delay were mostly because of waiting times for vehicle mobilization, waiting for blood and radiology results, and bed availability. Modifying these factors could save up to 28% of the stabilization time.