Air Medical Journal最新文献_第6页

Air Medical and Transport Simulation Training of Critically Ill Cases With Radioactive Contamination in Nuclear Power Stations by Japanese Helicopter Emergency Medical Services 日本直升机紧急医疗服务对核电站放射性污染危重病人的空中医疗和运输模拟训练

Q3 Nursing

Air Medical Journal

Pub Date : 2026-01-01 Epub Date: 2025-09-25 DOI: 10.1016/j.amj.2025.08.010

Shinsuke Tanizaki MD , Hiroyuki Azuma MD , Hisamasa Ishii MD , Naoto Okabe , Tatsuro Yoshinaga , Kenji Nakaya , Taketsune Kobuchi MD , Tetsuya Kimura MD , Shigenobu Maeda MD

Objective

Helicopter emergency medical service (HEMS) personnel require specialized training and continuous skill development tailored to their unique operational demands. These demands may include managing critically ill patients with radioactive contamination within radiologically controlled areas to ensure the delivery of high-quality care and safety. A unified consensus was archived after several discussions among relevant agencies, incorporating the safety of flight personnel of the helicopter-operating company and HEMS medical staff. Standardized procedures were developed. To our knowledge, no simulation-based training program for HEMS crew currently exists that specifically addresses the management of critically ill patients with radioactive contamination in such environments. This report aims to assess the validity of the training scenario based on newly established procedures throughout participant’s self-reported questionnaires.

Methods

An air medical and transport simulation training was conducted for life-threatening illnesses involving radioactive contamination at nuclear power stations. Participants completed self-reported evaluations using a 5-point Likert scale to assess the training.

Results

The specialized simulation scenario involved a patient with subarachnoid hemorrhage and suspected localized external contamination. The median scores for scenario-related scores were 1, indicating the highest levels of agreement, whereas the median scores for overall training and post-training feedback were 2, also demonstrating relatively high levels of agreement.

Conclusion

In our experience, simulation training scenarios involving critically ill patients with radioactive contamination in nuclear facilities enhance the competencies of both flight personnel and HEMS medical staff. These scenarios also support smoother implementation of HEMS responses to incidents within nuclear facilities and provide a basis for ongoing refinement and improvement of operational procedures.

目的直升机紧急医疗服务（HEMS）人员需要根据其独特的操作需求进行专门培训和持续的技能发展。这些要求可能包括在放射控制区内管理受放射性污染的危重病人，以确保提供高质量的护理和安全。直升机运营公司飞行人员的安全与HEMS医护人员的安全，经过相关部门的多次讨论，形成了统一的共识。制定了标准化程序。据我们所知，目前还没有针对急救人员的模拟培训计划，专门针对在这种环境中放射性污染的危重病人的管理。本报告旨在评估基于参与者自我报告问卷新建立程序的培训方案的有效性。方法开展核电站放射性污染危及生命疾病的空中医疗和运输模拟培训。参与者使用5分李克特量表完成自我报告评估来评估培训。结果专门的模拟场景涉及1例蛛网膜下腔出血患者，怀疑局部外部污染。场景相关得分的中位数为1，表明一致性的最高水平，而总体训练和训练后反馈的中位数得分为2，也表明了相对较高的一致性水平。结论根据我们的经验，核设施放射性污染危重病人的模拟训练场景可以提高飞行人员和HEMS医务人员的能力。这些情景还支持在核设施内更顺利地实施HEMS响应，并为持续改进和改进操作程序提供基础。

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引用次数: 0

Use of Health Care Simulation in Air Medical Settings: A Scoping Review 在空气医疗环境中使用卫生保健模拟：范围审查

Q3 Nursing

Air Medical Journal

Pub Date : 2026-01-01 Epub Date: 2025-11-11 DOI: 10.1016/j.amj.2025.10.004

William B. Belk MSc , Marybeth Wiedemann MSc , Paul O’Connor PhD , Roisin O’Malley PhD

Objective

Simulation-based training is well suited to unique and high-risk settings such as air medicine. Given that the use of simulation to educate air medical professionals continues to grow, there is a need to understand how simulation-based training methods have been used in air medicine thus far. This scoping review aimed to explore the use of simulation as a training method for air medical professionals.

Methods

The current review was conducted according to the 5-step process established by Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Five electronic databases were searched, alongside gray literature and reference list screening. Studies that used simulation-based methods to train air medical professionals were included.

Results

Of the 21 included studies, most programs used scenario-based simulation (65.0%), multimodal simulation (30.0%), or simulated participants (5.0%). Simulation programs typically involved native teams and targeted team development (50.0%) or focused on contextualized clinical skill building with partial teams (40.0%), whereas a single study focused on hands-on instruction of foundational clinical skills (5.0%) and observed and debriefed teams in the clinical setting (5.0%). The most common form of assessment was of reactions to the simulation program (55.0%), followed by changes in learning (45.0%), behavior (5.0%), and organizational impact (5.0%).

Conclusion

Research is required to identify the unique needs of the air medical setting and develop effective and feasible methods to address learning outcomes, the impact of which must be evaluated. Simulation should be embedded into air medical training programs, and educators should be supported with the resources, materials, and learning facilities needed to develop effective simulation programs.

目的以模拟为基础的训练非常适合于特殊和高风险的环境，如空气医学。鉴于利用模拟技术对航空医疗专业人员进行教育的情况不断增加，有必要了解迄今为止在航空医学中如何使用基于模拟的培训方法。这一范围审查的目的是探讨将模拟作为空中医疗专业人员的一种培训方法。方法本综述按照Arksey和O 'Malley建立的5步流程和系统评价的首选报告项目和范围评价的元分析扩展进行。检索了5个电子数据库，以及灰色文献和参考文献列表筛选。包括使用基于模拟的方法培训航空医疗专业人员的研究。在21项纳入的研究中，大多数项目使用基于场景的模拟（65.0%）、多模式模拟（30.0%）或模拟参与者（5.0%）。模拟项目通常涉及本地团队和目标团队发展（50.0%），或者侧重于局部团队的情境化临床技能建设（40.0%），而单一研究侧重于基础临床技能的实践指导（5.0%），并在临床环境中观察和报告团队（5.0%）。最常见的评估形式是对模拟程序的反应（55.0%），其次是学习变化（45.0%），行为变化（5.0%）和组织影响（5.0%）。结论需要进行研究，以确定空中医疗环境的独特需求，并制定有效可行的方法来解决学习结果，必须评估其影响。模拟应该嵌入到空中医疗培训计划中，教育工作者应该得到开发有效模拟计划所需的资源、材料和学习设施的支持。

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引用次数: 0

Obesity Status Is a Predictor of Prolonged Interfacility Transport by Air Ambulance: A Population-Based Retrospective Cohort Study 肥胖状况是空中救护延长设施间运输的一个预测因素：一项基于人群的回顾性队列研究

Q3 Nursing

Air Medical Journal

Pub Date : 2026-01-01 Epub Date: 2025-09-21 DOI: 10.1016/j.amj.2025.08.012

Setti I. Belhouari MD , Brodie T. Nolan MD, MSc , James J. Jung MD, PhD

Objective

Delays in access to emergency care are potentially detrimental to patient health. Evidence suggests that patients with obesity may be more prone to delays in health care settings.

Methods

The primary objective of this study is to determine whether obesity status is an independent predictor of prolonged interfacility transport by air ambulance to access definitive care in Ontario, Canada. This was a population-based retrospective cohort study of all emergent interfacility transfers of patients, at least 16 years of age, performed by Ontario’s sole air ambulance provider, a total of 15,466 patients, from January 2017 to December 2020. Six different time intervals were identified during the patients’ transfers from the site of emergency to a sending facility and, then, to a receiving facility. Obesity status was defined by the ambulance provider as weight ≥120 kg, and covariables included patient-, paramedic-, and institution-level characteristics. The primary outcome was the change in total modifiable time of transfer, defined as the sum of the 6 time intervals. Multivariable regression analyses explored the relationship between obesity status and total modifiable time after risk adjustment.

Results

Of the 15,466 patients transferred, 739 (4.8%) were classified with obesity status. The median total modifiable time was 137 minutes. Obesity status was associated with increase of 41 minutes in total modifiable time (95% confidence interval, 14-67 minutes; P < .01). Use of a rotor aircraft was associated with a reduction in total modifiable time of 154 minutes (95% confidence interval, 131-177 minutes; P < .01).

Conclusion

Obesity status was associated with an increase in modifiable duration of emergent air ambulance interfacility transfers in Ontario.

目的延迟获得紧急护理可能对患者健康有害。有证据表明，肥胖患者可能更容易在医疗机构延误。方法本研究的主要目的是确定肥胖状况是否是加拿大安大略省通过空中救护车获得最终护理的设施间运输的独立预测因素。这是一项基于人群的回顾性队列研究，对2017年1月至2020年12月期间由安大略省唯一的空中救护提供者执行的所有16岁以上患者的紧急设施间转移，共15466例患者进行了研究。在病人从急诊地点转移到发送设施，然后再转移到接收设施期间，确定了六个不同的时间间隔。救护车提供者将肥胖状态定义为体重≥120 kg，协变量包括患者、护理人员和机构层面的特征。主要结果是总可修改转移时间的变化，定义为6个时间间隔的总和。多变量回归分析探讨了肥胖状况与风险调整后总可调整时间的关系。结果15466例转院患者中，739例（4.8%）为肥胖。总可修改时间中位数为137分钟。肥胖状态与总可调整时间增加41分钟相关（95%置信区间，14-67分钟；P < 0.01）。使用旋翼飞机可减少154分钟的总可修改时间（95%置信区间，131-177分钟；P < 0.01）。结论肥胖状况与安大略省紧急空中救护设施间转移的可修改时间增加有关。

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引用次数: 0

Transitioning From Fire-Based EMS to Critical Care Flight Medicine 从基于火灾的EMS到重症监护飞行医学的转变

Q3 Nursing

Air Medical Journal

Pub Date : 2026-01-01 Epub Date: 2025-11-22 DOI: 10.1016/j.amj.2025.10.008

Christopher A. Warren NRP, FP-C, CCP-C

Transitioning from fire-based emergency medical services to the world of critical care flight medicine represents a dramatic professional evolution. This shift demands not only new clinical competencies but also a profound transformation in mindset, autonomy, and operational readiness. Fixed-wing critical care flight paramedics must master complex equipment, medications, and physiology under unique constraints, including altitude and international operations. This subject review explores the nuances of this transition from firsthand experience, offering insight to clinicians considering or undergoing the shift into aeromedical transport.

从火灾紧急医疗服务到重症监护飞行医学的过渡代表了一个戏剧性的专业演变。这种转变不仅需要新的临床能力，还需要在思维方式、自主性和操作准备方面进行深刻的转变。固定翼危重病护理飞行护理人员必须掌握复杂的设备，药物和生理在独特的约束条件下，包括高度和国际操作。本主题综述从第一手经验探讨了这种转变的细微差别，为考虑或正在转变为航空医疗运输的临床医生提供了见解。

引用次数: 0

Prehospital Symptom Management for Pediatric Patients 儿科患者院前症状管理

Q3 Nursing

Air Medical Journal

Pub Date : 2026-01-01 Epub Date: 2025-11-22 DOI: 10.1016/j.amj.2025.10.011

Ashley A. Macdonald ACP , Jonathan Lee CCP , Aaron J. Lacy MD, MHPE , James L. Li MD, MEd, FAEMS

引用次数: 0

Pilot Study Assessing Feasibility of Focused Newborn Cardiac Ultrasound by Transport Team Members to Identify Hypoxemic Congenital Heart Disease 初步研究评估转运小组成员集中新生儿心脏超声识别低氧先天性心脏病的可行性

Q3 Nursing

Air Medical Journal

Pub Date : 2026-01-01 Epub Date: 2025-10-18 DOI: 10.1016/j.amj.2025.09.007

Brittany Shutes MD, MPH , Jonathan A. Wheeler MD , Charles McCombs MD , Caleb Carmin RN , Samantha Gee MD , Karen Texter MD , John Kovalchin MD , Clifford L. Cua MD , Delia Gold MD

Objective

Hypoxemia is a common presentation of neonatal critical illness. Identifying critical congenital heart disease (CHD) causing hypoxemia is pivotal in determining immediate medical management. In this work, the preliminary results from development of a transport team–focused cardiac ultrasound (US) protocol were presented.

Methods

Phase 1 involved baseline survey of transport team motivation and prior experience followed by structured education and hands-on simulation sessions to teach the basics of cardiac anatomy and US. Participants complete pre- and post-education knowledge assessments. In phase 2, participants performed supervised bedside US on hospitalized infants to practice skills, familiarize themselves with the handheld US device, and learn the focused cardiac US protocol. The US images were compared with a recent comprehensive echocardiogram and assessed for image quality and diagnostic certainty by 2 pediatric cardiologists.

Results

A total of 25 transport team members completed paired pre- and post-testing in phase 1. They had high team member motivation to improve US skills and cardiac anatomy knowledge and demonstrated improved post-education scoring with median score increasing from 20/43 (47%) (interquartile range [IQR]: 17-25) to 34/43 (79%) (IQR: 34-41.5) (P < .05). In phase 2, 17 transport members completed 42 scans on 14 unique infants, 10 with CHD. Of 42 scans, 39 (93%) had sufficient image quality to make a diagnosis, with 37 (88%) having “high” diagnostic certainty and 36 (86%) matched complete transthoracic echocardiogram, without missed diagnosis. The median completion time was 17 (IQR: 12.8-20.6) minutes.

Conclusion

The first 2 phases of this study have demonstrated that transport team members can use handheld US technology to obtain timely and sufficient quality cardiac images to allow for identifying and triaging of CHD in infants. This novel, resource-conscious application has the potential to streamline the care of hypoxemic newborns after undergoing protocol efficiency refinement, independent proficiency testing, and study of remote application.

目的低氧血症是新生儿危重症的常见表现。识别严重的先天性心脏病（CHD）引起低氧血症是决定立即医疗管理的关键。在这项工作中，提出了一种以运输团队为中心的心脏超声（US）方案的初步结果。方法第一阶段包括对运输团队动机和先前经验的基线调查，随后是结构化的教育和动手模拟课程，教授心脏解剖学和US的基础知识。参与者完成教育前和教育后的知识评估。在第二阶段，参与者对住院婴儿进行有监督的床边超声，以练习技能，熟悉手持式超声设备，并学习重点心脏超声方案。美国图像与最近的综合超声心动图进行比较，并由2名儿科心脏病专家评估图像质量和诊断确定性。结果在第一阶段，共有25名运输团队成员完成了配对的前后测试。他们有很高的团队成员动机来提高美国技能和心脏解剖知识，并表现出教育后得分的提高，中位数得分从20/43(47%)（四分位数间距[IQR]: 17-25）增加到34/43 (79%)(IQR: 34-41.5) （P < 0.05）。在第二阶段，17名运输人员对14名婴儿进行了42次扫描，其中10名患有冠心病。在42次扫描中，39次（93%）具有足够的图像质量进行诊断，37次（88%）具有“高”诊断确定性，36次（86%）匹配完整的经胸超声心动图，没有漏诊。中位完成时间为17分钟（IQR: 12.8-20.6）。本研究的前两个阶段表明，运输团队成员可以使用手持式超声技术获得及时、充分、高质量的心脏图像，从而识别和分诊婴儿冠心病。这种新颖的、具有资源意识的应用程序在经过方案效率改进、独立能力测试和远程应用研究后，具有简化低氧新生儿护理的潜力。

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引用次数: 0

Operation of Doctor Helicopters in Eastern Shizuoka Prefecture During the Tsunami Caused by the Massive Earthquake Near the Kamchatka Peninsula 在堪察加半岛附近大地震引发海啸期间，医生直升机在静冈县东部的运作

Q3 Nursing

Air Medical Journal

Pub Date : 2026-01-01 Epub Date: 2025-10-08 DOI: 10.1016/j.amj.2025.09.002

Youichi Yanagawa MD, PhD

On July 30, 2025, at approximately 08:25, a magnitude 8.7 earthquake occurred near the Kamchatka Peninsula. Although the earthquake itself caused no direct damage in eastern Shizuoka Prefecture, a tsunami was predicted to reach Japan, prompting the issuance of a tsunami warning. In response to the forecast—predicting tsunami heights of up to 3 m in eastern Shizuoka—operations of the physician-staffed helicopter were relocated to an inland landing site, away from the coastal area, to ensure the safety of patients, medical personnel, and the aircraft. To the best of our knowledge, no similar operational reports have been published in English-language medical literature. This report was therefore compiled as a reference for future documentation and disaster preparedness.

2025年7月30日，大约8时25分，堪察加半岛附近发生了8.7级地震。虽然地震本身没有对东部静冈县造成直接破坏，但据预测海啸将到达日本，促使日本发布了海啸预警。根据预测，静冈东部的海啸高度可达3米，为此，配备医生的直升机的操作被转移到远离沿海地区的内陆着陆点，以确保患者、医务人员和飞机的安全。据我们所知，英语医学文献中没有发表过类似的手术报告。因此，编写这份报告是作为今后文件编制和备灾的参考。

引用次数: 0

External Ventricular Devices in Air Medical Retrievals 空气医学检索中的外心室装置

Q3 Nursing

Air Medical Journal

Pub Date : 2026-01-01 Epub Date: 2025-09-24 DOI: 10.1016/j.amj.2025.08.004

Anita Wall BNSc, PGCertNSc (Int Care), DipMid, MAdvNPrac, PGCertNSc (Clin Teach), Grad Cert in Education , Clinton Gibbs MBBS, FACEM, MPHTM, DipDHM, PGCertAeromedRet , Lachlan Quick MBBS, FACEM, FCICM , Jan Sadewasser MBBS, FACEM, FRCEM, AFACAsM , Katie Clift MBChB, MRCS, FRCA, FANZCA , Richard C. Franklin PhD, MScoSci, FARLF, PHFAA

Objective

Describe the clinical characteristics of patients with an external ventricular drain (EVD) air medically retrieved.

Methods

A retrospective chart audit of adults with an EVD air medically retrieved between January 2018 and June 2022 was conducted using the Retrieval Services Queensland database. Patients with a diagnosis of subarachnoid hemorrhage were identified, and then a manual review was conducted to identify EVD cases.

Results

A total of 60 patients met the review criteria. However, 34 patients did not have an EVD in situ, 1 was not transported, and 2 charts were non-retrievable, leaving 21 patients in this review. Of the patients, 76% were mechanically ventilated and 10% had no EVD drainage (suspected to be blocked). Blood pressure fluctuations occurred in 67% of the cases (79% during flight). Separate analgesia/anesthetic infusions were administered in 75% of the patients, with 83% requiring rate increases and 100% requiring boluses for increases in blood pressure. Hypertension in 3 patients occurred post-EVD being turned off and resolved when EVD was turned back on, and bolus sedation/analgesia was provided.

Conclusion

The air medical transport of patients with an EVD is a low-frequency transfer. Therefore, the use of clinical practice guidelines will enable best practice assessment and management.

目的探讨经医学检索的室外漏（EVD）患者的临床特点。方法使用昆士兰检索服务数据库对2018年1月至2022年6月期间医学检索到的EVD成人病例进行回顾性图表审计。诊断为蛛网膜下腔出血的患者被确定，然后进行人工审查以确定EVD病例。结果60例患者符合审查标准。然而，34例患者没有原位EVD， 1例未被转移，2例图表不可检索，本综述中有21例患者。76%的患者进行了机械通气，10%的患者没有EVD引流（怀疑有阻塞）。67%的病例出现血压波动（79%在飞行期间）。75%的患者进行了单独的镇痛/麻醉输注，其中83%的患者需要增加血压，100%的患者需要大剂量的血压升高。3例患者在EVD关闭后出现高血压，并在EVD重新打开并给予大剂量镇静/镇痛后得到解决。结论埃博拉病毒病患者的空运医疗转运是一种低频转移。因此，使用临床实践指南将使最佳实践评估和管理成为可能。

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引用次数: 0

Corrigendum to “Comparison of the Agreement and Accuracy Between Paramedic and Hospital Diagnosis” Air Medical Journal, Volume 41 (2022), Pages 228-232 《护理人员和医院诊断的一致性和准确性比较》的勘误表《空中医学杂志》，第41卷（2022年），228-232页

Q3 Nursing

Air Medical Journal

Pub Date : 2026-01-01 Epub Date: 2025-11-12 DOI: 10.1016/j.amj.2025.10.001

Mahdi Mokhtari

引用次数: 0

Prospective Development and Validation of a Weight Prediction Tool for Patients With Obesity Undergoing Critical Care Transport Using Width and Arm Circumference 使用宽度和臂围预测肥胖症危重患者体重预测工具的前瞻性开发和验证

Q3 Nursing

Air Medical Journal

Pub Date : 2026-01-01 Epub Date: 2025-10-12 DOI: 10.1016/j.amj.2025.09.004

Kenneth Williams MD, MSc , Michael Peddle MD , Justin Smith BHA, MBA , Mahvareh Ahghari MEng , Brodie Nolan MD, MSc

Objective

Obesity rates are rising, affecting health care systems and causing potential delays in critical care transfers. Accurate weights are important for critical care transport to ensure the appropriate transport asset is selected and dispatched in a timely fashion. Inaccurate weight measurements can lead to various unnecessary delays, including not sending appropriate nonbariatric assets, delays due to secondary dispatch, and delays due to systemic overuse of these bariatric capable assets. The primary objective of this study was to develop and validate a weight prediction tool for patients with obesity undergoing critical care transport. The secondary objective was to compare the performance of this model to the Crandall weight prediction tool.

Methods

A prospective observational study was conducted, collecting data from patients transported by Ornge air ambulance between May 2022 and April 2023. Adults weighing >100 kg undergoing interfacility transfers were included. Four predictive models, using height, arm circumference, width, and girth measurements, were evaluated against actual patient weights and analyzed separately for males and females. Model performance was evaluated by mean squared error, mean absolute error (MAE), mean absolute percentage error, R², and F-statistic.

Results

The Ornge model using arm circumference and width demonstrated the highest accuracy and stability in predicting patient weight for both males and females. This model exhibited the lowest MAE of 12.2 kg, was within a margin of 20% error 91.2% of the time, and had an overall false negative error of 6.9%, outperforming all other models.

Conclusion

The Ornge arm circumference and width-based model offers a reliable method for predicting patient weight in air ambulance settings. Implementing this tool could improve the efficiency and safety of patient transfers by reducing delays caused by inaccurate weight estimations, thereby expediting access to critical care. Further research is recommended to validate these findings in larger and more diverse populations.

肥胖率正在上升，影响到卫生保健系统，并造成重症监护转移的潜在延误。准确的重量对于重症监护运输非常重要，以确保及时选择和派遣适当的运输资产。不准确的体重测量可能导致各种不必要的延迟，包括不发送适当的非减肥资产，由于二次调度造成的延迟，以及由于系统过度使用这些减肥能力资产造成的延迟。本研究的主要目的是为接受重症监护转运的肥胖患者开发和验证体重预测工具。第二个目标是比较该模型与克兰德尔权重预测工具的性能。方法开展前瞻性观察研究，收集2022年5月至2023年4月期间由orange空中救护车运送的患者数据。体重100公斤的成年人也包括在内。使用身高、臂围、宽度和周长测量的四种预测模型与实际患者体重进行了评估，并分别对男性和女性进行了分析。通过均方误差、平均绝对误差（MAE）、平均绝对百分比误差、R2和f统计量来评价模型的性能。结果使用臂围和臂宽的奥兰治模型在预测男性和女性患者体重方面显示出最高的准确性和稳定性。该模型的MAE最低，为12.2 kg，误差在20%范围内的概率为91.2%，总体假阴性误差为6.9%，优于所有其他模型。结论基于奥兰治臂围和臂宽的模型是预测空中救护中患者体重的可靠方法。实施这一工具可以减少因体重估计不准确造成的延误，从而提高患者转移的效率和安全性，从而加快获得重症监护的速度。建议进一步研究以在更大和更多样化的人群中验证这些发现。

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引用次数: 0