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Pre-Hospital Care
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Even if HEMS teams land at the scene of an accident, many patients will still be transferred by road ambulance. Helicopter transfer of patients has advantages in terms of transfer time to hospital but also has many disadvantages. Air transport is very noisy, it is difficult to communicate in-flight, vibrations from the engine cause disruptions in monitoring and can dislodge medical kit and travel sickness is a risk to patients. Once loaded onto a helicopter there is little space to manoeuvre a patient and it becomes very difficult to carry out procedures en route—such as CPR or thoracostomy. A ground-based land ambulance can easily pull over, should interventions need to be carried out during transport. Moreover, loading and disembarking from an aircraft with a critically unwell patient takes a number of minutes and often offsets the time saved versus land transportation.
Abdominal Injuries
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
A decision for laparotomy at this echelon of care depends on the current circumstances: resources, mass casualty admission, possibility of rapid transportation, duration of the evacuation. In an ideal scenario with air transport immediately available and close location of a rear-deployed hospital (a Role 3 MTF), a stable patient may be safely evacuated. In a less-than-ideal scenario (darkness, a sandstorm, hostile activity), a more aggressive approach must be undertaken. There is a significant risk of patient deterioration during transport; a stable patient with penetrating abdominal injury or with blunt injury and a significant amount of blood in the abdomen has to undergo surgical exploration. It may turn out to be non-therapeutic intervention, but it helps mitigate life-threatening intra-abdominal injuries. Patients with haemodynamic compromise and suspected abdominal injuries undergo immediate laparotomy.
Creating a supportive environment for optimal family practice
Published in Michael Kidd, Cynthia Haq, Jan De Maeseneer, Jeffrey Markuns, Hernan Montenegro, Waris Qidwai, Igor Svab, Wim Van Lerberghe, Tiago Villanueva, Charles Boelen, Cynthia Haq, Vincent Hunt, Marc Rivo, Edward Shahady, Margaret Chan, The Contribution of Family Medicine to Improving Health Systems, 2020
Michael Kidd, Cynthia Haq, Jan De Maeseneer, Jeffrey Markuns, Hernan Montenegro, Waris Qidwai, Igor Svab, Wim Van Lerberghe, Tiago Villanueva, Charles Boelen, Cynthia Haq, Vincent Hunt, Marc Rivo, Edward Shahady, Margaret Chan
Associations and networks of health professionals practicing in disadvantaged areas provide additional support. When resources are available, air transport has the potential to reduce isolation and speed the transfer of emergency patients from rural areas. Modern communication tools such as the Internet and satellite-based telephones may be used to provide rapid consultation and reduce the isolation of rural health professionals anywhere in the world. Professional associations offer opportunities for education, networking, problem solving, recognition, and other important social benefits.Box 5.14.lists some ways of attracting family doctors to work in disadvantaged areas.
Appropriate Air Medical Services Utilization and Recommendations for Integration of Air Medical Services Resources into the EMS System of Care: A Joint Position Statement and Resource Document of NAEMSP, ACEP, and AMPA
Published in Prehospital Emergency Care, 2021
John W. Lyng, Sabina Braithwaite, Heidi Abraham, Christine M. Brent, David A. Meurer, Alexander Torres, Peter V. Bui, Douglas J. Floccare, Andrew N. Hogan, Justin Fairless, Ashley Larrimore
Stakeholders should work to identify and adopt objective, evidence-based criteria to drive decisions to request air medical services for both scene response and interfacility transfers based on the clinical, safety, and economic considerations discussed previously. When such objective criteria are not able to be used, education should be provided to personnel who are in positions to request air resources regarding the local air and ground EMS response capabilities and limitations, and air medical services utilization, inclusion, and cancelation criteria (126, 135). EMS oversight bodies must establish protocols addressing authorized requestors, dispatching, communication requirements, and quality assurance. State governments will likely provide the majority of the oversight, rules, and regulations for air medical services utilization. Minimal training requirements for health care clinicians on air transport services in that system should also be clearly presented.
An application of fuzzy logic on importing medicines
Published in International Journal of Healthcare Management, 2021
Binayak S. Choudhury, Partha S. Dhara, P. Saha
In our protocol, we take into account the three parameters, namely, the transportation cost, tax and the domestic market price. Other factors can be as well taken into consideration and included in the protocol. We take three representative factors to illustrate the protocol. All these three factors may be widely varying over the set of countries. The transportation cost may be low if imported from a neighbouring country while it may be very high if it has to be transported from a country which is situated in the other part of the globe requiring air transport. Taxations have very wide variations across different countries. The costs of medicines in the respective domestic markets of the foreign countries may also be very different from one country to another. Further all these factors depend on volatile factors like political parameters, exchange rates, etc. It is difficult to project certain estimated value of these quantities for the long run. This is why it is pragmatic to represent them by fuzzy numbers. A particular feature of the protocol is that no defuzzification is involved here which amounts to a substantial simplification of the scheme.
Predictors of Definitive Airway Sans Hypoxia/Hypotension on First Attempt (DASH-1A) Success in Traumatically Injured Patients Undergoing Prehospital Intubation
Published in Prehospital Emergency Care, 2020
Elizabeth K. Powell, William R. Hinckley, Uwe Stolz, Andrew J. Golden, Amanda Ventura, Jason T. McMullan
Traumatic injuries are the leading cause of death in persons age 1–44 and account for 214,000 deaths each year (1). Many of these traumatically injured patients will require air transport, and some will require advanced airway intervention. Out-of-hospital intubations are challenging due to poor lighting, oral secretions/blood and emesis, limited personnel with varying degrees of training, and the physical location of the patient. Despite the difficulty in intubating in the prehospital environment, prehospital intubation of traumatically injured patients by helicopter EMS crews can lead to improved outcomes (2, 3). However, increased morbidity and mortality have also been associated with prehospital intubation due to peri-intubation hypoxia, hypotension, and hyperventilation (4, 5).