A descriptive analysis of air medical directors in the United States.

INTRODUCTION: The purpose of this study was to describe the characteristics and functions of U.S. physician air medical directors. METHODS: This descriptive study included physician directors of U.S. rotor-wing and fixed-wing air medical services. Data were obtained using a standardized survey in regard to the training, education, and roles/responsibilities of directors of critical care air medical services (AMSs). RESULTS: Data from 153 of 276 surveys (55.4%) were analyzed and reported in this study. Air medical directors' residency training varied, but emergency medicine was the most frequently reported training type (38.0%). Most directors reported less than 5 years of job experience in AMS (57.3%), had neither residency/fellowship-based flight experience (63.9%) nor practical flight experience (60.5%), and performed director functions on a part-time basis (93.2%). The six most commonly reported medical director activities were medical protocol development (87.6%), quality improvement activities (86.3%), medical crew training (80.4%), administrative negotiations (79.1%), on-line medical control (71.9%), and personnel hiring (59.5%). The three most common sources of continuing education for medical directors were literature review (95.8%), attendance at medical conferences (79.2%), and participation in professional organizations (59.7%). CONCLUSION: These data describe the characteristics of U.S. air medical directors and identify physician contributions to patient care in the aviation environment.

Flight physiology. Clinical considerations.

Altitude-related complications and the stresses of flight represent the components of flight physiology. Understanding the complexities associated with patient management relative to barometric pressure changes and hypoxia is of paramount concern to air medical personnel. This article reviews flight physiology as well as appropriate precautions and interventions that must be practiced to provide optimal patient care at various altitudes.

Factors associated with the safety of EMS helicopters.

The accident rate for emergency medical service (EMS) helicopters is thought to be approximately twice the rate for other commercial (Part 135) helicopters. This observation has led to numerous news reports and to the publication of conclusions of a National Transportation Safety Board investigation. The data for these reports come from investigations of EMS helicopter accidents and incidents. The authors surveyed all listed civilian EMS helicopter programs to examine both helicopter ambulance mishaps and the number of safely completed missions. Epidemiological methods were then used to compare the safety records of different groups of EMS helicopters. The single most important factor identified was the number of flights made by the program during the study period: busy programs had an eightfold lower accident rate (P less than .0005) and a three-fold lower total mishap (accidents + incidents) rate (P less than .0005) than less active programs. Programs with the ability to fly under instrument flight rules (IFR) at the pilots discretion had no mishaps (P = .044) during the study period. Multivariate analysis shows this IFR capability to be marginally significant as an independent factor (P = .099).

Activity-sensing permanent internal pacemaker dysfunction during helicopter aeromedical transport.

STUDY OBJECTIVES: This study was designed to establish the frequency, magnitude, and possible etiologies of the dysfunction of activity-sensing internal pacemakers during helicopter aeromedical transport. DESIGN: Two models of Medtronic Activitrax pacemakers were attached externally to healthy adult volunteers. Each volunteer then was loaded into the helicopter and subjected to a flight sequence. Pacemaker firing rates throughout this sequence were recorded. SETTING: On separate days, Aerospatiale Dauphin and Twinstar helicopters completed a total of 23 flights. TYPE OF PARTICIPANTS: Four healthy adult volunteers, two men and two women, participated. INTERVENTIONS: These included intra- and inter-flight threshold re-programming and external magnet application. RESULTS: The average preflight pacemaker rate of 65 beats per minute increased to an average in-flight rate of 105 beats per minute, which resolved to preflight rates on shutdown. This pattern was consistently extinguished with external magnet application. CONCLUSION: The effect of rotor motion and flight vibration on the rate-response of the Activitrax pacemaker is both predictable and easily preventable. Possible guidelines for the safe transport of these patients, using pacemaker reprogramming or external magnet application, are examined.

Taking to the skies.

The role of Helicopter EMS must be to improve patient care and/or to ensure the most rapid transport of critically ill or injured patients. It has been suggested by Rhee et al, that the aeromedical service can be justified when the speed of the helicopter transport, the skills of the medical crew, and/or the ability of the helicopter to overcome environmental obstacles is likely to contribute to improved patient outcome. If one adds the essentials of well-trained, professional personnel and equipment, the "helicopter" becomes an important part of the overall medical care system and an essential component in improving patient outcome. While reviewing the role of the HEMS, it cannot be sufficiently emphasized that such a service in no way replaces an established ground ambulance system. A proficient, well-trained and well-equipped ground EMS program remains the backbone of an efficient pre-hospital and interhospital system. HEMS cannot be viewed as an isolated component of any EMS system. Instead, it must serve to complement the existing resources of the community. These is sufficient literature to suggest that the use of air medical services in transporting patients to tertiary care facilities or trauma centers has led to an improvement in overall survival rates. At the same time, an apparent paradox in mortality rate has occurred at the receiving hospital. While more patients are saved by speedy transport to a hospital, the mortality rate in that hospital may actually increase. Some patients who may have died from their injuries at the scene, or in transit, now die upon admission.(ABSTRACT TRUNCATED AT 250 WORDS)