Nationwide status of aeromedical pre-hospital and retrieval medicine in Australia.

OBJECTIVE: To survey the current structure, capability and operational scope of pre-hospital and retrieval aeromedical teams across Australia. METHODS: The medical directors of all Australian civilian adult aeromedical retrieval organisations with pre-hospital teams and/or doctors for inter-hospital critical care patient transport were contacted in a survey to qualitatively assess capacity and team structure. RESULTS: All 17 organisations contacted completed the survey. While there is diversity in team structure with the pairing of doctors, paramedics and nurses, capacity for patient care is generally homogenous. A doctor/paramedic model is the more common team structure for rotary-wing missions, and doctor/nurse for fixed-wing. Differences are mostly due to state government controlled aspects of their health services. An advanced degree of intensive patient care occurs outside of the hospital. Land and sea rescue is an important aspect of Australian aeromedical work. CONCLUSION: Aeromedicine in Australia has many consistent elements, but variable contexts have resulted in a diversity of operational models.

External Aortic Compression in Noncompressible Truncal Hemorrhage and Traumatic Cardiac Arrest: A Scoping Review.

External aortic compression has been investigated as a treatment for non-compressible truncal haemorrhage in trauma patients. We sought to systematically gather and tabulate the available evidence around external aortic compression. We were specifically interested in its ability to achieve hemostasis and aid in resuscitation of traumatic arrest and severe shock and to consider physiological changes and adverse effects. A scoping review approach was chosen due to the highly variable existing literature. We were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, using the specific extension for scoping reviews. Searches were done on PubMed and Scopus databases in October 2020. We found that a range of studies have investigated external aortic compression in a variety of settings, including case reports and small case series, porcine hemorrhage models and effects on healthy volunteers. External aortic compression for postpartum hemorrhage in a single center provided some evidence of effectiveness. Overall the level of evidence is limited, however, external aortic compression does appear able to achieve cessation of distal blood flow. Furthermore, it appears to improve many relevant physiological parameters in the setting of hypovolemic shock. Application for more than 60 minutes appears to cause increasingly problematic complications. In conclusion we find that the role of external aortic compression warrants further research. The intervention may have a role as a bridge to definitive treatment of noncompressible truncal haemorrahge.

Advanced Ventilation and Monitoring During Helicopter Hoist Extraction of an Intubated Patient.

The intubated and ventilated patient in austere and inaccessible environments requiring helicopter hoist extraction presents significant procedural and logistical challenges. This case report describes the use of a mechanical ventilator and visible advanced monitoring throughout the entirety of the patient journey from the prehospital scene to the hospital, including the period during hoist extraction as human external cargo.

Ventilation of intubated patients during HEMS hoisting operations.

In response to the review "Advanced airway management in hoist and longline operations in mountain HEMS - considerations in austere environments: a narrative review." by Pietsch et al. we refer to recently published original research describing manual versus automatic ventilation of intubated patients during helicopter hoisting operations.

Ventilatory choices for intubated patients during helicopter stretcher winching.

INTRODUCTION: The winching of intubated patients on a stretcher into a helicopter is a rare event. Intermittent positive pressure ventilation is mandatory, which can either be performed manually with a self-inflating bag, or automatically using a portable ventilator. Theoretically automatic ventilation would provide improved oxygenation, more stable arterial carbon dioxide levels and a reduced risk of airway disconnection. Furthermore, the stretcher attendant may better perform winching procedures with higher situational awareness, contributing to crew and patient safety. However ventilator failure, and the diagnosis and management of such, is of concern. OBJECTIVE: The aim of this study is to compare automatic against manual ventilation during intubated helicopter stretcher winching. METHOD: The trial had two phases. Initially a static winch on a hoist simulator was performed, followed by live winching into a helicopter. All stretcher attendants performed two winches with an intubated manikin. During one winch, the manikin was manually ventilated, and an automatic ventilator was used for the other. Airway pressures were measured. RESULTS: Automatic ventilation did not fail. Compared with automatic ventilation, manual ventilation displayed significant pauses, inconsistent rates and both high and low airway pressures. Automatic ventilation permitted better situational awareness and performance in winching manoeuvres. One airway disconnection occurred during manual ventilation. CONCLUSIONS: During helicopter winching, automatic ventilation is superior in providing controlled, consistent and reliable ventilation for intubated patients. The stretcher attendant is also able to provide more attention to the winching manoeuvres with subsequent safety gains. The risk of automatic ventilator failure is low.