Evaluation of the helicopter in aeromedical transfers.

Since the end of the Vietnam conflict, the technology of moving patients by helicopter has been applied to peacetime uses. There is doubt, however, that the helicopter has much to offer the patient when used as a routine and semi-emergency ambulance. This study reviewed 52 consecutive aeromedical evacuation requests which included both civilian and military patients. By comparing the patient's condition at both pickup, delivery and his subsequent course, it was determined that most patients would not have been unduly harmed by the slower methods of ground transfer. Only 33% of the patients were benefitted by rapid aeromedical transfer. Those patients benefitted can roughly be grouped as true surgical and medical emergencies. The use of the helicopter for routine transfers is to be discouraged.     

直升机应急医疗救治现状与发展

目的 综述国内外有关直升机应急医疗救护的发展情况. 资料来源与选择国内外该领域的相关文献. 资料引用引用国内外公开发表的文献资料36篇. 资料综合本文回顾了直升机医疗救护的历史及现状、直升机医疗救护的应用以及我国直升机医疗救护的发展情况,提出了对我国直升机医疗救护工作的发展建议. 结论 直升机应急医疗救护具有反应迅速、机动性强、受气候条件影响较小等优点而广泛应用于世界各国.直升机应急医疗救护为抢救人的生命尽可能地赢得时间,是适合现代医疗卫生的有效救治手段.中国在直升机应急医疗救护方面已取得长足进步,但与世界先进水平相比尚有很大距离,建立一支具有中国特色的直升机应急医疗救援体系十分必要. Abstract： Objective To review the domestic and abroad development of helicopter emergency medical service. Literature resource and selection Relevant articles published in China and abroad.Literature quotation Thirty-six published references were cited. Literature synthesis The paper reviewed the history and actuality of helicopter emergency medical service and its applications.The evolution in China was also reviewed and expected and the suggestions for future development were proposed. Conclusion Helicopter emergency medical service is being widely used in the world due to its advantages, such as rapid response, high flexibility, less weather influence, etc. It wins the furthest possibilities in saving people's life, and such effective rescue and cure concept is fitted to modern medication. China has made a remarkable progress in the development of helicopter emergency medical service but is still behind with the world's advanced stage. Building the system with Chinese characteristics would be the critical affair.     

Marie Marvingt and the development of aeromedical evacuation

The development of air ambulances was one of the most important advances in military medicine in the 20th century. It is often forgotten today how difficult a task it was to achieve military, governmental, popular, and medical support in the early years of the century for this then-heretical concept. While many individuals were involved in this development, one of the most influential and effective proponents was Mademoiselle Marie Marvingt, of France. One of the foremost sports-women of her day, she was a free balloon pilot, a surgical nurse, and the third woman in the world to receive her fixed-wing pilot's license. In the area of air evacuation, she was a true visionary, ordering the construction of an air ambulance in 1912, and devoting the remainder of her long life to gaining its full acceptance in the medical armamentarium. Unlike many visionaries, she lived to see the full adoption of her proposals; her efforts should forever be remembered whenever an air ambulance is seen.     

The aeromedical implications of atrial fibrillation

A retrospective study was undertaken to determine the incidence of spontaneous atrial fibrillation (AF) in a group of asymptomatic pilots. The electrocardiograms of 13,037 aircrew members accumulated between 1964 and 1986 were reviewed and those coded for AF were extracted. In each case an attempt was made to investigate factors relating to the onset, course, and prognosis of the AF. Eight subjects (mean age 50.1 years) were found to have AF. Of this group, two had a single isolated episode of AF for which a specific precipitating factor was implicated, three had recurrent paroxysmal AF of which one progressed to chronic persistent AF, and three had chronic persistent AF from the outset. The mean follow-up period for the eight subjects was 13.6 years. The two pilots who had isolated attacks of AF have thus far had no subsequent episodes of AF. Five of the remaining six have been completely well, while one required treatment for an embolus to his left leg. Concerning the aeromedical implications, we believe that pilots demonstrating single isolated episodes of AF in the presence of a normal heart, and in whom recovery is complete, should be allowed to return to full aviation duties on a waiver clause. Patients with chronic AF, lone AF, or paroxysmal AF should be excluded from all flying duties.     

直升机航空救护队员的飞行前培训

实施直升机航空救护时 ,易受飞行、气候条件、人员等因素影响。为充分发挥每个人的作用 ,飞行前对直升机救护队员 (包括急救队员和特勤队员 )进行航空知识及相关技能培训非常重要。一、对象与方法1 对象 :救护直升机上的机组乘员都应是被培训对象。只有通过良好的培训 ,才能保证直升机救护的顺利进行。直升机救护队员分为特勤队和急救队两部分 ,进行交叉培训。医疗队培训重点为航空知识及相关技能 ,特勤队重点培训基本急救常识。必要时协助舱内急救。搜救、吊运、逃生、特殊病人救援注意要点 ,可作为共同培训课目。2 方法 :(1)培训方法 :以…     

The basis for the development of a fuselage evacuation time for a ditched helicopter

HYPOTHESIS: When a helicopter ditches or crashes in water, unless the buoyancy bags are inflated, it commonly sinks inverted. Thus, crew and passengers must make an underwater escape. It is postulated that later passengers in the escape sequence do not have the breath-holding ability to conduct a successful escape, particularly if the water is cold. This contributes to the 20-50% mortality rate in survivable accidents. METHODS: There were 132 immersed subject evaluations which were conducted in daylight and darkness to measure escape times from a helicopter underwater escape trainer, configured to the Super Puma, seated for 15 and 18 passengers. The subjects were highly experienced instructors or Navy clearance divers. RESULTS: The time from when each subject's head disappeared underwater until each subject surfaced and total fuselage evacuation time were measured and any problems hampering escape were noted. Breath-holding for the last subject out ranged from 28 to 92 s. An emergency breathing system was used by a minimum of four subjects each time and a maximum of 11 subjects in one condition. The buoyancy of the survival suit was the principal component that hampered escape. CONCLUSION: Breath-holding times were too long for the later subjects to escape without resorting to an EBS, in spite of the fact that they were highly trained. For regular crew and passengers flying over water, this would explain the high mortality, etc. Therefore, a new helicopter standard should be developed requiring fuselage design to accommodate total evacuation within 20 s from underwater. For current helicopters, where this cannot be achieved, passengers should be provided with some form of air supply, or, after ditching, the helicopter should be modified so that it will stay afloat on its side and retain an air space in the cabin.     

Characteristics of patients transported by an aeromedical service for acute toxicologic emergencies: a 5-year experience

INTRODUCTION: Aeromedical services are used routinely in the prehospital and interhospital transfer of patients with trauma, neurosurgical, cardiac, and other conditions requiring specialized care. The use of aeromedical transport in patients with acute toxicologic emergencies is not well described. We sought to investigate and describe the characteristics of patients transported by our aeromedical service. SETTING: The study was performed at an urban critical care transport service operating both ground and aeromedical units and transporting an average of 3,362 patients per year during the study period. METHODS: Charts from the 5-year period of 2000 to 2004 for which a toxicologic emergency was coded as the primary diagnosis were identified and reviewed by the authors. Data abstracted included age, sex, toxin(s) involved, treatment rendered at the scene/bedside and en route by the transport team, and additional data (electrocardiogram [ECG] findings, serum levels) when appropriate. RESULTS: One hundred thirty-three patients were transported (for a total of 135 transports). Most (82%) were transported by air. Carbon monoxide was the most common toxic exposure, accounting for 16% of all transports. Fifty-seven percent of the patients were intubated, with 11% intubated by the flight crew. Antidotes were administered in 40 patients, with naloxone and bicarbonate being the most common. CONCLUSION: Acute toxicologic emergencies accounted for a small percentage of total transports. The most common additional intervention by flight crews was endotracheal intubation. Identification of common poisonings encountered by flight crews may assist services in developing education and quality assurance programs.     

A multicenter evaluation of the accuracy of prehospital eFAST by a physician-staffed helicopter emergency medical service

Emergency Radiology - The purpose of this study is to report the relative accuracy of prehospital extended focused assessment with sonography in trauma (eFAST) examinations performed by HEMS...     

The energy expenditure of helicopter pilots

The energy expenditure of Army Air Corps and Royal Air Force pilots has been measured during flight in Gazelle and Puma helicopters respectively. Heart rates were also recorded. The results were compared with resting values obtained in the crewroom before flight, and confirmed the findings of other authors that the energy cost of flying helicopters in level flight is about 50% higher than that of sitting at rest.     

A retrospective analysis of the intubations performed during 5 years of helicopter emergency medical service in Amsterdam

INTRODUCTION: Different skilled personnel perform prehospital airway management, by far one of the most challenging skills with major consequences upon failure. SETTING: The setting for this study was the helicopter emergency medical service at the Vrije Universiteit Medical Center, Amsterdam, the Netherlands. METHODS: We conducted a retrospective analysis of all medical charts of intubated trauma patients in the period from May 1995 to May 2000. We focused on intubation reasons and conditions. RESULTS: In 43 of 653 patients (7%) the process of intubation was recorded as being difficult, leading to 5 failed intubations (11.6%). In 432 of 653 trauma victims (66%), general anaesthesia was required before intubation. Forty (9%) of these patients died, most soon after arrival in the hospital. The clinical condition of 221 (34%) patients was so poor that they did not require additional drugs for intubation; 73% of those patients died, with two-thirds dying at the accident site. CONCLUSION: The rate of difficult intubation in this analysis is low (7%). The overall airway failure (11.6%) is the same as seen in the literature when sedation and relaxation are used. An adult trauma victim with a Revised Trauma Score of 0 has a very poor prognosis of survival.     

The use of chemical restraint in helicopter transport

Introduction: Helicopter transport of the combative patient is a major safety hazard facing air medical teams. Although physical restraints alone are helpful, the addition of chemical restraint (CR) often is necessary to control these patients while in flight.

Methods: A survey was conducted to determine the current practices of using nonparalyzing CR in air medical transport programs nationwide. The survey consisted of 24 questions on the use of CR during transport. Each U.S. program belonging to the Association of Air Medical Services was contacted by telephone, and a flight nurse or paramedic provided answers based on personal experience and statistics compiled by his or her individual program.

Results: Of the 100 programs responding, benzodiazepines were used most commonly to control agitation with 51% using midazolam. Patients with a head injury required CR more frequently than any other condition (73%). Crews flying larger aircraft reported less need for CR. A physician order was required by only 30% of the programs, but delays infrequently endangered the patient (2%). Only 7% of the responding programs had a patient whose condition deteriorated because of CR.

Conclusion: CR is necessary in air medical transport. Most programs use short-acting benzodiazepines. Crews in smaller aircraft use CR more frequently, and head injury is the most common condition requiring such restraint.     

用超文本标记语言开发外军卫生工作体制查询系统

为适应我军卫勤研究工作的需要，充分利用Ｉｎｔｅｒｎｅｔ军事医学信息资源，我们应用超文本标记语言开发了外军卫生工作体制查询系统。该系统的为１５个子系统，主要数据源自外军卫生工作体制手册，部分数据是可链接的外军军事医学机构的Ｉｎｔｅｒｎｅｔ节点。所有文字、图像和超文本标记语言（ＨＴＭＬ）进行显示标记和链接标记，锭接方向有纵向链接、向链接和外向链接，链接形式是文字、图像、声音三种信息媒体之间的链接。查询