Air Medical Transport of Trauma Patients

This report reviews the current status of air medical transportation of trauma patients. Aspects reviewed include patient care, dispatch, safety, andpossible future directions in air medical patient care.     

Heart rate and leukocytes after air and ground transportation in artificially ventilated neonates: a prospective observational study

Objective  To evaluate the effect of interhospital air and ground transportation of artificially ventilated neonates on heart rate and peripheral blood leukocyte counts. Design  Prospective, observational study. Setting  Level III multidisciplinary Neonatal and Pediatric Intensive Care Unit. Patients  Fifty-eight near-term artificially ventilated transported neonates between May 2006 and April 2007. Interventions  Day-helicopter, day- and night-ground transportation. Measurements and results  Heart rate at retrieval, on admission to the ICU and 1 h later, and peripheral blood leukocyte counts on admission and 1 d later were compared. Fifteen neonates were transported by helicopter during the daytime (D-HEL), 20 by daytime ground and 23 by nighttime ground transportation (D-GROUND, N-GROUND). No differences in delivery mode, birth weight, gestational age, gender, primary diagnoses for transportation, response time and duration of transportation were found between the groups. Similarly, no differences in pH, pCO₂, blood pressure and skin temperature at retrieval and on admission to the ICU were found between the three groups. The mean heart rate at retrieval did not differ significantly, while on arrival in the ICU and 1 h later the D-GROUND group of patients showed a significantly higher mean heart rate compared to the D-HEL and N-GROUND groups. Moreover, leukocyte counts on arrival in the ICU showed significantly higher leukocyte counts in the D-GROUND group of patients compared to the D-HEL group of patients. Conclusions  These results demonstrate that there is an association between daytime ground transportation and higher heart rate and peripheral blood leukocytes.     

急诊危重患者转运护理进展

急诊护理是急诊医学的重要组成部分,是一门用最少数据、最短时间和最佳技能来挽救患者生命,减轻患者痛苦的专业艺术,它直接体现了医院的综合技术水平和服务水平。急诊患者中大多数为危重患者,发病突然、病情凶险、变化快、随时可能危及生命,必须分秒必争进行抢救。研究表明,伤后60分钟是决定伤员生死的关键时刻,属危重抢救阶段,被称为抢救的黄金时间,要求医护人员把有效的初步急救措施,以最快的速度送到患者身边,进行基础生命支持和抢救,以维持其生命,     

急危重病人院内转运的护理

目的 探讨急危重病人院内转运的护理措施.方法 对140例急危重病人进行转运前的评估及准备,转运途中实施有效的监护,并对危急情况采用处理措施.结果 140例急危重病人经积极有效处理,均能安全转运.结论 急危重病人转运前的评估及充分准备,转运途中医护分工合作及全面的监护,及时有效的护理措施是有效保证病人安全转运的关键.     

Body temperature change and outcomes in patients undergoing long-distance air medical transport

Background

Short-distance air medical transport for adult emergency patients does not significantly affect patients' body temperature and outcomes. This study aimed to examine the influence of long-distance air medical transport on patients' body temperatures and the relationship between body temperature change and mortality.

区域性危重新生儿院前网络转运911例分析

【目的】讨论危重新生儿院前网络转运的意义。【方法】建立以本院NICU为网络中心,以本市及周边地区共41家基层医院为成员单位的区域性危重新生儿院前网络转运系统,对转运新生儿倒数、病种分布、预后等临床资料进行分析。【结果】三年来转运911例危重新生儿,转运新生儿逐年增加（P〈0．05）,转运后放弃47例,死亡67例,病死率逐年降低（P〈0．05）。299例转运新生儿进行了转运前新生儿危重病例评分,其中非危重组68例,无死亡,危重组181例,死亡10例,病死率5．52％,极危重组50例,死亡8例,病死率16％。评分病情越重,病死率越高,差异有统计学意义（P〈0．01～0．05）。【结论】建立完善的网络转运系统,掌握转运指征和及时转运,对保证危重新生儿转运救治成功率,降低病死率有重要意义。     

An Evidence-based Guideline for the Air Medical Transportation of Prehospital Trauma Patients

Abstract

Background. Decisions about the transportation of trauma patients by helicopter are often not well informed by research assessing the risks, benefits, and costs of such transport. Objective. The objective of this evidence-based guideline (EBG) is to recommend a strategy for the selection of prehospital trauma patients who would benefit most from aeromedical transportation. Methods. A multidisciplinary panel was recruited consisting of experts in trauma, EBG development, and emergency medical services (EMS) outcomes research. Representatives of the Federal Interagency Committee on Emergency Medical Services (FICEMS), the National Highway Traffic Safety Administration (NHTSA) (funding agency), and the Children's National Medical Center (investigative team) also contributed to the process. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to guide question formulation, evidence retrieval, appraisal/synthesis, and formulate recommendations. The process followed the National Evidence-Based Guideline Model Process, which has been approved by the Federal Interagency Committee on EMS and the National EMS Advisory Council. Results. Two strong and three weak recommendations emerged from the process, all supported only by low or very low quality evidence. The panel strongly recommended that the 2011 CDC Guideline for the Field Triage of Injured Patients be used as the initial step in the triage process, and that ground emergency medical services (GEMS) be used for patients not meeting CDC anatomic, physiologic, and situational high-acuity criteria. The panel issued a weak recommendation to use helicopter emergency medical services (HEMS) for higher-acuity patients if there is a time-savings versus GEMS, or if an appropriate hospital is not accessible by GEMS due to systemic/logistical factors. The panel strongly recommended that online medical direction should not be required for activating HEMS. Special consideration was given to the potential need for local adaptation. Conclusions. Systematic and transparent methodology was used to develop an evidence-based guideline for the transportation of prehospital trauma patients. The recommendations provide specific guidance regarding the activation of GEMS and HEMS for patients of varying acuity. Future research is required to strengthen the data and recommendations, define optimal approaches for guideline implementation, and determine the impact of implementation on safety and outcomes including cost.     

空间站任务阶段航天员的医疗救护保障北大核心CSCD

目的回顾总结载人航天史上曾经发生的主要问题以及我国自2003年神舟五号首次载人航天任务以来主着陆场航天员医疗保障的经验,重点分析自神舟十二号开始的空间站建造期间的技术状态和返回特点,制定有针对性的伤病救治预案,确保航天员安全。方法总结国外航天史上航天员发生意外伤害的教训,尤其是空间站阶段,结合我国载人航天的航天员医疗保障经验,针对空间站任务飞船在轨时间长、主着陆场调整的任务特点,提出系列的组织、预案以及救治方案。结果在原有舱前急救、直升机ICU综合救护平台的基础上,进一步优化了急救程序,制定了不同复杂地形情况下的救治预案及航天员的快速救治和后送原则。结论空间站任务医疗救护的综合救援方案、直升机救护平台的构建以及组织实施,可以保障空间站任务航天员各种情况返回的有效救治。     

危重病患者血清胃泌素测定的临床意义

报告８个病种３２５例危重病患者血清胃泌素的测定结果并与５８例正常人对比。结果表明：危重病患者不管是否伴有消化道出血，其血清胃泌素均有意义地升高（Ｐ＜０．００１）。说明危重病患者有高胃泌素血症存在。并与消化道出血和ｐＨ值降低可能有一定关系。提示在危重病治疗时，不管是否有消化道出血，及早应用抑制胃泌素分泌的药物对保护胃粘膜，预防消化道出血可能有一定益处。     

Autopsy in critical illness: is it obsolete?

The autopsy continues to have important implications for patient management in critical illness. It is not obsolete. Autopsy data help us to track shifts in disease prevalence over time and to heighten surveillance for serious diagnoses that are commonly missed. These data help us to identify important contributors to death that may be remediated through quality assurance and control programs. In discrete patient subsets, information from autopsies may reinforce the degree of certainty surrounding end-of-life decision-making.