Laboratory and flight tests of medical equipment for use in U.S. Army Medevac helicopters

When used in an air medical setting, medical equipment designed for use in hospitals can fail from the stresses of in-flight use, or they interfere with critical rotor-wing aircraft systems. From January 1989 to June 1992, 34 medical devices, including monitor/defibrillators, infusion pumps, vital-signs monitors, ventilators and infant transport incubators, were tested under extreme conditions of temperature, humidity, altitude and vibration (MIL-STD 810D). Electromagnetic emissions and susceptibility were measured (MIL-STD 461C and 462), and human factors were evaluated. The devices were flight tested in a UH-60 MEDEVAC helicopter. Thirty-two percent of the medical devices failed at least one environmental test, and 91% of the devices failed to meet electromagnetic interference standards. Failures included excess conducted and radiated emissions and susceptibility to radiated emissions. Five (15%) of the devices were judged unsuitable for use in the UH-60 MEDEVAC helicopter. Testing is critical to discover the ability of a medical device to perform in the harsh rotor-wing MEDEVAC environment. Failure of a device or interference with aircraft systems can result in loss of a patient or aircrew.     

Effect of electromagnetic interference by neonatal transport equipment on aircraft operation

The number of civilian air ambulance services operating in the United States has been steadily increasing. The quantity and sophistication of electronic equipment used during neonatal transport have also increased. All medical equipment generates some electromagnetic interference (EMI). Excessive EMI can interfere with any of an aircraft's electrical systems, including navigation and communications. The United States military has strict standards for maximum EMI in transport equipment. Over the past 15 years, approximately 70% of neonatal transport monitors, ventilators, and incubators have failed testing due to excessive EMI. As neonatal transport equipment becomes more sophisticated, EMI is increased, and there is greater potential for aircraft malfunction. The Federal Aviation Administration should develop civilian standards for acceptable EMI, civilian aircraft operators must be aware of the possible dangers of excessive EMI, and equipment which does not meet future FAA standards should not be purchased.     

Air medical transport of patients from offshore oil and gas facilities. Historical accident data and initial experience

The offshore petroleum exploration and production industry (OSI) is isolated from traditional means of access to emergent health care and may benefit from the unique attributes of helicopter air medical transport. This study was undertaken to review the incidence of OSI-related incidents, injuries and deaths, and report the initial experience of a civilian hospital-based helicopter air transport program in the evacuation of offshore patients. It was learned that the mean annual incidence of major OSI accidents from 1980 to 1986 was 19.1 (+/- 7.0). Mean annual mortality and reported injury were 14.7 (+/- 7.6) and 36.7 (+/- 25.4) patients respectively. Fires and explosions were the most frequently reported events at 62 per year (+/- 11.5/year). Nine OSI patients were evacuated by helicopter during the study's eight-month pilot period (seven for trauma and two for medical illness). One of the nine patients had been exposed to a potentially hazardous substance, requiring changes in the air medical team's operations, aircraft and equipment. The study shows that the offshore petroleum environment is ideally suited for air medical transport, as injuries are common and medical illnesses are to be expected. However, air medical programs operating offshore must deal with additional regulatory requirements and develop operational procedures to ensure safety during these flights.     

Ambulance use in a military population: epidemiology and implications.

Because no studies have been reported on ambulance use in military populations, a 2-year epidemiologic study of all ambulance responses on Hickam Air Force Base was conducted. Findings included a higher utilization rate and a greater proportion of pediatric patients than might be expected in comparable civilian populations. Serious trauma was uncommon, but a wide spectrum of serious medical emergencies was seen. Advanced life support was indicated in 22% of all responses, and its availability improved patient outcome. Based on these and other findings, recommendations are made for upgrading military prehospital care to meet both base population needs and current civilian community standards.     

Statewide air medical transports for Massachusetts

In 1997, the Massachusetts Department of Public Health (MDPH) established a process to centralize air medical transport information. This database is one of the first statewide, population-based sources for civilian rotary-wing air medical transports (U.S. Coast Guard, police, and military missions are not included). The purpose of this database is to facilitate MDPH review of air medical transport service utilization, with input from a multidisciplinary committee. This article discusses the challenges in producing uniform data from multiple service submissions and presents aggregate "baseline" utilization information for 1996. These data served as a starting point for later studies using data linkage. This indexed article is the first to report statewide, population-based data for all types of air medical helicopter transports. The only other indexed "statewide air medical transport" paper focused on scene transports to trauma centers in Pennsylvania. A previous article by the authors in the July-September 2000 Air Medical Journal provided an overview of air medical transports for fatal motor vehicle crashes for 1 region of the state.     

Foreign health sector capacity building and the U.S. military

The U.S. joint military medical community has an increasing role in collaborative health sector engagement internationally as part of a whole of government approach to successful operations. The military must master the ability to catalyze health sector gains that can be developed by hosts, U.S. Government, and international agencies in both permissive environments and conflict zones. Capacity building is helping a partner develop their own capabilities, standards, and resources to the point of self-sufficiency. Optimal effects will come through understanding the military and civilian health sectors of nations and regions, grasping the importance of health to stability and security, and integrating efforts with global health initiatives. The goal is to cultivate military and civilian relationships that assist host nation-led sustainable health sector effects that result in enduring positive U.S. national security outcomes.     

美国空中急救概况

美军大规模使用直升飞机转运伤员开始于朝鲜战争及后来的越南战争。根据已取得的成功经验,空中急救(air medicine)现已成为美国平时完整创伤急救系统不可分割的重要组成部分。笔者重点介绍美国空中急救的方法与经验,以供国内创伤急救医学有关人员在决策或开展中国的空中急救项目．时参考。     

The American Society for Testing Materials F-30 Committee on EMS

The American Society for Testing Materials (ASTM) F-30 Committee on Emergency Medical Services (EMS) began creating voluntary consensus standards for EMS including air medical transport in 1984. The F-30 Committee is composed of more than 200 members who represent both the "producers" and the "users" of EMS. Approximately 10 of the 39 standards published by the F-30 Committee either deal directly or indirectly with air medical programs. The standards are refined through yearly evaluation and reviewed in detail every four years. Due to concerns with the ASTM process, several of the initial members resigned in 1988. Changes made to the scope and practice of the F-30 Committee have resulted in some of these participants returning to the process. New standards must be developed only after a "needs assessment" demonstrates that such a standard should exist. Relevant pre-existing standards must be reviewed. Clinical practice has been excluded from the work of the F-30 Committee. Air medical programs may participate as members of the F-30 Committee for a nominal yearly fee, which provides members with an updated book of standards. Meetings are held biannually. The Guide for Establishing the Qualifications, Education and Training of EMS Aeromedical Patient Care Providers is approaching its four-year review, and a number of other standards, which are of particular interest to the air medical community, are currently under development.     

Patterns of accreditation performance in army family practice residencies.

Army leadership emphasizes training in all segments of its population, including family medicine. Standards for medical professional training, however, are provided by a civilian agency, the Accreditation Council for Graduate Medical Education (ACGME). In order to search for performance patterns, the authors reviewed the last two accreditation documents of each Army Family Practice residency. After independently scoring the documents against the written standards, the scores were compared with the actual written findings from the ACGME Residency Review Committee. The authors discuss patterns and trends resulting from this analysis, and recommend areas for future growth in the military training of family physicians.     

Air medical transport systems as a health-care integrator. Association of Air Medical Services

Air medical transport services are an essential, cost-effective component of health-care delivery in the United States. Air medical transport services provide rapid access to high-quality, sophisticated medical technologies over large geographic areas. They reduce the cost of duplicating resources by obviating the need to provide similar levels of access and service at multiple locals in the region. The sophistication and quality of care maintained during transport provides a level of services not available with traditional ground transport services, particularly in rural areas. Air medical transport services also facilitate linkages between primary, secondary and tertiary-care facilities, allowing integration of programs and services to create regionalized systems of healthcare. While numerous strategies are necessary to reduce health-care costs in the United States without reducing quality and access, air medical transport systems are uniquely positioned to support the efficient integration of regional healthcare services, while maintaining the highest standards of care for patients.     

The management of head injuries on military operations

The management of head injured patients has recently been reviewed with the development of civilian guidelines for best practice. These are common injuries which often have significant sequelae for patients and costs for health care providers. Evolving civilian standards of care have implications for military medicine which is often practised in challenging environments. Considerable planning and resources are necessary to meet these standards in an operational environment. The current standards and the problems of applying them in an operational theatre are discussed.     

Civilian medical qualification determinations

Much like their counterparts in private industry, federal medical officers, particularly preventive and occupational medicine physicians, must ensure a workforce fit to perform their duties. Meeting this objective often requires balancing competing interests between employers and employees. The medical examination is the method for protecting the government's interests in identifying federal civilian applicants and workers who are medically unqualified to perform their duties while also preventing discrimination against qualified individuals with disabilities. Scant published guidance on performing authorized medical examinations and analyzing the resultant information is available for federal medical officers. This is needed to foster an equitable, compliant decision for both federal employers and employees. Using the Department of Defense as an example, this article provides a legal road map for the practitioner by defining medical standards and physical requirements, discussing medical examinations, and examining disability determinations.     

Air ambulance regulations: a model

Prior attempts at establishing minimal federal air ambulance regulations and standards have been unsuccessful. However, reports of poor patient medical care during transport by some air ambulance services is now forcing many states to initiate air ambulance regulations. In 1984, the State of Utah Emergency Medical Services convened a special subcommittee to develop aeromedical regulations for the State of Utah. Using a three-level approach based upon the patient's requirements for basic, advanced, or specialized medical care and the urgency of transport, the subcommittee was able to derive medical categories necessary for the selection and utilization of air ambulance services. Minimum air ambulance regulations were then established for aircraft configuration, flight crew requirements, minimal equipment and medications, and the responsibilities of the medical director or designee for each of the three levels of medical care. We conclude that the application of a levels approach based upon the patient's medical requirements may be useful in assisting other states attempting to establish flexible but specific regulations directed at the safe transport of patients by aeromedical evacuation.     

Prehospital care and the military.

Significant evolution has occurred in prehospital care over the past decade. Civilian emergency medical service (EMS) systems have become progressively sophisticated. Military systems have tended to maintain a wartime philosophy toward prehospital care, and thus its peacetime ambulance service, at times, is not prepared to provide the same standard of care given by the civilian community. This article reviews the current status of civilian and military EMS and attempts to put in perspective the directions that the military could go to improve on the prehospital care it provides.     

The 2003 Air Medical Leadership Congress: findings and recommendations

To address important concerns facing the air medical community, 149 air medical transport leaders, providers, consultants, and experts met September 4-6, 2003, in Salt Lake City, Utah, for a 3-day summit-the Air Medical Leadership Congress: Setting the Health Care Agenda for the Air Medical Community. Using data from a Web-based survey, top air medical transport issues were identified in four core areas: safety, medical care, cost/benefit, and regulatory/compliance. This report reviews the findings of previous congresses and summarizes the discussions, findings, recommendations, and proposed industry actions to address these issues as set forth by the 2003 congress participants.     

A review of drug use during air medical transport to optimize an air ambulance formulary

INTRODUCTION: The advent of air medical transport has pushed the delivery of critical care medicine into the prehospital arena. As a result, a wide variety of pharmacologic agents must be available in the air medical setting. PURPOSE: The purpose of this study was to conduct a retrospective review of drugs used during air medical transport to allow a streamlining of the air ambulance formulary. METHODS: All flights completed since the inception of the study's helicopter air ambulance program in 1985 through September 1991 were analyzed to determine which medications were used in flight. Drugs were counted if they were administered while in flight for either a scene or interhospital transport. RESULTS: Review of 2,694 flights showed that 45 individual drugs had been routinely carried during the study period. Many of these agents were administered fewer than five times during the six years, and 10 drugs were not used at all. CONCLUSION: As a result of this investigation, the formulary for our air medical transport service was modified. The authors recommend similar critical audits of drugs carried in flight be performed by other air ambulance services.     

Humanitarian assistance medicine: perceptions of preparedness: a survey-based needs assessment of recent U.S. Army internal medicine residency graduates

The U.S. military provides humanitarian assistance in many areas around the globe. With recent changes in the force structure of the U.S. Army, internal medicine physicians are now at the forefront of providing this care, but the extent of their involvement is not known. This study measured the frequency with which recently trained Army internists provided humanitarian assistance, and it assessed their perceived preparedness for such missions. All graduates from Army internal medicine programs for 4 consecutive years were invited by e-mail to participate in an Internet-based survey. Eighty-nine personnel (49% of those contacted) completed the survey. Of those in a deployable position for >6 months, 72% provided medical humanitarian assistance. Most thought that additional training was needed, especially in tropical disease management, sanitation, and the practices of civilian humanitarian workers. This study demonstrates that military-trained internists are frequently involved in humanitarian assistance medicine, and it suggests that they might benefit from additional training.     

The controller, aviation medicine and air safety

Aviation medicine has researched many important facts on pilots, but little on direct relationships between controllers, aviation medicine and air safety. The unsuspecting flying public accepts a 'blind faith' in aircraft and pilots, unaware that aircraft are controlled within 'suspect' ATC systems. The deceptive simplicity of controlling air traffic in apparently limitless skies belies the complexity of man-machine ATC systems operated in ever-crowded airspace, sometimes with antiquated equipment and indifferent communications. The indivisible operational controller/pilot team strives to meet similar ICAO medical standards and operate within the limitations of non-standardised recorded air traffic. Despite controllers' intensive stress at air disasters and 'almost' air disasters, air traffic must continually be controlled for air safety; but, countless human lives (and insurance dollars) saved are possibly camouflaged within the smoke screen of ATC. In New Zealand aviation, the Accident Compensation Corporation is statutorily responsible for air-safety, but accident investigators need controllers' expertise. Has a climate of complacency evolved towards air safety such that New Zealand's Erebus and other air disasters could have been avoided? Controllers are that crucial link in aviation with personal medical fitness vital to the air safety of the unsuspecting flying public. Controllers' dedicated aim for complete air safety in ATC shall benefit from greater understanding within aviation medicine and in-depth medical research.     

The evolution of dependent medical care in the U.S. Army

There is great focus within the military medical community regarding the ever growing cost of medical care overall and dependent care specifically. A great deal of discussion relates to the delivery of care through a growing military-civilian partnership, where an increased amount of health care will be referred to an ever growing network of civilian providers. The U.S. military establishment now stands at an important crossroad leading into the future of dependent care. However, the special concerns, which arise from the responsibility of caring for military dependents, are not a solely recent phenomenon. Ever since the establishment of a permanent standing U.S. Army in the late 1700s, there have been families in need of medical treatment. Although changes occurred continuously, the development and evolution of policies regulating the delivery of medical care to dependants can be divided into three periods. The first is the longest and ranges from the establishment of the Army until the year 1900. The second period spans from 1900 to the post-Korean War year of 1956. The third and final period is from 1956 to 1975. Special changes and advances in each of these periods have served to shape the face of dependent care in today's Army Medical Department.     

A nationwide survey of civilian air ambulance services

To identify and characterize civilian air ambulance services, a questionnaire was mailed nationwide to 583 prospective air ambulance services, with 154 responding. Our survey identified differences between hospital, hospital-affiliated, and private air ambulance services as to aircraft ownership, availability, types of aircraft, types of patients being transported, types of medical personnel and equipment, aircraft retrofit, and their feelings regarding air ambulance regulations. We found that hospital air ambulances are better suited for transporting critically ill patients while many private air ambulances appear better suited to transport nonemergency patients. Hospital-affiliated air ambulance services, although not as consistent in providing the specialized care of hospital air ambulances, appear better able to provide critical care than private air ambulance services. Based upon this data, we recommend that air ambulance regulations be directed at levels of patient care. Such regulations and guidelines will assist patient safety during aeromedical transports without jeopardizing currently operating air ambulance services.