Rita Weber

Helicopter transport of patients during acute myocardial infarction

Initial experience with a regional system of emergency helicopter transport of patients with acute myocardial infarction (AMI) referred for emergent cardiac catheterization and percutaneous transluminal coronary angioplasty (PTCA) is described. Two hundred fifty patients with AMI were transported from within a 150-mile radius to Duke University Medical Center over a 15-month period. All patients were within 12 hours of onset of symptoms. Thrombolytic therapy was administered to 240 (96%) patients (72% before or in-flight). The time to administration of thrombolytic therapy ranged from 30 to 120 minutes (median 180), while the time to arrival in the interventional catheterization laboratory ranged from 105 to 815 minutes (median 300). The flight time was 12 to 77 minutes (median 31). Most patients had 1- or 2-vessel coronary artery disease; the baseline ejection fraction ranged from 27 to 70% (median 42). Transient hypotension was the most common complication both pre-flight and in-flight. Third-degree atrioventricular block and nonsustained ventricular tachycardia were the next most common complications. Ventricular fibrillation or sustained ventricular tachycardia occurred before takeoff in 38 patients (15%). No patients had ventricular fibrillation, asystole or respiratory arrest during transport. Fluid boluses for hypotension were the most common intervention. Five patients required cardiopulmonary resuscitation in-flight; 3 before lift-off and 2 required a brief period of cardiopulmonary resuscitation during sustained ventricular tachycardia. Fourteen patients had pressor therapy, military antishock trousers or both to maintain adequate blood pressure. Neither cardioversion, defibrillation nor intubation were performed in-flight. Thus, inflight complications are infrequent and can be managed en route to an intervention center.(ABSTRACT TRUNCATED AT 250 WORDS)

Differences in air ambulance patient mix demonstrated by physiologic scoring

Severity of illness or injury should be the primary justification for aeromedical transport. To determine whether differences in patient severity were detectable in air transport programs, helicopter-transported patients were examined by three established physiologic scores: the Trauma Score, the Acute Physiology and Chronic Health Evaluation Score, and the Rapid Acute Physiology Score. These scores were obtained prospectively on 1,868 consecutive patient transfer requests from six air medical services for periods ranging from two to six months. A patient meeting strict physiologic criteria was considered critically ill. Overall, 42.6% of the patients (range, 34.8% to 53.3%) were considered critically ill. Patients transported from inpatient hospital units and patients with cardiac disease were less likely to be critically ill than those transported emergently from scenes of accident or from emergency departments. There were also significant differences between programs with regard to the percentage of critically ill patients transported. This study suggests that physiologic scoring may be useful in comparing air ambulance programs and that a majority of patients transported by these services may not be critically ill.

Air medical transport utilization review in North Carolina.

OBJECTIVE To perform a review of the collective experience of all hospital-based helicopter ambulances in the state of North Carolina for compliance with utilization review criteria. DESIGN Flight records of the six members of the North Carolina Aeromedical Affiliation for the months of November and December 1989 were compared with utilization review criteria by an independent reviewer. A secondary review was performed by a staff member for each service. Scene responses and patients flown to a hospital other than the sponsor were evaluated. SETTING All six hospital-based helicopter services in North Carolina. TYPE OF PARTICIPANTS All available flight records for November and December 1989. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of 756 transports, 747 flight records were available for review. Initial review demonstrated compliance with the criteria for 713 (95.4%) patients; secondary review showed compliance for 18 of 34 flights not meeting initial review, for an overall compliance rate of 97.9%. Compliance rates for scene responses and transports taken to a hospital other than the sponsoring facility were 96.6% and 94.1%, respectively. CONCLUSIONS Review of all flights over a period of two-months by all six hospital-based helicopter services in North Carolina using utilization review criteria demonstrated a very high rate of compliance with the established criteria.

A concerted effort to boost medicare reimbursement in North Carolina

In summary, a group of hospital-based air medical services in North Carolina were able to work cooperatively to develop a one-day seminar for their Medicare intermediary. This utilized personnel from all of the participating hospitals in an educational framework designed to enhance understanding of the uniqueness of air medical services and their differences from ground transport services. The benefits of this effort are being seen on a regular basis through enhanced Medicare payment of claims.

Helicopter Transport of Patients with Acute Ischemic Syndromes

Improved understanding of the pathophysiology of acute ischemic syndromes as well as the rapid evolution of advanced technology for the treatment of coronary disease has led to an increasing need to make specialized resources available to the patient with an acute manifestation of ischemic heart disease. The Coronary Artery Surgery Study and other observational analyses of outcome in coronary disease have demonstrated that patients with stable symptoms have a low risk of morbid events (1). In contrast, patients with unstable angina which persists in the hospital and acute myocardial infarction remain at high risk of death or future infarction. Evidence has accumulated that the availability of specialized personnel and equipment can reduce mortality and morbidity associated with these syndromes (2). Furthermore, as promising new therapies are developed they will need to be tested at specialized centers.