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Biomedical subjects

H Herron

Publications and source records attributed to H Herron.

9 recordsLinked to original sources
PubMed1999

Helicopter transport of patients to tertiary care centers after cardiac arrest.

Air transport is commonly used to transfer survivors of cardiac arrest from rural hospitals to large tertiary-care centers, presumably to improve outcome. To examine this issue, a retrospective review of patients stabilized after a cardiac arrest was conducted; 157 transports were reviewed. The mean age of patients was 37.9 +/- 27.8 yrs, with a male to female ratio of 2.2:1. Survivors were significantly older than nonsurvivors. Thirty-one of 69 patients (45%) with primary cardiac disease were discharged alive from the hospital, 75% without neurological sequelae. Only a minority of patients with noncardiac medical illness (7%), electrical injury (33%), suffocation (15%), near-drowning (15%), and inhalation (0%) were discharged alive from the hospital. Outcomes for cardiac arrest in adult patients older than 65 years (32.3% survival) were similar to those for adult patients younger than 65 years (36.2% survival) (P = .887). These results show that survivors of a primary cardiac event have a favorable outcome when transferred by air to tertiary centers when compared with historical controls that were transported by ground. On the other hand, cardiac arrests from noncardiac medical illness, suffocation, near-drowning, and inhalation have a grim prognosis. Prospective studies should clarify the role of air transport in these patients.

Adolescent↗
PubMed1995

Man vs. tree.

Explore the source record for details and available documents.

Air Ambulances↗
PubMedDate not supplied

Air medical transport for the trauma patient requiring cardiopulmonary resuscitation: a 10-year experience.

INTRODUCTION: Air medical response and transport for the injured patient in cardiopulmonary arrest remain controversial. This study is a large, single-program experience. METHODS: A retrospective chart review and descriptive study of all injured patients requiring cardiopulmonary resuscitation (CPR) immediately before or during air medical transport. The crew functioned under advanced cardiac life support/advanced trauma life support protocols. SETTING: The patients, when transported, went to a variety of facilities, with the majority of patients transported to a level-I trauma center. The service area was primarily rural. RESULTS: During 1985 to 1994, inclusive, there were 12,518 completed missions. A total of 320 injured patients required CPR (284 with blunt injury and 36 with penetrating injury), six of the 320 patients (1.9%) survived. Survivors and nonsurvivors did not differ significantly in age, mechanism of injury, time from initiation of CPR to arrival in the emergency department (ED), year of injury or initial cardiac rhythm. All survivors did, however, present to the ED in normal sinus rhythm with a palpable blood pressure. CONCLUSION: Air medical transport for the injured patient without signs of life following prehospital intervention appears futile.

Air Ambulances↗
PubMedDate not supplied

Trauma and nontrauma cardiopulmonary arrest: a national survey.

INTRODUCTION: This survey attempts to identify the current standard of care for the air medical transport of the patient in cardiopulmonary arrest. METHOD: An Association of Air Medical Services/National Flight Nurses Association-approved survey by a single mailing with an anonymous response. SETTING: All rotor-craft programs with current memberships in AAMS. RESULTS: Fifty-three of the 178 questionnaires mailed were returned. Program demographics, crew composition and transport volumes were typical of other reported national experiences. The majority of programs (84%) had standing operational protocols for trauma and non-trauma cardiopulmonary arrests. The indications for not initiating or discontinuing CPR, the transport of the patient in cardiopulmonary arrest, triage and financial considerations varied widely between air medical programs. CONCLUSIONS: This study provides some insight on the current air medical management of the patient in cardiopulmonary arrest. National practice guidelines should be developed and tested prospectively in future studies.

Air Ambulances↗
PubMedDate not supplied

Emergency scene endotracheal intubation before and after the introduction of a rapid sequence induction protocol.

INTRODUCTION: A change in airway management protocol provided the opportunity to evaluate scene airway management by air medical crew before and after the introduction of a rapid sequence induction protocol. METHODS: A retrospective chart review and a descriptive study of scene trauma patients whose airway was established primarily by an air medical crew during two study periods: April 1994 through March 1995 (group 1, before rapid sequence induction) and April 1995 through March 1996 (group 2, after rapid sequence induction). Data collected included demographics, type of airway, Glasgow Coma Scale score, scene time, and outcome. The setting included a four helicopter air medical transport program using nurse/paramedic crews with a service area of 25,000 square miles in central, southeastern, and northeastern Ohio. RESULTS: Group 1 patients (n = 148) averaged 31.6 years of age and were primarily male (79.7%) with blunt injuries (92.6%) with an average Glasgow Coma Scale score of 7.7. Group 2 (n = 95) was similar, averaging 31.1 years of age, primarily male (77.9%) with blunt injuries (94.7%) and a Glasgow Coma Scale score of 8.6. Groups 1 and 2 differed in oral endotracheal intubation rate (19/118 versus 36/95 [p = 0.03]) and in scene time (15.7 minutes versus 20.1 minutes [p = 0.0012]). The groups did not differ in rate of successful intubation or the rate of subsequent cricothyrotomy. CONCLUSION: Rapid sequence induction added significantly to ground time without significantly increasing intubation success rate or decreasing cricothyrotomy rate. Its use at the scene of injury may not be appropriate.

Adult↗
PubMedDate not supplied

Air medical transport of the injured patient: scene versus referring hospital.

INTRODUCTION: In a rural service area, does the outcome of air medical patients transferred from the scene of injury differ from that of patients transferred from a primary receiving hospital? METHODS: Retrospective review of all injured patients transported by air to a single trauma center during calendar year 1996. Data collected include basic patient demographics, time of injury, revised trauma score (RTS), injury severity score (ISS), probability of survival (PS), hospital length of stay (LOS), complications, disposition, and mortality. RESULTS: Concerning trauma admission, 594 of 1461 (40.7%) were transported by air: 363 from the scene (24.9%) and 231 from referring hospitals (15.8%). These two groups were similar in demographics, injury severity, hospital LOS, and crude mortality: RTS, 6.61 versus 6.68 (P > 0.05); ISS, 16.0 versus 16.0 (P > 0.05); LOS = 6.9 days versus 7.3 days (P > 0.05); mortality = 11.8% versus 10.8% (P > 0.05). The groups differed significantly, however, in time from injury to definitive care (34.2 minutes versus 196.2 minutes, P < 0.001), overall complication rate (39.1% versus 57.6%, P = 0.009), and potentially preventable deaths (PS > 0.5, 11.6% versus 44%, P = 0.02). CONCLUSION: Patient groups were similar, suggesting similar triage criteria. Patients transferred from a referring hospital took almost six times longer to reach definitive care and may have suffered an increased morbidity and mortality on this basis.

Adult↗
PubMedDate not supplied

Air medical program merger and stress.

INTRODUCTION: How does the stress of a program merger affect job stress in air medical transport? METHODS: This study was an anonymous survey of 104 transport personnel in a Mid-western critical care transport program with merged air and ground components. Tools included the Social Readjustment Rating Scale (SRRS), which quantitates stressful life events on a weighted scale that allows summation as a score, and the Medical Personnel Stress Survey (MPSS), which quantitates work stress in four categories: organizational stress (OS) related to work environment, frustration/exhaustion (FE) related to patient care, job satisfaction (JS) related to decreased self-worth, and psychosomatic complaints (PC), stress manifested as personal illness. Statistical analysis was performed with a variety of tools. RESULTS: Fifty of 104 personnel responded completely. The average SRRS was low at 130.9; only 20% had scores above 200. No significant differences in MPSS occurred in personnel with high and low SRRS scores. Additionally, the SRRS correlated weakly with OS (r = -0.297, P < 0.05). Within the MPSS, OS correlated with FE and JS (r = 0.493, P = 0.0005; r = -0.593, P < 0.0001) and FE correlated with JS (r = -0.36, P = 0.01). CONCLUSION: The overall personnel stress levels in this air medical program with merged air and ground components were low and appeared to be unrelated to organizational stress. This finding may be a result in part of the careful attention paid to stress and the elimination of stressors during the merger process.

Air Ambulances↗