Urgent air transport can be improved: study

Paramedics can be better prepared for the critical emergencies that occur while transporting acutely ill patients by air, says the author of an Ontario study.

In Monday's online issue of the Canadian Medical Association Journal, Dr. Jeff Singh of the University Health Network in Toronto reported that one in 20 acutely ill patients experienced a critical event,the researchers defined as ranging from worsening blood pressure to death. That conclusionwasbased on a study of 19,228 adult patients transported in the province.

"This rate is low but clinically important given the serious nature of these events and the challenging out-of-hospital environment in which they occurred," the authors wrote, noting that the rate was comparable to that among acutely ill patients in hospital.

The authors suggest their findings could have implications for changes to the training recieved by paramedic transport crews and to the processes of selecting and preparing patients for transportation.

"Some of the emergencies involved patients who had trouble breathing and needed to be put on a breathing machine during transport," Singh said in an email.

"This is technically very challenging and it would be preferable to do this prior to transport (in a nice bright emergency department rather than in a cramped helicopter, ambulance or plane). We are using this information to develop a tool that will identify these patients who are at high risk of needing this procedure so that they can be treated proactively prior to takeoff."

Putting some patients ona ventilator before the flight could prevent some of the in-flight emergencies, the study suggests.

Guiding trainingfor paramedics

Health-care resources in Ontario are largely foundin cities that are separated by large expanses of land. That fact contributes to the need to transport about 17,000 patients by air every year, Singh said.

A critical care physician, Singh said he sometimes sees very sick patients arrive at the intensive care unit after a harried medical transport during which an emergency occurred. That ledhim to ask if the safety of medical transport could be improved.

The highly trained transport crews managed critical eventsduring transport very well, even though the patients were unstable, Singh said.

Researchers identified several factors that were linked with emergencies during transit, including gender (women were more at risk), traumatic injuries, cardiovascular disease, assisted ventilation and blood pressure instability.

The team is looking into why women seemed to be at increased risk of critical events. Perhaps men are referred to hospital earlier and are less sick when transported than women, or it could be thatwomen show different symptoms that are diagnosed more slowly, delaying their care, as is the case with heart disease, Singh said.

The findings may provide insight for training medical crews regarding what in-flight emergencies are likely, or offer evidence for experts developing dispatch criteria, saidDr. Alex Isakov, of the department of emergency medicine at Emory University in Atlanta, in acommentary accompanying the study.

Ornge Transport Medicine, Ontario's air-medical transport group, is already using the results to create simulations of the most common emergencies to help train paramedic crews.