Incidence and predictors of critical events during urgent air--medical transport

Singh, Jeffrey M.; MacDonald, Russell D.; Bronskill, Susan E.; Schull, Michael J.
October 2009
CMAJ: Canadian Medical Association Journal;10/27/2009, Vol. 181 Issue 9, p579
Academic Journal
Background: Little is known about the risks of urgent air-medical transport used in regionalized health care systems. We sought to determine the incidence of intransit critical events and identify factors associated with these events. Methods: We conducted a population-based, retrospective cohort study using clinical and administrative data. We included all adults undergoing urgent air-medical transport in the Canadian province of Ontario between Jan. 1, 2004, and May 31, 2006. The primary outcome was in- transit critical events, which we defined as death, major resuscitative procedure, hemodynamic deterioration, or inadvertent extubation or respiratory arrest. Results: We identified 19 228 patients who underwent air-medical transport during the study period. In-transit critical events were observed in 5.1% of all transports, for a rate of 1 event per 12.6 hours of transit time. Events consisted primarily of new hypotension or airway management procedures. Independent predictors of critical events included female sex (adjusted odds ratio [OR] 1.3, 95% confidence interval [CI] 1.1-1.5), assisted ventilation before transport (adjusted OR 3.0, 95% CI 2.3-3.7), hemodynamic instability before transport (adjusted OR 3.2, 95% CI 2.5-4.1), transport in a fixed-wing aircraft (adjusted OR 1.5, 95% CI 1.2-1.8), increased duration of transport (adjusted OR 1.02 per 10-minute increment, 95% CI 1.01-1.03), on-scene calls (adjusted OR 1.7, 95% CI 1.4-2.1) and type of crew (adjusted OR 0.6 for advanced care paramedics v. critical care paramedics, 95% CI 0.5-0.7). Interpretation: Critical events occurred in about 1 in every 20 air-medical transports and were associated with multiple risk factors at the patient, transport and system levels. These findings have implications for the refinement of training of paramedic transport crews and processes for triage and transport


Related Articles

  • Tammy Roehrich, volunteer EMT. VAUGHAN, CARRIE // HealthLeaders Magazine;Dec2008, Vol. 11 Issue 12, p33 

    The article focuses on Tammy Roehrich, a volunteer emergency medical technician (EMT), named by the periodical "HealthLeaders" as one of the people who make healthcare better. Roehrich, a resident of Fessenden, North Dakota, wherein 90% to 95% of ambulance services are volunteer organizations,...

  • Long-term mechanical ventilation part 2: principles. Hewitt-Taylor, Jaqui // British Journal of Healthcare Assistants;Sep2008, Vol. 2 Issue 9, p440 

    An increasing number of people require long-term mechanical ventilation, and healthcare assistants often provide their everyday support. It is therefore useful to know how the system works.

  • ST. JOHN AMBULANCE.  // Beaver;Oct/Nov2008, Vol. 88 Issue 5, p9 

    The article offers information on St. John Ambulance, an organization that provides medical care, in Canada. It reveals that the organization was founded by St. John which aims to provide medical first aid and ambulance service to sick pilgrims during the eleventh-century. Statistical...

  • Riding to the Rescue. Hall, Christopher // Louisville Magazine;Jul2005, Vol. 56 Issue 7, p27 

    This article presents information on veteran emergency medical technician with Louisville Emergency Medical Services paramedic Brian Stoess. Shortly after Brian Stoess was hired as an emergency medical technician in 1988, he rode an ambulance as a third crewmember, observing and training. On one...

  • Multidisciplinary Practice in Action: The Rural Paramedic - It's Not Only Lights and Sirens. Mulholland, Peter; O'Meara, Peter; Walker, Judith; Stirling, Christine; Tourle, Vianne // Journal of Emergency Primary Health Care;2009, Vol. 7 Issue 2, p1 

    Objectives This paper examines the Tasmanian portion of a four state study commissioned by the Australian Council of Ambulance Authorities in order to examine the expanded scope of practice for Australian rural paramedics. The objectives of this paper were to describe the expanded role for the...

  • Out of hours care: a profile analysis of patients attending the emergency department and the general practitioner on call. Philips, Hilde; Remmen, Roy; De Paepe, Peter; Buylaert, Walter; Van Royen, Paul // BMC Family Practice;2010, Vol. 11, p88 

    Background: Overuse of emergency departments (ED) is of concern in Western society and it is often referred to as 'inappropriate' use. This phenomenon may compromise efficient use of health care personnel, infrastructure and financial resources of the ED. To redirect patients, an extensive...

  • Attitudes about football helmet removal procedures from students in a paramedic education classroom. Vieson, M.; Wimer, J.W. // Journal of Athletic Training (National Athletic Trainers' Associ;Apr-Jun98 Supplement, Vol. 33 Issue 2, pS61 

    Highlights a study which looked at the attitudes of Emergency Medical Technicians (EMTs) preparing for certification, with regards to the removal of a football helmet in the case where cervical-spine fracture or dislocation is a possibility. Use of a survey to gather information; Hypothesis...

  • A review of patients who suddenly deteriorate in the presence of paramedics. Boyle, Malcolm J.; Smith, Erin C.; Archer, Frank // BMC Emergency Medicine;2008, Vol. 8, Special section p1 

    Background: The report of the Ministerial Review of Trauma and Emergency Services in Victoria, Australia, recommended that paramedics be permitted to divert to the closest hospital in incidences of life threatening situations prior to and during transport. An audit of patients that suddenly...

  • Intensive Care Physician- Versus Qualified Nurse-Based Critical Care Transport.  // MD Conference Express;Aug2011, p11 

    The article reports on research on hospital patient transport which was conducted by physician Erik van Lieshout of the University of Amsterdam in Amsterdam, The Netherlands. Lieshout's research, which featured a randomized controlled trial, found that qualified nurses can safely accompany...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics