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Russell D Macdonald - One of the best experts on this subject based on the ideXlab platform.
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preTransport risk assessment of agitated patients in Air Medical Transport
Air Medical Journal, 2021Co-Authors: Russell D Macdonald, Yuen Chin LeongAbstract:Abstract Objective To determine the ability for a simple preTransport mental health risk assessment tool for patients who are agitated or experiencing an acute psychiatric illness to predict in-transit disruptive behavior necessitating additional intervention(s) while being Transported via Air ambulance. Methods We conducted this retrospective cohort study using existing data from the provincial Air and land critical care Transport system (Ornge) in Ontario, Canada, from April 2019 until March 2020. A total of 498 cases were included in this study. Transport medicine physicians fill in the modified mental health risk assessment tool as part of their preTransport assessment of each mental health patient undergoing Transport. The Transport medicine physician–derived risk score is categorized as low, moderate, and high. The primary outcomes were sensitivity, specificity, and predictive values of the modified tool for predicting pre- or in-transit disruptive behavior necessitating escalation in care. Results Of those patients meeting the study criteria, 207, 198, and 93 cases were assessed as low, moderate, and high risk, respectively, for potential agitation or disruptive behavior requiring escalation of care during Transport. The sensitivity, specificity, positive predictive value, and negative predictive value were 70% (95% confidence interval [CI], 69.2%-70.8%), 87.1% (95% CI, 86.9%-87.2%), 37.6% (95% CI, 37.0%-38.2%), and 96.3% (95% CI, 96.2%-96.4%), respectively. Conclusion A simple preTransport risk assessment tool can reliably rule out the need for escalation of care during Air Medical Transport of the potentially agitated patient. This may help improve resource utilization and safety, without sacrificing quality of care.
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Air Medical Transport myths
Canadian Journal of Emergency Medicine, 2020Co-Authors: Russell D Macdonald, Michael Lewell, Sean Moore, Andy Pan, Michael Peddle, Bruce SawadskyAbstract:The role of Air Medical and land-based critical care Transport services is not always clear amongst traditional emergency Medical service providers or hospital-based health care practitioners. Some of this is historical, when Air Medical services were in their infancy and their role within the broader health care system was limited. Despite their evolution within the regionalized health care system, some myths remain regarding Air Medical services in Canada. The goal is to clarify several commonly held but erroneous beliefs regarding the role, impact, and practices in Air Medical Transport.
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blood product transfusion during Air Medical Transport a needs assessment
CJEM, 2020Co-Authors: Russell D Macdonald, Aliya RamjaunAbstract:OBJECTIVES Early administration of blood products to patients with hemorrhagic shock has a positive impact on morbidity and mortality. Smaller hospitals may have limited supply of blood, and Air Medical systems may not carry blood. The primary outcome is to quantify the number of patients meeting established physiologic criteria for blood product administration and to identify which patients receive and which ones do not receive it due to lack of availability locally. METHODS Electronic patient care records were used to identify a retrospective cohort of patients undergoing emergent Air Medical Transport in Ontario, Canada, who are likely to require blood. Presenting problems for blood product administration were identified. Physiologic data were extracted with criteria for transfusion used to identify patients where blood product administration is indicated. RESULTS There were 11,520 emergent patient Transports during the study period, with 842 (7.3%) where blood product administration was considered. Of these, 290 met established physiologic criteria for blood products, with 167 receiving blood, of which 57 received it at a hospital with a limited supply. The mean number of units administered per patient was 3.5. The remaining 123 patients meeting criteria did not receive product because none was unavailable. CONCLUSION Indications for blood product administration are present in 2.5% of patients undergoing time-sensitive Air Medical Transport. Air Medical services can enhance access to potentially lifesaving therapy in patients with hemorrhagic shock by carrying blood products, as blood may be unavailable or in limited supply locally in the majority of patients where it is indicated.
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assessment of pain management during interfacility Air Medical Transport of intubated patients
Air Medical Journal, 2019Co-Authors: Ayesha Zia, Russell D Macdonald, Sean Moore, James Ducharme, Christian VaillancourtAbstract:Abstract Objective The management of pain is an important component of care in the prehospital and Transport setting. However, recent evidence suggests that pain control is infrequently achieved in these settings. The objective of the current study was to determine the proportion and frequency of opioid analgesia provided to intubated patients during interfacility Transport by an Air Medical Transport system. Methods This was a health records review examining electronic records of intubated patients Transported by Ornge from July 2015 to November 2015. Cases were identified using Ornge database, and intubated patients were selected based on the inclusion criteria. A standardized data extraction form was piloted and used by a single trained data extractor. The primary outcome was whether analgesia was provided. Secondary outcomes included the frequency of administration and dose adequacy of an opioid analgesia; the analgesic used; adverse events; and the impact of age, sex, past Medical history of chronic pain, or reason for transfer on pain management. Results Of the 500 potential patient Transports, 448 met our inclusion criteria. Among the 448 patients, 295 (65.8%) were men, 327 (73.0%) received analgesia, and 211 (64.3%) received more than 1 dose during Transport (median frequency of 2 doses, interquartile range = 1 to 3). The average Transport time was 135 minutes, and repeated dosing (> 1 repeat dose) occurred primarily (45.5%) in Transports of over 180 minutes. Fentanyl was the most commonly used analgesic (97.9%), and the most common dose was 50 µg (51.8%). Adverse events occurred in 8 patients (2.5%), most commonly new hypotension (mean arterial pressure Conclusion Seventy-three percent of intubated patients Transported by Ornge received an opioid analgesic, most commonly fentanyl. We found no clinically relevant difference in the administration of analgesics based on age, sex, past Medical history of chronic pain, or reason for transfer other than repatriation to the originating hospital.
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dispatch decision making in an Air Medical Transport system
Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 2016Co-Authors: Wayne C W Giang, Mahvareh Ahghari, Lavinia Hui, Birsen Donmez, Russell D MacdonaldAbstract:Air Medical Transport relies on effective dispatching of Air and land vehicles to provide the fastest and best care possible for patient transfers. These difficult dispatch decisions are characterized by high time pressure, uncertainty, and the dynamic and complex environment of Medical Transportation. This paper describes a preliminary study of the decision making processes that occur during dispatch decisions at Ornge, the Air Medical Transportation system in Ontario, Canada. We drew upon the Critical Decision Method and the structured data analysis approach to understand the major decision points faced by Ornge’s dispatchers, and the cues and sources of information attended to in those situations. We found that the decision points deal with three main goals: maintain situation awareness, match resource to transfer, and plan logistics of transfer. Furthermore, we found that time estimation might play an important role in helping dispatchers coordinate within the dispatch team and with their external par...
Michael J Schull - One of the best experts on this subject based on the ideXlab platform.
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incidence and predictors of critical events during urgent Air Medical Transport
Canadian Medical Association Journal, 2009Co-Authors: Jeffrey M Singh, Russell D Macdonald, Susan E Bronskill, Michael J SchullAbstract: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.
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incidence and predictors of critical events during urgent Air Medical Transport
Canadian Medical Association Journal, 2009Co-Authors: Jeffrey M Singh, Russell D Macdonald, Susan E Bronskill, Michael J SchullAbstract: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.
Catalin Toma - One of the best experts on this subject based on the ideXlab platform.
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feasibility of remote ischemic peri conditioning during Air Medical Transport of stemi patients
Prehospital Emergency Care, 2016Co-Authors: Christian Martingill, Francis X. Guyette, Max Wayne, Oladipupo Olafiranye, Catalin TomaAbstract:Remote ischemic peri-conditioning (RIPC) has gained interest as a means of reducing ischemic injury in patients with acute ST-elevation myocardial infarction (STEMI) who are undergoing emergent primary percutaneous coronary intervention (pPCI). We aimed to evaluate the feasibility, process, and patient-related factors related to the delivery of RIPC during Air Medical Transport of STEMI patients to tertiary pPCI centers. We performed a retrospective review of procedural outcomes of a cohort of STEMI patients who received RIPC as part of a clinical protocol in a multi-state Air Medical service over 16 months (March 2013 to June 2014). Eligible patients were Transported to two tertiary PCI centers and received up to four cycles of RIPC by inflating a blood pressure cuff on an upper arm to 200 mmHg for 5 minutes and subsequently deflating the cuff for 5 minutes. Data regarding feasibility, process variables, patient comfort, and occurrence of hypotension were obtained from prehospital records and prospectively completed quality improvement surveys. The primary outcome was whether at least 3 cycles of RIPC were completed by Air Medical Transport crews prior to pPCI. Secondary outcomes included the number of cycles completed prior to pPCI, time spent with the patient prior to Transport (bedside time), patient discomfort level, and incidence of hypotension (systolic blood pressure 30 minutes Transport for pPCI may be the ideal group for RIPC utilization.
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abstract 19724 renoprotective effect of remote ischemic peri conditioning during Air Medical Transport of patients with st segment elevation myocardial infarction
Circulation, 2015Co-Authors: Oladipupo Olafiranye, Christian Martingill, Adetola Ladejobi, Catalin TomaAbstract:Background: Acute kidney injury (AKI) manifesting as acute increase in serum creatinine is a recognized complication to cardiac catheterization. Patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI) have a markedly increased risk of developing AKI. At present, there is no universally accepted strategy for prevention of AKI in the setting of primary PCI. We assessed whether remote ischemic peri-conditioning (RIPC) stimulus during ambulance Transport of STEMI patient would reduce the rate of creatinine rise post primary PCI. Method: We evaluated STEMI patients transferred to two hospitals participating in the National Cardiovascular Data Registry (NCDR) Acute Coronary Treatment Intervention Outcomes Network Registry-Get With the Guidelines (ACTION Registry-GWTG) between March, 2013 and March, 2015. Patients were transferred by an Air Medical critical care service utilizing RIPC as part of a standard protocol and compared to controls matc...
Jeffrey M Singh - One of the best experts on this subject based on the ideXlab platform.
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incidence and predictors of critical events during urgent Air Medical Transport
Canadian Medical Association Journal, 2009Co-Authors: Jeffrey M Singh, Russell D Macdonald, Susan E Bronskill, Michael J SchullAbstract: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.
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incidence and predictors of critical events during urgent Air Medical Transport
Canadian Medical Association Journal, 2009Co-Authors: Jeffrey M Singh, Russell D Macdonald, Susan E Bronskill, Michael J SchullAbstract: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.
Oladipupo Olafiranye - One of the best experts on this subject based on the ideXlab platform.
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feasibility of remote ischemic peri conditioning during Air Medical Transport of stemi patients
Prehospital Emergency Care, 2016Co-Authors: Christian Martingill, Francis X. Guyette, Max Wayne, Oladipupo Olafiranye, Catalin TomaAbstract:Remote ischemic peri-conditioning (RIPC) has gained interest as a means of reducing ischemic injury in patients with acute ST-elevation myocardial infarction (STEMI) who are undergoing emergent primary percutaneous coronary intervention (pPCI). We aimed to evaluate the feasibility, process, and patient-related factors related to the delivery of RIPC during Air Medical Transport of STEMI patients to tertiary pPCI centers. We performed a retrospective review of procedural outcomes of a cohort of STEMI patients who received RIPC as part of a clinical protocol in a multi-state Air Medical service over 16 months (March 2013 to June 2014). Eligible patients were Transported to two tertiary PCI centers and received up to four cycles of RIPC by inflating a blood pressure cuff on an upper arm to 200 mmHg for 5 minutes and subsequently deflating the cuff for 5 minutes. Data regarding feasibility, process variables, patient comfort, and occurrence of hypotension were obtained from prehospital records and prospectively completed quality improvement surveys. The primary outcome was whether at least 3 cycles of RIPC were completed by Air Medical Transport crews prior to pPCI. Secondary outcomes included the number of cycles completed prior to pPCI, time spent with the patient prior to Transport (bedside time), patient discomfort level, and incidence of hypotension (systolic blood pressure 30 minutes Transport for pPCI may be the ideal group for RIPC utilization.
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abstract 19724 renoprotective effect of remote ischemic peri conditioning during Air Medical Transport of patients with st segment elevation myocardial infarction
Circulation, 2015Co-Authors: Oladipupo Olafiranye, Christian Martingill, Adetola Ladejobi, Catalin TomaAbstract:Background: Acute kidney injury (AKI) manifesting as acute increase in serum creatinine is a recognized complication to cardiac catheterization. Patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI) have a markedly increased risk of developing AKI. At present, there is no universally accepted strategy for prevention of AKI in the setting of primary PCI. We assessed whether remote ischemic peri-conditioning (RIPC) stimulus during ambulance Transport of STEMI patient would reduce the rate of creatinine rise post primary PCI. Method: We evaluated STEMI patients transferred to two hospitals participating in the National Cardiovascular Data Registry (NCDR) Acute Coronary Treatment Intervention Outcomes Network Registry-Get With the Guidelines (ACTION Registry-GWTG) between March, 2013 and March, 2015. Patients were transferred by an Air Medical critical care service utilizing RIPC as part of a standard protocol and compared to controls matc...