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Londons air ambulance

Marius Rehn, Anne Weaver, Karim Brohi, Sarah Eshelby, Laura Green, Jo Røislien, David J Lockey
BACKGROUND: Current management principles of haemorrhagic shock after trauma emphasize earlier transfusion therapy to prevent dilution of clotting factors and correct coagulopathy. London's air ambulance (LAA) was the first UK civilian pre-hospital service to routinely offer pre-hospital red blood cell (RBC) transfusion (phRTx). We investigated the effect of phRTx on mortality. METHODS: Retrospective trauma database study comparing mortality before-implementation with after-implementation of phRTx in exsanguinating trauma patients...
April 16, 2018: Shock
Marius Rehn, Gareth Davies, Paul Smith, David Lockey
OBJECTIVE: The potential increased risk of an emergency response using a rapid response vehicle (RRV) should only be accepted when it allows a clinically significant time saving for management of patients who are critically injured or sick. Air ambulance services often use an RRV to maintain operational resilience. We compared the RRV response time on emergency versus standard driving to inform emergency services of time efficacy of emergency response in an urban environment. METHODS: Prospective observational controlled study of response data of emergency and standard driving...
December 2017: Emergency Medicine Journal: EMJ
M Rehn, A E Weaver, S Eshelby, J Røislien, D J Lockey
INTRODUCTION: The current management of severely injured patients includes damage control resuscitation strategies that minimise the use of crystalloids and emphasise earlier transfusion of red blood cells (RBC) to prevent coagulopathy. In 2012, London's air ambulance (LAA) became the first UK civilian pre-hospital service to routinely carry RBC to the trauma scene. OBJECTIVE: To investigate the effect of pre-hospital RBC transfusion (phRTx) on overall blood product consumption...
October 24, 2017: Transfusion Medicine
S Wolf, J Morris, K Kennedy, M Lawn, T Mcloughlin, K Feane, J Uprichard, A Weaver, S Allard, L Green
BACKGROUND: Haemorrhage is the leading cause of mortality during trauma. In 2012, London's Air Ambulance introduced Blood on Board (BOB), transfusing group O red cells (RBC) to trauma patients at the scene. OBJECTIVES: This study assessed the impact of BOB on the number of mixed field samples received by the laboratory, the number of group O RBC transfused to non-group O patients and the ratio of RBC to fresh frozen plasma (FFP) transfused in the initial 24 h. METHODS: Three major trauma centres collected data on patients for whom the major haemorrhage protocol was activated between August 2008 and February 2012 pre-BOB and March 2012 and December 2013 post-BOB...
March 12, 2017: Transfusion Medicine
Samy Sadek, David J Lockey, Robbie A Lendrum, Zane Perkins, Jonathan Price, Gareth Edward Davies
This report describes the first use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the pre-hospital setting to control catastrophic haemorrhage. The patient, who had fallen 15 meters, suffered catastrophic internal haemorrhage associated with a pelvic fracture. He was treated by London's Air Ambulance's Physician-Paramedic team. This included insertion of a REBOA balloon catheter at the scene to control likely fatal exsanguination. The patient survived transfer to hospital, emergency angio-embolization and subsequent surgery...
October 2016: Resuscitation
Marius Rehn, Gareth Davies, Paul Smith, David J Lockey
OBJECTIVE: Emergency medical vehicle collisions are an inherent risk for health care providers, patients, and other road users. Air ambulance services often use rapid response cars (RRCs) to maintain operational resilience. We aim to describe the operational concept of London's Air Ambulance (LAA) RRCs and activity over a 1-year period. METHODS: This was a retrospective dispatch database study. The RRC operational concept, car configuration, and training are also described...
May 2016: Air Medical Journal
Usman Tariq, Meera Sood, Danë Goodsman
OBJECTIVE: This research focused on the facilitator's role in the simulated patient training "moulages" used by London's Air Ambulance (LAA) for their team training. Facilitators are chosen based on their experience and expertise in the field. The aim of this research was to gain insight into the role of moulage facilitator. METHODS: An ethnographic approach was employed, using the notion of "progressive focusing." Overt observational fieldwork was performed, with the resulting field notes evaluated by content analysis...
March 2015: Air Medical Journal
Akos Soti, Peter Temesvari, Laszlo Hetzman, Attila Eross, Andras Petroczy
In 2011 the Hungarian Air Ambulance Nonprofit Limited Company introduced a new Rapid Sequence Intubation standard operating procedure using a template from London's Air Ambulance. This replaced a previous ad-hoc and unsafe prehospital advanced airway management practice. It was hoped that this would increase clinical standards including internationally comparable results. All Rapid Sequence Intubations performed by the units of the Hungarian Air Ambulance under the new procedure between June 2011 and November 2013 were reviewed in a retrospective database analysis...
2015: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Ian Wilmer, Graham Chalk, Gareth Edward Davies, Anne Elizabeth Weaver, David John Lockey
OBJECTIVE: The identification of serious injury is critical to the tasking of air ambulances. London's Air Ambulance (LAA) is dispatched by a flight paramedic based on mechanism of injury (MOI), paramedical interrogation of caller (INT) or land ambulance crew request (REQ).This study aimed to demonstrate which of the dispatch methods was most effective (in accuracy and time) in identifying patients with serious injury. METHODS: A retrospective review of 3 years of data (to December 2010) was undertaken...
October 2015: Emergency Medicine Journal: EMJ
Richard M Lyon, Jerry Van Antwerp, Charles Henderson, Anne Weaver, Gareth Davies, David Lockey
Intranasal evaporative cooling presents a novel means of initiating therapeutic hypothermia after an out-of-hospital cardiac arrest (OHCA). Few studies have evaluated the use of intranasal therapeutic hypothermia using the Rhinochill device in the prehospital setting. We sought to evaluate the use of Rhinochill in the Physician Response Unit of London's Air Ambulance, aiming to describe the feasibility of employing it during prehospital resuscitation for OHCA. We prospectively evaluated the Rhinochill device over a 7-month period...
October 2014: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Jan Schumacher, Stuart A Gray, Sophie Michel, Roger Alcock, Andrea Brinker
INTRODUCTION: Emergency pediatric life support (EPLS) of children infected with transmissible respiratory diseases requires adequate respiratory protection for medical first responders. Conventional air-purifying respirators (APR) and modern loose-fitting powered air-purifying respirator-hoods (PAPR-hood) may have a different impact during pediatric resuscitation and therefore require evaluation. OBJECTIVE: This study investigated the influence of APRs and PAPR-hoods during simulated pediatric cardiopulmonary resuscitation...
February 2013: Prehospital and Disaster Medicine
Maryam Ahmad, Danë Goodsman, Emma Lightbody
BACKGROUND: Studies show that prehospital care is an important, yet often neglected part of the medical undergraduate curriculum. Thus, the Prehospital Care Programme (PCP) was introduced at Barts and the London School of Medicine and Dentistry in 2008, aiming to expose medical undergraduates to this unique area of medicine. CONTEXT: The programme makes use of the links between the medical school and the London Ambulance Service (LAS) and the London Air Ambulance (LAA), and places students from Bachelor of Medicine and Bachelor of Surgery (MBBS) years 2-5 with mentors from these services during a series of working shifts...
June 2012: Clinical Teacher
Philip Hyde, Rod Mackenzie, Gail Ng, Cliff Reid, Gale Pearson
BACKGROUND: Every day throughout the UK, ambulance services seek medical assistance in providing critically ill or injured patients with pre-hospital care. OBJECTIVE: To identify the current availability and utilisation of physician-based pre-hospital critical care capability across England, Wales and Northern Ireland. DESIGN: A postal and telephone survey was undertaken between April and December 2009 of all 13 regional NHS ambulance services, 17 air ambulance charities, 34 organisations affiliated to the British Association for Immediate Care and 215 type 1 emergency departments in England, Wales and Northern Ireland...
March 2012: Emergency Medicine Journal: EMJ
Per P Bredmose, Karel Habig, Gareth Davies, Gareth Grier, David J Lockey
INTRODUCTION: We describe a system of scenario-based training using simple mannequins under realistic circumstances for the training of pre-hospital care providers. METHODS: A simple intubatable mannequin or student volunteers are used together with a training version of the equipment used on a routine basis by the pre-hospital care team (doctor + paramedic).Training is conducted outdoors at the base location all year round. The scenarios are led by scenario facilitators who are predominantly senior physicians...
2010: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
P P Bredmose, D J Lockey, G Grier, B Watts, G Davies
The safe delivery of adequate analgesia and appropriate sedation is a priority in prehospital care. The use of ketamine is described for analgesia and sedation in 1030 trauma patients in a physician-led prehospital trauma service. Ketamine was mainly used in awake non-trapped patients with blunt trauma for procedural sedation and analgesia. Detailed database searches did not demonstrate loss of airway, oxygen desaturation or clinically significant emergence reactions after ketamine administration. Ketamine is relatively safe when used by physicians in prehospital trauma care...
January 2009: Emergency Medicine Journal: EMJ
Bahman S Roudsari, Avery B Nathens, Carlos Arreola-Risa, Peter Cameron, Ian Civil, Giouli Grigoriou, Russel L Gruen, Thomas D Koepsell, Fiona E Lecky, Rolf L Lefering, Moishe Liberman, Charles N Mock, Hans-Jörg Oestern, Elenie Petridou, Thomas A Schildhauer, Christian Waydhas, Moosa Zargar, Frederick P Rivara
OBJECTIVES: To compare patient- and injury-related characteristics of trauma victims and pre-hospital trauma care systems among different developed and developing countries. METHOD: We collated de-identified patient-level data from national or local trauma registries in Australia, Austria, Canada, Greece, Germany, Iran, Mexico, New Zealand, the Netherlands, the United Kingdom and the United States. Patient and injury-related characteristics of trauma victims with injury severity score (ISS) >15 and the pre-hospital trauma care provided to these patients were compared among different countries...
September 2007: Injury
S A Bland
Since the 7th July, the Civil Contingencies Act 2004 has now come into force. Emergency services are required to have plans in place to response to a range of major incidents. The role of pre-hospital physicians has been recognised for sometime and was highlighted during the inquiry by Hidden QC into the 1988 Clapham rail disaster. The medical response from both HEMS and London BASICS was extraordinary on the day due to the significant number of clinicians attending the clinical governance day. The three post 7/7 reports have made several recommendations, the main recommendations focusing on communications and the management of uninjured survivors and relatives...
2006: Journal of the Royal Naval Medical Service
P D Dissmann, S Le Clerc
BACKGROUND: The benefits of helicopter emergency medical services (HEMSs) attending the severely injured have been documented in the past. The benefits of doctors attending HEMS casualties have been demonstrated in particular in inner-urban and metropolitan areas. However, for UK regions with potentially less major trauma, concerns have been raised by ambulance services that a willingness of doctors to "stay and play" may lead to unnecessary delays on-scene without any additional benefit to the patient...
January 2007: Emergency Medicine Journal: EMJ
Charles D Deakin, Daniel M Sado, Timothy J Coats, Gareth Davies
BACKGROUND: End-tidal carbon dioxide (Petco2) concentration is a marker of the pathophysiologic state because it is a reflection of cardiac output. Petco2 correlates with outcome after prehospital primary cardiac arrest, but association with outcome from prehospital trauma has not been established. METHODS: Between 1998 and 2001, Petco2 was recorded in 191 blunt trauma patients requiring prehospital intubation. Rapid sequence intubation was performed using suxamethonium (1 mg/kg) and etomidate (0...
July 2004: Journal of Trauma
T J Coats, S Keogh, H Clark, M Neal
OBJECTIVE: The purpose of this study is to present the rationale for an algorithm that describes the place of resuscitative thoracotomy in the prehospital management of a patient with penetrating chest injury, and to review a 6-year experience using this algorithm. METHODS: This study was a retrospective review of all cases where a prehospital thoracotomy was performed by the medical teams of the London Helicopter Emergency Medical Service. RESULTS: Thirty-nine prehospital thoracotomies were performed...
April 2001: Journal of Trauma
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