Currently, many airplanes and helicopters are used as air ambulances to transport high-acuity patients. Unfortunately, civilian air medical transport in the United States has experienced a significant number of serious and fatal accidents. At the moment, additional research is needed to identify what factors affect air medical safety.

Accident reports from the National Transportation Safety Board (NTSB) were queried. Accident reports were analyzed if the accident occurred from 2000 through 2020, involved a helicopter or airplane on an air medical flight (as identified by the NTSB), and had at least one fatality. The date of the accident, the model of aircraft involved, and NTSB-determined probable causes of the accident were examined.

Eighty-seven (87) accidents and 239 fatalities took place from January 2000 through December 2020. Nearly three-fourths (72.4%) of fatalities occurred on helicopters, while just 27.6% occurred on airplanes. Interpreting the NTSB findings, various human factors probably contributed to 87.4% of fatalities. These include pilot disorientation, pilot errors, maintenance errors, impairment, fatigue, or weather misestimation. Nighttime-related factors probably contributed to 38.9% of fatalities, followed by weather-related factors (35.6%), and various mechanical failures (17.2%).

These data show that the probable causes of fatal air medical accidents are primarily human factors and are, therefore, likely preventable. Developing a safety-first culture with a focus on human factors training has been shown to improve outcomes across a wide range of medical specialties (eg, anesthesia, surgery, and resuscitation). While there have been fewer fatal accidents in recent years, a continued emphasis on various training modalities seems warranted.

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.

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.

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.

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.

Devices used for support of patients requiring air rescue or conveyance are subjected to severe environments that may affect their ability to function when needed or may affect other systems within the transporting vehicle.

The ability of four portable ventilators, a suction device, and plastic and rubber tracheal tubes to withstand changes in temperature, vibration, sudden deceleration, and electromagnetic fields was studied in the laboratory setting. In addition, the effects of the operation of these devices on the flight instrumentation was investigated.

All of the ventilators tested delivered stable minute volumes at temperatures above zero, but in sub-zero temperatures problems were encountered with the driving gas. Vibrations produced alterations in the performance of two of the ventilators, and resonant frequencies were detected that are identical to those produced by the rotors of the helicopter used.

Suctioning became difficult at temperatures below −5° C as the mucus froze in the collecting tubing. The motor produced electromagnetic fields that interfered with the aircraft instrumentation, and resonant frequencies had a deleterious effect on the circuit boards. Plastic tubes were adversely affected by cold, and these chilled tubes were excessively sensitive to vibration and shocks.

The devices used in various aircraft influence certain vital maneuver systems of the craft. Studies on portable ventilators, a suction device, and tracheal tubes showed that, under specific conditions, the equipment was safe to patients and was not hazardous to the aviation safety. However, under certain conditions commonly encountered during air rescue operations, the equipment became dys-functional or presented safety hazards to the aircraft, and, hence, the crew. The Swedish Air Force has adopted three different criteria constellations: 1) operative; 2) storing; and 3) transport environment.

Crashes involving commercial airliners stress emergency medical services (EMS) and rescue operations to performance far in excess of everyday activities, and special adaptations of everyday responses need to be implemented. Fortunately, these events are infrequent and usually do not occur more than once in any location. The responses that occur must be highly coordinated and efficient. Little is known about the responses to such events. This study examines the EMS and rescue responses associated with eight recent crashes involving commercial airliners in the United States.

To identify common factors for which alterations in responses may enhance the survival and decrease the morbidity to victims involved in commercial aviation crashes.

Eight commercial airliner crashes in the United States from 1987 through 1991.

Case review using: 1) press and media accounts; 2) U.S. National Transportation and Safety Board testimony and reports; and 3) structured interviews with airport, fire, EMS, and hospital personnel. Data were collated and common factors identified for the cases. Findings are classified into: 1) conditions at the crash sites; 2) initial responses; 3) scene management; 4) scene status; 5) patient transport; 6) hospital responses; and 7) preplanning exercises.

Common factors that impaired responses for which some remediation is possible include: 1) new methods for training including computerized simulations; 2) improvements in rescue-extrication equipment and supplies; 3) stored caches of EMS equipment and supplies at airports; 4) ambulance transport capabilities; and 5) augmentation of patient transport capabilities.

Many lessons can be learned through structured studies of commercial aircraft crashes. These findings suggest that simple and relatively inexpensive modifications may enhance all levels of emergency response to such events.

To examine the effects of age, race, gender, and insurance status on utilization and times-to-transport (TTT) for interhospital air medical transfers from rural hospitals to tertiary care centers.

A retrospective review of interhospital transport records. The TTT was examined as a function of age, gender, race, and insurance status using the Student's t-test for unpaired samples. The Exact Binomial Test (alpha error at 0.05) was used to compare the observed versus expected transport rates for non-whites.

A total of 268 patient transfers from hospitals within a two-county region in central Pennsylvania to tertiary care centers was analyzed. All records with sufficient demographic, TTT, or insurance data were included. Absence of data was the only exclusion.

The TTT (mean ± SD) was longer (2666 ± 3940 minutes (min.) versus 619 ± 909 min., respectively) for adult than pediatric patients (p <O1), and (2588 ± 4041 min. versus 640 ± 1301 min., respectively) for insured versus uninsured patients (p <.O1). The observed proportion of non-whites transported was less than expected (.41% versus 2.1 %) based on the proportion of non-whites in the region (p <.O5).

The TTT was longer for adults than for children and for the insured than the uninsured. Non-whites were transported less frequently than predicted.