A new study published in the Canadian Medical Association Journal (CMAJ) reports that during air-medical transport of acutely-ill patients, one in twenty experiences a critical event such as death, major resuscitation or blood pressure deterioration.

The study examined 19,228 transported adult patients in Ontario, Canada and is the largest of its type. Researchers attempted to determine which factors were related with in-transit adverse events.

In transit critical events were associated to factors, such as traumatic injuries, female gender, cardiovascular disease, assisted ventilation or blood pressure instability and on-scene treatment. In addition, transport characteristics varied with geography. Transports in northern Ontario dealt with more surgical and medical cases and had longer transport distances. Whereas in southern Ontario, helicopter calls for trauma patients were frequent.

Concerning the fact that women are more at risk of adverse events, Dr. Jeff Singh, University Health Network, Toronto and coauthors write that “this observation may be attributable to differences in disease presentations, differential treatment or differences in referral patterns and transport requests between men and women.”

Several critical events were associated to airway management. They may have been avoided through adequate preparation before transport.

The authors point out that their findings may be of some support for determining protocols for air transport of patients at high-risk of in-transit resuscitation. In addition, the information may provide assistance in training paramedic transport crews and in preparing patients by hospital staff before transport.

In an associated note, Dr. Alex Isakov, from the Department of Emergency Medicine, Emory University in Atlanta, USA, observes: “This data may provide insight for medical crew training regarding likely in-flight medical management scenarios, or markers for more robust stabilization of patients by hospital staff preparing patients for transport. It may also help in the development of evidence-based criteria for dispatch.”

“Incidence and predictors of critical events during urgent air-medical transport”
Jeffrey M. Singh MD MSc, Russell D. MacDonald MD MPH, Susan E. Bronskill PhD,Michael J. Schull MD MSc
CMAJ 2009. DOI:10.1503/cmaj.080886

“Urgent air-medical transport: Right patient, place and time”
Alexander Isakov MD MPH
CMAJ 2009. DOI:10.1503/cmaj.091258
Canadian Medical Association Journal

Written by Stephanie Brunner (B.A.)