BackgroundPhysician-staffed helicopter emergency services (HEMS) can provide benefit through the delivery of specialist competence and equipment to the prehospital scene and through expedient transport of critically ill patients to specialist care. This paper describes the integration of such a system in a rural Swedish county.MethodsThis is a retrospective database study recording the outcomes of every emergency call centre dispatch request as well as the clinical and operational data from all completed missions during this service’s first year in operation.ResultsDuring the study period, HEMS completed 478 missions out of which 405 (84,7%) were primary missions to prehospital settings and 73 (15,3%) were inter-hospital critical care transfers. A majority (55,3%) of primary missions occurred in the regions furthest from our hospitals, in municipalities housing only 15,6% of the county’s population. The NACA (IQR) score on primary and secondary missions was 4 (2) and 5 (1), respectively.ConclusionsThis study describes the successful integration of a physician-based air ambulance service in a Scandinavian rural region. Municipalities distant from our hospitals benefitted as they now have access to early specialist intervention and expedient transport to critical hospital care. Our hospitals and most populated areas benefitted from HEMS secondary mission capability as they gained a dedicated ICU transport service that could provide specialist intensive care during rapid inter-hospital transfer.

Background In pre‐hospital care, pre‐intubation checklists (PICL) are widely implemented as a safety measure and guidelines support their use. However, the true value of PICL among experienced airway providers is unknown. This study aims to explore possible benefits and disadvantages of PICL in the pre‐hospital setting. Methods We performed a subgroup analysis of a prospective, observational, multicentre study on pre‐hospital advanced airway management in the Nordic countries between May 2015 and November 2016. The original trial was designed to investigate the success rates of pre‐hospital tracheal intubations and the incidence of complications. Our study limited inclusion to drug assisted intubations performed by anaesthesiologists. Intubation success rates and complication rates were plotted against checklist use. Results We analyzed 588 pre‐hospital intubations for medical and traumatic emergencies. Overall, checklists were used in 60.5% of instances. Applying checklists was associated with increased success at first and second intubation attempts. There was no significant difference in the overall success rates (99.4% and 99.1%). Oesophageal misplacement was more common in the No‐PICL group (2.2% vs 0.3%) but otherwise the incidence of airway related complications did not differ between the groups. Scene time was significantly shorter in the No‐PICL group (23.6 vs 27.5 minutes). Conclusion In this retrospective study, checklist use correlated with fewer attempts at intubation when securing the airway. Despite this, we found no association between checklist use and the overall TI success rate or the incidence of serious adverse events. Scene times were shorter without PICL.

Objectives Indication for invasive mechanical ventilation in COVID‐19 pneumonia has been a major challenge. This study aimed to evaluate if lung ultrasound (LUS) can assist identification of requirement of invasive mechanical ventilation in moderate to severe COVID‐19 pneumonia. Materials and Methods Between April 23 and November 12, 2020, hospitalized patients with moderate to severe COVID‐19 (oxygen demand ≥4 L/min) were included consecutively. Lung ultrasound was performed daily until invasive mechanical ventilation (IMV‐group) or spontaneous recovery (non‐IMV‐group). Clinical parameters and lung ultrasound findings were compared between groups, at intubation (IMV‐group) and highest oxygen demand (non‐IMV‐group). A reference group with oxygen demand <4 L/min was examined at hospital admission. Results Altogether 72 patients were included: 50 study patients (IMV‐group, n = 23; non‐IMV‐group, n = 27) and 22 reference patients. LUS‐score correlated to oxygen demand (SpO 2 /FiO 2 ‐ratio) (r = 0.728; p < 0.0001) and was higher in the IMV‐group compared to the non‐IMV‐group (20.0 versus 18.0; p = 0.026). Based on receiver operating characteristic analysis, a LUS‐score of 19.5 was identified as cut‐off for requirement of invasive mechanical ventilation (area under the curve 0.68; sensitivity 56%, specificity 74%). In 6 patients, LUS identified critical coexisting conditions. Respiratory rate and oxygenation index ((SpO 2 /FiO 2 )/respiratory rate) ≥4.88 identified no requirement of invasive mechanical ventilation with a positive predictive value of 87% and negative predictive value of 100%. Conclusions LUS‐score had only a moderate diagnostic value for requirement of invasive mechanical ventilation in moderate to severe COVID‐19. However, LUS proved valuable as complement to respiratory parameters in guidance of disease severity and identifying critical coexisting conditions.