To determine if utilizing a single paramedic crew configuration is safe for transporting low acuity patients requiring only a primary care paramedic (PCP) level of care in Air Ambulances.

We studied single-PCP transports of low acuity patients done by contract air ambulance carriers, organized by Ornge (Ontario’s Air Ambulance Service) for one year. We only included interfacility transports. We excluded all scene calls, and all Code 4 (emergent) calls. Our primary outcome was clinical deterioration during transport. We then asked a panel to analyze each case of deterioration to determine if a dual-PCP configuration might have reasonably prevented the deterioration or have better treated the deterioration, compared to a single-PCP configuration.

In one year, contract carriers moved 3264 patients, who met inclusion criteria. 85% were from Northern Ontario. There were 21 cases of medical deterioration (0.6%±0.26%). Paper charts were found for 20 of these cases. Most were self-limited cases of pain or nausea. A small number of cases (n=5) were cardiorespiratory decompensation. There was 100% consensus amongst the panel that all cases of clinical deterioration were not related to team size. There was also 100% consensus that a dual-PCP team would not have been better able to deal with the deterioration, compared to a single-PCP crew.

We found that using a single-PCP configuration for transporting low acuity patients is safe. This finding is particularly important for rural areas where air ambulance is the only means for accessibility to care and where staffing issues are magnified.

International literature describing the profile of trauma patients attended by a statewide emergency medical services (EMS) system is lacking. Most literature is limited to descriptions of trauma responses for a single emergency medical service, or to patients transported to a specific Level-1 trauma hospital. There is no Victorian or Australian literature describing the type of trauma patients transported by a state emergency medical service.

The purpose of this study was to define a profile of all trauma incidents attended by statewide EMS.

A retrospective cohort study of all patient care records (PCR) for trauma responses attended by Victorian Ambulance Services for 2002 was conducted. Criteria for trauma categories were defined previously, and data were extracted from the PCRs and entered into a secure data repository for descriptive analysis to determine the trauma profile. Ethics committee approval was obtained.

There were 53,039 trauma incidents attended by emergency ambulances during the 12-month period. Of these, 1,566 patients were in physiological distress, 11,086 had a significant pattern of injury, and a further 8,931 had an identifiable mechanism of injury. The profile includes minor trauma (n = 9,342), standing falls (n = 20,511), no patient transported (n = 3,687), and deceased patients (n = 459).

This is a unique analysis of prehospital trauma. It provides a baseline dataset that may be utilized in future studies of prehospital trauma care. Additionally, this dataset identifies a ten-fold difference in major trauma between the prehospital and the hospital assessments.

Search and rescue helicopters from the Royal Norwegian Air Force conduct ambulance and search and rescue missions in the Barents Sea. The team on-board includes an anesthesiologist and a paramedic. Operations in this area are challenging due to long distances, severe weather conditions, and arctic winter darkness.

One-hundred, forty-seven ambulance and 29 search and rescue missions in the Barents Sea during 1994–1999 were studied retrospectively with special emphasis on operative conditions and medical results.

Thirty-five percent of the missions were carried out in darkness. The median time from the alarm to first patient contact was 3.3 hours and the median duration of the missions was 7.3 hours. Forty-eight percent of the missions involved ships of foreign origin. Half the patients had acute illnesses, dominated by gastrointestinal and heart diseases. Most of the injuries resulted from industrial accidents with open and closed fractures, amputations, and soft tissue damage. Ninety percent of the patients were hospitalized; 7.5% probably would not have survived without early medical treatment and rapid transportation to a hospital.

Using a heavy search and rescue helicopter in the Barents Sea was the right decision in terms of medical gain and operative risk.