CCT CORE mission

Assembled in 2008 with support from MedEvac Foundation International and Dr. Suzanne K. Wedel of Boston MedFlight, CCT CORE aims to facilitate collaboration in transport medicine research. We are interested in all modes of specialized patient transport, with particular focus on air medical triage, utilization, and potential benefits. CCT CORE is managed by faculty and fellows of the EMS Division at Beth Israel Deaconess Medical Center & Harvard Medical School.

CCT CORE's current interests include evaluation of clinical and logistics circumstances in which helicopter transport may be advantageous. Myriad situational factors determine utility of helicopter emergency medical services (HEMS) in a given case. While some of these factors (e.g. crew experience) are not easily studied, logistics factors are objective in their measurement. In some emergencies (e.g. trauma, stroke, ST-elevation myocardial infarction), HEMS-mediated time savings may translate into improved patient outcomes. CCT CORE is interested in evaluating and adding to evidence guiding decisions regarding air vs. ground transport. An example recent endeavor was assessing precise ties between time savings and outcomes improvement focused on ST-elevation and time to primary percutaneous coronary intervention. Other recent publications have assessed artificial intelligence applications in the HEMS, prehospital transfusion, and evaluation of the previous year's air medical transport outcomes studies.

HOARD is a spreadsheet assembly of HEMS research addressing patient-centered outcomes. While not comprehensive, HOARD is intended as a useful information source for those interested in HEMS potential benefits on patient outcomes. HOARD is described in detail in a 2023 Air Medical Journal paper (doi at left); access is available via emailing CCT CORE.

There are myriad questions surrounding HEMS triage, logistics, utilization, and potential benefits. Although not all such questions have definitive answers, there is a substantial body of relevant evidence. CCT CORE offers a HEMS monograph as a tool for those interested in exploring the state of evidence on helicopter triage, utilization, and effectiveness. The monograph can be obtained by emailing the author, Stephen H. Thomas.

To aid in streamlining HEMS crew stabilization time at referring hospitals, CCT CORE authored SPRINT: Stabilizing Patients Rapidly for INterfacility Transport. Developed with support from from MedEvac Foundation International and the Oklahoma State Department of Health, SPRINT materials are freely available via emailing CCT CORE.

Commencing with the initial CCT CORE project, a 10-center North American airway study, CCT CORE collaborators have worked to contribute to the transport evidence base. A partial bibliography follows.

Airway

Thomas S, Judge T, Lowell MJ, MacDonald RD, Madden J, Pickett K, Werman HA, Shear ML, Patel P, Starr G, Chesney M, Domeier R, Frantz P, Funk D, Greenberg RD.  Airway management success and hypoxemia rates in air and ground critical care transport:  A prospective multicenter study.  Prehospital Emergency Care 2010; 14:283-291.

Price B, Arthur AO, Brunko M, Frantz P, Dickson JO, Judge T, Thomas SH.  Hemodynamic consequences of ketamine vs etomidate for endotracheal intubation in the air medical setting.  American Journal of Emergency Medicine 2013; 31:1124-1132.

Artificial intelligence in HEMS

Hsueh J, Fritz C, Thomas CE, Reimer AP, Reisner AT, Schoenfeld D, Haimovich A, Thomas SH. Applications of artificial intelligence in helicopter EMS: a scoping review. Air Med J 2023, published online 20 Dec 2023. doi 10.1016/j.amj.2023.11.012

Antibiotics for open fractures

Thomas SH, Arthur AO, Howard Z, Shear ML, Kadzielski JJ, Vrahas MS.  Helicopter EMS crew administration of antibiotics for open fractures: TREAT Fx Study.  Air Medical Journal 2013; 32(2):74-79.

HEMS literature overview & broad-based outcomes studies

Rudman JS, Fritz CL, Thomas SA, McCartin M, Price J, Blumen IJ, Thomas SH. Helicopter EMS outcomes research 1983 to 2022: Evidence overview and longitudinal trends. Air Med J 2023. doi 10.1016/j.amj.2023.07.003

Schoenfeld D, Thomas CE, McCartin M, Blumen IJ, Galvagno SM, Thomas SH. Natural experiment outcomes studies in rotor-wing air medical transport: Systematic review and meta-analysis of before-and-after and helicopter-unavailable publications 1970-2022. Air Med J 2023; published online 5 Dec 2023. doi 10.1016/j.amj.2023.11.005

Fritz CL, Rudman J, McCartin M, Price J, Shecter J, Backstrom D, Thomas SA, Thomas SH. Recent outcomes research in helicopter EMS: A scoping review of publication-year 2023 additions to the Helicopter Outcomes Assessment Research Database. Air Med J 2024. doi 10.1016/j.amj.2024.05.002

Patient safety

MacDonald R, Yelle R, Oake-Vecchiato J, Melis C, Bigham BL.  Derivation of a taxonomy to categorize adverse events and near-misses in transport medicine.  Air Medical Journal 2011; 30(5): 254-255.

GIS systems in HEMS logistics

Soulek JJ, Arthur AO, Williams E, Schieche C, Banister N, Thomas SH. Geographical information systems (GIS) programs' accuracy for interfacility air transport distances and times. Air Medical Journal 2014; 33: 165-171.

Time savings & related outcomes benefit

Phillips M, Arthur AO, Chandwaney R, Hatfield J, Brown B, Pogue K, Thomas M, Lawrence M, McCarroll M, McDavid M, Thomas SH. Helicopter transport effectiveness of patients for primary percutaneous coronary intervention. Air Medical Journal 2013; 32: 144-152.

Pathan S, Soulek J, Qureshi I, Werman H, Reimer A, Brunko MW, Alinier G, Irfan FB, Thomas SH. Helicopter EMS and rapid transport for ST-elevation myocardial infarction: The HEARTS Study. J Emerg Med Trauma Acute Care 2017; 8.

Price J, Rudman J, Schoenfeld D, Thomas SA, Rees P, Bloom B, McCartin M, Blumen I, Thomas SH. Survivorship with incrementally faster times to primary percutaneous coronary intervention (SWIFT-PPCI): A systematic review and meta-analysis. Am J Cardiol 2023; 207: 356-362. doi 10.1016/j.amjcard.2023.08.178 

Schoenfeld D, Ho KKL, McCartin MP, Fritz C, Petcu R, Cohen J, Ottanelli C, Ullman E, Blumen I, Thomas SH. Longitudinal assessment of a single referring-receiving hospital pair to assess air vs. ground elapsed time from transport request to arrival at cardiac catheterization laboratory: An observational cohort study. Air Med J 2024 (available online 9 Dec 2024); doi  10.1016/j.amj.2024.11.007

Legere B, Mohamed A, Elsherifc S, Saqqurd R, Schoenfeld D, Slebonick AM, McCartin M, Price J, Zachrison KS, Edlow JA, Saqqur M, Shuaib S, Thomas SH. Success with incrementally faster times to endovascular therapy (SWIFT-EVT): A systematic review and meta-analysis. J Stroke Cerebrovasc Dis 2024; 10.1016/j.jstrokecerebrovasdis.2024.107964 

Trauma & transfusion

Fritz C, Thomas SA, Galvagno SM, Thomas SH. Survival benefit of helicopter scene response for patients with an injury severity score of at least nine: A systematic review and meta-analysis. Prehosp Emerg Care 2023 ePub Jul18 doi 10.1080/10903127.2023.2232453

Schoenfeld D, Rosen C, Harris TE, Thomas SH. Assessing the one-month mortality impact of civilian-setting prehospital transfusion: A systematic review and meta-analysis. Acad Emerg Med 2024 ePub Mar22 doi 10.1111/acem.14882

McCartin MP, Wool GD, Thomas SA, Panfil M, Schoenfeld D, Blumen IJ, Tataris KL, Thomas SH. Management considerations for air medical transport programs transfusing RhD positive red-blood-cell containing products to females of childbearing potential. Air Med Journal 2024; doi 10.1016/j.amj.2024.03.012