Air medical services are the use of aircraft, including both fixed-wing aircraft and helicopters to provide various kinds of urgent medical care, especially prehospital, emergency and critical care to patients during aeromedical evacuation and rescue operations.
161-832: During World War I , air transport was used to provide medical evacuation – either from frontline areas or the battlefield itself. In 1928, in Australia, John Flynn founded the Flying Doctor Service (later the Royal Flying Doctor Service), to provide a wide range of medical services to civilians in remote areas; these included from routine consultations with travelling general practitioners , to air ambulance evacuations and other emergency medical services . Fixed wing military air ambulances came into regular use during World War II. Helicopters became more commonly used for such purposes during
322-523: A Bosnian Serb named Gavrilo Princip assassinated Archduke Franz Ferdinand , heir to the Austro-Hungarian throne. Austria-Hungary held Serbia responsible, and declared war on 28 July. After Russia mobilised in Serbia's defence, Germany declared war on Russia and France , who had an alliance . The United Kingdom entered after Germany invaded Belgium , whose neutrality it guaranteed, and
483-645: A blue-water navy was vital for global power projection; Tirpitz had his books translated into German, while Wilhelm made them required reading for his advisors and senior military personnel. However, it was also an emotional decision, driven by Wilhelm's simultaneous admiration for the Royal Navy and desire to surpass it. Bismarck thought that the British would not interfere in Europe, as long as its maritime supremacy remained secure, but his dismissal in 1890 led to
644-592: A grenade at the Archduke's car and injured two of his aides. The other assassins were also unsuccessful. An hour later, as Ferdinand was returning from visiting the injured officers in hospital, his car took a wrong turn into a street where Gavrilo Princip was standing. He fired two pistol shots, fatally wounding Ferdinand and his wife Sophie . According to historian Zbyněk Zeman , in Vienna "the event almost failed to make any impression whatsoever. On 28 and 29 June,
805-540: A guerrilla warfare campaign and only surrendered two weeks after the armistice took effect in Europe. Before the war, Germany had attempted to use Indian nationalism and pan-Islamism to its advantage, a policy continued post-1914 by instigating uprisings in India , while the Niedermayer–Hentig Expedition urged Afghanistan to join the war on the side of Central Powers. However, contrary to British fears of
966-462: A business enterprise, or funded by public donations. It may also be reasonable to differentiate between dedicated aircraft and those with multiple purposes and roles. Finally, it is reasonable to differentiate by the type of aircraft used, including rotary-wing , fixed-wing , or very large aircraft. The military role in civilian air ambulance operations is described in the History section. Each of
1127-408: A change in policy and an Anglo-German naval arms race began. Despite the vast sums spent by Tirpitz, the launch of HMS Dreadnought in 1906 gave the British a technological advantage. Ultimately, the race diverted huge resources into creating a German navy large enough to antagonise Britain, but not defeat it; in 1911, Chancellor Theobald von Bethmann Hollweg acknowledged defeat, leading to
1288-468: A combination of these roles. In almost all cases, the government provides guidelines to hospitals and EMS systems to control operating costs—and may specify operating procedures in some level of detail to limit potential liability. However, the government almost always takes a 'hands-off' approach to the actual running of the system, relying instead on local managers with subject matter (physicians and aviation executives) expertise. Ontario's ORNGE program and
1449-690: A consideration in some contexts, in the United States, the primary measure of effectiveness is patient outcomes. Improvements in ground ambulance prehospital care have created uncertainty as to whether helicopter emergency medical services transport is associated with better patient outcomes compared with ground transportation. A U.S. study using 2014 data found that after adjusting for age, Injury Severity Score, and gender, trauma patients who were transferred by helicopter were 57.0% less likely to die than those transferred by ground ambulance (95% CI 0.41 to 0.44, p<0.0001). A retrospective review study reached
1610-435: A critical role, often then selling the rights to larger companies that have the resources to run the clinical trials. Drug discovery is different from Drug Development. Drug Discovery is often considered the process of identifying new medicine. At the same time, Drug development is delivering a new drug molecule into clinical practice. In its broad definition, this encompasses all steps from the basic research process of finding
1771-613: A direct threat. The 1908–1909 Bosnian Crisis began when Austria annexed the former Ottoman territory of Bosnia and Herzegovina , which it had occupied since 1878. Timed to coincide with the Bulgarian Declaration of Independence from the Ottoman Empire, this unilateral action was denounced by the European powers, but accepted as there was no consensus on how to resolve the situation. Some historians see this as
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#17327796411091932-471: A gap between the German armies as they closed on Paris. The French army, reinforced by the British expeditionary corps, seized this opportunity to counter-attack and pushed the German army 40 to 80 km back. Both armies were then so exhausted that no decisive move could be implemented, so they settled in trenches, with the vain hope of breaking through as soon as they could build local superiority. In 1911,
2093-621: A great deal of experience in piloting their aircraft because the conditions of air ambulance flights are often more challenging than regular non-emergency flight services. After a spike in air ambulance crashes in the United States in the 1990s, the U.S. government and the Commission on Air Medical Transportation Systems ( CAMTS ) stepped up the accreditation and air ambulance flight requirements, ensuring that all pilots, personnel, and aircraft meet much higher standards than previously required. The resulting CAMTS accreditation, which applies only in
2254-575: A group of 2245 elderly Americans (average age of 71) surveyed over the period 2010 – 2011, those percentages were 88%, 38%, and 64%. One of the key classifications is between traditional small molecule drugs; usually derived from chemical synthesis and biological medical products ; which include recombinant proteins , vaccines , blood products used therapeutically (such as IVIG ), gene therapy , and cell therapy (for instance, stem cell therapies). Pharmaceuticals or drugs or medicines are classified into various other groups besides their origin on
2415-678: A higher level of care at the scene of a trauma and faster transport to a trauma center. They can also provide critical care when transporting patients from community hospitals to trauma centers. Air ambulance transport is expensive, and if utilised poorly is therefore not cost effective. When inappropriately deployed to a patient close to a hospital, an air ambulance may add delay to the patient reaching hospital. In research from 1996, air ambulance services in England and Wales demonstrated no evidence of improvement in vehicle response times (i.e. time from 999 call to an ambulance vehicle being on-scene with
2576-505: A list of essential medicines . A sampling of classes of medicine includes: Pharmaceuticals may also be described as "specialty", independent of other classifications, which is an ill-defined class of drugs that might be difficult to administer, require special handling during administration, require patient monitoring during and immediately after administration, have particular regulatory requirements restricting their use, and are generally expensive relative to other drugs. Drugs affecting
2737-964: A local business or even a multi-national company may choose to fund local air ambulance service as a goodwill or public relations gesture. Examples of this are common in the European Union , where in London the Virgin Corporation previously donated to the Helicopter Emergency Medical Service, and in Germany and the Netherlands a large number of the 'Christoph' air ambulance operations are actually funded by ADAC , Germany's largest automobile club and DRF Luftrettung. In Australia and New Zealand , many air ambulance helicopter operations are sponsored by
2898-421: A non-medically equipped and staffed aircraft simply transports patients without care in flight. Military organizations and NATO refer to the former as medical evacuation (MEDEVAC) and to the latter as casualty evacuation (CASEVAC) . Air Traffic Control (ATC) grants special treatment to air ambulance operations, much like a ground ambulance using lights and a siren, only when they are actively operating with
3059-430: A not-for-profit mutual insurance company, specifies the circumstances in which costs for air medical services are covered. The medical personnel of a helicopter ambulance has historically been a Physician/Nurse combination, Paramedic/Nurse, or a Nurse/Nurse combination. The need for a Physician/Nurse combination has diminished with more protocol and evidence-based applications for care by nurses and other clinicians and so
3220-574: A paramedic provided from whichever fire department rescue unit has responded. Sometimes the air ambulance may be run as a dual concern with another governmental body - for example, the Wiltshire Air Ambulance was run as a joint Ambulance Service and police unit until 2014. In other cases, the paramedic staffs the aircraft full-time, but has a dual function. In the case of the Maryland State Police, for example,
3381-430: A patient. When this happens, air ambulance aircraft take the call sign MEDEVAC (formerly LIFEGUARD) and receive priority handling in the air and on the ground. As with many Emergency Medical Service (EMS) innovations, treating patients in flight originated in the military. The concept of using aircraft as ambulances is almost as old as powered flight itself. Although balloons were not used to evacuate wounded soldiers at
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#17327796411093542-548: A possibility. This was accentuated by British and Russian support for France against Germany during the 1911 Agadir Crisis . German economic and industrial strength continued to expand rapidly post-1871. Backed by Wilhelm II, Admiral Alfred von Tirpitz sought to use this growth to build an Imperial German Navy , that could compete with the British Royal Navy . This policy was based on the work of US naval author Alfred Thayer Mahan , who argued that possession of
3703-452: A process known as reverse pharmacology . Hits from these screens are then tested in cells and then in animals for efficacy . Even more recently, scientists have been able to understand the shape of biological molecules at the atomic level and to use that knowledge to design (see drug design ) drug candidates. Modern drug discovery involves the identification of screening hits, medicinal chemistry , and optimization of those hits to increase
3864-411: A process of identifying a new medicine. Development: Chemicals extracted from natural products are used to make pills, capsules, or syrups for oral use. Injections for direct infusion into the blood drops for eyes or ears. Preclinical research : Drugs go under laboratory or animal testing, to ensure that they can be used on Humans. Clinical testing: The drug is used on people to confirm that it
4025-834: A revolt in India, the outbreak of the war saw a reduction in nationalist activity. Leaders from the Indian National Congress and other groups believed support for the British war effort would hasten Indian Home Rule , a promise allegedly made explicit in 1917 by Edwin Montagu , the Secretary of State for India . In 1914, the British Indian Army was larger than the British Army itself, and between 1914 and 1918 an estimated 1.3 million Indian soldiers and labourers served in Europe, Africa, and
4186-516: A significant escalation, ending any chance of Austria cooperating with Russia in the Balkans, while also damaging diplomatic relations between Serbia and Italy. Tensions increased after the 1911–1912 Italo-Turkish War demonstrated Ottoman weakness and led to the formation of the Balkan League , an alliance of Serbia, Bulgaria, Montenegro , and Greece . The League quickly overran most of
4347-519: A similar conclusion: "Patients transported by helicopter to an urban trauma centre ... had improved survival than those arriving by other means of transport." Patient survival is not the only possible measure of patient outcome. In the case of stroke patients, for instance, various outcome measures could be used. There are many considerations in determining whether to dispatch air medical services. Availability, distance and flight conditions are primary considerations. Even when available, an air ambulance
4508-525: A single rotor-wing aircraft based in Toronto. An important difference in the Ontario program involved the emphasis of service. "On scene" calls were taken, although less commonly, and a great deal of the initial emphasis of the program was on the interfacility transfer of critical care patients. Operating today through a private contractor ( ORNGE ), the system operates 33 aircraft stationed at 26 bases across
4669-890: A standing air ambulance system, as did Siam (Thailand). In 1928 the first formal, full-time air ambulance service was established in the Australian outback . This organization became the Royal Flying Doctor Service and still operates. In 1934, Marie Marvingt established Africa's first civil air ambulance service, in Morocco. In 1936, air ambulance services were established as part of the Highlands and Islands Medical Service to serve more remote areas of Highland Scotland . Air ambulances quickly established their usefulness in remote locations, but their role in developed areas developed more slowly. After World War II ,
4830-499: A suitable molecular target to supporting the drug's commercial launch. Drug development is the process of bringing a new drug to the market once a lead compound has been identified through the process of drug discovery . It includes pre-clinical research (microorganisms/animals) and clinical trials (on humans) and may include the step of obtaining regulatory approval to market the drug. Drug Development Process Discovery: The Drug Development process starts with Discovery,
4991-826: A typical paramedic, so medical control permits them to exercise more medical decision-making latitude. Assessment skills tend to be considerably higher, and, particularly on inter-facility transfers, permit the inclusion of functions such as reading x-rays and interpretation of lab results. This allows for planning, consultation with supervising physicians, and issuing contingency orders in case they are required during flight. Some systems operate almost entirely off-line, using protocols for almost all procedures and only resorting to on-line medical control when protocols have been exhausted. Some air ambulance operations have full-time, on-site medical directors with pertinent backgrounds (e.g., emergency medicine); others have medical directors who are only available by pager. For those systems operating on
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5152-598: A vein , or by drops put into the ear or eye . A medication that does not contain an active ingredient and is used in research studies is called a placebo . In Europe, the term is "medicinal product", and it is defined by EU law as: In the US, a "drug" is: Drug use among elderly Americans has been studied; in a group of 2,377 people with an average age of 71 surveyed between 2005 and 2006, 84% took at least one prescription drug, 44% took at least one over-the-counter (OTC) drug, and 52% took at least one dietary supplement ; in
5313-478: A war on two fronts; the Schlieffen Plan envisaged using 80% of the army to defeat France, then switching to Russia. Since this required them to move quickly, mobilization orders were issued that afternoon. Once the German ultimatum to Russia expired on the morning of 1 August, the two countries were at war. At a meeting on 29 July, the British cabinet had narrowly decided its obligations to Belgium under
5474-402: A weak Ottoman government, rather than an ambitious Slav power like Bulgaria . Russia had ambitions in northeastern Anatolia while its clients had overlapping claims in the Balkans. These competing interests divided Russian policy-makers and added to regional instability. Austrian statesmen viewed the Balkans as essential for the continued existence of their Empire and saw Serbian expansion as
5635-455: A whole, the Somme offensive led to an estimated 420,000 British casualties, along with 200,000 French and 500,000 Germans. The diseases that emerged in the trenches were a major killer on both sides. The living conditions led to disease and infection, such as trench foot , lice , typhus , trench fever , and the ' Spanish flu '. At the start of the war, German cruisers were scattered across
5796-418: A wider coverage area than a land ambulance. This makes them particularly useful in sparsely-populated rural areas. Air medical services have a particular advantage for major trauma injuries. The controversial theory of the golden hour suggests that major trauma patients should be transported as quickly as possible to a specialist trauma center . Therefore, medical responders in a helicopter can provide both
5957-504: Is a medicine or a chemical compound used to treat or cure illness. According to Encyclopædia Britannica , medication is "a substance used in treating a disease or relieving pain ". As defined by the National Cancer Institute , dosage forms of medication can include tablets , capsules , liquids, creams , and patches. Medications can be administered in different ways, such as by mouth , by infusion into
6118-410: Is a specially outfitted helicopter or fixed-wing aircraft that transports injured or sick people in a medical emergency or over distances or terrain impractical for a conventional ground ambulance . Fixed-wing aircraft are also more often used to move patients over long distances and for repatriation from foreign countries. These and related operations are called aeromedical . In some circumstances,
6279-419: Is an increasing trend as state health services agencies address the issues surrounding the safety of emergency medical services flights . Some examples are the states of Colorado, New Jersey, New Mexico, Utah, and Washington. According to the rationale used to justify the state of Washington's adoption of the accreditation requirements, requiring accreditation of air ambulance services provides assurance that
6440-508: Is known, however, that from 1908 to 1913, military spending by the six major European powers increased by over 50% in real terms. The years before 1914 were marked by a series of crises in the Balkans, as other powers sought to benefit from the Ottoman decline. While Pan-Slavic and Orthodox Russia considered itself the protector of Serbia and other Slav states, they preferred the strategically vital Bosporus straits to be controlled by
6601-458: Is not always the faster choice in comparison to ground ambulances. Ground ambulances are more numerous and more ubiquitous, so will often be closer to the scene. Ground ambulances can depart their base almost immediately, while air medical services must complete preflight routines prior to departure. A nearby suitable landing site may not be available due to trees, wires, etc. Air medical services tend to have an advantage where ground access routes to
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6762-495: Is one pilot and two medical crew is: "3 to go, 1 to say 'NO'". If one flight member is not comfortable with the flight for whatever reason, the flight is cancelled. Some have questioned the safety of air medical services. While the number of crashes may be increasing, the number of programs and use of services has also increased. Factors associated with fatal crashes of medical transport helicopters include flying at night and during bad weather, and postcrash fires. An air ambulance
6923-422: Is safe to use. FDA Review: drug is sent to FDA before launching the drug into the market. FDA post-Market Review: The drug is reviewed and monitored by FDA for the safety once it is available to the public. The regulation of drugs varies by jurisdiction. In some countries, such as the United States, they are regulated at the national level by a single agency. In other jurisdictions, they are regulated at
7084-481: Is sometimes better to wait for air medical services with a specialized team to transport a patient even though a local land ambulance and an ad hoc local medical team may be able to transfer a patient from a remote hospital to definitive care faster than air ambulance. In the United States, insurance coverage may be a factor. For example, the Coverage Policy Manual for Arkansas Blue Cross BlueShield,
7245-523: Is still a lengthy, "expensive, difficult, and inefficient process" with a low rate of new therapeutic discovery. In 2010, the research and development cost of each new molecular entity (NME) was approximately US$ 1.8 billion. Drug discovery is done by pharmaceutical companies, sometimes with research assistance from universities. The "final product" of drug discovery is a patent on the potential drug. The drug requires very expensive Phase I, II, and III clinical trials, and most of them fail. Small companies have
7406-798: Is the Anatomical Therapeutic Chemical Classification System . The World Health Organization keeps a list of essential medicines . Drug discovery and drug development are complex and expensive endeavors undertaken by pharmaceutical companies , academic scientists, and governments. As a result of this complex path from discovery to commercialization, partnering has become a standard practice for advancing drug candidates through development pipelines. Governments generally regulate what drugs can be marketed, how drugs are marketed , and in some jurisdictions, drug pricing . Controversies have arisen over drug pricing and disposal of used Medicine . Medication
7567-402: Is the single most important factor to be considered when deciding whether to transport a patient by helicopter. Weather, air traffic patterns, and distances (such as from the trauma scene to closest level 1 trauma centre) must also be considered. Another reason for cancelling a flight is based on the comfort of the flight crew with the flight. The general rule of safety is upon the crew, when there
7728-406: Is used for euthanasia and physician-assisted suicide . Euthanasia is not permitted by law in many countries, and consequently, medicines will not be licensed for this use in those countries. A single drug may contain single or multiple active ingredients . The administration is the process by which a patient takes medicine. There are three major categories of drug administration: enteral (via
7889-469: Is used per day (e.g., four times a day). It may include event-related information (e.g., 1 hour before meals, in the morning, at bedtime), or complimentary to an interval, although equivalent expressions may have different implications (e.g., every 8 hours versus 3 times a day). In the fields of medicine, biotechnology , and pharmacology , drug discovery is the process by which new drugs are discovered. Historically, drugs were discovered by identifying
8050-574: The Schutzkorps was established, and carried out the persecution of Serbs. The assassination initiated the July Crisis, a month of diplomatic manoeuvring between Austria-Hungary, Germany, Russia, France and Britain. Believing that Serbian intelligence helped organise Franz Ferdinand's murder, Austrian officials wanted to use the opportunity to end their interference in Bosnia and saw war as
8211-641: The World War . In August 1914, the magazine The Independent wrote "This is the Great War. It names itself". In October 1914, the Canadian magazine Maclean's similarly wrote, "Some wars name themselves. This is the Great War." Contemporary Europeans also referred to it as " the war to end war " and it was also described as "the war to end all wars" due to their perception of its unparalleled scale, devastation, and loss of life. The first recorded use of
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#17327796411098372-517: The Asia-Pacific , and in Europe was characterised by trench warfare ; the widespread use of artillery , machine guns, and chemical weapons (gas); and the introductions of tanks and aircraft . World War I was one of the deadliest conflicts in history , resulting in an estimated 10 million military dead and more than 20 million wounded , plus some 10 million civilian dead from causes including genocide . The movement of large numbers of people
8533-695: The Australian Naval and Military Expeditionary Force landed on the island of New Britain , then part of German New Guinea . On 28 October, the German cruiser SMS Emden sank the Russian cruiser Zhemchug in the Battle of Penang . Japan declared war on Germany before seizing territories in the Pacific, which later became the South Seas Mandate , as well as German Treaty ports on
8694-470: The Korean and Vietnam wars. Later, helicopters were introduced to civilian health care, especially for shorter distances, in and around large cities: transporting paramedics or specialist doctors as needed and transporting patients to hospitals, especially for major trauma cases. Fixed-wing aircraft remained in use for long-distance medical transport. Air medical services can travel faster and operate in
8855-552: The Learjet 35 and 36 , Learjet 31 , King Air 90 , King Air 200 , Pilatus PC-12 & PC-24 , and Piper Cheyenne . Due to the configuration of the medical crew and patient compartments, these aircraft are normally configured to only transport one patient but some can be configured to transport two patients if so needed. Additionally, helicopters have stricter weather minimums that they can operate in and commonly do not fly at altitudes over 10,000 feet above sea level. Beginning in
9016-721: The Rüstungswende or 'armaments turning point', when he switched expenditure from the navy to the army. This decision was not driven by a reduction in political tensions but by German concern over Russia's quick recovery from its defeat in the Russo-Japanese War and subsequent 1905 Russian Revolution . Economic reforms led to a significant post-1908 expansion of railways and transportation infrastructure, particularly in its western border regions. Since Germany and Austria-Hungary relied on faster mobilisation to compensate for their numerical inferiority compared to Russia,
9177-664: The Second World War . The first use of medevac with helicopters was the evacuation of three British pilot combat casualties by a US Army Sikorsky R-4 in Burma during WW2 , and the first dedicated use of helicopters by U.S. forces occurred during the Korean War , between 1950 and 1953. The French used light helicopters in the First Indochina War . While popularly depicted as simply removing casualties from
9338-743: The Siege of Paris in 1870, air evacuation was experimented with during the First World War . The first recorded British ambulance flight took place in 1917 in Ottoman Empire when a soldier in the Camel Corps who had been shot in the ankle was flown to hospital in a de Havilland DH9 in 45 minutes. First Recorded Aeromedical Evacuation in the British Army The same journey by land would have taken some 3 days to complete. In
9499-943: The United States Air Force , the German Luftwaffe , and the British Royal Air Force . The Swedish National Air Medevac - SNAM is an exception to the military only rule where the system is owned by the Swedish Civil Contingencies Agency Myndigheten för samhällsskydd och beredskap and the 737-800 aircraft is provided under contract when so required by Scandinavian Airlines. Each operates aircraft staffed by physicians, nurses, and corpsmen/technicians, and each can provide long-distance transport with full medical support to dozens of patients simultaneously. However, in recent years, exceptions to
9660-828: The United States entered the war on the Allied side following Germany's resumption of unrestricted submarine warfare against Atlantic shipping. Later that year, the Bolsheviks seized power in the Russian October Revolution , and Soviet Russia signed an armistice with the Central Powers in December, followed by a separate peace in March 1918. That month, Germany launched an offensive in
9821-652: The Westpac Bank . In these cases, the operation may vary but is the result of a carefully negotiated agreement between government, EMS, hospitals, and the donor. In most cases, while the sponsor receives advertising exposure in exchange for funding, they take a 'hands-off' approach to daily operations, relying instead on subject matter specialists. In some cases, air ambulance services may be provided by means of voluntary charitable fundraising, as opposed to government funding, or they may receive limited government subsidy to supplement local donations. Some countries, such as
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#17327796411099982-506: The affinity , selectivity (to reduce the potential of side effects), efficacy/ potency , metabolic stability (to increase the half-life ), and oral bioavailability . Once a compound that fulfills all of these requirements has been identified, it will begin the process of drug development prior to clinical trials . One or more of these steps may, but not necessarily, involve computer-aided drug design . Despite advances in technology and understanding of biological systems, drug discovery
10143-3535: The central nervous system include psychedelics , hypnotics , anaesthetics , antipsychotics , eugeroics , antidepressants (including tricyclic antidepressants , monoamine oxidase inhibitors , lithium salts , and selective serotonin reuptake inhibitors (SSRIs)), antiemetics , anticonvulsants /antiepileptics, anxiolytics , barbiturates , movement disorder (e.g., Parkinson's disease ) drugs, nootropics , stimulants (including amphetamines ), benzodiazepines , cyclopyrrolones , dopamine antagonists , antihistamines , cholinergics , anticholinergics , emetics , cannabinoids , and 5-HT (serotonin) antagonists . The main classes of painkillers are NSAIDs , opioids , and local anesthetics . For consciousness (anesthetic drugs) Some anesthetics include benzodiazepines and barbiturates . The main categories of drugs for musculoskeletal disorders are: NSAIDs (including COX-2 selective inhibitors ), muscle relaxants , neuromuscular drugs , and anticholinesterases . Antibiotics , sympathomimetics , antihistamines , anticholinergics , NSAIDs , corticosteroids , antiseptics , local anesthetics , antifungals , and cerumenolytics. Bronchodilators , antitussives , mucolytics , decongestants , inhaled and systemic corticosteroids , beta2-adrenergic agonists , anticholinergics , mast cell stabilizers , leukotriene antagonists . Androgens , antiandrogens , estrogens , gonadotropin , corticosteroids , human growth hormone , insulin , antidiabetics ( sulfonylureas , biguanides / metformin , thiazolidinediones , insulin ), thyroid hormones , antithyroid drugs, calcitonin , diphosphonate , vasopressin analogues . Antifungal , alkalinizing agents , quinolones , antibiotics , cholinergics , anticholinergics , antispasmodics , 5-alpha reductase inhibitor , selective alpha-1 blockers , sildenafils , fertility medications . NSAIDs , anticholinergics , haemostatic drugs , antifibrinolytics , Hormone Replacement Therapy (HRT), bone regulators, beta-receptor agonists , follicle stimulating hormone , luteinising hormone , LHRH , gamolenic acid , gonadotropin release inhibitor , progestogen , dopamine agonists , oestrogen , prostaglandins , gonadorelin , clomiphene , tamoxifen , diethylstilbestrol . Emollients , anti-pruritics , antifungals , antiseptics , scabicides , pediculicides , tar products, vitamin A derivatives , vitamin D analogues , keratolytics , abrasives , systemic antibiotics , topical antibiotics , hormones , desloughing agents, exudate absorbents, fibrinolytics , proteolytics , sunscreens , antiperspirants , corticosteroids , immune modulators. Antibiotics , antifungals , antileprotics , antituberculous drugs , antimalarials , anthelmintics , amoebicides , antivirals , antiprotozoals , probiotics, prebiotics, antitoxins , and antivenoms. Vaccines , immunoglobulins , immunosuppressants , interferons , and monoclonal antibodies . Anti-allergics , antihistamines , NSAIDs , corticosteroids . Tonics, electrolytes and mineral preparations (including iron preparations and magnesium preparations ), parenteral nutrition , vitamins , anti-obesity drugs , anabolic drugs , haematopoietic drugs, food product drugs. Cytotoxic drugs , therapeutic antibodies , sex hormones , aromatase inhibitors , somatostatin inhibitors, recombinant interleukins , G-CSF , erythropoietin . Contrast media . A euthanaticum
10304-410: The human gastrointestinal tract ), injection into the body, and by other routes ( dermal , nasal , ophthalmic , otologic , and urogenital ). Oral administration , the most common form of enteral administration, can be performed using various dosage forms including tablets or capsules and liquid such as syrup or suspension. Other ways to take the medication include buccally (placed inside
10465-487: The hydrophone and depth charges were introduced, destroyers could potentially successfully attack a submerged submarine. Convoys slowed the flow of supplies since ships had to wait as convoys were assembled; the solution was an extensive program of building new freighters. Troopships were too fast for the submarines and did not travel the North Atlantic in convoys. The U-boats sunk more than 5,000 Allied ships, at
10626-821: The tank . After the First Battle of the Marne in September 1914, Allied and German forces unsuccessfully tried to outflank each other, a series of manoeuvres later known as the " Race to the Sea ". By the end of 1914, the opposing forces confronted each other along an uninterrupted line of entrenched positions from the Channel to the Swiss border. Since the Germans were normally able to choose where to stand, they generally held
10787-520: The "military-only" rule have grown with the need to quickly transport patients to facilities that provide higher levels of care or to repatriate individuals. Air medical companies use both large and small fixed-wing aircraft configured to provide levels of care that can be found in Trauma centres for individuals who subscribe to their own health insurance or affiliated travel insurance and protection plans. In most jurisdictions, air ambulance pilots must have
10948-588: The 1839 Treaty of London did not require it to oppose a German invasion with military force; however, Prime Minister Asquith and his senior Cabinet ministers were already committed to supporting France, the Royal Navy had been mobilised, and public opinion was strongly in favour of intervention. On 31 July, Britain sent notes to Germany and France, asking them to respect Belgian neutrality; France pledged to do so, but Germany did not reply. Aware of German plans to attack through Belgium, French Commander-in-Chief Joseph Joffre asked his government for permission to cross
11109-563: The 1879 Dual Alliance , which became the Triple Alliance when Italy joined in 1882. For Bismarck, the purpose of these agreements was to isolate France by ensuring the three Empires resolve any disputes between themselves. In 1887, Bismarck set up the Reinsurance Treaty , a secret agreement between Germany and Russia to remain neutral if either were attacked by France or Austria-Hungary. For Bismarck, peace with Russia
11270-441: The 1913 Treaty of London , which had created an independent Albania while enlarging the territories of Bulgaria, Serbia, Montenegro and Greece. However, disputes between the victors sparked the 33-day Second Balkan War , when Bulgaria attacked Serbia and Greece on 16 June 1913; it was defeated, losing most of Macedonia to Serbia and Greece, and Southern Dobruja to Romania. The result was that even countries which benefited from
11431-526: The 1920s several services, both official and unofficial, started up in various parts of the world. Aircraft were still primitive at the time, with limited capabilities, and the effort received mixed reviews. Exploration of the idea continued, however, and France and the United Kingdom used fully organized air ambulance services during the African and Middle Eastern Colonial Wars of the 1920s. In 1920,
11592-450: The 1990s, the number of air ambulance crashes in the United States, mostly involving helicopters, began to climb. By 2005, this number had reached a record high. Crash rates from 2000 to 2005 more than doubled the previous five year's rates. To some extent, these numbers had been deemed acceptable, as it was understood that the very nature of air ambulance operations meant that, because a life was at stake, air ambulances would often operate on
11753-569: The Austrians and Serbs clashed at the battles of the Cer and Kolubara ; over the next two weeks, Austrian attacks were repulsed with heavy losses. As a result, Austria had to keep sizeable forces on the Serbian front, weakening their efforts against Russia. Serbia's victory against Austria-Hungary in the 1914 invasion has been called one of the major upset victories of the twentieth century. In 1915,
11914-646: The Austrians briefly occupied the Serbian capital, Belgrade . A Serbian counter-attack in the Battle of Kolubara succeeded in driving them from the country by the end of 1914. For the first 10 months of 1915, Austria-Hungary used most of its military reserves to fight Italy. German and Austro-Hungarian diplomats scored a coup by persuading Bulgaria to join the attack on Serbia. The Austro-Hungarian provinces of Slovenia , Croatia and Bosnia provided troops for Austria-Hungary. Montenegro allied itself with Serbia. Bulgaria declared war on Serbia on 14 October 1915 and joined in
12075-553: The Balkan Wars, such as Serbia and Greece, felt cheated of their "rightful gains", while for Austria it demonstrated the apparent indifference with which other powers viewed their concerns, including Germany. This complex mix of resentment, nationalism and insecurity helps explain why the pre-1914 Balkans became known as the " powder keg of Europe ". On 28 June 1914, Archduke Franz Ferdinand of Austria , heir presumptive to Emperor Franz Joseph I of Austria , visited Sarajevo ,
12236-604: The British, while suppressing the " Mad Mullah " in Somaliland , used an Airco DH.9A fitted out as an air ambulance. It carried a single stretcher under a fairing behind the pilot. The French evacuated over 7,000 casualties during that period. By 1936, an organized military air ambulance service evacuated wounded from the Spanish Civil War for medical treatment in Nazi Germany ; this service continued during
12397-456: The CQC together ensuring fundraising, air and clinical operations are in line with national regulation and best practice. The code goes further with an expectation of mutual support and working within its policy and best practice guides. The nature of the air operation frequently determines the type of medical control required. In most cases, an air ambulance staffer is considerably more skilled than
12558-404: The Central Powers. However, the pro-German King Constantine I dismissed the pro-Allied government of Eleftherios Venizelos before the Allied expeditionary force arrived. The Macedonian front was at first mostly static. French and Serbian forces retook limited areas of Macedonia by recapturing Bitola on 19 November 1916 following the costly Monastir offensive , which brought stabilisation of
12719-649: The Chinese Shandong peninsula at Tsingtao . After Vienna refused to withdraw its cruiser SMS Kaiserin Elisabeth from Tsingtao, Japan declared war on Austria-Hungary, and the ship was sunk in November 1914. Within a few months, Allied forces had seized all German territories in the Pacific, leaving only isolated commerce raiders and a few holdouts in New Guinea. Some of the first clashes of
12880-465: The European Union, almost all air ambulance service is on a fee-for-service basis, except for systems that operate by private subscription. Many jurisdictions have a mix of operation types. Fee-for-service operators are generally responsible for their own organization but may have to meet government licensing requirements. Rega of Switzerland is an example of such a service. In some cases,
13041-569: The Franco-German model, the physician is almost always physically present, and medical control is not an issue. Most aircraft used as air ambulances, with the exception of charter aircraft and some military aircraft, are equipped for advanced life support and have interiors that reflect this. The challenges in most air ambulance operations, particularly those involving helicopters, are the high ambient noise levels and limited amounts of working space, both of which create significant issues for
13202-623: The German High Seas Fleet was confined to port. German U-boats attempted to cut the supply lines between North America and Britain. The nature of submarine warfare meant that attacks often came without warning, giving the crews of the merchant ships little hope of survival. The United States launched a protest, and Germany changed its rules of engagement. After the sinking of the passenger ship RMS Lusitania in 1915, Germany promised not to target passenger liners, while Britain armed its merchant ships, placing them beyond
13363-640: The German Army increased in size from 1908 to 1914, he changed the allocation of forces between the two wings to 70:30. He also considered Dutch neutrality essential for German trade and cancelled the incursion into the Netherlands, which meant any delays in Belgium threatened the viability of the plan. Historian Richard Holmes argues that these changes meant the right wing was not strong enough to achieve decisive success. The initial German advance in
13524-693: The German right wing would sweep through the Netherlands and Belgium , then swing south, encircling Paris and trapping the French army against the Swiss border. The plan's creator, Alfred von Schlieffen , head of the German General Staff from 1891 to 1906, estimated that this would take six weeks, after which the German army would transfer to the East and defeat the Russians. The plan was substantially modified by his successor, Helmuth von Moltke
13685-539: The German system in 1983 when Christophorus 1 entered service at Innsbruck. Also in the year 1975 Hans Burghart, one of the inventor of the civilian air rescue in Germany, presented at one Academic conference in the US the concept "Rescue Helicopters in Primary and Secondary Missions" which had impact for the aviation training at Fort Rucker , Alabama . The first civilian, hospital-based medical helicopter program in
13846-486: The Germans bled heavily as well, with anywhere from 700,000 to 975,000 casualties between the two combatants. Verdun became a symbol of French determination and self-sacrifice. The Battle of the Somme was an Anglo-French offensive from July to November 1916. The opening day on 1 July 1916 was the bloodiest single day in the history of the British Army , which suffered 57,500 casualties, including 19,200 dead. As
14007-492: The John S. Dunn Helistop, one of the busiest helipads in the world, with space for four helicopters. A final area of distinction is the operation of large, generally fixed-wing air ambulances. In the past, the infrequency of civilian demand for such a service confined such operations to the military, which requires them to support overseas combat operations. Military organizations capable of this type of specialized operation include
14168-688: The Middle East. In all, 140,000 soldiers served on the Western Front and nearly 700,000 in the Middle East, with 47,746 killed and 65,126 wounded. The suffering engendered by the war, as well as the failure of the British government to grant self-government to India afterward, bred disillusionment, resulting in the campaign for full independence led by Mahatma Gandhi . Pre-war military tactics that had emphasised open warfare and individual riflemen proved obsolete when confronted with conditions prevailing in 1914. Technological advances allowed
14329-728: The Ottomans joined the Central Powers in November. Germany's strategy in 1914 was to quickly defeat France, then to transfer its forces to the east, but its advance was halted in September , and by the end of the year the Western Front consisted of a continuous line of trenches stretching from the English Channel to Switzerland. The Eastern Front was more dynamic, but neither side gained a decisive advantage, despite costly offensives. Italy , Bulgaria , Romania , Greece and others joined in from 1915 onward. In April 1917,
14490-613: The Ottomans' territory in the Balkans during the 1912–1913 First Balkan War , much to the surprise of outside observers. The Serbian capture of ports on the Adriatic resulted in partial Austrian mobilisation, starting on 21 November 1912, including units along the Russian border in Galicia . The Russian government decided not to mobilise in response, unprepared to precipitate a war. The Great Powers sought to re-assert control through
14651-856: The Polish Lotnicze Pogotowie Ratunkowe (LPR) are examples of this type of operating system. The Polish LPR is a national system covering the entire country and funded by the government through the Ministry of Health but run independently, there is no independent HEMS operator in Poland . In North East Ohio, including Cleveland , the Cuyahoga County -owned MetroHealth Medical Center uses its Metro Life Flight to transport patients to Metro's level I trauma and burn unit. There are 5 helicopters for North East Ohio and, in addition, Metro Life Flight has one fixed-wing aircraft. In
14812-613: The Russian Stavka agreed with the French to attack Germany within fifteen days of mobilisation, ten days before the Germans had anticipated, although it meant the two Russian armies that entered East Prussia on 17 August did so without many of their support elements. By the end of 1914, German troops held strong defensive positions inside France, controlled the bulk of France's domestic coalfields, and inflicted 230,000 more casualties than it lost itself. However, communications problems and questionable command decisions cost Germany
14973-778: The Saskatchewan government in Regina, Saskatchewan, Canada, established the first civilian air ambulance in North America. The Saskatchewan government had to consider remote communities and great distances in providing health care to its citizens. The Saskatchewan Air Ambulance service continues to be active as of 2023. J. Walter Schaefer founded the first air ambulance service in the U.S., in 1947, in Los Angeles. The Schaefer Air Service operated as part of Schaefer Ambulance Service . Two research programs were implemented in
15134-538: The Serbian retreat toward the Adriatic coast in the Battle of Mojkovac on 6–7 January 1916, but ultimately the Austrians also conquered Montenegro. The surviving Serbian soldiers were evacuated to Greece. After the conquest, Serbia was divided between Austro-Hungary and Bulgaria. In late 1915, a Franco-British force landed at Salonica in Greece to offer assistance and to pressure its government to declare war against
15295-559: The U.K., use a mix of such systems. In Scotland, the parliament has voted to fund air ambulance service directly, through the Scottish Ambulance Service. In England and Wales, however, the service is funded on a charitable basis via a number of local charities for each region covered. Great strides have been made in the UK, with the 'Association of Air Ambulance (AAA)'. This organization is widely credited for having created
15456-473: The U.S. to assess the impact of medical helicopters on mortality and morbidity in the civilian arena. Project CARESOM was established in Mississippi in 1969. Three helicopters were purchased through a federal grant and located strategically in the north, central, and southern areas of the state. Upon termination of the grant, the program was considered a success and each of the three communities were given
15617-540: The United Kingdom, the Scottish Ambulance Service operates two helicopters and two fixed-wing aircraft twenty-four hours per day. In some jurisdictions, cost is a major consideration, and the presence of dedicated air ambulances is simply not practical. In these cases, the aircraft may be operated by another government or quasi-government agency and made available to EMS for air ambulance service when required. In southern New South Wales, Australia,
15778-539: The United States began operation in 1972. Flight For Life Colorado began with a single Alouette III helicopter, based at St. Anthony Central Hospital in Denver, Colorado. In Ontario, Canada, the air ambulance program began in 1977, and featured a paramedic-based system of care, with the presence of physicians or nurses being relatively unusual. The system, operated by the Ontario Ministry of Health, began with
15939-517: The United States, includes the requirement for an air ambulance company to own and operate its own aircraft. Some air ambulance companies, realizing it is virtually impossible to have the correct medicalized aircraft for every mission, instead charter aircraft based on the mission-specific requirements. While in principle CAMTS accreditation is voluntary, a number of government jurisdictions require companies providing medical transportation services to have CAMTS accreditation to be licensed to operate. This
16100-651: The West was very successful. By the end of August, the Allied left, which included the British Expeditionary Force (BEF), was in full retreat , and the French offensive in Alsace-Lorraine was a disastrous failure, with casualties exceeding 260,000. German planning provided broad strategic instructions while allowing army commanders considerable freedom in carrying them out at the front, but von Kluck used this freedom to disobey orders, opening
16261-485: The Younger . Under Schlieffen, 85% of German forces in the west were assigned to the right wing, with the remainder holding along the frontier. By keeping his left-wing deliberately weak, he hoped to lure the French into an offensive into the "lost provinces" of Alsace-Lorraine , which was the strategy envisaged by their Plan XVII . However, Moltke grew concerned that the French might push too hard on his left flank and as
16422-643: The active ingredient from traditional remedies or by serendipitous discovery. Later chemical libraries of synthetic small molecules , natural products , or extracts were screened in intact cells or whole organisms to identify substances that have a desirable therapeutic effect in a process known as classical pharmacology . Since sequencing of the human genome which allowed rapid cloning and synthesis of large quantities of purified proteins, it has become common practice to use high throughput screening of large compound libraries against isolated biological targets which are hypothesized to be disease-modifying in
16583-446: The aggressor, German Chancellor Bethmann Hollweg delayed the commencement of war preparations until 31 July. That afternoon, the Russian government were handed a note requiring them to "cease all war measures against Germany and Austria-Hungary" within 12 hours. A further German demand for neutrality was refused by the French who ordered general mobilization but delayed declaring war. The German General Staff had long assumed they faced
16744-474: The attack by the Austro-Hungarian army under Mackensen's army of 250,000 that was already underway. Serbia was conquered in a little more than a month, as the Central Powers, now including Bulgaria, sent in 600,000 troops in total. The Serbian army, fighting on two fronts and facing certain defeat, retreated into northern Albania . The Serbs suffered defeat in the Battle of Kosovo . Montenegro covered
16905-399: The basis of pharmacological properties like mode of action and their pharmacological action or activity, such as by chemical properties , mode or route of administration , biological system affected, or therapeutic effects . An elaborate and widely used classification system is the Anatomical Therapeutic Chemical Classification System (ATC system). The World Health Organization keeps
17066-634: The battlefield (which they did), helicopters in the Korean War also moved critical patients to hospital ships after initial emergency treatment in field hospitals. Knowledge and expertise of use of air ambulances evolved parallel to the aircraft themselves. By 1969, in Vietnam , the use of specially trained medical corpsmen and helicopter air ambulances led U.S. researchers to determine that servicemen wounded in battle had better rates of survival than motorists injured on California freeways. This inspired
17227-543: The best way of achieving this. However, the Foreign Ministry had no solid proof of Serbian involvement. On 23 July, Austria delivered an ultimatum to Serbia, listing ten demands made intentionally unacceptable to provide an excuse for starting hostilities. Serbia ordered general mobilization on 25 July, but accepted all the terms, except for those empowering Austrian representatives to suppress "subversive elements" inside Serbia, and take part in
17388-483: The border and pre-empt such a move. To avoid violating Belgian neutrality, he was told any advance could come only after a German invasion. Instead, the French cabinet ordered its Army to withdraw 10 km behind the German frontier, to avoid provoking war. On 2 August, Germany occupied Luxembourg and exchanged fire with French units when German patrols entered French territory; on 3 August, they declared war on France and demanded free passage across Belgium, which
17549-486: The campaign saw the first use of anti-aircraft warfare after an Austrian plane was shot down with ground-to-air fire, as well as the first medical evacuation by the Serbian army. Upon mobilisation, in accordance with the Schlieffen Plan , 80% of the German Army was located on the Western Front, with the remainder acting as a screening force in the East. Rather than a direct attack across their shared frontier,
17710-649: The capital of the recently annexed Bosnia and Herzegovina . Cvjetko Popović , Gavrilo Princip , Nedeljko Čabrinović , Trifko Grabež , Vaso Čubrilović ( Bosnian Serbs ) and Muhamed Mehmedbašić (from the Bosniaks community), from the movement known as Young Bosnia , took up positions along the Archduke's motorcade route, to assassinate him. Supplied with arms by extremists within the Serbian Black Hand intelligence organisation, they hoped his death would free Bosnia from Austrian rule. Čabrinović threw
17871-466: The chance of a decisive outcome, while it had failed to achieve the primary objective of avoiding a long, two-front war. As was apparent to several German leaders, this amounted to a strategic defeat; shortly after the First Battle of the Marne , Crown Prince Wilhelm told an American reporter "We have lost the war. It will go on for a long time but lost it is already." On 30 August 1914, New Zealand occupied German Samoa (now Samoa ). On 11 September,
18032-400: The cheek), sublingually (placed underneath the tongue), eye and ear drops (dropped into the eye or ear), and transdermally (applied to the skin). They can be administered in one dose, as a bolus . Administration frequencies are often abbreviated from Latin, such as every 8 hours reading Q8H from Quaque VIII Hora . The drug frequencies are often expressed as the number of times a drug
18193-520: The cost of 199 submarines. World War I also saw the first use of aircraft carriers in combat, with HMS Furious launching Sopwith Camels in a successful raid against the Zeppelin hangars at Tondern in July 1918, as well as blimps for antisubmarine patrol. Faced with Russia in the east, Austria-Hungary could spare only one-third of its army to attack Serbia. After suffering heavy losses,
18354-522: The creation of new independent states, including Poland , Finland , the Baltic states , Czechoslovakia , and Yugoslavia . The League of Nations was established to maintain world peace, but its failure to manage instability during the interwar period contributed to the outbreak of World War II in 1939. Before World War II , the events of 1914–1918 were generally known as the Great War or simply
18515-449: The creation of strong defensive systems largely impervious to massed infantry advances, such as barbed wire , machine guns and above all far more powerful artillery , which dominated the battlefield and made crossing open ground extremely difficult. Both sides struggled to develop tactics for breaching entrenched positions without heavy casualties. In time, technology enabled the production of new offensive weapons, such as gas warfare and
18676-965: The crowds listened to music and drank wine, as if nothing had happened." Nevertheless, the impact of the murder of the heir to the throne was significant, and has been described by historian Christopher Clark as a "9/11 effect, a terrorist event charged with historic meaning, transforming the political chemistry in Vienna". Austro-Hungarian authorities encouraged subsequent anti-Serb riots in Sarajevo . Violent actions against ethnic Serbs were also organised outside Sarajevo, in other cities in Austro-Hungarian-controlled Bosnia and Herzegovina, Croatia and Slovenia. Austro-Hungarian authorities in Bosnia and Herzegovina imprisoned approximately 5,500 prominent Serbs, 700 to 2,200 of whom died in prison. A further 460 Serbs were sentenced to death. A predominantly Bosniak special militia known as
18837-725: The evolving Emergency Medical Services. As the concept was proven, dedicated civilian air ambulances began to appear. On November 1, 1970, the first permanent civil air ambulance helicopter, Christoph 1 , entered service at the Hospital of Harlaching , Munich, Germany. The apparent success of Christoph 1 led to a quick expansion of the concept across Germany, with Christoph 10 entering service in 1975, Christoph 20 in 1981, and Christoph 51 in 1989. As of 2007, there are about 80 helicopters named after Saint Christopher , like Christoph Europa 5 (also serving Denmark), Christoph Brandenburg or Christoph Murnau am Staffelsee . Austria adopted
18998-695: The expansion of the French colonial empire . In 1873, Bismarck negotiated the League of the Three Emperors , which included Austria-Hungary , Russia and Germany. After the 1877–1878 Russo-Turkish War , the League was dissolved due to Austrian concerns over the expansion of Russian influence in the Balkans , an area they considered to be of vital strategic interest. Germany and Austria-Hungary then formed
19159-498: The feasibility of using military helicopters to augment existing civilian emergency medical services. These programs were highly successful at establishing the need for such services. The remaining challenge was in how such services could be operated most cost-effectively. In many cases, as agencies, branches, and departments of the civilian governments began to operate aircraft for other purposes, these aircraft were frequently pressed into service to provide cost-effective air support to
19320-497: The first experiments with the use of civilian paramedics in the world. The US military recently employed UH-60 Black Hawk helicopters to provide air ambulance service during the Iraq War to military personnel and civilians. The use of military aircraft as battlefield ambulances continues to grow and develop today in a variety of countries, as does the use of fixed-wing aircraft for long-distance travel, including repatriation of
19481-400: The first time on the Western Front. Several types of gas soon became widely used by both sides and though it never proved a decisive, battle-winning weapon, it became one of the most feared and best-remembered horrors of the war. In February 1916, the Germans attacked French defensive positions at the Battle of Verdun , lasting until December 1916. Casualties were greater for the French, but
19642-620: The flight paramedic is a serving State Trooper whose job is to act as the Observer Officer on a police helicopter when not required for medical emergencies. In many cases, local jurisdictions do not charge for air ambulance service, particularly for emergency calls. However, the cost of providing air ambulance services is considerable and many, including government-run operations, charge for service. Organizations such as service aircraft charter companies, hospitals, and some private-for-profit EMS systems generally charge for service. Within
19803-595: The front. Serbian and French troops finally made a breakthrough in September 1918 in the Vardar offensive , after most German and Austro-Hungarian troops had been withdrawn. The Bulgarians were defeated at the Battle of Dobro Pole , and by 25 September British and French troops had crossed the border into Bulgaria proper as the Bulgarian army collapsed. Bulgaria capitulated four days later, on 29 September 1918. The German high command responded by despatching troops to hold
19964-542: The globe, some of which were subsequently used to attack Allied merchant shipping . These were systematically hunted down by the Royal Navy, though not before causing considerable damage. One of the most successful was the SMS ; Emden , part of the German East Asia Squadron stationed at Qingdao , which seized or sank 15 merchantmen, a Russian cruiser and a French destroyer. Most of the squadron
20125-473: The ground responder's ability to determine whether the patient's condition warrants air medical transport. Protocols and training must be developed to ensure appropriate triage criteria are applied. Excessively stringent criteria can prevent rapid care and transport of trauma victims; relaxed criteria can result in the patient being unnecessarily exposed to the potential dangers of dangerous weather conditions or other aviation-related risks. Crew and patient safety
20286-589: The helicopter that responds as an air ambulance is actually operated by the local hydroelectric utility, with the New South Wales Ambulance Service providing paramedics, as required. In some cases, local EMS provides the flight paramedic to the aircraft operator as-needed. In the case of the Los Angeles County Fire Department, the helicopters are brush fire choppers also configured as air ambulances with
20447-549: The high ground, while their trenches tended to be better built; those constructed by the French and English were initially considered "temporary", only needed until an offensive would destroy the German defences. Both sides tried to break the stalemate using scientific and technological advances. On 22 April 1915, at the Second Battle of Ypres , the Germans (violating the Hague Convention ) used chlorine gas for
20608-399: The hospital are congested and for locations more distant from hospitals. In some situations, it may be desirable to dispatch a ground ambulance that can arrive on the scene first to provide immediate patient care, and an air ambulance to transport the patient(s) to a trauma center. It also should be borne in mind that faster may not always be better. In the context of interhospital transport, it
20769-710: The inclusion of respiratory therapists in all modes of air transport is becoming more prominent. World War I World War I or the First World War (28 July 1914 – 11 November 1918), also known as the Great War , was a global conflict between two coalitions: the Allies (or Entente) and the Central Powers . Fighting took place mainly in Europe and the Middle East , as well as in parts of Africa and
20930-596: The increased number of car accidents in 1979 on highways , the Yugoslavian government made a decision to buy new or redistribution of use of old helicopters. Air ambulance service, sometimes called Aeromedical Evacuation or simply Medevac , is provided by a variety of different sources in different places in the world. There are a number of reasonable methods of differentiating types of air ambulance services. These include military / civilian models and services that are government -funded, fee-for-service, donated by
21091-470: The investigation and trial of Serbians linked to the assassination. Claiming this amounted to rejection, Austria broke off diplomatic relations and ordered partial mobilisation the next day; on 28 July, they declared war on Serbia and began shelling Belgrade . Russia ordered general mobilization in support of Serbia on 30 July. Anxious to ensure backing from the SPD political opposition by presenting Russia as
21252-815: The key divisions is by level of control , which distinguishes prescription drugs (those that a pharmacist dispenses only on the order of a physician, physician assistant , or qualified nurse ) from over-the-counter drugs (those that consumers can order for themselves). Another key distinction is between traditional small molecule drugs, usually derived from chemical synthesis , and biopharmaceuticals , which include recombinant proteins , vaccines , blood products used therapeutically (such as IVIG ), gene therapy , monoclonal antibodies and cell therapy (for instance, stem cell therapies). Other ways to classify medicines are by mode of action, route of administration , biological system affected, or therapeutic effects . An elaborate and widely used classification system
21413-517: The line, but these forces were too weak to re-establish a front. Medication A medication (also called medicament , medicine , pharmaceutical drug , medicinal drug or simply drug ) is a drug used to diagnose , cure , treat, or prevent disease. Drug therapy ( pharmacotherapy ) is an important part of the medical field and relies on the science of pharmacology for continual advancement and on pharmacy for appropriate management. Drugs are classified in many ways. One of
21574-485: The medical profession. Other U.S. states require either CAMTS accreditation or a demonstrated equivalent, such as Rhode Island, and Texas, which has adopted CAMTS' Accreditation Standards (Sixth Edition, October 2004) as its own. In Texas, an operator not wishing to become CAMTS accredited must submit to an equivalent survey by state auditors who are CAMTS-trained. Virginia and Oklahoma have also adopted CAMTS accreditation standards as their state licensing standards. While
21735-465: The ocean, even to neutral ships. Since there was limited response to this tactic, Germany expected a similar response to its unrestricted submarine warfare. The Battle of Jutland in May/June 1916 was the only full-scale clash of battleships during the war, and one of the largest in history. The clash was indecisive, though the Germans inflicted more damage than they received; thereafter the bulk of
21896-735: The opportunity to continue the helicopter operation. Only the one located in Hattiesburg, Mississippi did so, and it was therefore established as the first civilian air medical program in the United States. The second program, the Military Assistance to Safety and Traffic (MAST) system, was established in Fort Sam Houston in San Antonio in 1969. This was an experiment by the Department of Transportation to study
22057-644: The original intent of CAMTS was to provide an American standard, air ambulance services in a number of other countries, including three in Canada and one in South Africa, have voluntarily submitted themselves to CAMTS accreditation. In the UK, the AAA has a Code of Conduct that binds one of the most regulated areas of operation together. It brings the Fundraising Standards Board, CAA / EASA and
22218-450: The patient) for air ambulance attended patients compared to those attended by a land ambulance. The same review found patient did not arrive at hospital any quicker when attended by an air ambulance. When the same authors looked at health outcomes in Cornwall and London they found no evidence that the attendance of an air ambulance (HEMS) service improved survival in trauma patients. Effective use of helicopter services for trauma depends on
22379-529: The political climate that made the helicopter industry and National Health Service recognise the enormous contribution charities make to trauma care in the United Kingdom. In 2013, the AAA published the "Framework for a High Performing Air Ambulance Service" which details many of the developments from 2008 to 2013. In recent years, the service has moved towards the physician-paramedic model of care. This has necessitated some charities commissioning clinical governance services, however many air ambulances operate under
22540-431: The primary means of transportation between communities is by boat. Early in aviation history, many of these communities began to rely on civilian "bush" pilots, who fly small aircraft and transport supplies, mail, and visiting doctors or nurses. Bush pilots probably performed the first civilian air ambulance trips, albeit on an ad hoc basis—but clearly, a need for these services existed. In the early 1920s, Sweden established
22701-681: The protection of the " cruiser rules ", which demanded warning and movement of crews to "a place of safety" (a standard that lifeboats did not meet). Finally, in early 1917, Germany adopted a policy of unrestricted submarine warfare , realising the Americans would eventually enter the war. Germany sought to strangle Allied sea lanes before the United States could transport a large army overseas, but, after initial successes, eventually failed to do so. The U-boat threat lessened in 1917, when merchant ships began travelling in convoys , escorted by destroyers . This tactic made it difficult for U-boats to find targets, which significantly lessened losses; after
22862-423: The province, performing both interfacility transfers and on-scene responses in support of ground-based EMS. Today, across the world, the presence of civilian air ambulances has become commonplace and is seen as a much-needed support for ground-based EMS systems. In other countries of Europe, like SFR Yugoslavia , first air ambulance appeared in the 1980s. Most of the fleet was previously used in military service. With
23023-660: The provision of ongoing care. While equipment tends to be high-level and very conveniently grouped, it may not be possible to perform some assessment procedures, such as chest auscultation , while in flight. In some types of aircraft, the aircraft's design means that the entire patient is not physically accessible in flight. Additional issues occur with respect to pressurization of the aircraft. Not all aircraft used as air ambulances in all jurisdictions have pressurized cabins and those that do typically tend to be pressurized to only 10,000 feet above sea level. These pressure changes require advanced knowledge by flight staff with respect to
23184-552: The remaining models is explored separately. This information applies to air ambulance systems performing emergency service. In almost all jurisdictions, private aircraft charter companies provide non-emergency air ambulance service on a fee-for-service basis. In some cases, governments provide air ambulance services, either directly or via a negotiated contract with a commercial service provider, such as an aircraft charter company. Such services may focus on critical care patient transport, support ground-based EMS on scenes, or may perform
23345-428: The same aircraft may be used to search for missing or wanted people. Like ground ambulances, air ambulances are equipped with medical equipment vital to monitoring and treating injured or ill patients. Common equipment for air ambulances includes medications , ventilators , ECGs and monitoring units, CPR equipment, and stretchers . A medically staffed and equipped air ambulance provides medical care in flight—while
23506-429: The service meets national public safety standards. The accreditation is done by professionals who are qualified to determine air ambulance safety. In addition, compliance with accreditation standards is checked on a continual basis by the accrediting organization. Accreditation standards are periodically revised to reflect the dynamic, changing environment of medical transport, with considerable input from all disciplines of
23667-436: The specifics of aviation medicine, including changes in physiology and the behaviour of gases. There are a large variety of helicopter makes that are used for the civilian HEMS models. The commonly used types are the Bell 206 , 407 , and 429 , Eurocopter AS350 , BK117 , EC130 , EC135 , EC145 , and the Agusta Westland 109 , 169 & 139 , MD Explorer and Sikorsky S-76. Fixed-wing aircraft varieties commonly include
23828-464: The state level, or at both state and national levels by various bodies, as is the case in Australia. The role of therapeutic goods regulation is designed mainly to protect the health and safety of the population. Regulation is aimed at ensuring the safety, quality, and efficacy of the therapeutic goods which are covered under the scope of the regulation. In most jurisdictions, therapeutic goods must be registered before they are allowed to be marketed. There
23989-551: The tasking ambulances services clinical governance. The AAA now publishes Best Practice Guidance on a range of operational and clinical functions and provides a code of conduct that all full members, both ambulance services and charities must uphold. Memorial Hermann Life Flight is a not-for-profit hospital-based critical care air ambulance service in Houston , Texas , USA. As of 2023, it operates six EC-145 twin-engine helicopters. The service relies on community support and fundraising efforts. Memorial Hermann Life Flight operates from
24150-415: The term First World War was in September 1914 by German biologist and philosopher Ernst Haeckel who stated, "There is no doubt that the course and character of the feared 'European War' ... will become the first world war in the full sense of the word." For much of the 19th century, the major European powers maintained a tenuous balance of power , known as the Concert of Europe . After 1848, this
24311-584: The threat posed by the closing of this gap was more important than competing with the Royal Navy. After Germany expanded its standing army by 170,000 troops in 1913, France extended compulsory military service from two to three years; similar measures were taken by the Balkan powers and Italy, which led to increased expenditure by the Ottomans and Austria-Hungary. Absolute figures are difficult to calculate due to differences in categorising expenditure since they often omit civilian infrastructure projects like railways which had logistical importance and military use. It
24472-811: The very edge of their safety envelopes, going on missions in conditions where no other civilian pilot would fly. As a result, nearly fifty percent of all EMS personnel deaths in the United States occur in air ambulance crashes. In 2006, the United States National Transportation Safety Board ( NTSB ) concluded that many air ambulances crashes were avoidable, eventually leading to the improvement of government standards and CAMTS accreditation. Whilst some air ambulances do have effective methods of funding, in England, they remain almost entirely charity funded, as improved cost-benefit ratios are generally achieved with land-based attendance and transfers. Health outcomes, for example from London's Helicopter Emergency Medical Service , remain uncertain. Although cost-effectiveness may be
24633-429: The war ended with the Armistice of 11 November 1918 . The Paris Peace Conference of 1919–1920 imposed settlements on the defeated powers, most notably the Treaty of Versailles , by which Germany lost significant territories, was disarmed, and was required to pay large war reparations to the Allies. The dissolution of the Russian, German, Austro-Hungarian, and Ottoman Empires redrew national boundaries and resulted in
24794-413: The war involved British, French, and German colonial forces in Africa. On 6–7 August, French and British troops invaded the German protectorates of Togoland and Kamerun . On 10 August, German forces in South-West Africa attacked South Africa; sporadic and fierce fighting continued for the rest of the war. The German colonial forces in German East Africa , led by Colonel Paul von Lettow-Vorbeck , fought
24955-418: The west , which despite initial successes left the German Army exhausted and demoralised. A successful Allied counter-offensive from August 1918 caused a collapse of the German front line. By early November, Bulgaria, the Ottoman Empire and Austria-Hungary had each signed armistices with the Allies, leaving Germany isolated. Facing a revolution at home , Kaiser Wilhelm II abdicated on 9 November, and
25116-427: The wounded. Currently, a NATO working group is investigating unpiloted aerial vehicles (UAVs) for casualty evacuation. The first civilian uses of aircraft as ambulances were probably incidental. In northern Canada, Australia, and in Scandinavian countries, remote, sparsely populated settlements are often inaccessible by road for months at a time, or even year-round. In some places in Scandinavia, particularly in Norway,
25277-432: Was a major factor in the deadly Spanish flu pandemic. The causes of World War I included the rise of Germany and decline of the Ottoman Empire , which disturbed the long-standing balance of power in Europe, as well as economic competition between nations triggered by industrialisation and imperialism . Growing tensions between the great powers and in the Balkans reached a breaking point on 28 June 1914, when
25438-403: Was challenged by Britain's withdrawal into so-called splendid isolation , the decline of the Ottoman Empire , New Imperialism , and the rise of Prussia under Otto von Bismarck . Victory in the 1870–1871 Franco-Prussian War allowed Bismarck to consolidate a German Empire . Post-1871, the primary aim of French policy was to avenge this defeat, but by the early 1890s, this had switched to
25599-654: Was refused. Early on the morning of 4 August, the Germans invaded, and Albert I of Belgium called for assistance under the Treaty of London . Britain sent Germany an ultimatum demanding they withdraw from Belgium; when this expired at midnight, without a response, the two empires were at war. Germany promised to support Austria-Hungary's invasion of Serbia, but interpretations of what this meant differed. Previously tested deployment plans had been replaced early in 1914, but those had never been tested in exercises. Austro-Hungarian leaders believed Germany would cover its northern flank against Russia. Beginning on 12 August,
25760-600: Was returning to Germany when it sank two British armoured cruisers at the Battle of Coronel in November 1914, before being virtually destroyed at the Battle of the Falkland Islands in December. The SMS Dresden escaped with a few auxiliaries, but after the Battle of Más a Tierra , these too were either destroyed or interned. Soon after the outbreak of hostilities, Britain began a naval blockade of Germany . This proved effective in cutting off vital supplies, though it violated accepted international law. Britain also mined international waters which closed off entire sections of
25921-586: Was the foundation of German foreign policy but in 1890, he was forced to retire by Wilhelm II . The latter was persuaded not to renew the Reinsurance Treaty by his new Chancellor , Leo von Caprivi . This gave France an opening to agree the Franco-Russian Alliance in 1894, which was then followed by the 1904 Entente Cordiale with Britain. The Triple Entente was completed by the 1907 Anglo-Russian Convention . While not formal alliances, by settling long-standing colonial disputes in Asia and Africa, British support for France or Russia in any future conflict became
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