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Study objective <p>To identify factors associated with the mission outcome (transport completed vs. not transported) of air medical transport (AMT), with particular attention to environmental and operational constraints such as haze-related air pollution.</p> Methods <p>We conducted a retrospective analysis of all requests to the Northern Thailand Sky Doctor program (SkyDoc) from Jan 1, 2020, to Sept 30, 2024. Patient demographics, mission characteristics, environmental conditions, and operational variables were extracted from program records and merged with daily PM2.5 and PM10 concentrations from the national air quality monitoring network. The primary outcome was mission outcome, defined as transport completed versus not transported. We analyzed factors associated with non-transport.</p> Results <p>Among 656 mission requests, 412 (62.8%) were transport and 244 (37.2%) were not transported. Patients were predominantly male (57.2%) with a median age of 49 years (IQR 28–67). The most frequent diagnostic categories were ST-elevation myocardial infarction (32.3%), major trauma (21.2%), and stroke (11.7%). Non-transport was most often due to medical contraindications (25.8%), aircraft or landing-zone unavailability (23.8%), adverse weather (18.9%), and haze-related air pollution (12.7%). Seasonal peaks in not transport were observed from February through April, coinciding with regional surges in particulate matter. In multivariable analysis, twilight-hour requests (16:00–20:00) were associated with non-transport (adjusted OR 0.29; 95% CI 0.13–0.67; <i>p</i> &lt; 0.01), whereas secondary missions were more likely to be transport than primary missions (adjusted OR 3.51; 1.47–8.40; <i>p</i> &lt; 0.01). Higher PM2.5 concentrations were independently associated with non-transport (adjusted OR 0.99; 0.97–0.99; <i>p</i> = 0.018). PM10 was not associated with outcomes.</p> Conclusion <p>AMT in northern Thailand is constrained by both medical and environmental factors. Twilight-hour requests, mission type, and PM2.5 concentrations independently influenced mission completion. These findings highlight the need for haze-adapted flight protocols, enhanced forecasting, and system-level strategies to safeguard patient access to aeromedical care during seasonal pollution surges.</p>

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Barriers to helicopter emergency medical services in a Haze-Prone, mountainous region of Northern Thailand

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月13日

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  • Krongkarn Sutham,
  • Prasan Piamanan,
  • Boonyarit Kamthip,
  • Weerapont Kaewpaengchan,
  • Nattikarn Meelarp,
  • Wachira Wongtanasarasin,
  • Borwon Wittayachamnankul

摘要

Study objective

To identify factors associated with the mission outcome (transport completed vs. not transported) of air medical transport (AMT), with particular attention to environmental and operational constraints such as haze-related air pollution.

Methods

We conducted a retrospective analysis of all requests to the Northern Thailand Sky Doctor program (SkyDoc) from Jan 1, 2020, to Sept 30, 2024. Patient demographics, mission characteristics, environmental conditions, and operational variables were extracted from program records and merged with daily PM2.5 and PM10 concentrations from the national air quality monitoring network. The primary outcome was mission outcome, defined as transport completed versus not transported. We analyzed factors associated with non-transport.

Results

Among 656 mission requests, 412 (62.8%) were transport and 244 (37.2%) were not transported. Patients were predominantly male (57.2%) with a median age of 49 years (IQR 28–67). The most frequent diagnostic categories were ST-elevation myocardial infarction (32.3%), major trauma (21.2%), and stroke (11.7%). Non-transport was most often due to medical contraindications (25.8%), aircraft or landing-zone unavailability (23.8%), adverse weather (18.9%), and haze-related air pollution (12.7%). Seasonal peaks in not transport were observed from February through April, coinciding with regional surges in particulate matter. In multivariable analysis, twilight-hour requests (16:00–20:00) were associated with non-transport (adjusted OR 0.29; 95% CI 0.13–0.67; p < 0.01), whereas secondary missions were more likely to be transport than primary missions (adjusted OR 3.51; 1.47–8.40; p < 0.01). Higher PM2.5 concentrations were independently associated with non-transport (adjusted OR 0.99; 0.97–0.99; p = 0.018). PM10 was not associated with outcomes.

Conclusion

AMT in northern Thailand is constrained by both medical and environmental factors. Twilight-hour requests, mission type, and PM2.5 concentrations independently influenced mission completion. These findings highlight the need for haze-adapted flight protocols, enhanced forecasting, and system-level strategies to safeguard patient access to aeromedical care during seasonal pollution surges.