This prospective high-fidelity simulation study evaluated whether trained HEMS physician-nurse teams (n=14, in 7 teams) could successfully perform REBOA during active helicopter transport, using standardized hemorrhagic shock scenarios in AW109 and Bell 412 full-motion helicopter simulators.
In-flight REBOA deployment succeeded in 100% of simulations; median time to balloon inflation was 7 min 32 sec, with first-attempt femoral access success in 78.6% of cases. Higher OSAPRA competency scores correlated with shorter procedural times, and the AW109 cabin yielded faster inflation times than the Bell 412.
Findings are limited to simulation only — no real-patient or in-flight clinical data; very small sample (7 teams, 14 clinicians); results may not generalize across other helicopter platforms or HEMS skill mixes.
In-flight REBOA appears technically feasible when performed by trained HEMS teams, but clinical implementation should await real-world validation. Cabin configuration and operator competence both matter — team training and aircraft selection may influence outcomes.
