REBOAHEMS: A Standardized, Competency-Based Operational Training Model for Air Medical REBOA Implementation

Massive hemorrhage remains a leading cause of preventable trauma mortality. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been proposed as a potential prehospital intervention, including within helicopter emergency medical services (HEMS). However, safe REBOA implementation in air medical environments poses unique operational challenges, and training models specifically adapted to these conditions remain scarce. The objective of this study is to develop and evaluate the operational feasibility of a structured training program designed to prepare HEMS crews for REBOA implementation under real air medical constraints.

REBOAHEMS was designed as a competency-based, blended-learning program consisting of a 12-hour online phase and a 12-hour in-person high-contextual-fidelity simulation phase conducted in helicopter cabin simulators (Bell 412 and AW109). A prospective educational evaluation was performed in HEMS physicians and nurses, assessing knowledge acquisition (pre-/post-test), procedural performance in simulation (Objective Structured Assessment of Prehospital REBOA Application scores and time to aortic occlusion), participant satisfaction, and early indicators of perceived transfer to clinical practice.

A total of 14 HEMS clinicians completed the program. Participants demonstrated significant improvement in theoretical knowledge and consistent procedural performance during simulated air medical scenarios. The mean time to aortic occlusion was 9.0 ± 3.6 minutes. Overall satisfaction was high. Although participants reported increased identification of potential REBOA candidates after training, no clinical REBOA deployments occurred due to a lack of device availability.

REBOAHEMS represents a feasible approach to preparing HEMS crews for REBOA performance under air medical operational constraints. The findings highlight that training alone is insufficient for clinical implementation, emphasizing the critical role of organizational readiness, equipment availability, and governance structures. This model offers a reproducible framework for air medical programs seeking to safely advance REBOA readiness and implementation.