{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:20:06Z","timestamp":1792790406016,"version":"4.5.0"},"posted":{"date-parts":[[2026,9,23]]},"group-title":"Emergency Medicine","reference-count":19,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute of Minority Health and Health Disparities","award":["K08MD016445"],"award-info":[{"award-number":["K08MD016445"]}],"id":[{"id":"https:\/\/ror.org\/0493hgw16","id-type":"ROR","asserted-by":"crossref"}]},{"name":"AIM-AHEAD Artificial Intelligence\/Machine Learning Consortium to Advance Health Equity and Researcher Diversity Program","award":["3OT2OD032581-01S5-800"],"award-info":[{"award-number":["3OT2OD032581-01S5-800"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,9,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In rural Alaska, where most communities lack road access, air ambulances serve as a critical link between remote communities and hospital services.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To examine how air ambulance utilization decisions are made within the rural Alaskan health organization ecosystem.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted semi-structured interviews with five key stakeholders. Transcripts were analyzed thematically using the Practical, Robust Implementation and Sustainability Model (PRISM).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Four themes emerged that collectively define the structure of the air ambulance decision-making system, each reflecting interactions across multiple PRISM domains: limited formal guidance, logistical constraints affecting transport options, variability driven by communication and clinician risk tolerance, and reliance on unwritten rules. Together, these describe decision-making in a limited information state with incomplete feedback, leading to experiential and locally evolved practices.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Air ambulance use reflects clinical\u2013logistical constraints rather than critical illness alone. Linking transport decisions to outcomes and developing structured decision support may improve consistency and optimize care delivery.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.09.21.26363602","type":"posted-content","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T19:10:22Z","timestamp":1790190622000},"source":"Crossref","is-referenced-by-count":0,"title":["High stakes, low information, no roads: a qualitative evaluation of determinants of air ambulance utilization and decision making in rural Alaska"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9093-1831","authenticated-orcid":false,"given":"Brian","family":"Rice","sequence":"first","affiliation":[{"name":"Stanford University, Department of Emergency Medicine, Palo Alto, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon A.","family":"Berger","sequence":"additional","affiliation":[{"name":"Maniilaq Association, Kotzebue ,AK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Onders","sequence":"additional","affiliation":[{"name":"Maniilaq Association, Kotzebue ,AK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sar","family":"Medoff","sequence":"additional","affiliation":[{"name":"Emory University, Emory Healthcare, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Saul","sequence":"additional","affiliation":[{"name":"Stanford University, Department of Emergency Medicine, Palo Alto, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026092603201240000_2026.09.21.26363602v1.1","unstructured":"Alaska Department of Transportation & Public Facilities. Alaska Community Transportation Dataset. Published online 2023. https:\/\/dot.alaska.gov\/"},{"key":"2026092603201240000_2026.09.21.26363602v1.2","unstructured":"U.S. Census Bureau. 2020 Decennial Census Redistricting Data (Public Law 94\u2013171). Published online 2021. https:\/\/www.census.gov\/programs-surveys\/decennial-census\/about\/rdo\/summary-files.html"},{"key":"2026092603201240000_2026.09.21.26363602v1.3","unstructured":"U.S. Census Bureau. 2020 Decennial Census Demographic and Housing Characteristics File (DHC). Published online 2023. https:\/\/www.census.gov\/data\/tables\/2023\/dec\/2020-census-dhc.html"},{"key":"2026092603201240000_2026.09.21.26363602v1.4","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2024-214444"},{"key":"2026092603201240000_2026.09.21.26363602v1.5","unstructured":"Alaska Native Epidemiology Center. Alaska Native Health Status Report: |eThird Edition. 2021. Accessed October 9, 2023. http:\/\/anthctoday.org\/epicenter\/publications\/HealthStatusReport\/Alaska-Native-Health-Status-Report-3rd-Edition.pdf"},{"key":"2026092603201240000_2026.09.21.26363602v1.6","doi-asserted-by":"publisher","DOI":"10.3402\/ijch.v71i0.18543"},{"key":"2026092603201240000_2026.09.21.26363602v1.7","doi-asserted-by":"publisher","DOI":"10.1007\/s10900-017-0349-0"},{"key":"2026092603201240000_2026.09.21.26363602v1.8","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph20227030"},{"key":"2026092603201240000_2026.09.21.26363602v1.9","unstructured":"Rice B. No Golden Hour in Alaska. West J Emerg Med. 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