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management suggestions. Note that these recommendations are not a substitution for close collaboration with medical control, and all adverse events should be promptly reported per organizational protocols. OBJECTIVE In prehospital helicopter emergency medical service (HEMS) settings, the medical team has limited monitoring options, usually restricted to systemic variables. Regional tissue oxygenation (rO2) can be assessed by near-infrared spectroscopy (NIRS), but clinical NIRS monitors are unpractical ("big boxes" and additional cables)