Best of Med Flight

1. Best of Med Flight

2. Landing Zone Preparation & Communications Why is this so important?

3. Undesignated / Spontaneous LZs • High risk –espc at night • Obstacles on approach Wires Cell Towers • Ground hazards – signs, poles debris • LZ security – people vehicles • How well was it scouted out –we are 100% dependent on your eyes

4. Alternate LZs.You don’t have to land the helicopter exactly at the accident scene That’s why God put wheels on the ambulance

5. Designated LZs

6. Communication • MF dispatch 608-263-3258 • Your county 911 dispatch • Cell contact on scene

7. Initial Info • Location – street and cross street • Relationship to city, well known landmark • Contact agency • Cell contact on scene • Contact frequency – Typically Marc 2 • Incident type and basic patient info • Do you need more than 1 helicopter?

8. Radio contact • MARC 2 • 5-10 minutes out • Use vehicle radios – handheld have limited range • Our #1 interest – LZ information • VERY brief patient update

9. What to do if no radio contact ?

10. Common LZ Problems • Personnel “marking” the LZ • Personnel approaching aircraft before blades stop turning • LZ security once helicopter lands • LZ has to be secured 5 minutes prior to landing until 2 minutes after takeoff • No vehicle, regardless of height within 50 ft of aircraft. Especially ambulances

11. Brownout / Whiteout

12. Large Patients Im not afraid of heights Im afraid of widths

13. Meanwhile in Germany…

15. A Slippery Slope.. • Car 1 looses control on ice at highway speeds • Collides with car 2. Both go over 30 degree embankment • Car 1 slides sideways, impacts tree into drivers door • Car 2 T-bones Car 1 into passenger side

16. 2 occupants of car 2 self extricate –minor injuries • EMS arrives – Extensive damage toCar 1. Driver is obviously pinned. Talking but confused • Walmart parking lot 200 yrds from scene • Med Flight called – Landed within 15 minutes

20. Significant intrusion on both passenger and driver doors • Pt alert, confused, slightly agitated. Pinned by legs • Complaining of chest/abd pain • Collar placed. IV established, O2 • Initial VS 150/80 100 18

21. Wisconsin EMS Rule 11a If it is Saturday night and you respond to an accident scene after 10pm and do not find a drunk- Keep looking because you are missing a patient

22. CAR 2 CAR 1

23. Initial Approach • Car 2 winched up towards highway exposing passenger side of Car 1 • Plan is to remove passenger door and top

24. Additional support personnel beamed down from the Enterprise

26. The concept of “Holding the C-Spine”

27. Passenger side is no go • Now at 50 minutes post incident • Outside temp 35 F • Patient becoming more agitated-yelling • BP dropping 100/70 • Lets hold things for a minute..

28. Medical Interventions • Given Ketamine 50 mg IVP • IO placed in L humeral head • Concern re internal bleeding –TXA • Started PRBCs

31. Pt BP improves slightly • Dissociated state –protecting airway • T= 50 mins Tree cut away • Top removed • Pt starts to vomit and vomit and vomit

32. EMS rules regarding vomit • The volume of vomit always exceeds the size of the container be a factor of 2 • Standard suction is useless for Saturday night puke ( consists of McNuggets & partially chewed burritos pressurized by a pitcher of Milwaukee's Best) –you need a shop vac • Always point the pt at the person you like least

33. Tailoring the Extrication (speed/spinal precautions) to the patients condition & environmental issues

34. Situation a little more urgent • Pt quickly put in a KED • Lifted out – put on long board • Transferred to ambulance

35. Why don’t you just put him in the helicopter and go?

36. In the Ambulance • Initial GCS 13 –now 7 • Pt intubated using Glidescope • Given 2 units of PRBCs • 10 minute flight • To the trauma bay….

37. In The Emergency Dept • BP 90-100 systolic • Labs –hgb 8.5 Etoh 0.19 • FAST exam with ultrasound positive • CT scan of head/neck – negative • CT Scan of abd/pelvis – extensive splenic laceration

38. What is a FAST exam?Focused Assessment by Sonography for Trauma

40. Taken to the OR • Uneventful splenectomy • Transfused total of 4 units PRBCs • Discharged to home POD 5

41. Case #3

43. 16 y/o healthy female • Alone in the lap pool at waterpark • Found unresponsive in 4 ft of water • Immediately picked up on security video • Submerged 3-4 mins MAX • Park EMTs pull her from water, no pulse • 911 called • Start CPR, AED applied, shock advised • Immobilized, C-collar

44. We have a pulse • Local paramedic service arrives • VS 110/60 HR 120 irreg • Bagged on 100% O2 sats 85% • No evidence of trauma • Frothy sputum, bilat rales • GCS 6-7 Pupils 4-5mm reactive • IVs x 2

45. Prior to MF • Pt intubated, high airway pressures • Freq suctioning, • 12 lead –freq multifocal PVCs, no STEMI • MF lands at hospital helipad as ambulance arrives

46. Handoff • Vital signs and Neuro status unchanged • Pt sedated, paralyzed put on ventilator • What is the history again??

47. Uneventful flight Home • Handoff to ED • Evaluated in ED – head CT NL • CXR – pulmonary edema • Most labs and studies c/w drowning • Admitted to PICU • Its just another tragic drowning..

49. Whats the history again? • 16 y/o healthy 5’ 7” • No etoh, drugs, trauma • Lap pool is 4’ deep • Call to the water park – Can you pull the security videos? • What about the initial AED?