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Air Medical Overview

Air Medical Overview. Air Medical Objectives. Understand the history of air medical transports. Relate statistics to improved patient mortality and morbidity. Be able to determine the most effective mode of transport for the patient’s condition, geography and weather. Air Medical Objectives.

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Air Medical Overview

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  1. Air Medical Overview Transport Considerations CCEMTP

  2. Air Medical Objectives • Understand the history of air medical transports. • Relate statistics to improved patient mortality and morbidity. • Be able to determine the most effective mode of transport for the patient’s condition, geography and weather. Transport Considerations CCEMTP

  3. Air Medical Objectives • Define and describe what air medical appropriateness involves. • Describe the different mission profiles. • Describe crew resource management. • Identify flight considerations for both the patient and crew. Transport Considerations CCEMTP

  4. History of Aeromedicine • 1870 Prussian Siege of Paris • 1890-1910 M. de Mooy, Chief of Dutch Medical Service • WWI-modified DeHaviland aircraft • WWII-beginning of modern eraof aeromedical transport Transport Considerations CCEMTP

  5. History of Aeromedicine • Korean War • Bell-47 • Sikorksy S-51 • August 4, 1950 • 1958 Bill Mathews • Vietnam War • Bell UH-1 Huey Transport Considerations CCEMTP

  6. History of Aeromedicine • 1960’s • Accidental Death and Disability: The Neglected Disease of Modern Society • Samaritan Hospital System-Phoenix, AZ • State of Maryland • 1972 St. Anthony’s Hospital in Denver, CO • Late 1970’s-early 1980’s Transport Considerations CCEMTP

  7. Statistics • Despite more advanced weapon capabilities and increased destructive firepower WW II - 5.8% mortality 6 to 12 Hours Korean - 2.4% mortality 2 to 4 Hours Vietnam - 1.7% mortality 35 minutes Transport Considerations CCEMTP

  8. History of Aeromedicine Today, there are more than 265 aeromedical programs in the United States alone, each with specially trained flight crews, consisting primarily of registered flight nurses and paramedics. Transport Considerations CCEMTP

  9. History of Aeromedicine • 1st generation air medical program characteristics * Single engine helicopters * Strong medical direction * Highly educated ALS flight crews * Service to owner hospital * Excess bed capacity at owner hospital * Transport fees below actual cost Transport Considerations CCEMTP

  10. History of Aeromedicine • 2nd generation air medical program * Increased government interest in appropriateness * Fiscal benefits to receiving hospital Characteristics * Certificate of need required * Quantitative research to predict use * Ability to service multiple medical missions * “No patient too critical” theory Transport Considerations CCEMTP

  11. History of Aeromedicine • 3rd generation air medical program * FAA attention to accident rate * Reimbursement rates declined Characteristics * Twin engine aircraft * Safety strategies * Hospital involvement in transport guidelines * Quality assurance and auditing Transport Considerations CCEMTP

  12. Enhancing the Golden Hour • Air medical transports allow the injured or sick person, in the rural setting, faster access to an advance care facility. • Regional deployment • Education regarding how/when to access air transports. • Ground and air personnel training in specialty skills and equipment. • Efficient transfers of care. Transport Considerations CCEMTP

  13. Modes of Transportation • May vary widely from agency to agency and by region of country. • Determination of optimal mode is dictated by: • Patient acuity • Distance • Weather conditions • Topography of region Transport Considerations CCEMTP

  14. Mobile (ground) Transports • aka ambulances • Generally used to transport critically ill/injured patients in urban setting • Distance is typically 0-50 miles from patient’s location to receiving facilities. • Available in many different body and engine types depending on the uses for that unit. Transport Considerations CCEMTP

  15. Larger interior Less noise Less expensive Multiple provider capabilities No weight limitations Less weather dependant Limited to single patient transport Slower than air Limited travel distance Ability to transport specialized equipment Mobile (ground) TransportsAdvantages Disadvantages Transport Considerations CCEMTP

  16. Rotor Wing (helicopter) • Used to transport critically ill/injured patients. • Can travel up 150 miles • Wide variety available for use. Transport Considerations CCEMTP

  17. Speed (100-180mph) Specialized personnel/technology Few altitude issues (<2000ft) Can serve large population Multiple patient ability Weather restrictions Interior space limitations Expensive Landing requirements FAA communications Adverse crew effects Weight limitations Cost to patient Special housing Rotor Wing (helicopter)Advantages Disadvantages Transport Considerations CCEMTP

  18. Today’s air medical aircraft Bell 222 BK117 Transport Considerations CCEMTP

  19. Today’s air medical aircraft Eurocopter EC 135 MD Explorer Transport Considerations CCEMTP

  20. Today’s air medical aircraft AS 355 Augusta 109 Transport Considerations CCEMTP

  21. Today’s air medical aircraft Sikorsky S-76 Bell 430 Transport Considerations CCEMTP

  22. Fixed Wing (airplane) • Used to transport critically ill or injured patients. • Transports >150 miles • Often used in combination with mobile critical care units to transport patient to and from aircraft site. Transport Considerations CCEMTP

  23. Speed Multiple patient ability Able to travel great distances Specialized personnel/technology No weight limitations Instrument assisted flying Adverse altitude considerations for patient/crew FAA communications Cost to patient Expensive Small portion of community served Landing/housing requirements Fixed Wing (airplane)Advantages Disadvantages Transport Considerations CCEMTP

  24. Today’s air medical aircraft Fixed wing aircraft Transport Considerations CCEMTP

  25. Air Medical AppropriatenessWho will benefit from air transport? • Indications * Any adult, child, or neonate - Acute medical and surgical problem - In need of specialty care - At scene of illness or injury * Where time required to transport patient by ground to definitive care is considered to be excessive. Transport Considerations CCEMTP

  26. Air Medical AppropriatenessWho will not benefit from air transport? • Contraindications * Patients with terminal illnesses * Patients with DNR orders * Patients in arrest without return of spontaneous pulse * Patients who will overwhelm crew Transport Considerations CCEMTP

  27. Air Medical AppropriatenessRelative Contraindications • Severe anemia • Hemoglobinopathy • MI within 10 days or complications within 5 days prior to flight • Uncontrolled dysrhythmia • Pregnancy >24 weeks • Closed head injury • Recent eye surgery • Non-acute hypovolemia Transport Considerations CCEMTP

  28. Air Medical AppropriatenessBenefits vs. Risks • Effects of Altitude • Effects of Hypoxemia • Pacemaker patients • Ambient pressures • Humidity, noise, and vibration Transport Considerations CCEMTP

  29. Air Medical EfficacyAre there measurable benefits of air transport? • Intuitively - Makes sense - Decreasing transport time - Faster means of transportation - More direct route of travel • Quantitative data - unavailable - Precise time savings - Increased level of care - Effects on morbidity and mortality Transport Considerations CCEMTP

  30. Mission Profile • Crew configuration • EMT-P/RN • RN/RN • RN/MD • Pilot • Other Transport Considerations CCEMTP

  31. Mission Profile • Specialty teams • Neonatal • Pediatric • ECMO • IABP • Organ • Escort Transport Considerations CCEMTP

  32. Mission Designations • FAA • Federal Regulations Title 14- Aeronautics and Space • Part 135 • Commuter and on demand operations and rules governing persons on such aircraft • Part 91 • General operating and flight rules Transport Considerations CCEMTP

  33. Mission Profile • Air medical utilization * Time - distance - environmental issues * Acuity • Scene • ICU • E.D. • Cath lab • Neonatal Transport Considerations CCEMTP

  34. Mission Profile • Medical equipment / soft packs • Reduced weight / size monitors • No breakables Transport Considerations CCEMTP

  35. Mission Profile Service oriented Military Critical care ALS / BLS Search and rescue Law enforcement Fire department Transport Considerations CCEMTP

  36. Crew Resource Management • Crew may also have adverse reactions to: • Aircraft humidity • Noise • Vibration Transport Considerations CCEMTP

  37. Flight Considerations • Helpful flight crew hints * A well trained crew anticipates hazards * Hypoxia is the greatest potential hazard * Barometric pressure changes cause pain * Gas expansion should be anticipated * Minimize the effect of self-imposed stress Transport Considerations CCEMTP

  38. Flight Considerations • Helpful patient care hints * Discontinue all unnecessary IV lines * Insert prophylactic indwelling lines * Pre-medicate and sedate * Low hemoglobin = blood infusion * Get all medical records and x-rays * Empty all indwelling lines / tidy up Transport Considerations CCEMTP

  39. Receiving facility Available bed Qualified personnel Agreed to accept Sending facility Copies of records Arrange qualified transfer Medical necessity forms Flight Considerations Emergency medical condition that poses a serious health threat or threatens impairment of organs or bodily function Transport Considerations CCEMTP

  40. Customer Service • Patient/facility communication • Correct/complete patient records • Accurate patient status reports given at time of pick-up and delivery. “Bed to bed with chart in hand” with everyone’s expectations exceeded Transport Considerations CCEMTP

  41. Limitations of air medical transport • Aircraft by nature… • Are crowded and claustrophobic • Are noisy • Compromise performance of CPR • Contain vibration/movement/poor lighting • Limit the senses of the care provider • Are prone to extreme temperatures Transport Considerations CCEMTP

  42. ProfessionalOrganizations • AMPA - Air Medical Physician Association • NEMSPA - National EMS Pilots Association • ASTNA –Air & Surface Transport Nurses Association aka National Flight Nurses Association • NFPA - National Flight Paramedics Association • NAACS - National Association of Air Medical Communication Specialists Transport Considerations CCEMTP

  43. Professional Organizations • AAMS - Association of Air Medical Services • Mission Statement • To assure that every person has access to quality air medical and critical care transport Transport Considerations CCEMTP

  44. Professional Organizations • Organized forum for improving services • Mechanism for voluntary compliance • Marker of excellence to guide federal and state agencies • Accreditation standards as a benchmark for quality • Maintain currency for industry standardization Transport Considerations CCEMTP

  45. Air Medical Periodicals Transport Considerations CCEMTP

  46. Summary • Air medical transports are essential in decreasing mortality rates. • Allow faster access to more specialized tertiary care facilities. • Allow rapid access to health care system. • Major source of support to community hospitals and rural areas. Transport Considerations CCEMTP

  47. QUESTIONS? Transport Considerations CCEMTP

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