Flight paramedic

OBJECTIVE: To determine whether prehospital providers can successfully place a pediatric King laryngeal tube (LT-D) and ventilate a Laerdal SimBaby pediatric simulator during a respiratory arrest simulation. METHODS: We studied the ability of 45 paramedics and flight nurses to place the pediatric King LT-D in a SimBaby manikin. For the purposes of this study, paramedics and flight nurses were considered equivalent, because in this air medical system they have the same scope of practice in regard to airway skills...

OBJECTIVE: To compare the success and ease of bougie-assisted intubation (BAI) with those of traditional endotracheal intubation (ETI) in a simulated difficult airway (20.4 seconds for BAI vs. 16.7 seconds for ETI, p = 0.102). METHODS: This was a prospective, randomized, crossover, single-blind study comparing BAI with ETI in a simulated difficult airway. The 35 participants included paramedics, flight nurses, and emergency medicine resident physicians. Participants were already experienced in ETI and received a brief demonstration of BAI...

AIMS: To investigate the safety and efficacy of early aeromedical transfer after acute coronary syndromes (ACS). The Island of Jersey is 160 km from the UK and as no catheter laboratory facilities exist locally, patients with ACS are transferred to tertiary centres by air ambulance in the UK for further investigations. METHODS: All patients transferred to the UK for investigation after ACS in 2008 were identified retrospectively from coronary care admission records and the local flight transfer database...

This past spring, a flight team was activated by a rural advanced life support ground service for a scene call approximately 30 minutes from their base for an 80-year-old man found lying in the middle of a brush fire. The ground paramedics did not know how the patient came to this position. During the initial call to the flight service, ground emergency medical services (EMS) reported that the patient had 100% burns that varied in severity from superficial to full thickness. The intercept was requested for emergent transport to a burn center, analgesia, and advanced airway management...

In late October, a hospital-based flight team was activated at 9:30 pm for an approximately 30-year-old man involved in a high-speed motor vehicle crash into a tree. Per emergency medical services (EMS) documentation, flight service was requested for advanced airway management and rapid transport of the patient to a Level 1 trauma center. Ground transport was estimated at 60+ minutes, whereas actual flight time was less than 15 minutes. On the crew's arrival at the designated landing zone, they were escorted to an ambulance where a 100-kg man was immobilized on a stretcher...

INTRODUCTION: Transport medicine personnel are potentially exposed to jet fuel combustion products. Setting-specific data are required to determine whether this poses a risk. OBJECTIVE: This study assessed exposure to jet fuel combustion products, compared various engine ignition scenarios, and determined methods to minimize exposure. METHODS: The Beechcraft King Air B200 turboprop aircraft equipped with twin turbine engines, using a kerosene-based jet fuel (Jet A-1), was used to measure products of combustion during boarding, engine startup, and flight in three separate engine start scenarios ("shielded": internal engine start, door closed; "exposed": ground power unit start, door open; and "minimized": ground power unit right engine start, door open)...

Medical problems during flight have become an important issue as the number of passengers and of miles flown continue to rise. Cabin pressurization causes hypoxia, hypobaria and decreased humidity, which are responsible for most medical incidents occurring during flight. Worldwide daily medical incidents are estimated at 350, i.e., one per 14,000 to 39,600 passengers. Medical advice is obtained in 69% of cases, from physicians (40%), nurses (25%), or paramedics (4%) on board the plane. The leading causes of medical incidents are gastrointestinal (25%), cardiac (10%), and neurological (10%) diseases...

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BACKGROUND: The Brain Trauma Foundation (BTF) Guidelines for prehospital management of traumatic brain injury (TBI) recommend a goal end-tidal carbon dioxide of 30 mm Hg to 35 mm Hg in patients without signs of herniation. METHODS: We examined prehospital concordance with BTF Guidelines, selected demographic and physiologic variables and outcomes for 100 consecutive admissions to a well-established Level I regional trauma center. All patients had blunt TBI with Glasgow Coma Score < or = 8 without signs of herniation...

INTRODUCTION: Air medical personnel frequently face the challenge of the emergency airway. The Combitube is an airway device commonly used by emergency medical services (EMS) providers as either a primary or rescue airway. OBJECTIVE: We sought to evaluate the performance and preference of air medical personnel using a newer laryngeal tube airway device, the King LT, versus the Combitube in a simulator model. METHODS: Participants included flight physicians, nurses, and paramedics in our air medical transport program...

BACKGROUND: Literature spanning the last two decades has identified potential harm associated with out-of-hospital endotracheal intubation performed by ground paramedics. Previous researchers have reported intubation success rates of 66% to 97% in the air medical setting. OBJECTIVE: To examine the success of endotracheal intubation and rescue techniques performed by air medical personnel during the first eight years of operation of the air ambulance service. METHODS: This study was a retrospective survey of health records utilizing data from LifeFlight of Maine's airway procedure quality review database, covering the first eight years of system encounters...

In the event of major incidents, neighbouring air ambulances can be used to assist. To assess the potential benefit of this cooperation, three fictitious major incidents were described to emergency service dispatch desks to assess the availability and response times for neighbouring air ambulances. A medical infrastructure at each site could be in place in a shorter time when the mutual aid scheme was used. This short study demonstrates the increased availability of doctors and flight paramedics that can be achieved by cooperation schemes...

A 37-year-old man was severely burned while trying to fill a lighter with fuel while smoking. He sustained full-thickness (third-degree) burns over 60% to 70% of his body, including the oropharynx. A ground-based paramedic was unable to orotracheally intubate the patient after the administration of morphine and diazepam. The flight crew's assessment found an awake, alert man who was unable to speak because of his oral injuries. The Glasgow Coma Scale was estimated to be 10. In addition, the patient was wheelchair-bound from an undefined neuromuscular disease...

INTRODUCTION: Aeromedical agencies are used routinely to transport critically ill patients to specialty centers. The characteristics of patients suffering a cardiac arrest during transport by aeromedical flight personnel are not well-documented. We completed a retrospective analysis of aeromedical patient care records in order to describe the pre-arrest characteristics and the return of spontaneous circulation (ROSC) in this subset of patients. MATERIALS AND METHODS: A retrospective chart reviews of patients suffering from cardiac arrest while being treated by a single aeromedical transport service between 1998 and 2000...

OBJECTIVES: Studies finding adverse outcomes associated with emergency medical services intubation (ETI) have prompted recommendations for prehospital services to improve tracking of oxygenation during airway management. Our goals were to 1) implement a documentation requirement for helicopter EMS (HEMS) crews, entailing tracking and notation of the lowest SpO2 value (peri-ETI SpO2 nadir) occurring during HEMS crew ETI, and 2) assess the findings associated with the peri-ETI SpO2 documentation parameter...

Secondary brain injury may occur early after severe traumatic brain injury due to hypoxia and/or hypotension. Prehospital care by ambulance paramedics has the goal of preventing and treating these complications and, thus, improving outcomes. In Australia, most ambulance services recommend paramedics attempt endotracheal intubation in patients with severe head injury. Even though most patients with severe head injury retain airway reflexes, most states do not allow the use of appropriate drugs to facilitate intubation...

BACKGROUND: Recent reports have questioned the safety and efficacy of prehospital rapid sequence intubation (RSI) for patients with head trauma. The purpose of this study is to determine the rate of successful prehospital RSI, associated complications, and delays in transport of critically injured trauma patients treated by a select, well-trained group of paramedics with frequent exposure to this procedure and a rigorous quality control system. METHODS: A helicopter paramedic group's database of patient flight records (1999 to 2003) was merged with registry data of a suburban Level I trauma center...

The objective of the current work was to test ergonomic interventions aimed at reducing the magnitude of trunk muscle exertions in firefighters/paramedics (FFPs) providing emergency medical services (EMS) when transporting patients down the stairs. The interventions, developed using focus groups, were a footstrap to prevent the patient from sliding down on the backboard, a change in the handle configuration on the stairchair, and 2 devices, the "backboard wheeler" and a tank tread-like device (descent control system, DCS) for a stretcher, that change the backboard and stretcher carrying tasks into rolling and sliding tasks...

OBJECTIVES: To compare laryngoscopy conditions produced by etomidate-only intubation (EOI) with those produced by rapid-sequence intubation (RSI) in the prehospital air medical setting. METHODS: A prospective crossover trial design used two helicopters staffed by the same flight paramedics and nurses. Each aircraft used an EOI protocol (0.3 mg/kg) for six months. An RSI protocol using the same dose of etomidate plus succinylcholine (1.5 mg/kg) was used for the alternate six months...

OBJECTIVE: To determine the short-term outcome of patients refusing transport after emergency medical services (EMS) evaluation at an international airport. METHODS: This was a prospective, descriptive, observational study of patients who refused transport after evaluation by Philadelphia Fire Department paramedics at Philadelphia International Airport from July 2003 through March 2004. Paramedics contacted a medical command physician (MCP), who recorded the patient's contact information...