Flight critical care nurse

Trauma is the leading cause of death in the United States for those younger than 35 years and injuries sustained from trauma are a significant source of moderate to severe disability. The inability to establish, secure, or maintain a definitive airway is a major cause of preventable death and secondary injury due to inadequate oxygenation and ventilation. Prehospital airway management is an essential skill of any prehospital care provider. A critical component to providing excellent airway management is the ability of the provider to quickly establish endotracheal intubation without complications such as hypoxia, hyper/hypocapnea, or hypotension...

Evacuating the injured is an important part of disaster medicine. Aircraft provide timely access to distant and remote areas and, in an emergency, can evacuate sick or injured individuals in such areas quickly and safely for critical treatment elsewhere. Aeromedical evacuation (AE) comprises the two categories of fixed-wing ambulance service and helicopter emergency medical service (HEMS). Each aims to accomplish unique objectives. In Taiwan, the Second Taiwan Strait Crisis in 1958 established the unique role and functions of medical flight nursing...

Nurses play a critical role in Taiwan's helicopter emergency medical service, an essential healthcare response service for residents of outlying islands. The care skillsets required of nurses in special care and urgent care environments are significantly more specialized than those in other professional care environments. This article discusses the development of the civil helicopter emergency medical service (HEMS) and elements essential to HEMS nursing care efficacy. These elements can be grouped under the categories of pre-flight preparation, assessment for flight-readiness and in-flight care, decision-making abilities, personal physical characteristics, training and experience...

AIM: To describe and characterise the interhospital transport workload of a New Zealand based flight service over a 5-year period. METHOD: Wellington Flight Service database records from 1 November 2005 to 31 October 2010 were reviewed. Details of mission purpose, timings, transport type, severity of illness, clinical service requesting the transfer, and medical crew in attendance, were examined. RESULTS: The Flight Service completed 4046 transport missions over 5 years...

INTRODUCTION: Application of cricoid pressure is a frequently used technique in both rapid sequence intubation in multiple settings and in a more controlled setting in the operating room. In a survey of emergency department personnel performed at the University of Michigan, it was found that there is a knowledge deficit in the recommended force and the anatomic localization of cricoid pressure. Participants in the original study, which included emergency nurses, medical residents, and attending physicians, rated their training in cricoid pressure as poor or nonexistent...

While unsafe behavior of frontline hospital staff, primarily physicians and nurses, is sometimes the proximal cause of adverse events, the critical importance of system-wide, hospital organizational factors is now being acknowledged(1,2). These organizational factors create the "safety culture" that influences the occurrence of these proximal failures.(3) The concept of safety culture originated in high-reliability organization theory, which was largely developed by a group of social scientists at the University of California at Berkeley who studied high-risk organizations that have achieved very low accident and error rates, for example, aircraft carrier flight decks, nuclear power plants and air-traffic control systems...

The objective of this study was to use descriptive and phenomenological methods with Critical Care Air Transport Team (CCATT) nurses to identify knowledge and skills required to provide care for critically ill patients in a combat environment. Unstructured interviews, focus groups, written narratives, group interviews, participant observation, and review of in-flight documentation of care were used to obtain data from 23 registered nurses who had deployed with CCATT missions. Dimensions that emerged from the data included: clinical and operational competence, personal, physical, and psychosocial readiness, soldier and survival skills, leadership, administrative concerns, group identification and integration, aircraft air and evacuation familiarity, and nurse characteristics...

In current military operations, the survival rates of critically injured casualties are unprecedented. An often hidden aspect of casualty care is safe transport from the point of injury to a field hospital and subsequently on to higher levels of care. This en route critical care, which is provided by flight medics under the most austere and rigorous conditions, is a crucial link in the care continuum. This article introduces the role and capabilities of US Army MEDEVAC and reflects the author's recent experience in Afghanistan as a flight medic...

BACKGROUND: Since 1967 the gold standard for nurse staffing levels in intensive care and subsequently critical care units has been one nurse for each patient. However, critical care has changed substantially since that time and in recent years this standard has been challenged. Previously individual nursing organisations such as the British Association of Critical Care Nurses (BACCN) and the Royal College of Nursing have produced guidance on staffing levels for critical care units. This paper represents the first time all three UK Professional Critical Care Associations have collaborated to produce standards for nurse staffing in critical care units...

AIM: This paper presents a middle-range Theory of Flight Nursing Expertise. BACKGROUND: Rotary-wing (helicopter) medical transport has grown rapidly in the USA since its introduction, particularly during the past 5 years. Patients once considered too sick to transport are now being transported more frequently and over longer distances. Many limitations are imposed by the air medical transport environment and these require nurses to alter their practice. DATA SOURCES: A literature search was conducted using Pubmed, Medline, CINAHL, secondary referencing and an Internet search from 1960 to 2008 for studies related to the focal concepts in flight nursing...

BACKGROUND: Current United States (US) military doctrine emphasizes rapid evacuation of casualties to fixed medical facilities remote from the theater of war. To support this strategy, the Air Force has formed Critical Care Air Transport (CCAT) teams consisting of a physician, nurse, and respiratory therapist. STUDY OBJECTIVE: To describe the characteristics of US Air Force CCAT team operations at Balad Air Base, Iraq over a 1-year period. METHODS: Balad Air Base was the primary collection point in Iraq for patients requiring evacuation outside of the country during the study period...

BACKGROUND: The critical care air transport team program is a component of the U.S. Air Force Aeromedical Evacuation system. A critical care air transport team consists of a critical care physician, critical care nurse, and respiratory therapist along with the supplies and equipment to operate a portable intensive care unit within a cargo aircraft. DISCUSSION: This capability was developed to support rapidly mobile surgical teams with high capability for damage control resuscitation and limited capacity for postresuscitation care...

The crew resource management training program was developed by the aviation industry in response to critical and fatal errors by the flight team. This article examines the evolution and application of crew resource management to the healthcare industry. The goal of this evolution was to increase patient safety through better communication and teamwork. To accomplish this goal, teamwork training programs, such as MedTeams, are being introduced to healthcare professionals. Clinical studies have yet to show conclusive results of these training programs...

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...

OBJECTIVE: The Royal Air Force Critical Care Air Support Teams (CCASTs) have a philosophy to undertake transfers of critically ill patients from anywhere in the world back to a UK medical facility in a stable or improved clinical condition. The training they receive is primarily taught by traditional didactic methods, with no standardisation of education between teams that are expected to deliver care to the same standard. Notwithstanding there being no current compromise to patient care during air transfer, it was important to consider the benefits of an alternative experiential teaching modality...

BACKGROUND AND PURPOSE: In rural America, patients are often first seen at a small community hospital and then transferred to a tertiary care center by helicopter for further care. If acute clinical research were feasible during the aerial interhospital transport, more patients might be enrolled in trials at a critical earlier stage. METHODS: Prospective data were collected for all aerial transfers of a university-based helicopter service from April 2005 to January 2006...

INTRODUCTION: Cognitive awareness under general anesthetic may occur in up to 0.2% of patients, with approximately twice the risk in chemically paralyzed patients. Patients in emergency and critical care areas frequently receive neuromuscular blocking agents (NMBA), but a recent survey indicated that only 90% to 96% of critical care nurses routinely provide concurrent sedative medications to those patients. We sought to determine the potential for awake paralysis in patients transported by helicopter critical care transport teams and to evaluate for associations with clinical factors...

INTRODUCTION: Air medical teams provide around-the-clock critical care, a pattern at risk of inducing performance-altering fatigue from circadian disruption and sleep deprivation. Safety is an essential issue in the air medical industry, but little data are available on shift length and on-duty rest practices. We report the results of a survey concerning those practices and analyze the relationships to crew duty practices by program model (hospital-operated, vendor-operated, independent, or public safety), base location, flight volume, and job requirements...

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BACKGROUND: Emergency air medical transport provides the means for critically ill or injured patients to rapidly access sophisticated medical flight teams and medical centers. However, issues such as surging emergency medical services helicopter accidents, expected pilot and nurse shortages, falling reimbursements, and new compliance regulations are now threatening these important but expensive transport services. Unless an industry strategy can be developed to address these and other threats, many medical flight programs may be forced to curtail the availability of these lifesaving services...