Being a physician in fixed-wing medical flights is no small task. Being responsible for a patient in an intensive care unit setting, hundreds of feet above the ground while he battles for life can be quite daunting. What compound the gravity of the situation are the limited resources at the disposal of physicians manning the medical flights. It’s only the world- class training and a cool, professional head on the shoulders that comes to aid in situations like this, day in and day out. Here, we describe some of the training requirements that are typically needed.
Initial Training for Medical Flights
Well, the training starts even before one applies for the job. The training is a little different from the one that you receive in hospitals. You need to be adept in working with limited resources. Also, it is important to understand that problems that one can face up in high altitudes. Gas pockets within the body and limited oxygen are just some of those. Training is optional in some regions but in others, they are absolutely mandatory. The documentation of such training might needed to be vetted by organizations like National Accreditation Alliance for Medical Transport Applications. The training, however, can be obtained through organizations like European Aero-Medical Institute or Commission on Accreditation of Medical Transport Systems.
Keeping the Skills Current for Medical Flights is Vital
Some skills are more important than others, like the ability to intubate a patient quickly. Yearly ALS refresher courses are expected to be in place by most medical flight companies. Since, hospitals often see critical patients, experience handling them in emergency settings is considered an added advantage by most air ambulance companies.
Ongoing Training for Full-Time Professionals on Medical Flights
Most of the reputed air ambulance companies offer their medical staff ongoing training. While some of this training is conducted in-house, others may be outsourced to external agencies that are accredited. In all, these efforts and checks are put in place for the safety of both the medical flight professionals and the patients under their care.
The study of aviation physiology is quite extensive. On diving deep into this subject, it becomes apparent that air blocks are major factors that bring about physiological changes in relation to altitude. To say that principles of aviation physiology hold good for medical flights too is stating the obvious. In this guide, we highlight some of the very common air blocks. These must be considered every time a person opts for a flight, pressurize or unpressurized.
Ear Blocks on Medical Flights
The symptoms primarily start as a feeling of fullness; however, the symptom may take a slightly painful turn in higher altitudes and ultimately lead to vertigo. The solutions though are pretty simple: yawning, swallowing and Valsalva are quite effective.
Sinus Blocks on Medical Flights
There can be two types of sinus blocks. The first type is maxillary sinus block. This is characterized by sharp pain beneath the cheekbones as well as upper dentition. The second type is frontal and is characterized by severe pain under the eyebrow as well as eye corners. The best remedy for this is Valsalva maneuver.
Gastrointestinal Tract Blocks on Medical Flights
Our digestive system can hold a lot of trapped gas. When a person travels on a high-altitude medical flight, this collection of gas can lead to physiological changes in the gastrointestinal tract causing discomfort and sometimes, slight pain. Belching and flatus can provide instant relief.
Tooth Blocks on Medical Flights
This is not the most common air block on medical flights; however, these can be quite painful and irritating. Sometimes, the natural gaps within teeth and gaps that occur due to dental procedures can retain air and act like bubbles. These air blocks can cause pain at high altitude. There is no immediate remedy for this condition. It is advised that the patient visit a dentist upon landing.
It must be noted that any discomfort that does not go away even after the above-suggested techniques must be dealt with all seriousness. In extreme cases, descent or landing may be warranted.
Now, that’s a scary situation isn’t it? Imagine that you’re in an air ambulance and it crashes in the wilderness. What would be your first reaction if you know that you’re going to be stranded for at least a couple of days? Search for food, correct? In reality, that’s the worst mistake that you can make. A typical human being can survive up to 3 weeks with no food at all but can only last up to 3 days without any water. We bring you several survival tips in this guide.
Staying Close to the Crashed Air Ambulance Vehicle is Vital
Wandering off in the wilderness in search of help is not wise. The rescue personnel are, obviously, going to look for the crash site and not wandering survivors. If you’ve moved too far away from the crash site, you might not even be found. So, it’s wise to stay close to the air ambulance and wait for help.
Protect Yourself from Harsh Weather Conditions
If the air ambulance is still in a condition where it can provide you shelter, use it. If not, try to erect a simple tent with sticks that can protect you from the sunlight. It must be noted that aircrafts are not the ideal shelters in extreme weather conditions. Seeking other forms of shelter is advised. The survivor, in this case, needs to be innovative.
Lighting a Fire and Hunting for Water is Important for Survival
Fire not only keeps the survivor warm, but also acts as a signal for rescuers. Keep the fire lit at all times as much as possible; however, beware of the dangers that a fire poses. Don’t get it too big. Also, your air ambulance might still have some water reserves left; use it judiciously. If you find a water source nearby, use purifying tablets before consuming it. If you do not have these, simply boil it for about 5 minutes.
The advancement in medical flight performance has a lot to do with the development in oxygen equipment in recent times. Typically, medical flights make use of portable oxygen equipment at altitudes less than 10 thousand feet above the sea level and fixed oxygen equipment if attitudes above 10 thousand feet are achieved by the air ambulance on a regular basis. Typically, the oxygen equipment consists of storage system, tubing, gauges, and mask. Traditionally, oxygen has been carried in gaseous form; however, the new advancements in technology have made way to solid stage oxygen which allows for carrying of greater quantities of oxygen.
Equipment Check Before the Medical Flight Takes Off
It must be ensured that all occupants of the medical flight are well aware of how to don and doff oxygen masks and fit the head harness properly. They should also be knowledgeable about checking the pressure gauges and indicators. Of course, it’s also necessary to check them for faults before the flight. The paramedics would do all these checks for the patients aboard the medical flight.
Each oxygen container is designed to withstand altitude up to a certain level. This must be taken into consideration before embarking on the medical journey. The expected duration of breathing and the duration of the flight are other aspects that must be considered.
Types of Oxygen Masks and Regulators
Continuous flow regulator ensures a 100% flow of oxygen. This usually contains a re-breather mask that allows the user to reuse some of the exhaled oxygen.
Demand and pressure demand works by providing oxygen to the user on demand. In other words, the oxygen only becomes available when the user is inhaling. Such oxygen usage is very stable and can be used up to 10 thousand feet above the sea level. This type of oxygen release becomes necessary in fixed wing aircraft where there travel long distances, often across continents.
The last thing that comes to mind during emergencies is money. Staying alive takes priority over everything else and naturally so. It is after the emergency and when you are inadequately covered by insurance that air ambulance cost finally comes into picture. There are several factors on which medical flight costs depend on. In this guide, we briefly discuss the important cost factors.
The Distance that Air Ambulance Needs to Cover
Unlike a cab that usually considers the distance from the point that you occupy it, air ambulance charges go beyond this point. You might be expected to cover the cost from the air ambulance base to your location and also for the journey undertaken by the air ambulance to get back to its base. Opting for the nearest air ambulance might make more sense in situations like these.
The Type of Air Ambulance Vehicle
For longer distances, an air ambulance with a jet engine might be more suited. Of course, this might translate into higher costs. At the same time, helicopters are ideal for emergencies that occur on busy streets. While one cannot exactly choose which vehicle to hire, it must be understood that aircraft type and costs are directly related to each other.
The Extent of Care the Health Condition Demands
There are two components to medical care: personnel and equipment. If the condition demands that the air ambulance be loaded with advanced life support and monitoring systems, the costs will shoot up. Also, there might be a requirement for specialized human care that only highly skilled professionals can provide. And such care usually comes at a premium.
Air Ambulance Landing Fees and Logistical Charges
When an air ambulance lands on an airport or helipad, it is usually charged a fee for it. Also there might be other charges such as visa, hospital booking, ground ambulance charges, etc. Your air ambulance service provider is obviously going to factor all that in while drawing the bill.
One of the most basic criteria for insurances approving and covering costs of medical flights is establishing that there was actually a medical necessity for availing the service. However, understanding what constitutes a ‘medical necessity’ is important. Of course, we have discussed, in our earlier guides, that the decision to summon air ambulances can only be taken by the treating medical professionals in the hospital or at the site of accidents. Let’s dive into this topic a little deep here.
Medical Flights and their Advantage Over Ground Ambulances
It must be established or deemed important to leverage the advantage that medical flights have over ground ambulances. The instability that comes with transporting a patient via ground ambulance and the need for rapid medical transportation could be the two reasons to avail medical flight services. Further, the condition of the patient should be such that he or she could suffer serious medical consequences or even face death if an air ambulance is not used.
Accessibility of the Destination
An air ambulance can become a ‘medical necessity’ if the destination is located in a region that is remote or completely inaccessible to other forms of transportation. The ground approach to the destination could be such that it poses a serious threat to the patient owing to the terrain.
Time Taken to Reach the Nearest Treating Facility
There are times when a delay as small as 30 minutes to an hour can mean the difference between life and death. The ground ambulances may be available in such scenarios but the time that they take to reach the treating facility could be a deterrent and the advantage of quick transportation that comes with medical flights could be the advantage. Of course, the severity of the illness or the disease condition would be the primary factor behind this decision.
Literally translated, hypoxia means diminished availability of oxygen to the body, something that is quite common in medical air transport scenarios. However, a pre-existing condition that already has made the patient struggle for oxygen can further exacerbate while on the flight. Here, we discuss the reasons and also the different types of hypoxia. The intent is to create a quick reference for medical air transport personnel.
Why Worry About Hypoxia Onboard a Medical Air Transport Vehicle
The biggest risk of hypoxia is when the medical air transport flies over 12,000 square feet above the sea level in an unpressurized air craft. It must be noted that medical flights are pressurized at high altitudes. However, if not, and if no supplemental oxygen is available immediately, it can lead to hypoxia. This kind of hypoxia usually affects the lungs as is caused by partial pressure reduction of O2.
Histotoxic Hypoxia Could be a Danger
Histotoxic hypoxia is diminished ability to filter oxygen owing to narcotic or any other toxic substance. The patient loses the ability to get adequate oxygen. In situations like these, the medical air transport crew must take special care to avoid exacerbating the situation. The combination of histotoxic hypoxia and lack of oxygen pressure due to altitude can prove to be a deadly situation.
Understanding Stagnant Hypoxia
This is another form of hypoxia and is caused by exertion of positive G force in the Z axis. Other causes are heart failures and shock. All these interfere with the blood circulation for the worse and deprive the human body of adequate oxygen. However, medical air transport services always carry oxygen onboard and these conditions are easily taken care of.
Hypemic Hypoxia is Another Cause
This type of hypoxia is caused by health conditions that affect the oxygen levels in the blood. Prime examples for this are anemia and carbon monoxide positioning, both of which affect blood oxygen levels.
Not all medical travels warrant a medical flight. When time is in your hand but the treatment for the ailment demands that you travel long distances, medical flight stretchers can be quite useful and economical. The cost of this service would be a fraction of what an air ambulance would cost you. However, there are certain points that one must keep in mind before booking a medical stretcher and we discuss those in some detail here.
How Isolated is the Patient in the Medical Flight Stretcher?
Medical stretchers naturally occupy more space than a normal seat would. Plus there might be the need of space for some basic medical equipment. All this space translates into higher cost. The agency you have hired might cut corners by trying to make do with minimum space. It is wise to clarify this beforehand. Isolation from the rest of the fight is extremely necessary.
Does the Air Ambulance Company take Care of the Logistics?
You do not want to risk taking the patient in your car to the airport. It is always wise to have an ambulance for this purpose. Does the agency take care of this? Also, the on-boarding and off-boarding of the patient must be a quick process. The agency needs to anticipate all possible hurdles to this and take care of it well in advance.
Booking the Hospital Bed on Arrival in Advance
You do not want to run around to book a bed in the hospital of your desire. While you standby the loved one with health issues, the agency must take care of booking the hospital bed in advance. It is vital that you ask about this beforehand and take confirmation of the booking. Of course, the ambulance too must be ready in the airport upon arrival to save time and get through the process quickly.
Lastly, one must not hesitate to clarify any doubts that they may have, with the coordinator.
We have mentioned in our guides earlier that the best thing to do is leave patient care to the paramedics or emergency medical professionals before the air ambulance arrives. However, there can be times when such help is not available on time. It is in instances like these that the knowledge of some basic facts and maneuvers come handy. We discuss such minimum interventions below.
Pre Air Ambulance Arrival First Aid starts with Calling 911
It is only prudent to first seek professional help and then proceed to offer help. Most times, our foremost instinct is to jump into helping the victim physically, but in the process that precious and live-saving call to 911 emergency services might be delayed significantly. If you strongly feel the need to intervene directly, ensure that you have someone nearby call 911 immediately. Your presence of mind in this matter is vital.
After You Call the Emergency Number
What you do after the emergency call, is entirely situational. Let’s explore some scenarios here:
- Commence cardiopulmonary resuscitation or CPR if you see that the patient is not breathing.
- If the patient is bleeding profusely, apply pressure to stop it. You can prepare a tourniquet by tying a rope to restrict the flow of blood towards the wound.
- If the patient has any amount of food, vomit or blood in the mouth, place the patient on his side with his arm or a pillow-like material under the head.
- If you see that the victim is unconscious while lying face down, turn him over so that he rests on his back.
If the victim is conscious, calm him down by reassuring that help is on the way. Remember, your reassurance to the patient is vital to eliminate anxiety. Bring in some positivity into the situation. Even simply holding the patient’s hand would suffice.
There’s no denying that an air medical transport pilot’s job pays well and is also quite exciting. Responding to emergencies and being amidst action all the time is definitely thrilling, but how does one get there? That’s what we explain here.
An Air Medical Transport Pilot Must Hold a Degree
It’s not necessary that you are an aeronautical engineer. Choose among subjects such as English, physics or mathematics. Holding at least a 2-year degree is mandatory, although it is preferred that you hold a 4-year degree.
Check Whether You Physically Qualify to Fly an Air Medical Transport Vehicle
Simply visit the Federal Aviation Administration website and look for an Aviation Medical Examiner close to the place that you stay. You will be given a medical test by this examiner and if you pass, you will be given a certificate stating the same. At least a class 2 certificate must be obtained as it is mandatory for commercial flying.
Choose the Right Flight School
It is essential that you enrol in a flight school that is recognized by the Federal Aviation Administration. Look for the various accreditations that the school has. Keep in mind that the trainer too must be certified by the Federal Aviation Administration. During the course, you must gain enough instrument flying experience. Air medical transport pilots often have to fly in adverse weather conditions where visibility is poor. This is when flying with the aid of instruments comes handy. It is a mandatory skill for air medical transport pilots.
Garner Enough Flying Hours
Air ambulance pilots are expected to have a good amount of experience under their belt; however, paying for flight hours can be quite expensive. An easy way out is becoming an instructor. This will give you enough hours so that you can comfortably apply for the job.