Category Archives: Medical

Guidelines for Handling Medical Flight Patients Who Have Fainted (Part 2)

In a previous post, we talked about some of the specific guidelines you need to follow when treating patients who have fainted. Also known as syncope, fainting is a common occurrence and as a medical flight paramedic, you may encounter a few patients in this situation. In this post, you’ll get more details about the guidelines released by the American College of Cardiology so you can get a thorough understanding of what to do.

More tips on handling medical flight patients with syncope

The previous post talked about the initial steps you need to take when you encounter a patient who has fainted. And those steps can be used by medical flight paramedics. According to the American College of Cardiology, health care professionals can follow the guidelines below when they have to treat a patient who faints:

  1. Some patients may have fainted because of irregular heartbeats, which can even be life-threatening. To determine whether your patient is facing this issue, doctors can use an implantable cardioverter-defibrillator to regulate the heartbeats.
  2. For syncope patients who have heart conditions, beta-blockers can be a good option.
  3. Health care providers should advise fainting patients to restrict their exercise in the future.
  4. Patients with recurring fainting spells resulting from very low heart rate might require pacemakers. In case of patients with common faints, drugs may be enough to control the situation.
  5. In case of unexplained fainting, heart rhythm monitoring is a good option to determine whether or not the patient has intermittent heart rhythm issues resulting in fainting.

The American College of Cardiology also advises athletes with fainting issues to visit an experienced health care provider for a heart assessment. These are some of the basic guidelines that can help in providing the right level of care for people who faint.

Understanding Air Ambulance Flights that use Hoist Services

When a person is stuck in a challenging environment, nothing else is as effective as air ambulance flights that make use of hoists. Their presence not only ensures quick rescue but also saves a lot of time and effort when compared to a ground rescue, although they too have not been without hoist fatalities. However, that is a risk that the brave rescuers sometimes take. Here are some of the advantages, limitations, and risks associated with air ambulance flights that make use of hoists.

What Limits the Air Ambulance Flights?

  • If the winds are moving at a speed greater than 20 miles per hour, if the visibility is poor or the weather is simply harsh, air ambulance flights may not undertake a rescue mission.
  • There is a weight limit that comes with hoist operations and if the combined weight of the patient as well as the equipment exceeds 450 pounds, the mission might be abandoned.
  • Hoist operations are never undertaken during night hours
  • Conducting a hoist operation over water is tough and can be quite limiting.

The Factors taken into Consideration by Air Ambulance Flights

  • The nearest location where the aircraft can be fueled
  • Availability of landing area
  • The location of the nearest command post
  • All information related to the patient such as the weight, age, people along with the patient, etc
  • Availability of a backup plan in case the mission cannot be carried out

The Different Types of Hoists Used by Air Ambulance Flights

  • Rescuer Backpack: This contains hoist equipment that’s best suited for rescue along with some emergency medical equipment in anticipation of the injury.
  • Bauman Bag: This equipment is used in winters when the injured patient needs to be kept warm. The bag is a splinter that fits automatically around the patient keeping him or her warm.
  • Rescue Net: Here, the patient is placed prone in a rescue net which is then hooked to the hoist.
  • Seat Harness: This is used primarily to rescue uninjured patients or to rescue those who have very minor injuries that do not pose any threat to life. Here, the harness is simply placed around the patient and hooked up to be hoisted away.

Carrying out hoist rescue missions requires special approval by FAA which is granted only after a rigorous certification process.

Aircraft flying high in the city

Medical Flights and RVSM

RVSM is an abbreviation that stands for Reduced Vertical Separation Minimum. RVSM-approved medical flights must be fitted with certain gadgets such as autopilot and certified altimeter. These medical flights are allowed to fly 29,000 feet above the sea level.

RVSM allows aircrafts to fly maintaining reduced vertical distance between each other; thus, paving way for more medical flights to share airspace simultaneously and safely. While this may seem quite technical for a layman, there are other distinct advantages of flying above 29,000 feet. It brings speed, comfort and safety. Let’s discuss the importance of RVSM, especially with long-distance medical flights.

Safety of Medical Flights and RVSM

Safety is always the primary concern when you choose an air ambulance. Medical flights coursing at lower altitudes are more susceptible to turbulence. Such turbulences can cause unnecessary anxiety in the patient which is not advisable when the condition of the patient is critical or the patient is already anxious about his or her health.

Speed of Medical Flights and RVSM

Time is always of essence when choosing an air ambulance. Medical flights flying at higher altitudes fly quicker and burn lesser fuel. This means that the air ambulance does not have to stop frequently for fueling. Circling the airport, landing, fueling and resuming flight can be quite time consuming and RVSM approved medical flights avoid/ reduce such hassles greatly.

Comfort of Medical Flights and RVSM

The reduced chances of turbulence, when flying at higher altitudes, make travel comfortable for the patient. The difference in comfort level is not too great but for a patient who has a fragile health condition, the small difference can mean a lot. There is also the peace of mind that comes along when you know that the aircraft carrying you will take lesser time.

Cost is always a consideration when choosing medical flights. The fact that a RVSM approved aircraft burns less fuel could translate into lesser costs for you.

Career as Air Ambulance Transport Nurse

Nursing is a profession that demands passion and the compassion to care. While salaries are not always the best, the job satisfaction is always high as nurses are closely involved in making the lives of those they touch better. If you choose to be an air ambulance transport nurse, your professional life is, no doubt, going to be exciting. Administering medical care on airlifted patients warrants certain specific skill sets. Let’s first discuss the salaries of air ambulance transport nurses.

Salaries of Air Ambulance Transport Nurses

According to the US Bureau of Labor Statistics, registered nurses, on an average, earned $67,930 per annum. The top 10% of this group earned in excess of 94,720 while the bottom 10% earned less than $45,040. Looking specifically at the salaries earned by Air ambulance transport nurses, the salaries varied between $66,560 and $70,500 in 2011; this is in accordance with the data collected by University of Washington.

Outlook for Air Ambulance Transport Nursing as a Career

The US Bureau of Labor Statistics projects excellent demand for nurses in general. The employment growth is slated to hover around 26% until 2020. This growth is excellent and almost twice the projected pace of growth (14%) of all occupations in the United States.

Education of Air Ambulance Transport Nurses

As per Discover Nursing, air ambulance transport nurses need to be RN (registered nurses) first before venturing into air rescues. To become an RN one needs to opt among the following three choices:

  • Bachelor’s degree in nursing
  • Associate degree in nursing
  • Nursing diploma

The next step is to clear National Council Licensure Examination for RN. The employers may demand additional certifications based on the demand of the job. They might expect the air ambulance transport nurse to be:

  • Certified flight registered nurse
  • Emergency medical technician-paramedic
  • Emergency medical technician-basic

To be “certified” flight nurse, one needs to work as a flight nurse for at least two years according to Board of Certification for Emergency Nursing. Working in critical care and emergency units is considered an added advantage for better employment opportunities.

Role of Air Ambulance Services in Organ Transplant

It’s often a long and painful wait for an organ donor, no matter which part of the world you’re from. The number of donors around the world is much lesser than those waiting for a donor. Then, there is the issue of organ suitability. All these issues make finding an organ a prized opportunity. It is also vital that the organ reaches the recipient on time and this is where the air ambulance services often come into picture.

How Do Air Ambulance Services Help?

Air ambulance services help transport organs from the remotest of the places to the recipient in the shortest possible time. While air ambulance choppers are used for short distances, fixed wing medical aircrafts are used for longer distances. The air ambulance services are always available on-call in situations like these where a few minutes can mean the difference between life and death. Air ambulance services are considered 100% safe when transporting organs such as kidneys and liver. There are instances where even heart has been airlifted.

What Makes Air Ambulance Services Ideal for Organ Transport?

Two obvious reasons are the reach and the time taken by air ambulance services. The sophisticated aircrafts also provide a congenial environment for carrying the human organs. Unexpected eventualities like road blocks are virtually nonexistent. The air ambulance services also pave way to carry the patient quickly – with all necessary medical care – to a facility that specializes in organ transplantation. We need to understand that often recipients too are carried to a particular location, depending on factors such as time and availability of specialized hospitals.

The point to note is that most air ambulance services will take complete responsibility of coordinating the entire transport so that the organ reaches safely and on time. There are also insurance covers available to cover such air ambulance services. All it takes is a bit of planning and coordinated effort.

Airambulance cabin filled with Medical Equipment

Structural Guidelines for Fixed Wing Airambulance Transport

All most all states in the United States have laid down certain minimum requirements that a fixed wing airambulance must satisfy. The guidelines given below have been issued by the state of Tennessee but the structural guidelines are, in general, similar in other states too.

Airambulance Doors

The doors of the airambulance must be wide enough that a stretcher can be passed through it without tilting it more than 30 degrees. This guideline ensures that the transit of the patient into the airambulance is safely done.

Vertical Height of the Airambulance

It is vital that there is enough headspace so that the medical personnel can function optimally and provide adequate care for the patient. For this reason, all airambulance vehicles must have a minimum vertical height of 30 inches.

The lighting of the Aircraft

The electrical capacity of the airambulance must be equipped to provide “sufficient” light inside, such that medical care is not hindered due to lack of it. The service providers are allowed to make use of portable lamps to achieve this.

Guidelines for Airambulance Equipments

To ensure stability of the patient while entering the aircraft and during the transport, the stretchers must be fitted with at least two restraining straps to keep the patient in place.

The suction devices must have a capacity to produce suction of at least 12 inches of mercury.

Oxygen bags or masks must be available within the airambulance. There must be enough stock so that 95% fraction inspired oxygen is available at all times. The equipment must be capable of adjusting flow between 2 to 5 liters of oxygen per minute.

Adequate sanitary supplies like trash disposal bags, emesis bags, urinal, bedpan, towels, etc, must be available.

Basic tools like stethoscope, blood pressure cuff, dressing materials, and flashlights must be kept handy.

As a patient and a customer availing airambulance services, it is your right to have these facilities and being aware of such basic things about air ambulances can help.

Patient on a stretcher with paramedics

Preparing the Patient for a Medical Flight

It is important that the medical flight taken by a patient is both safe and comfortable. Following certain guidelines ensures that the medical flight transport is carried out smoothly and quickly. Here, we discuss the vital considerations that must top your mind.

Proper Documentation for Medical Flight

Laws specify that transfer orders by the treating physician and acceptance documents by the receiving facility must be in order before the patient boards a medical flight. Also, the patient’s medical chart, discharge summary, lab results and other medical information must be carried. A photo ID is vital and must be kept handy. Consent for medical flight transport must be sent to the air ambulance operator beforehand.

Medications and Equipments during the Medical Flight

An IV access must be ready. If the patient does not need IV access on a continuing basis, it can be capped. All medications that are necessary and those that are meant for comfort must be administered. These meds must also be provided to the crew in case the need arises midair. This also includes IV medications.

Casts, Traction, and Diapers

If the patient is being treated with a circumferential cast, it must be bivalved beforehand. Hanging weights for traction are not suited for a medical flight. Appropriate traction device must be used instead. An unconscious patient must be diapered prior to transfer to the medical flight and any tube feeding must be discontinued about 7 to 8 hours in advance.

Accompanying the Patient in Medical Flight

The passenger accompanying the patient must have prior approval. If the condition of the patient demands that no one accompanies him or her during the medical flight, the passenger must comply. Most fixed wing aircrafts have limited space and one must understand that it is essential for the medical staff to have enough space to function efficiently. Even when accompanying the patient, the passenger must occupy minimum space possible.

Knowing these guidelines well in advance helps make the medical flight travel a comfortable one.

A neonate being transferred from ground ambulance to air ambulance

Fixed-Wing Air Medical Transport Precautions

When you accompany a patient to a fixed wing air medical transport vehicle, you would be accompanied by qualified professionals belonging to both ground ambulance and air ambulance. However, knowing certain protocols can always come handy, and ensure a safe and swift transfer of the patient to the air medical transport vehicle.

Getting to the Air Medical Transport Vehicle

First and foremost, the ground ambulance needs to wait for the aircraft to shut down its engines completely before approaching it. Even when the ambulance approaches the air medical transport vehicle, it has to stop at least 25 feet away. All flashing lights must be switched off and only the headlights must be used in case of poor visibility.

You must wait for the crew to arrive to the ground ambulance to take the patient away. Switch off the ground ambulance immediately after reaching the destination to avoid the exhaust fumes getting into the aircraft. Keep in mind that the aircraft might be pressurized to a certain degree and the exhaust fumes can be quite a disturbance.

Taking the Patient to the Air Medical Transport Vehicle

Walking in front of the wing of the airplane is a strict no. Also, refrain from opening the doors of the air ambulance. Assist in loading the patient only if help is requested. If the help is sought, do not stay inside the air medical transport vehicle unnecessarily after loading the patient, unless you are travelling along. Never hesitate to ask what you must and must not do once inside and when travelling with the patient.

Before Exiting the Airport

It is wise to leave the airport only after the air medical transport vehicle takes off. Inform the crew of any issues such as debris or animals in the vicinity that might hinder takeoff. Even when the ground ambulance moves away from the aircraft, the flashing lights must be switched off.

Finally, have all your questions relating to the medical travel answered before the transfer. Your questions at the last moment can unnecessarily waste valuable time.

Picture of Sikorsky S-76 chopper

Airambulance and Your Safety – Know a Little About the Choppers

It is remarkable to know that airambulance services or Helicopter Emergency Medical Services ferry over 400,000 people safely each year in the US. Most of these rescues are usually conducted in tough weather conditions and poor visibility. Landing is another concern as pilots have to land the airambulance in unfamiliar terrains.

The fact remains that airambulance services today are increasingly turning commercial and safety is sometimes put on the backburner. The FAA has been extremely active in regulating the airambulance market in recent times, laying down new rules for safety. In this realm, we look at certain facts. However, a good chopper can cut the risks to a huge extent. Here, we discuss a few of those briefly.

The Various Airambulance Choppers and their Capabilities

There are several airambulance helicopters that are used in emergency situations these days. As a person who might potentially be in need of these at some point, you must know a little about the popular helicopters out there.

Bell 206: The cost varies from $800 thousand to $3 million. It is a single engine airambulance that can host only one pilot. It has only limited weather capability. It also has limits when it comes to carrying load such as fuel and medical equipment.

Eurocopter EC135: The cost varies from $4 million to $6 million. It sports a twin engine and can host 2 pilots simultaneously. It has excellent weather capability and can run on autopilot. It can fly for longer distances. This airambulance can carry equipments such as balloon pumps and ventilators.

Sikorsky S76: The cost of this chopper varies between $7 and $12 million. It is a twin engine helicopter that can host two pilots at a time. It has instrument weather capability and can also run on autopilot. It has specialty transport capabilities such as onboard pediatric care. This airambulance has the highest distance range.

Considering the fact that helicopter airambulance operations accounted for the second highest commercial accidents in 2014 as reported by FAA, it becomes vital that you know a bit about these helicopters.

Healthcare Standards in Medical Flight Services and the US Law

Megan Gilbreath was a resident of Abilene, Texas. She was an 18-year-old student who was involved in a motor vehicle accident involving her pickup. She had a rollover accident where she sustained a head injury and a broken leg. A medical flight was quick to respond and she was all set to be transported to the nearest medical facility.

However, one major error was committed. The EMT that belonged to the medical flight service had intubated her wrongly. The tube that was supposed to carry oxygen was inserted into the esophagus instead of her windpipe. As a result she was declared brain dead by the time the medical flight took her to the treating facility. All the while oxygen was being pumped to her stomach instead of her lungs.

Are You Safe on a Medical Flight with Mere FAA Regulations?

It must be noted that FAA is a regulating body for flights of all types and not just medical flights. This means the medical flight service providers don’t really have regulations that govern them when it comes to ensuring adequate medical care on the flight. FAA only has the say when it comes to medical flight safety when flying. It concerns itself with issues such as crew safety in bad weather conditions and medical flight during bad visibility at night.

Who Regulates the Medical Flight when it Comes to Standard of Care?

The Airline Deregulation Act of 1978 that paved way for using air ambulances during medical emergencies had one major flaw. It exempted the medical flight service providers when it came to “routes, prices, and services.” This loophole allows the medical flight service providers to have their own standards when it comes to services.

This however does not mean that all air ambulance service providers cut costs when it comes to standard of care. Most medical flight operators maintain high standards of medical care. However, in the highly competitive air ambulance sector, it is possible that there are medical flight service providers who cut corners through not-so-well trained or inadequately trained medical staff.

The Airline Deregulation Act of 1978 does have a provision where the states can regulate the medical aspect of air ambulances; the only condition is that such regulation should not impact the economics of operating a medical flight “significantly.” In essence, there is scope and hope for regulations in this regard.