As a medical flight paramedic, you would understand that many patients could have been saved if only you had the right equipment. Many air ambulance planes operate on charity and may not have sufficient equipment aside from the basics. If air ambulance operators can afford to supply their aircrafts with high-tech devices, however, portable ultrasounds are a crucial addition.
Importance of Portable Ultrasounds on Medical Flight Aircrafts
If your air ambulance aircraft is equipped with a portable ultrasound, here are some of the ways you can make use of it:
- Identifying OB emergencies – Pre-hospital ultrasound can be used to identify emergency cases like placenta abruption and ectopic pregnancy with around 95% accuracy.
- Confirming airway placement – A portable ultrasound can help you confirm the correct placement of endotracheal tube for airway management. Using this device, you will have better accuracy in differentiating main tracheal intubation from right mainstream intubation.
- Identifying dyspnea causes – With the help of a field ultrasound device, you can more accurately determine the cause of acute dyspnea. You will have a better idea whether it was caused by chronic obstructive pulmonary disease or pulmonary edema.
- Better evaluation of cardiac motion – Medical flight paramedics strive to safely deliver patients to the appropriate medical facility. But in many cases, lack of equipment may prevent you from thoroughly evaluating cardiac motion. This may result in incorrect pre-hospital treatment procedures.
But with a field ultrasound, you should be able to have better accuracy in evaluating cardiac motion. This can help you with correct diagnosis and treatment procedures, increasing the survival to hospital admission.
- Diagnosing strokes – An ultrasonic device can also help you accurately diagnose time-sensitive conditions like strokes. Timely stroke diagnosis can also ensure the transportation of the patient to the appropriate stroke center for specialized treatment.
As a medical flight paramedic, you will come across different situations and patients with various conditions. You might even come across patients undergoing a seizure, in which case you will need to carry out immediate and correct intervention to improve the patient outcome. Many seizure patients will even encounter respiratory issues, making the situation even more critical. This post will help you find out some useful facts about seizures and the accompanying respiratory issues.
Assessment Process for Seizure Patients
Seizures often last for only a few minutes and by the time you arrive on scene, the patient might be unconscious or in a postictal phase. But sometimes, seizures may last more than 20 minutes or even recur before the patient becomes conscious again. These cases are life-threatening and are known as status epilepticus.
Medical flight paramedics should carry out the following assessment steps for seizure patients:
- Determine the duration of the seizure and how many seizures they have had
- Determine whether or not the patient had regained consciousness after each seizure
- Try to determine the underlying cause of the seizure – any medical condition, injury, or trauma that could result in it
- Enquire about any complaints the patient had before the seizure
Airway Management Tips for Medical Flight Paramedics
When carrying out airway management for seizure patients, protecting the upper airway is crucial. You will also need to administer high-flow oxygen and ensure proper ventilation. In case a patient is still seizing or positical, you need to use a non-rebreather mask to administer oxygen and set it at 12-15 liters per minute.
Additionally, stopping the seizure is crucial to ensure proper airway management. So if the patient is still actively seizing you might need to consider administering anti-seizure medication because seizures that last more than 5 minutes might not stop unless you intervene.
As an air ambulance paramedic, your job is to improve the outcome for different medical conditions and injuries. So when it comes to stroke patients, you would be faced with a time-sensitive issue that needs to be addressed as quickly as possible. You will need to transport the patient immediately to a facility that is equipped with a CT scanner and other equipment for stroke care. However, you can also make some effort to provide pre-hospital care during the medical flight to further improve the outcome.
Pre-Hospital Stroke Care for Medical Flight Paramedics
When it comes to stroke care, the goal is to help the brain cells survive. So your responsibility involves attending to the ups and downs that may occur during homeostasis. You can prevent serious issues through the medical flight by caring for the issues listed below:
- Hypothermia – Although this may be beneficial for treatment in the future, you need to focus on maintaining normal body temperature for now. Try to prevent hyperthermia by removing any excess clothing and regulating the temperature in the aircraft. You should also prevent shivering, as this can increase body temperature.
- Hypoxia – This decreases the oxygen supply to the brain cells, which calls for supplemental oxygen to ensure normal oxygen saturation.
- Hypoglycemia – This withholds the primary energy source for the brain cells, meaning you will need to replenish the glucose supply without causing hyperglycemia.
- Hypotension – This needs to be controlled through fluid resuscitation so as to ensure that the brain cells get enough oxygen and nutrients for survival. If the patient has normal blood pressure, use a saline lock to make sure it remains that way. In case of hypertension, you will need to follow directions given by the in-flight doctor.
You transport a patient to a hospital but after you leave, the hospital staff is left with vague information about the patient’s medical history and medications as well as allergies and assessment details. So the staff has to track you down to find out more information, resulting in a lot of wasted time and resources. The end result is a delay in providing emergency care in a potentially critical situation despite a quick medial flight. This makes it crucial to successfully carry out your patient hand-offs with all the vital information.
Come up with a Standard Procedure to Compile Hand-Off Report
The patient hand-off period should be considered as the point of contact between providers, where they share crucial information about the patient. Although there may be several differences in the setting and circumstances surrounding this contact point, you can still ensure to standardize how the information is shared.
Medical flight crews and ground ambulance crews alike can make use of the SBAR approach developed by TeamSTEPPS. This approach provides you with a framework to effectively communicate with other medical care providers. It involves providing information about:
- Situation – Let them know exactly what’s going on with the patient
- Background – Let them know about the clinical background and/or context
- Assessment – Let them know about the details of the assessment you have carried out and what you think is the problem based on those reports
- Recommendation – Let them know what you recommend should be the next step in medical care for the patient
Importance of Standardizing Report Procedure for Medical Flight Crews
Having a set framework to compile and communicate your hand-off report helps other medical teams in providing quick and efficient care without wasting much time. They can see to it that the patient gets the right kind of care they need when they need it.
When you’re in the healthcare industry, you’re going to come across hundreds of different cases in your lifetime. This is especially true for medical flight crews who have to deal with emergency cases and patients who have undergone a traumatic experience. At some point of time, you may even come across patients with behavioral emergencies or violent tendencies. It is in such situations that you need to be extra cautious and employ your non-medical skills as well when dealing with such patients.
Dealing with Violent Patients for Medical Flight Crews
When you’re in the medical flight industry, your only focus cannot be on the patients’ safety. You have to think about your safety as well. This might prove to be a challenge when dealing with violent patients or patients displaying behavioral emergencies and hallucinations. Here are a few tips that will make your task easier:
- Make sure the air ambulance aircraft is equipped with soft arm restraints. These restraints will keep the patients in place without harming them. So you can prevent them from pulling out their IV or oxygen or even from taking a swing at you.
- Try to determine the medical reason for the behavior instead of immediately concluding that the patient has a mental illness. For instance, some patients may have had a head injury resulting in them being angry, violent, combative, or anxious. Try to conduct a thorough assessment in order to get to the root of the problem and take necessary action on time.
Try to remain calm despite the situation as your angst can further aggravate the patient. You can try to create a more relaxing environment for the patient by removing any stimuli of negative emotions. For instance, bright lights and loud noises could prove to be a negative trigger for such patients.
When you are in the air ambulance industry, it is natural that you come across different cases and incidents on a daily basis. You may often have to be part of missions in which the patient has been in a critical accident and is suffering from a serious injury. In such cases, there is a huge chance that they are suffering from a wound that is bleeding heavily. This makes it crucial for you stay updated with tips on how you can pack such wounds and provide better medical flight service and effective care for such patients.
Key Wound-Packing Tips for Medical Flight Paramedics
Take a look at the following useful tips in order to better improve how you pack wounds that are bleeding severely:
- Direct pressure – Applying direct pressure on the wound is the first step you will need to carry out. You can use a gauze, rag, hand, knee, or whatever is available to stem the flow as you prepare your supplies.
- Pushing in the wound – Now the next step is to push hard in the wound using your hand or finger so you can stop the bleeding.
- Proper packing – One of the most crucial steps for medical flight paramedics is to pack gauze (plain or hemostatic) into the wound. Keep doing this until no more gauze can go in.
- More pressure – Once you’re done with this step, apply firm pressure against the wound for about three minutes. This combined effort of wound packing and firm pressure usually does the trick to stop the bleeding.
After this, you will need to reassess the wound and see if the bleeding has stopped. If it has, you can then begin the transportation process but if it hasn’t, you will need to repeat the process.
Sepsis is commonly referred to as blood poisoning. It takes more lives than cancer and is more common than a heart attack. In fact, more than 4,000 children die in the U.S. every year because of sepsis. This makes it crucial for medical flight paramedics to proactively assess and care for patients with suspected sepsis. So here’s a brief guide to help you understand how to care for patients with this condition.
Initial Assessment for Septic Patients
Properly assessing a patient is crucial for medical flight paramedics and EMS providers alike. This speeds up the medical treatment process and also ensures the administration of appropriate care. In order to assess a patient suspected of having sepsis, it’s important to measure the body temperature accurately. A fever or a body temperature lower than normal may be detected if a patient has sepsis.
Fevers, chills, and body aches are some common symptoms of an infection. But not all patients may experience this especially when it comes to older individuals. Enquire about recent procedures like diagnostic tests or surgery, which may expose the patient to an infection risk. In addition, it’s important to measure the lactate level of a patient. If it’s greater than 4 mmols, it could be a strong indicator of sepsis.
To further confirm your suspicion of sepsis, it’s important to measure the exhaled carbon dioxide level of a patient. While a normal capnography reading may range between 35 and 45 mm Hg, a patient with sepsis generally exhibits a reading lower than 25 mm Hg. If this level of reading coincides with other vital signs that drove your suspicion of sepsis, the patient may be in need of immediate medical care.
Sepsis Treatment for Medical Flight Paramedics
It’s crucial to initiate sepsis treatment by administering large amounts of fluid to the patient. While you initiate antibiotic therapy, you may also need to maintain vascular tone through vasopressors like dopamine or norepinephrine.
Stroke is one of the top causes of death and long-term disability in the United States. Leaving a stroke untreated for one minute would result in about 1.9 million neurons being destroyed. If it’s untreated for an hour, the brain loses neurons equal to neuron loss occurring from 3.6 years of regular aging. This makes it crucial for a medical flight crew to conduct thorough assessment and provide necessary care for stroke patients or suspected stroke patients.
Detecting Symptoms of Stroke
If stroke is suspected, it is crucial to rush the patient to a facility that can rapidly assess and diagnose the condition in addition to providing treatment. However, many patients deny the symptoms. As a medical flight crew responding to a call in such cases, it’s important that you try to determine if the patient experienced or is experiencing some or all of the following symptoms:
- Sudden confusion
- Sudden vision trouble (one eye or both eyes)
- Sudden severe headache
- Sudden trouble with walking
- Sudden numbness or weakness around the face, arm, or leg
- Dizziness/loss of coordination
- Speech issues/trouble understanding
Providing Necessary Care to Stroke Patients as a Medical Flight Crew
Managing patients showcasing stroke symptoms requires team effort. With it being a time-dependent patient, you will need to have a protocol in place for providing organized and quick pre-hospital care to such patients. Although you may have a limited ability in terms of resources to provide care for a stroke patient, it would make a huge difference for you to alert a Stroke Team or make plans for rapid transportation to a stroke center.
During the transportation, try to carry out general neurological assessments as possible. Providing oxygen and, monitoring cardiac function, and drawing blood for labs, etc. should be quickly accomplished to streamline and expedite the care process.
Travelling by air ambulance can be easy when you choose the right service, as you’ll have a flight coordinator to assist you with everything. However, the process of availing medical flight can be a bit more complicated for patients with chronic kidney disease.
Preparing for a Medical Flight
When you have to travel with a kidney issue, you will need to work with a case worker in locating a dialysis facility at your travel destination. This is, if in case, you’re not getting hospitalized at the destination and are planning for a different accommodation.
Make sure you listen to your body when it’s telling you enough is enough. It’s important to communicate with your doctor regarding limits – whether it’s with water intake or food consumption.
Being Prepared for the Plane Ride
Healthy people can effortlessly get through a plane ride but that’s not always the case for people with a kidney issue. Air travel can pose a number of issues for such patients and it’s best to stay prepared in case such problems arise. Here are a few tips to help you prepare for the plane ride:
- Avoid packing your meds with the rest of your luggage, as it may be difficult to access them. Instead, carry them in your handbag so you can easily take them when needed. You can use a thermal lunch bag to carry medication that needs to be refrigerated. Make sure you also carry extra medication in case you lose the regular dosage.
- Although you would have communicated with your flight coordinator regarding allergies and medications, it’s still a good idea to be prepared with a list detailing the schedule and dosages. Keep this list handy in your wallet or purse in case you need it later on.
Although the medical flight crew will try to keep you as comfortable as possible, try to bring along anything that increases your comfort. Always communicate with them if you feel there’s a way they could help you further.
Contrary to popular belief, hospitals are rarely involved in dispatch of a medical flight. The decision is almost entirely taken by the ground crew and treating doctor who determine whether the patient would benefit from an air ambulance service or not. Of course, there are some protocols that are followed. Although the process and protocols vary depending on the jurisdiction, there are certain common determinants that we discuss here.
Time Taken for Medical Flight Dispatch
It must be understood that not all hospitals have a medical flight on standby. It takes a reasonable amount of time to get the flight ready for takeoff. If this time and the time required to transport the patient is too much when compared to ground ambulance transport, the latter may be chosen. There is also a cost consideration when the difference in time advantage is too small.
Location and Distance of Transfer
This is another important criterion. Sometimes the location is too far away from the hospital and the patient’s health does not permit long travel times. Also, the location may be inaccessible through roads. In circumstances like these, the decision is usually made to opt for a medical flight to keep the patient safe.
The Condition of the Patient
This is of extreme importance. A delay by half an hour can mean the difference between life and death for the patient. In scenarios like these, a decision is taken quickly to call for an air ambulance and the patient is transported. Near-drowning, prior history or suspected stroke, and severe trauma could be some of the conditions that could influence the decision.
The Weather Conditions for the Medical Flight
If there are adverse weather conditions that prevent the choppers from flying, the patient may be transported through other means. As a matter of policy, the lives of crew members are not put to risk knowing very well that taking off in bad weather could be fatal.
It is important to understand that the above are just a few of the reasons that influence medical flight dispatch decisions. It is always the competent medical authority that takes the final decision.