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.
Availing a medical flight can be quite intimidating, especially considering the stress of caring for a loved one who is already in distress. Here, we bring you a typical medical flight trip and how things usually pan out. In fact, we walk you through the entire process.
What Happens When You Contact a Medical Flight?
When you call a medical flight company, you will be greeted by customer support first who would collect certain basic information and then transfer you to a case manager or flight coordinator. Here pertinent information related to the medical flight would be relayed to you. This is the time that you can raise any initial concerns such as average flight cost, flight timing, distance, and accompanying the patient. You will be asked to confirm payment arrangement for the medical flight. Feel free to take help of the treating physician and hospital staff if you are not able to answer questions relating to the patients condition or ailment.
The Medical Flight Coordination Begins
The information gathered from you will be relayed to the medical director of the air ambulance provider. The director will, in turn, get in touch with the attending physician. The attending physician would lay down the medical necessities of the patient so that the flight can be prepared accordingly. This includes qualified staff as well as medical equipment, and also information regarding transfer to an appropriate medical facility.
On the Day of Medical Flight
The medical flight company will get in touch with all those involved in the transport of the patient, including the hospital staff. The ground ambulance would take the patient up to the medical flight and the patient would be taken onboard. The patient and the person accompanying would be briefed on safety precautions and the dos and don’ts.
Upon reaching the destination, a ground ambulance would be already waiting to ferry the patient to the medical facility which is pre-decided. The patient is carefully offloaded and reconnected to any vital medical equipment in the ground ambulance as necessary. The medical flight team would brief the receiving medical staff about the patient’s condition before signing off.
The onus of arranging and coordinating between medical facilities, ambulances and the medical flight is taken care by the hospital and the air ambulance staff. All you would need to do is take care of the payment procedure and pray for the good health of the patient.
Insurance is the foremost financial consideration when it comes to a medical flight; however, we’ve had enough discussion on the subject. There are also other factors that one must bear in mind. The cost of a medical flight largely depends on the aspects that we discuss below.
Does the Medical Flight Need Prepping for Special Equipment?
If the patient needs traction, cardiac monitors, ventilator and similar equipment, there is obviously going to be a cost attached to them. These factors will increase the price of the medical flight. If the medication is provided by the provider of the medical flight, the costs might even go higher.
The Destination and Duration of Medical Flight
It goes without saying that a longer medical flight costs more. However, the cost of flying from one country to another can push the costs even higher. As most health insurances do not cover overseas medical flight, the patient might have to bear a huge burden. Having a comprehensive travel insurance that covers such costs or being a part of medical flight membership programs is vital before overseas travel.
Distance between Transferring Facility and Receiving Facility from Airport/Helipad
Most of the medical flight service providers take care of all details including transportation of the patient from the transferring hospital to receiving hospital. One must understand that this demands considerable coordination. If the receiving facility is located in a foreign country, the service provider would have to take care of customs, visa, and other formalities too. The medical flight service providers charge for all their efforts. If it involves, ground transport, the patient will also be billed for that.
The costs might also depend on the type of aircraft used. Travelling through a long-range medical flight can be expensive but necessary. However, when it comes to medical transportation, all service providers are not equal. Some charge considerably more than others. It is for you to weigh the costs against the benefits and take a call, if at all possible.
A medical flight is not always necessary to fly a patient domestically or even internationally, and commercial airline stretcher can be a great alternative. However, it must be noted that the stretcher cannot always substitute a medical flight that is equipped with advanced patient care systems. But what if a patient doesn’t need an advanced patient care system? For a patient to fly using commercial airline stretcher, the foremost concern is stability and the suitability to fly, which is determined by the treating physician.
More about Commercial Airline Stretcher
Unlike the medical flight where the patient has the entire flight to himself, commercial airline stretcher uses a part of a regular flight. A few seats are usually taken off to accommodate the patient in a sleeping position on the stretcher, and also to have all necessary medical equipment. The relatives or loved ones of the patient can easily travel along with the patient as there is no constraint for space.
Scheduling a commercial airline stretcher is much easier as the flight would anyway be heading to the destination. However, the patient might need a longer ground transport as the aircraft would only land in the designated area. The cost of the commercial airline stretcher is much lower than a medical flight as it is not a dedicated medical flight for the patient.
Similarities between Medical Flight and Commercial Airline Stretcher
For one, the patient is required to obtain clearance before opting for the stretcher, just the way one does with a medical flight. The provider who offers you the stretcher service will most likely arrange for ground transport as well and coordinate with the receiving facility. The medical team and necessary supplies such as medications and medical equipments too would be arranged.
At the end of the day, making the choice between a medical flight and commercial airline stretcher largely depends on the condition of the patient and the decision of the treating doctor.
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.
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.
Speak of a medical flight and the fist thing that occupies your mind is the cost involved. With the absence of adequate insurance coverage, especially when abroad, one is compelled to think out of the box to come up with financially viable solutions that do not compromise on medical flight safety. Instead of looking at government aid or charity, medical flight companies must introspect and come up with ways that can keep tabs on the cost. Here we discuss a few of those.
A Medical Flight Must Avoid “Empty Leg”
There is always a distance that a medical flight must cover in order to reach the patient in distress. This distance where the medical flight does not actually carry a patient is called “empty leg.” What if another needy patient is carried the distance? The cost can thus be shared between two patients.
Quote One-Way Charge for the Medical Flight
Once the patient is flown to the destination, the flight is often compelled to return empty. With a good network in place, the medical flight can look for patients who need to use their services on the way back. The cost can thus be shared between two people essentially halving the cost.
A Medical Flight Company Can Share Resources
Rather than competing with each other, medical flight companies must look at sharing their resources and thus jointly bear the cost. The result would be cheaper overheads and resultant cheaper costs to the patients. Another way would be to employ contractors. For example, freelance pilots and nursing services can be hired on an as-needed basis.
Accommodate More than One Patient per Medical Flight
Medical flights that can accommodate more than one patient at a time can be very helpful. While the cost of a larger aircraft could be a bit high, aircraft maintenance, staff, fuel charges, etc., would certainly be less and could turn out to be a very viable long-term plan. The patients gain by paying less as the cost of travel can be shared.
There is no denying the fact that all these solutions cannot be implemented at times when there is a medical emergency. However, with good coordination between various medical flight service providers, there is a hope that costs can be contained to a large extent.