Aero-medical transfers Transfer Principles within the Rural Districts.

Aero-medical transfers

Transfer Principles within the Rural Districts

Emergencies Training-Hospital Outreach and Support

Airomedical transfer Airomedical transfer ObjectivesObjectives

• To examine the principles that apply when considering the mode of transfer

• To introduce the practical procedures necessaryfor effective preparation of an airomedical casevac

• To understand the basics of Safety around the aircraft on landing and take off

• To Know the steps needed for preparing a L.Z. for the Helicopter

Modes of transfer

What should we be considering

Introduction

• The transfer is generally considered the most dangerous phase during the care of a critical transfer

• The benefits of airomedical transfers are obvious – reduced exposure to risk

• Cost assumes different importance when all aspects of the transfer are considered

Methods of Transportation

Key aspects that must be considered:

• Triage

• Capacity

• Availability

• Evacuation and packaging

• Destination

Triage

• Triage category often dictates the manner in which patients are transported

• Red (unstable) patients are generally considered to be suitable for airomedical transfer

• However – assessment of triage tends to be inconsistent – impacts on use of Helicopters

• Growing realisation that even stable patients (yellow) may benefit from the use of helicopter transfer

• Cost effectiveness has been proven when all aspects of the transfer are considered – return trip, attendant, etc

Capacity

• Capacity of a resource very crucial in the decision to transfer a patient

• Fixed wing transfers have the advantage of being able to transfer several patients at a time

• Helicopters do have a few limitations though

• Even those that have been specifically designed for the E.M.S. environment have a tiny capacity to transport patients

Availability

• One of the key factors affecting the design of an EMS service in a particular area.

• The option of airomedical transfer offers several attractive options

• Central to this issue is keeping a critical resource in an area

• This should not be at any cost - (Remember the ambulance is there for the very reason that a critical patient

may need to be transferred)

Evacuation and packaging

• This may prove challenging when preparing the patient for flight.

• Access to the patient and the ability to perform treatment interventions are severely compromised

• Catch 22 - Often packaging time is significantly greater when airomedical resource is utilised

Destination

• Not based on the particular triage category alone – definitive care critical

• Trauma patients prognosis improves with rapidity of transport

• Also avoids the strain that a later transfer may

produce on an already overtaxed resource

• The goal must be to avoid secondary transfers

Non-emergency transfersNon-emergency transfers

• An ambulance may not be necessary for all patients undergoing inter-facility transfer – HealthNET is a case in point.

• However certain conditions must be met

• SKYMED is thus not the only mode of transfer that ensures that an ambulance stays in a particular town.

• Considered thought is needed before dispatching a resource for this goal.


Non-emergency transfersNon-emergency transfers

Conditions that must be met:

• The attendant or driver will not be expected to provide any medical attention

• The patient is considered medically stablemedically stable, and the act of transportation not expected to change the level of stability.

• The patient is not using any device (e.g., splint) or treatment modality (e.g., IV line) unless such a device is a part of the part of the patient's lifestyle patient's lifestyle and he/she has been trained to care for the device.

Understanding the principles of patient care in the flight

environment

Aero-medical transfers


Airomedical transferAiromedical transfer

Airomedical evacuation is safe for transporting almost any patient, But …

The Following conditions must be met:

Well-prepared, well-trained medical escort/team

Medical equipment that is qualified as “safe for use”

A therapeutic dose of pessimism


Airomedical InformationAiromedical Information

• The attending physician – determine destination, urgency, and mode of transport

• Discuss additional steps to further stabilize the patient

• An appropriate SAMPLE history

• The results of diagnostic tests

• Any special equipment requirements

• Any problems anticipated


The aeromedical transferThe aeromedical transferPre-flight stabilizationPre-flight stabilization

Critical aspect of any transfer Avoid ‘scoop and run’ – note exceptions

Immobilise all patients securely and comfortably – spinal cord injuries

Feng shui of aeromedicine – plan the packaging of you patients and equipment

Gather as much info from the facility staff


The aeromedical transferThe aeromedical transferManagementManagement

Airway• Adequately asses the respiratory status• Anticipate problems which may arise during

transfer• FiO2 requirements increase with altitude

Breathing• Respiratory emergencies must be managed

prior to transfer eg. pneumothorax, flail chest• Prophylactic chest drains may be needed

• No Glass drainage bottles



Circulation

• Maintaining adequate IV access is critical.

• Make sure all IV tubes and other attached lines are secured well.

• Consider saline locks for IV lines that are not needed for volume replacement

• Again - no glass bottles



Disability

• Neurological status must be assessed before and during transport.

• The Glasgow Coma Scale is a useful tool for such assessments. Note the time.

• This may need to be managed in consultation with the receiving physician.



Exposure

Ensure patient is comfortable – beware hypothermia

When packaging ensure access for treatment and examination

Consider inserting a nasogastric or orogastric tube.

Consider inserting a urinary catheter

Remember the escorts


The aeromedical transferThe aeromedical transferPreparation – patients/escortsPreparation – patients/escorts

Arrange for an appropriate escort(s) to accompany the patient.

The safety of the patient and the escort(s) during transport must be a priority at all times.

Prepare the patient and escort(s) for transport

Secure all passengers, equipment and supplies within the aircraft

Ensure all passengers are familiar with safety procedures and emergency exits.


The aeromedical transferThe aeromedical transferThe Receiving physicianThe Receiving physician

Before the transport begins: – When possible, contact the receiving physician and

healthcare facility

– Ensure that they can accept the client

– Discuss the relevant clinical information - ensure that all relevant documentation accompanies the patient – X-rays, notes, results

– Discuss additional steps that can be taken to further stabilize the client

Setting up a landing zone

Helicopters and LZs

Preparing an LZ

Touchdown area should not have more than a 1-2 degree slope.

Landing and take-off area should accommodate heli wingspan- min 25m

diametre.

Should have no tall structures within 50m.

Emergency Care-Hospital Outreach and Support


Preparing an LZ

• Is the LZ in an area where people normally walk?

• Is the LZ close to the hospital, so that someone can watch and protect it from theft and vandalism?

• Is there a windsock available close to the LZ to guide the pilot w.r.t. wind direction?


Preparing an LZ

• If it is on grass and has an underground sprinkler system, at what times is it activated.

• Do the prevailing winds channel around buildings, which may catch the pilot by surprise?

• Is the LZ accessible to hospital staff, with a trolley?


Preparing an LZ

• It should be asphalt, grass or hard-packed dirt, but not sand.

• Ensure that the area doesn’t get muddy when it rains. The trolley must run freely.

• Ensure that the area is free of rocks, stumps, pegs, garbage and other debris

How not to lose your head

Safety around helicopters


Helicopter Safety

• Do not load/unload while the rotor blades are turning.

Do not approach a helicopter with the blades turning, without permission.

Do not walk around the tail of the heli without permission.

Do not approach a helicopter from an uphill.

Do not smoke around a helicopter, ie. Fuel and 02


Helicopter Safety

• Do not carry long items like drip stands, splints or an extended arm above your head.

• Do not wear a hat when approaching a chopper.

• Do not use barrier reflective tape to cordon of the landing area. It will blow into the rotor.

• Do not run out to meet the chopper when it is landing.


Please..

• Keep all personnel inside the hosp and away from the landing area, until the rotors have stopped turning.

• Request the pilots permission, before approaching the helicopter.

• Approach the chopper from the front….always.


Please..

• Control bystanders and animals away from the landing area. Dogs ears are sensitive to the high-pitched noise, and they tend to want to bite the tail rotor.

• Approach chopper from below if it is on a slope.

• Stop all vehicles that may pass through the landing area… completely.


Please..

• Secure loose articles, to prevent them from lifting into the rotors.

• Check the landing area for any loose debri, before the choppers arrival.

• Have a C02 fire extinguisher at hand, and know how to use it.


Please..

• Have a trolley ready, with NO mattress, NO sheets and NO drip stands, and only approach when signalled to, when the rotors have stopped turning.


Summary

• We have just looked at:

• The principles that determine mode of transfer

• The aspects that influence the care of a patient in flight

• The basics of Safety around the aircraft on landing and take off

• The steps needed for preparing a L.Z. for the Helicopter

Questions

End

Date post:	16-Dec-2015
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Aero-medical transfers Transfer Principles within the Rural Districts.

Documents