BestBest

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Med FlightMed Flight

Ken HellerKen Heller Flight Flight NurseNurse

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From

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To

Lift

“Scene Request”

Scene 21 sm.

MVC

Single vehicle crash.

Middle-aged patient.

Lone Occupant of vehicle.

Landing Zone

Wires

Traffic

Congestion

Plowed field

Awake & alert.

Confused.

C/C pain in back, R leg, & Abd

Landing Zone

Landing Zone

Landing Zone

Patient

• Open R ankle injury.• Open L knee injury.• Back pain.• Right leg pain.• Abdominal pain.

• Denied chest pain.• Denied headache.• Denied arm pain.

EMS

• Extricated.• IV in R arm.• Splint• Immobilized

– C-collar– Long board– CID

• EMS requested MF due to mechanism of injury and open Fx’s.

• Normal BP.• Tachycardia.• Breathing normal.

Med Flight

• Patient awake & alert.• Confused.• No gross head

trauma.• Mental status waxes

and wanes.• Moves all fours.• Hypotension noted.

Pulses all fours.• Fluid bolus.• Behavior suggests

CHI.• C/C having to urinate

and lying on long board.

ED

• Airbags deployed but slid under—seatbelt?

• Not remember event.

• Must urinate.

Pulses all fours.

• Open Fx’s both legs.

Trauma

• Multiple rib Fx’s.• Open R ankle Fx.• Open L knee

dislocation.• Pelvic dislocation/Fx.• Burst Fx 4th lumbar.• Free air/fluid in Abd.

To the OR with:

Orthopedic Surgery.

Vascular Surgery.

Trauma Surgery

OR• Exploratory laparotomy.

– Splenectomy.– Repair

– Bowel perforation

– Mesenteric tears

– Colonic tear

• Bradycardia with hypotension.

Angiography of aorta: normal.

Thoracotomy: normal cardiac function.

Retroperitoneal hematoma.

Developed irreversible coagulopathy.

Outcome

• Remained hypotensive.

• On many pressors.

• Returned to ICU for resuscitation.

Pressors and blood products withdrawn.

Patient died at 1455.

Autopsy refused.

“Scene Request

32 sm.

MVC

“Patient mid-20’s.

Intersecton T-bone”

Patient

• Unrestrained.• No LOC.• Injuries to both legs.

• C/C leg pain.• GCS 15.• Remembered events.

EMS

• Prolonged extrication.• Immobilized.• Open and deformed

right femur fracture.• Left closed femur

fracture.•

• IV started.• IV meds.

– Fentanyl.– Versed.

• Reduced right tibia-fibula fracture and pillow splint.

• Left femur in Hare traction splint.

Med Flight

• Maintained Immobilization.

• Right leg remained in pillow splint.

• Left femur remained in Hare traction splint.

• Hare traction splint readjusted for helicopter.

• 12-minute flight.

ED

• Right tibia-fibula fxs.• Left femur.

• Orthopedics consult.• To OR.

OR

• R open tibia wound– Irrigation– Debridement– IM nailing

• L femur fracture– IM nailing

Outcome

• Discharged to a SNF for PT and assistance till on own.

“Scene Flight

67 sm”

“Head-on motor vehicle crash

Multiply victims”

Patient

• Head-on crash with fatalities.

• Patient pinned in car.

• Extrication prolonged.

• Awake & alert.• C/C bilateral lower

extremity pain.

EMS

• Three victims pinned.

• Blast force at impact point.

• Debris spread out away from impact.

• One fatality.

• One transported by ambulance became second fatality.

Med Flight

• Patient still pinned by legs.

• When extricated; was slid onto a longboard.

• Immobilized.• IV established.• Placed on monitor.• Mid hypotension.

• During flight received 1800cc.

• Heart rate slowed.• Systolic BP 117.• To ED for Trauma .

ED

• Multiply blood products to sustain BP.

• Taken to OR emergently.

• Trauma Surgery.

• Orthopedic Surgery.

• PVS Surgery.

OR

• Liver laceration.• Subarachnoid

hemorrhage.• Fractures:

– Right femur.– Left clavicle.– Right ribs.– Bilateral wrists.– Left toe.– Right orbital.

• To ICU.• Second OR for

abdominal closure.

Outcome

• Accepted in transfer at local hospital for Inpatient rehab.

Scene Flight

30 sm

Mid-aged patient

Motorcycle vs Auto

Patient

• Motorcycle rider.

• No helmet.

• Struck car head-on.

• Pain in left wrist.

• Pain in right ankle.

• Pain in pelvis.

EMS

• Immobilized.– C-collar.– Long board.– CID.– Splints.

• IV infusing.• Oxygen by nasa

cannula.

• Due to mechanism of injury & likely pelvis injury; Med Flight was called.

Med Flight

• Awake and alert.• Examined briefly in

roadway.• Load and go.

• Closed left wrist fx.• Closed right tib-fib fx.• Possible back injury.• Flight uneventful.

ED

• Trauma evaluation.

• Orthopedic eval.

• Sent to OR.

OR

• Intramedullary nailing of right closed midshaft tibia fx.

• Closed reduction & Percutaneous pinning of left distal radius fx.

Outcome

• Transferred to local hospital for rehab and PT.

46 sm

1st day.

Teenager

Boating Accident

Landing Zone

2nd day

Middle-aged patient

Campsite stove explosion with burns

Landing Zone

Patient

• Burns to:– Face.– Both upper

extremities.– Both lower extremities.

Landing Zone

EMS

• Burns to:– Face.– Both upper

extremities.– Both lower extremities.

Wrapped in clean sheets.

Requested MF for 3rd degree burns.

Med Flight

• IV started.• Fentanyl for pain.

• Flight uneventful

• Admitted to burn unit.

Burn unit

• 49% TBSA.

• Grafting of face and upper extremities.

• Month of burn care.

Outcome

Discharged after a month to a SNF for further cares.

Follow-up in burn clinic.

“Scene flight

9 sm”

“Middle-age patient

MVC”

“Watch for two sets of wires on the east side of the road!”

1

2

Block traffic with a vehicle

Patient

• Stopped to turn and rear-ended.

• Multi-car crash• Unrestrained back

seat passenger.• Doesn’t speak

English.

• Chest pain• Extremity pain.

EMS

• Extricated.• Immobilized.• No observed LOC.• Vital signs stable.

• Due to Mechanism of injury & inability to communicate; MF was requested.

Med Flight

• As rotors stopped; patient was being wheeled to us.

• Brief exam on EMS cot in roadway.

• Complaints of chest pain and extremity pain.

• Load and go.

• IV deferred for 3-minute flight.

• Placed on our monitor.

• Stable VS.

ED

• Right forehead abrasion.

• Parietal scalp hematoma.

• Right distal fibula fx.• A non-traumatic

thoracic aortic aneurysm.

• Trauma service.• Orthopedic Team.

Outcome

• Admit for observation.• Ortho placed the

fibular fracture in a Bledsoe boot.

• Thoracic aortic aneurysm.

• Discharged home after two days.

• F/U ortho clinic.• F/U Thoracic surgery

clinic.