Date post: | 19-Jan-2016 |
Category: |
Documents |
Upload: | cory-bradley |
View: | 214 times |
Download: | 1 times |
Choices in Intra-Facility Transfer
Louis Scrattish
Assistant Medical Director-UW Med Flight
University of Wisconsin School of Medicine and Public Health
December 3rd, 2015
Overview:
Vehicle Options
Crew Configurations
Equipment Variation
Know Your Local Options
Our Transport Mantra
• Right Vehicle• Right Crew• Right Equipment/Products• Right Destination
Our Transport Mantra
• Right Vehicle• Right Crew• Right Equipment/Products• Right Destination
Intra-Facility Transport Options
• Private Vehicle• BLS• ALS• Critical Care Ground• Air• Specialty Ground• Specialty Air
Vehicle-Ambulance Advantages
• More Room– Larger Medical Crew– Larger Patient– Continuous CPR– Access to Whole Pt
Eurocopter 135 Interior
Ambulance Advantages
• Larger Weather Window
• Don’t Need a Helipad
• More of them-May be Closer
• No Issues with Elevation Changes
Ambulance Advantages• Much More Affordable
– Ambulance $800-2500– HEMS $11,000-54,000
• Better Temperature Regulation– Pt Temp– Lines Freezing– Medication Issues (Mannitol)
Helicopter Advantages
• Faster– Average Speed 140-150mph
• Must Figure Warm Up/Cool Down Time of HEMS
• Longer Transports Favor HEMS– If speed only concern:
» <20 min ground transport-drive» 20-30 grey zone» >30 min ground transport-air
Helicopter Advantages
– Can Travel in a Straight Line• Traffic Jam?• Inefficient Route?• Going Through Large Urban
Area?
– Smoother Ride• Consider in Unstable Spinal
Injuries
Helicopter Advantages
• Safety– 1993 Houston study: Ambulances 13x
more likely to get in an accident based on number of accidents per miles traveled
Ambulances 5x more likely to get in an accident that resulted in injuries
Conditions Where Time Critical
• STEMI• Strokes where Lytics running, possible• Intracerebral Hemm
– Deterioration– Midline Shift
• Trauma’s Where Blood Products Infusing
Timing Possibly Less Critical
• Digit amputations where implantation not an option
• Burns (without airway compromise)• Improving Sepsis
Other Timing Considerations
• Crew Launch Time Critical– Varies Widely by Agency– For HEMS Longer at Night
Our Transport Mantra
• Right Vehicle• Right Crew• Right Equipment/Products• Right Destination
IFT Crew Configurations
• Most ambulance crews for IFT:– Mix of EMT-B, EMT-I, EMT-P– Critical Care Ground Often Includes Critical
Care Paramedic or RN
• Vast Majority of HEMS:– EMT-P/RN– A few EMT-P/EMT-P– <5% Physicians
Specialty Crews
• Respiratory Therapy• Neonatal Provider • PICU Provider• OB provider• Perfusionist
• Can be utilized by ground and air
In an Ideal World….
• Mode of Transport and Crew Completely Independent on Each Other
• Mix and Match
• Why doesn’t work?
When can RN/Physician be helpful?
• On Board Medical Control• Airway Needed, Rescue Airway in Place• Advanced Ventilator Settings• Medication Infusions
– Ie Pressors, Flolan• Pt deteriorating• Pediatrics
When can RN/Physician be helpful?
• On Board Medical Control• Airway Needed, Rescue airway in place• Advanced Ventilator Settings• Medication Infusions
– Ie Pressors, Flolan• Pt deteriorating• Pediatrics
Overview:
Right Vehicle
Right Crew
Right Equipment/Products
Right Destination
Know Your Local Options
ALS Equipment
• IV access• IVF• Many IV medications• Vital Sign Monitoring (incl SpO2)• Can Gain Airway if Needed (+/- VL)• +/- Ventilator
Critical Care Ground
• ALS plus the following:– Ventilator– Broader Array of Meds (Pressors, Paralytics)
– Invasive Monitoring• Arterial Line• ICP
HEMS
• ALS plus Critical Care plus:– pRBC’s– Video Laryngoscopy– +/- On Board Labs– On Board Chest Tubes– +/- TXA– Advanced Communications Centers
Med Flight
• pRBC’s, TXA, FFP• On board labs (ePOC)• Glidescope, CMAC
Overview:
Right Vehicle
Right Crew
Right Equipment/Products
Right Destination
Know Your Local Options
Summary
• HEMS Speed Advantage not a Simple Calculation
• HEMS a Safe Alternative• Crew and Equipment Needs often
Overlooked• Local Knowledge of Agencies Critical
Questions?