PROGRAM OPERATIONS

Enhancement of a Critical Care Transport Service • Skip Gentry, RN

Introduction Metro LIFE FLIGHT is a hospi-

tal-based air medical program locat- ed at MetroHealth Medical Center in Cleveland, Ohio. The Metro- Health Medical Center is a 750-bed hospital rated as a Level 1 trauma center. The program operates three Sikorsky S-76 helicopters that serve c o m m u n i t i e s wi thin a 250-mile radius of Cleveland. The crew mix includes a registered nurse, physi- cian, and two pilots.

In 1987 Met ro LIFE FLIGHT began to study the feasibility of a "backup" ground t ransport to the existing helicopter service. At the time, an average of 32 flights per month were turned down for vari- ous reasons. It seemed evident that a ground mobile intensive care unit (MICU) could s u p p l e m e n t the es tab l i shed air medical p rogram and provide enhanced service to the Metro. LIFE FLIGHT area.

After evaluation, three major rea- sons were found that prevented air transport from being used.

The first reason was weather . Northeastern Ohio is characterized by rapidly changing weather pat- terns. Not only is the region visited by freezing rain, fog, and tornadoes, but a phenomenon known as "lake effect snow fall" can result in heavy deposits of snow in a sh~rt period of t ime. Such cond i t i ons make air medical transport difficult.

Skip Gentry is a flight nurse for Metro LIFE FLIGHT in Cleveland, Ohio.

Metro LIFE FLIGHT's ground mobile intensive care unit (MICU) is a Chevrolet C-70 medium-duty truck with a 270 horsepower diesel " engine. The vehicle weighs 20,000 pounds.

The second reason was the prox- imity of Met ro LIFE FLIGHT to many referring institutions. Many such insti tutions have refused to transport patients short distances by air. However, on many occasions a critical care transport service was still indicated for the patient.

Finally, as ~in many urban-areas, many healthcare facilities did not have landing zones. Some institu- tions attempted to use parking areas for hel icopter landings, b u t these methods proved t ime-consuming, inefficient, and very difficult to ade- quately enforce.

On January 1, 1989, Metro LIFE FLIGHT added an MICU to its fleet of helicopters. The MICU has b e e n used as predicted: to provide trans- portation of critically ill or injured patients during periods of inclement weather when flying is prohibited, and to provide a critical care trans- port service for healthcare institu- t ions in c lose proximity to MetroHealth Medical Center--espe- cially those without landing zones.

Methods The following information was

obtained by reviewing the transport

The Journal of Air Medical Transport ° February 1992 17

r e q u e s t log ma in ta ined by the C o m m u n i c a t i o n s Cen te r at MetroHealth Medical Center. The reques ts were grouped under the following categories:

• Total flights: The total number of flights completed from January 1, 1989, to June 30, 1990

• Cance l ed f l ights : F l igh t requests turned down due to weath- er, close proximity, or no landing zone

• Ground transports: Transports completed by the mobile intensive care unit

Results The following results were com-

piled over 18 months , beginning January 1, 1989, through June 30, 1990:

• Total flights: 3,224 • Canceled flights: 592 • Ground transports: 304 • Ground transports caused by

weather: 147 or 48% • Ground transports due to prox-

imity: 90 or 30% • Ground transports due to no

landing zone: 67 or 22% As shown in the above statistics,

over the pas t 18 m o n t h s Me t ro LIFE FLIGHT has been able to com- plete 304 out of 592 canceled flights, or more than 50%. Those not trans- por ted by the MICU were e i ther kept at the referring institution or transferred by other means, such as an ambulance or other air medical helicopter service.

Of the ground transports, 147 or 48% were due to inclement weather at either the transferring or receiv- ing institutions. Ninety or 30% of the ground transports involved institu- t ions wi thin 1 to 4 mi les of the M e t r o H e a l t h Med ica l Center . Finally, 67 or 22% of the g round t r a n s p o r t s involved ins t i tu t ions without a landing zone.

Guidelines Metro LIFE FLIGHT has set spe-

cific gu ide l ines for uti l izing the MICU. When the need arises, the MICU can transport patients to or from area hospi ta ls less than 10 miles from MetroHeal th Medical

Center. In general, for flights can- celed due to weather, the MICU can be dispatched to 18 counties within a 75-mile rad ius of Me t roHea l th Medical Center.

The communicat ions specialist may offer the requestor the option of wait ing until the wea the r has cleared or assisting the requestor with alternative means of transport, such as an ambulance or other heli- copter service.

The Neonatal Service, a self-con- t a ined ent i ty of M e t r o H e a l t h Medica l Center , may util ize the veh ic le as needed , espec ia l ly to complete "reverse transports."

W h e n the need

arises, the MICU

can transport

patients to or from

area hospitals less

than 10 miles from

MetroHealth

Medical Center.

If the wea the r clears during a ground transport to the requesting facility and the patient's condition wa r r an t s a more rapid mode of t ransport , the medical crew may request the aircraft be dispatched to complete the mission. The pilots have the final decision to accept or to deny the mission.

Cost/Fees Metro LIFE FLIGHT was fortu-

nate to have the MICU donated by the Volunteer Auxiliary. The same fee s t r u c t u r e is u t i l ized by the

MICU and the helicopter service, thus eliminating any competi t ion between the two entities. The fee schedule is as follows:

* Base departure: $350.00 • Port to port miles: $12.00/mile

Equipment After careful research and analy-

sis, speci f ica t ions for the MICU were prepared and the vehicle pur- chased. The vehicle is a Chevrolet C-70 medium-duty t ruck powered by a Detroit 210 horsepower diesel engine.

The g r o s s curb we igh t of the veh ic le is app rox ima te ly 20,000 pounds . The engine has a b lock heater for cold weather operations. The drivetrain is completed by an Allison transmission.

A comfortable, steady ride is pro- vided by a combination air-ride and leaf -spr ing s u s p e n s i o n sys t em. Heavy-du ty b r a k e s and s h o c k absorbers easily stop and support the vehicle, even when fully loaded with equipment. This design affords the capability and flexibility to com- plete even the most difficult critical care transports.

The patient care area or "box" has a 72-inch headroom. The interi- or can be qu ick ly modi f i ed to accommodate two full-adult litters lengthwise in a center-mount posi- tion, or it can be quickly converted to a double neonate configuration. The interior is made to accommo- date the patient-care equipment and monitoring systems.

The vehicle contains two com- plete oxygen, suct ion, and com- pressed air systems, as well as the Lifepak 10 with external pacemaker, Lifepak 2000 pu l se ox imete r , Propaq vital signs monitor, Newport E-100 volume cycled ventilator, and Travenol syringe pumps. All of the patient-care equipment used in the MICU is interchangeable with the helicopter's equipment.

Lighting is provided by a Scotch- Guard sys t em, s imi lar to f iber optics, for easy control of interior lighting. An onboard refr igerator al lows for t e m p o r a r y s to rage of pharmaceutical agents and blood

18 The Journal of Air Medical Transport * February 1992

products. A stainless steel sink pro- vides for hygiene and an X-ray view- box permits radiological studies.

A Vanner 2000 invertor provides for the primary electrical system. In the unlikely event of an engine fail- ure, a Honda 6000 genera tor can supply all moni tor ing and equip- ment power.

Battery power provides a third backup system. Indeed, the possibil- ity of becoming s t randed without power is remote, but these safety features provide psychological secu- rity, knowing that patient care can be maintained.

Communications consist of cellu- lar t e l e p h o n e s , UHF, and VHF

The vehicle contains two

complete oxygen,

suction, and

compressed

air systems.

radios. With this combinat ion of equipment the crew can talk to any~ one, even the nurse at the bedside in the referring intensive care unit.

Mobile Intensive Care Staff The MICU medical team is the

same team that staffs the helicopter. The only difference is that the pilots do not drive the MICU; instead, a communications specialist from the communicat ions center performs this task. Each driver must pass a defensive driving course and pos- sess a working knowledge of the vehicle's power plant and electrical systems.

With a flight nurse and physi- cian, the level of care r ema ins unchanged from rotor-wing trans-

ports. A perfusionist accompanies ba l loon-pump t r anspo r t s . The neonatal team consists of a respira- tory therapist, neonatal nurse practi- t ioner , and neona to log i s t . No additional crew is needed, since the ground MICU is used as a backup to the helicopter.

Summary The MICU has provided a much

needed mode of transportation for

the critically ill or injured patient in the Met ro LIFE FLIGHT service area. Even t h o u g h our p r imary focus is hel icopter transport , the MICU has proved to be a valuable "backup" to our helicopter service. The MICU has paved the way to provide a more comprehensive ser- vice to the critically ill or injured pa t ien t in N o r t h e a s t e r n Ohio, r ega rd l e s s of wea the r or lack of landing zones. •

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