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Okay group I would like to generate some discussion and get
some feedback on this issue. We are looking at changing practice to
intubating more of our scene patients in the aircraft - in flight and take a
load and go approach. Now personally I am opposed to this approach as I
don't think it is the safest approach, the best environment and when everything
is placed in the scale I think it tips to intubating on scene and then
transporting as long as you have a time limit. Stay for 10 minutes then
leave etc.
1. I have asked our physicians involved in our program
when they accept non intubated trauma patients "Stabilization patients" that
they clear the room of all people and then darken the room, keep one other
person, draw up drugs, and then perform an RSI with just one other person,
secure the tube, and then call the 15 other people back into the room to
continue the resuscitation as that is the expectation of us.
2. I also have asked that when they make the decision to
intubate the patient do they take the patient to the CT scanner, scan them and
then return the ED and then intubate them, The process takes about 10-15
minutes or so and by the Time we make the decision on scene that the patient
requires a tube, get them loaded, equipment secured, us secured, take off, clear
the zone and clear sterile cockpit, find all the equipment that has moved around
despite setting it up ahead of time and get the patient intubated (that is if
they aren't fighting you) it realistically is a good 15 minute
delay.
3. Once you make the decision to intubate from that
moment on doesn't your risk increase exponentially if something happens to the
patient until you intubate? Wouldn't a lawyer have a heyday with
this? I decided they needed it in the ditch but it really is our protocol
to do it in the helicopter in flight (a much worse environment from a ditch I
might add).
Now can it be done? In a 222. yes actually in our
setup it is pretty easy to do physically. Is it safe to do? Is it in
the best interest? Why are physicians expecting us to do something they
are not willing to do themselves in a controlled setting of the hospital putting
us at risk? So what do people think? Is it your standard of practice
to intubate in your aircraft? Or do you just intubate in your aircraft if
the patient crashes. Do you usually intubate patient on scene? What
are you all doing out there??
thanks in advance for your feedback??
David RN Flight Nurse
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