Re: Aircraft - Inflight intubations - Scene flights

["J.D. Phipps" <jdprn@hotmail.com>]

David,
     First the disclaimer, I have only been a flight nurse for one year and 
have a grand total of 5 field intubations to my name.  That being said, my 
company prefers to intubate in the air.  Obviously if the patient is in 
resp. distress or overly combative then the intubation should (and does with 
us as well) take place on scene.  But as you know, even pt's with the lowest 
of GCS can have a wonderful resp. drive and therefore wait until airborn.  
You bring up a good question as to what a lawyer would do with this.  I 
certainly have no answers there.  As for your other examples, I would point 
out that of all those people on scene or in the ED, how many of them are 
qualified to be attempting the intubation or REALLY needed for the 
proceedure.  If you are unable to get the tube and your partner is unable to 
get the tube then are you going to let the three other paramedics on scene 
have a shot at it or is it time to move down the algorithm to a surgical 
airway. As for the time, to be truely effective the lidocaine should have 
time to circulate and there is preoxygenation going on here as well.  My 
company has Bell 222's and BO 105's.  I only have experience in the 105's 
and I can honestly say I feel comfortable doing this even in the tight 
confines of a 105.  I think back to my hospital days and remeber how much I 
hated transporting pt's to CT or where ever because  I was not in my 
familiar unit.  I concider the back of the 105 now to be my familiar place.  
I know where everything is (and in the 105 everything is at arms reach) and 
would rather be doing the airway there then in that ditch.  The only other 
thing I can think to offer is that of the importance of rapid transport to 
the trauma center.  If the airway can be safely done during transport then 
the extra time on scene could be costly.  On interfacility transports the 
answer is different. When ever possible do it prior.

J.D. Phipps, RN
Flight Nurse
Calstar


>From: "David Steele" <DSTEELE1@mn.rr.com>
>Reply-To: flightmed@flightweb.com
>To: "Flight Med" <Flightmed@flightweb.com>
>Subject: Aircraft - Inflight intubations - Scene flights
>Date: Sun, 3 Mar 2002 22:28:06 -0600
>
>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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