Flightmed archive for March-2002
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Flightmed archive for March-2002



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RE: Aircraft - Inflight intubations - Scene flights



OK. Let me ask any of the medics, Have you ever tubed some one in your 
Medic?  While running down the road... Hot to the hoapital..... in the 
bathroom of a trailer......????? Why not in the back of your helicopter?  
Yes Airway is number one, but you have some patient who needs his airway 
secured, they are maintaining their sats they are packaged ready togo.  Now, 
you have a 20 flight time to the trauma center.....you elect to try on scene 
you try a coupel of times your partner tries a couple of times you let 
another medic try a couple of times......you then try one more time.....you 
all have failed now you elect to bag your patient to the trauma center.  You 
have just now wasted 15 min on scene with an unintubated patient and still 
20 min to go.  what if you had loaded your patient in the aircraft, lift and 
attempt all of these tries in the air enroute to the trauma center.  15 min 
later when you decied to bag you patient you now only have 5 min to go.

No which is right for your patient????

Thanks for listening.
Mike


>From: AirMed1 <AirMed1@shannonhealth.org>
>Reply-To: flightmed@flightweb.com
>To: "'flightmed@flightweb.com'" <flightmed@flightweb.com>
>Subject: RE: Aircraft - Inflight intubations - Scene flights
>Date: Mon, 4 Mar 2002 07:57:55 -0600
>
>David,
>I think everyone will agree with you on this one.  Airway is #1 priority 
>for
>the patient.  We very seldom do anything else on scene but airway and
>package.  Everything else can be done in the air, ie. IV's drug etc. Are we
>jeopordizing the patients outcome by waiting 10- 15 minutes to intubate so
>we can load and go and do it in the air.  Most MD's have no idea what we 
>are
>expected to do in the air.  We are very luck to have a Medical Director who
>was a paramedic in Galveston while he was going to Medical school.  He 
>knows
>what it is like to be out in the field.  Ask the MD's involved in your
>program to ride out with you to get a feel for what you go through.  If 
>they
>are afraid of flying ask them to ride out with the local EMS.  I think they
>will agree with you after that.  Just my opinion.
>Fly Safe
>Jeff T. Hameister NREMT-P
>AirMed 1
>San Angelo, Tx
>
> > ----------
> > From: 	David Steele[SMTP:DSTEELE1@mn.rr.com]
> > Sent: 	Sunday, March 03, 2002 10:28 PM
> > To: 	Flight Med
> > Subject: 	Aircraft - Inflight intubations - Scene flights
> >
> > 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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