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



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RE: Aircraft - Inflight intubations - Scene flights



is anyone doing QA/QI on AIRWAY? what are the components of the QA/QI monitor? what are protocols for a "backup" if you can't get an ETT.  Do you use Combitubes or go to surgical airway?

just curious....  

  John Graham <medikjohn@yahoo.com> wrote:

AMEN!!!

John

--- duane smith wrote:
> 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
> >Reply-To: flightmed@flightweb.com
> >To: "'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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> >
> >
>
>
>
>
>
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