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Direction Of Head Of Stretcher In Fixed Wing Aircraft


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#1 jkihl

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Posted 31 January 2010 - 03:40 PM

Good Day,

We are looking for information on the impacts of which direction is optimal for the Head of the Stretcher in
Fixed Wing Aircraft to be placed?

Some documentation states the HOB must be towards the pilots to reduce the impact on preload during accent and
decent.
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#2 Medic09

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Posted 31 January 2010 - 04:48 PM

For some reason, I seem to recall there's mention of this in Holleran. Did you look there?
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Mordechai Y. Scher
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#3 jkihl

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Posted 31 January 2010 - 06:38 PM

For some reason, I seem to recall there's mention of this in Holleran. Did you look there?


Yes, Thank you for your reply..that is where I saw that, was hoping some of the other
fixed wing programs would step in here, and share their experience..
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#4 BrianACNP

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Posted 01 February 2010 - 12:55 AM

Good Day,

We are looking for information on the impacts of which direction is optimal for the Head of the Stretcher in
Fixed Wing Aircraft to be placed?

Some documentation states the HOB must be towards the pilots to reduce the impact on preload during accent and
decent.


Are you looking for sources or just conversation on here? I flew fixed wing for several years in both a Citation V jet and a King Air 200.

It all depends on your patient's physiology and the length of runways where you'll be landing or departing. If you have someone with a head injury or some concern for intracranial hypertension, then you do not want to position them in such a way that landing or takeoff will shift the blood volume to their head, worsening the intracranial hypertension. If you have someone with volume issues (hypervolemia or hypovolemia), then you want to take caution in positioning them in a manner that the G-force will worsen hypoxia (for hypervolemia w/ pulmonary edema) or facilitate hemodynamic instability (hypovolemia). Other examples exist, but hopefully you get the idea.

If you feel the need to adjust your patient's position to minimize the effect of these forces on your patient, then you need to coordinate with your pilots with regard to the runway size at the takeoff/landing runways prior to departure with your patient. If you're leaving an airport with a large runway (ie: an international airport)...or landing at one, then you have more latitude for that portion of the flight. Small runways lead to more pronounced forces (since you need to run the engines at full throttle before releasing the brake to achieve your takeoff speed.....or quick stop after landing on the runway) with more potential for that adverse physiologic response from your patient.

Our stretchers on the King Airs and jet were oriented to the patient facing towards the rear of the aircraft. I do not recall any FAA influence for this. And quite honestly, we rarely, if at all, changed the patient's position in the aircraft to minimize physiologic effects from landing/takeoff. I realize that the theory stands that direction of the patient and the G-forces associated with takeoff/landing can negatively impact a patient. However, I don't ever recall a patient becoming grossly unstable with takeoff/landing due to their physiology and the G-force associated with takeoff/landing.

Hope this helps.


Brian
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#5 justlookin

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Posted 01 February 2010 - 05:20 AM

We do quite a bit of fixed wing work as well. Patient is loaded with head facing aft. We rarely change this orientation as we do not operate out of very small fields where, as BrianACNP described, the G-forces are often more pronounced. Also, this orientation is unable to be changed for IABP/ECMO/VAD patients due to where those devices must be secured in our aircraft (which is towards the tail).

Hope this helps.
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#6 Macgyver

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Posted 01 February 2010 - 07:47 AM

Ditto above - very rarely had to reorient from rear facing. Usually the smaller airports are at the sending facilities, the acceleration forces tend to be greater than the landing forces in any event.

The only time I can remember orienting facing forward was for unstable laboring patients - the acceleration causes additional force on the cervix...

Also remember to use the shoulder straps (even though the Lifeport design is a poor one) especially if facing rearward. "Crashlanding" or runway excursion decelerations can cause the patient to slide under the lapbelts and end up in the airway seat/against the bulkhead (or even in the cockpit). Ditto to adding head and foot spineboard-to-Lifeport frame strapping (we use seat belt extensions at each end) to prevent spineboards from sliding on the Lifeport mattress during even normal takeoff/climb etc.

Read the synopsis (at least) on these "hard" (crash) landings...

C-GSAX
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#7 Macgyver

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Posted 01 February 2010 - 08:06 AM

Read the synopsis (at least) on these "hard" (crash) landings...

C-GSAX


Bad link - this one should work...

C-GSAX
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#8 LearRRT-CCEMTP

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Posted 01 February 2010 - 03:23 PM

At all the programs I have ever worked with we have ALWAYS flown patients facing aft with the head towards the flight deck. I have recently noticed that Angel Medflight in Scottsdale is flying most of their patients facing forward with the patient's head aft. You might try contacting them and asking them to share their research / experience for doing this.
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#9 Macgyver

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Posted 01 February 2010 - 07:31 PM

Read the synopsis (at least) on these "hard" (crash) landings...

C-GLOM


I love government websites . . . amended link that goes to the CORRECT page

C-GOLM
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Ken BHSc, RN, REMT-P