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#55 A Hard Day's Night


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#1 SerendepitySaki

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Posted 15 October 2010 - 07:18 PM

all right folks...just in time for Hallowe'en.....something wicked this way comes...!

in true AMRM spirit, MSDeltaFlt's gonna be working behind the scenes as a second set of eyes and ears to ensure that we all maintain situational awareness...

We've cooked up a hellish little mass casualty in the backwoods of the rural Ozarks...just for you...stand by...

same as #54....i am posting a teaser message now... all you have to do is select "Watch This Topic" and then, "Immediate Email Notification"... when i post the case, you'll be the first to know.
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LET THE WILD RUMPUS BEGIN !!!!!!
Sean G. Smith, RN-Alphabet Soup

#2 SerendepitySaki

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Posted 08 November 2010 - 07:50 PM

coming soon to a Flight Web near you.... B)
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LET THE WILD RUMPUS BEGIN !!!!!!
Sean G. Smith, RN-Alphabet Soup

#3 SerendepitySaki

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Posted 10 November 2010 - 05:35 PM

lead in...

you are on the final return leg from a longish multi-leg RW IFT just past dusk in the rural Ozarks ...

your pilot spots a glow at 1 o'clock...initial radio chatter seems to indicate a dwelling fire with casualties on a small horse ranch...local VFD on scene.

MSDeltaFlt and I await your responses....
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LET THE WILD RUMPUS BEGIN !!!!!!
Sean G. Smith, RN-Alphabet Soup

#4 ysumedic05

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Posted 10 November 2010 - 06:08 PM

Well this is my first post so here goes... First order of business would be to do a quick check of all supplies, drugs, o2, etc to make sure that we have adequate resources. Next contact comm. ctr. to make notification of the situation, see if they have any ability to get a ground contact frequency. Also be on high alert for other traffic in the area (who knows if any other RW is responding). Until everything gets sorted out initiate orbit until a definite report of the situation and LZ are established, most of all be alert of the surroundings.
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Justin Koper FP-C, NREMT-P

#5 SerendepitySaki

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Posted 10 November 2010 - 06:59 PM

GREAT! Thanks Justin! some possible additional topics for discussion: inadvertent IMC/IFR, pilot time out, bingo fuel, RTB, ICS/NIMS, etc....
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LET THE WILD RUMPUS BEGIN !!!!!!
Sean G. Smith, RN-Alphabet Soup

#6 TexRNmedic

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Posted 11 November 2010 - 02:05 AM

GREAT! Thanks Justin! some possible additional topics for discussion: inadvertent IMC/IFR, pilot time out, bingo fuel, RTB, ICS/NIMS, etc....


What is the turn-around for a fueling and fresh pilot? Weather, NVGs, TAWS, moonlight etc? What is my agency's policy for self-assigning to a scene without a request for HEMS? Kind of reminds me of my very limited time with hazmat, do I really want to go toward the big orange glow or keep at a safe distance? We have some pretty nasty refineries around here, and I don't think I would want to fly through an unknown plume.
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Wes Seale
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#7 JLP

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Posted 11 November 2010 - 12:14 PM

- contact local FD and EMS - see if they want help at all; what is the capabilty of local EMS; do they need help at all or can they handle it themselves just fine?
- determine an alternate landing site in safe area and whether you can get a pick-up to go to the scene itself, or get the patients brought to you; ideally an airfield where there is fuel, but at least a safer place than an unknown yard in poor visibility (a recipe for a CFIT or IIMC crash). Dusk is a dangerous time and your pilots are tired; if there is no good landing site and no chance of crew switch-out, forget it and go back to base. Too many HEMS crews are dead from crashes already.
- Make sure no one else is already enroute - if a fresh HEMS crew is coming, no point you dragging your tired, potentially fatigued-impaired self in, and multiple a/c raises the risk of a collision, especially in what is likely uncontrolled airspace.
- look at doing a crew drop-off (i.e. you) then the pilots go and switch out. Preferably get fresh medical crew with fresh pilots, so you can stabilize and prep the patient for transport but they take over and you still get to go rest. Tired medics/RN's can be as hazardous as tired pilots.
- determine where you will go; should you be arranging a hand-off or can you go direct to the receiving site? If travel time is long, plan out a hand-over to another RW crew or FW crew, so fresh hands can get involved.
- how many patients? if it is an MCI, is it better if you do triage/initial stabilization followed by handing patients off to other HEMS/land crews, rather than tying yourself to one patient?

- if you think you are going: Draw up and label your airway induction meds and prep multiple IV lines so you're not wasting prep time on scene. Pre-set vent for a "standard" adult and make sure all required lines and tubing are connected and tested. advise your medical control if you have to get orders for procedures, and get advance orders so as to save time. prepare tox kits, esp cyanide kit (usually not at the top of the med bag, so dig 'em out). Assume you are not 100% due to fatigue, and calculate all your drug doses, Parkland formula, vent settings, differential diagnoses, etc. Make sure you have your Broselow tape out - tired providers can kill kids due to simple math errors.

- Make sure you work out other possibilities while you are still enroute; many fires are actually homicides disguised as accidents, so make sure you are keeping occult trauma and poisoning in mind so that you don't get tunnel-vision'ed on "fire, smoke inhalation",

- fire up the in-aircraft espresso maker and pour everybody a strong one
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#8 medic1488

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Posted 11 November 2010 - 12:22 PM

- fire up the in-aircraft espresso maker and pour everybody a strong one


We can only dream. :D
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#9 pureadrenalin

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Posted 11 November 2010 - 02:16 PM

Working ground EMS for now..but..I'll chime in. I'll second all the comments made here already. This is a long flight, probably not a very complicated one, though, just exhausting to maintain concentration.

Moving on to the air side, pretty much everything everyone has said. Go through the mental checklist, think about potential victims, think about med supplies, closest definitive care, o2, pilot time remaining, fuel, crew mental capacity.

If the initial IFT was a multi-leg flight, it was probably well over an hour in duration...the pilot is going to be pretty cashed by now. Not to mention, the closest receiving may be some distance.

For me....it's far to sketchy to take this call in the current operational situation..ground or air.
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#10 SerendepitySaki

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Posted 13 November 2010 - 01:47 AM

all GREAT points....nice specific catch on the pilot timing out, Pure Adrenalin!.....waiting on a few more to chime in...head's up... this here's roughly a 3 parter and y'all are just barely in phase one....
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LET THE WILD RUMPUS BEGIN !!!!!!
Sean G. Smith, RN-Alphabet Soup

#11 Speed

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Posted 13 November 2010 - 02:43 AM

Are we going to be working w/ a healthy ICS?
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Mike Williams CCEMT-P/FP-C

#12 Sue

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Posted 13 November 2010 - 01:52 PM

I am a little late to this, but here it goes. How far out are we from our base? Is our crew 24 hours or 12 hours. We know it is dusk, so it is probably pilot switching time. Do we have time to go back and swap? I am with everyone else on the variable side of things. This is very sketchy. I am not going to show up unless I am asked for, and I am not going to land in the "hot" zone.
Ideally, fresh crew, fresh supplies....otherwise, improvisation will be the name of the game...that can make it fun.
I am guessing you guys are going to let us show up at this scene instead of flying past it!LOL

Sue
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Sue Toberman, RN

#13 SerendepitySaki

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Posted 13 November 2010 - 04:20 PM

Speed- sure! medical crew and the pilot can hear each other just fine! ;) sorry, bad ICS pun....(and with respect to NIMS, have you EVER seen a healthy one? no worries....aside from steering the scenario, ask and ye shall receive....)

Sue- good thoughts and GREAT to hear from you! You're not late at all!

More Data:

  • As far as potential receivings, mutual aid etc go: that is part of your NIMS homework... use CLINTON, AR 72031 and Google.....
  • You are pilots/aircrew....12/24, 7a-7p/7a-7a.
  • It is 1800ish.
  • Turn Around time is approx 90 minutes worst case scenario...some time might be shaved off that...
  • Crew drop off has not been addressed in your Policies and Procedures.
  • Weather not a factor for now. (MORE Homework....one of you guys studying for your FP-C or CFRN can state the actual numbers for RW in non-controlled airspace VMC/IMC)
  • You each have F4949 AN/AVS-9 Pinnacle, Class B goggles.
  • Your airframe has industry standard bells and whistles.
  • Your Pilot says that remaining fuel will let him give you a maximum 10 minute orbit on station to hash things out with dispatch, chain of command, fire up the espresso maker, etc.
  • Although your company has diverted for scene calls in the past, you are not authorized to auto-dispatch without clearing it through comms, nor has a request been made for your services at this time.
  • He agrees with Justin and JLP....he would like to fly in closer and at least orbit the scene to select a potential LZ. He figures if it's a horse ranch, there are probably grazing pastures...
  • what does the rest of the crew have to say?

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LET THE WILD RUMPUS BEGIN !!!!!!
Sean G. Smith, RN-Alphabet Soup

#14 Sue

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Posted 13 November 2010 - 10:46 PM

Speed- sure! medical crew and the pilot can hear each other just fine! ;) sorry, bad ICS pun....(and with respect to NIMS, have you EVER seen a healthy one? no worries....aside from steering the scenario, ask and ye shall receive....)

Sue- good thoughts and GREAT to hear from you! You're not late at all!

More Data:

  • As far as potential receivings, mutual aid etc go: that is part of your NIMS homework... use CLINTON, AR 72031 and Google.....
  • You are pilots/aircrew....12/24, 7a-7p/7a-7a.
  • It is 1800ish.
  • Turn Around time is approx 90 minutes worst case scenario...some time might be shaved off that...
  • Crew drop off has not been addressed in your Policies and Procedures.
  • Weather not a factor for now. (MORE Homework....one of you guys studying for your FP-C or CFRN can state the actual numbers for RW in non-controlled airspace VMC/IMC)
  • You each have F4949 AN/AVS-9 Pinnacle, Class B goggles.
  • Your airframe has industry standard bells and whistles.
  • Your Pilot says that remaining fuel will let him give you a maximum 10 minute orbit on station to hash things out with dispatch, chain of command, fire up the espresso maker, etc.
  • Although your company has diverted for scene calls in the past, you are not authorized to auto-dispatch without clearing it through comms, nor has a request been made for your services at this time.
  • He agrees with Justin and JLP....he would like to fly in closer and at least orbit the scene to select a potential LZ. He figures if it's a horse ranch, there are probably grazing pastures...
  • what does the rest of the crew have to say?


Googled that area in Clinton, Arkansas. Looks to me like there are at least 2-3 hospitals and one with a heliport. The Clinton Municipal airport is not far, either. Not sure about trauma centers. Looks like they may be upwards of 30 miles or so from Clinton. Surely, my Arkansas comrades know these answers.
These are my random thoughts for the moment:
I am with my pilot. If he/she would like to scope out the scene and possible LZs...then do it.
I would stay in close contact with my dispatch and keep the locals up on the radio, as well. Should time allow for it, I may consider going back to base for fuel and pilot change and wait for dispatch to this call. In the mean time...assess my supplies and be prepared for a goat roping.
Not knowing the entire situation at the scene; is it possible to consider Clinton Municipal as an LZ? It would be reasonably controlled air space, and all would be talking to each other in that air space. I am not familiar with this airport, so I do not know how far it is from the scene.
You also said the wx was still good, but should it be a problem, I may consider this a place for an IFR approach if it is available to me.
Sean, you are killing me. I hope I don't sound totally stupid. :P
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Sue Toberman, RN

#15 SerendepitySaki

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Posted 13 November 2010 - 10:50 PM

more food for thought....where's the nearest Burn Center?
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LET THE WILD RUMPUS BEGIN !!!!!!
Sean G. Smith, RN-Alphabet Soup

#16 Sue

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Posted 13 November 2010 - 10:58 PM

Looks like Memphis, TN to me.

Sue
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Sue Toberman, RN

#17 Sue

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Posted 13 November 2010 - 11:03 PM

Looks like Memphis, TN to me.

Sue


and Arkansas Children's if there are youngsters involved.
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Sue Toberman, RN

#18 SerendepitySaki

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Posted 13 November 2010 - 11:19 PM

nice catch(es).... are you reading my mind....? stuff to be thinking ahead on for ICS/NIMS...

another "freebie" ....

1. you do NOT belong to ANY of the current REAL flight programs in the area.... you are a fictional program.... you may, however, call on existing services, should the need arise...
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LET THE WILD RUMPUS BEGIN !!!!!!
Sean G. Smith, RN-Alphabet Soup

#19 ysumedic05

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Posted 14 November 2010 - 01:56 AM

A few questions: I like Sue's idea of landing at the regional airport for some control to the airspace but my question is how far is the scene from the airport, and also are there any reliable ground transports to shuttle from scene to airport? Also how far out is the nearest "local" air provider for possible guidance and since I have the distinct feeling that there are going to be multiple critical patients at the scene it might be a good idea to get them coming if it comes down to it. Plus they might have more familiarity with local agencies (since the ICS is going to most likely be unorganized at best). This is going to get interesting.......
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Justin Koper FP-C, NREMT-P

#20 SerendepitySaki

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Posted 14 November 2010 - 02:21 AM

remember Justin.....almost ALL of the information you're asking for is freely available on the web... the flight programs i'll help you with.... go here:

http://www.flightweb...php?category=17


A few questions: I like Sue's idea of landing at the regional airport for some control to the airspace but my question is how far is the scene from the airport, and also are there any reliable ground transports to shuttle from scene to airport? Also how far out is the nearest "local" air provider for possible guidance and since I have the distinct feeling that there are going to be multiple critical patients at the scene it might be a good idea to get them coming if it comes down to it. Plus they might have more familiarity with local agencies (since the ICS is going to most likely be unorganized at best). This is going to get interesting.......


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LET THE WILD RUMPUS BEGIN !!!!!!
Sean G. Smith, RN-Alphabet Soup