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Accidental extubation during transport


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#1 FlightWeb News

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Posted 30 May 2013 - 12:55 PM

This newspaper article discusses the accidental extubation of a pediatric patient during an air medical transport.

Family says boy left brain damaged after STARS air ambulance flighthttp://feeds.feedburner.com/~r/FlightwebNews/~4/PNqna9YgWMI
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#2 Macgyver

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Posted 30 May 2013 - 09:20 PM

As Dr. Richard Orr proved several years ago, there is a reason that the incidence of negative outcomes and adverse events on pede/neo transports conducted by non-specialty (adult-pede) teams is about EIGHT TIMES HIGHER than when conducted by specialty teams.

This is not a slam at STARS or any other program, it is an industry wide international issue. And problem.

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Pediatric specialized transport teams are associated with improved outcomes.
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Ken BHSc, RN, REMT-P

#3 Macgyver

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Posted 31 May 2013 - 02:57 AM

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Ken BHSc, RN, REMT-P

#4 MA_Flt_Medic

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Posted 31 May 2013 - 12:28 PM

Tragic. Was there no ETCO2? I get how a tube becomes dislodged (adult or pedi) but I don't understand how it goes unrecognized for so long.
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Nunquam Quietus

#5 Richard

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Posted 31 May 2013 - 12:29 PM

Two Things: SECURE TUBE: I use Neobars on ALL PEDS from 25Kg and Down. Black, Gray or Peach. Tegaderm/Steristrip. It takes a few minutes but it is tight and ET position is visible. CAPNOGRAPHY: Breath to breath to breath...I have lost an airway in flight and I knew precisely when it occurred and why. Losing a tube happens. NOT KNOWING should never.
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Richard P. Mitchell, RRT-NPS
Pediatric Respiratory Therapist
Vidant Medical Center, Greenville, NC and
HHS/OS/ASPR/OPEO/NDMS/DMAT-NC1 & MAC-ST

#6 Macgyver

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Posted 31 May 2013 - 11:05 PM

May need to spend more time with ground EMS teams as well as new hires Training Program
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Ken BHSc, RN, REMT-P

#7 Macgyver

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Posted 22 December 2013 - 10:37 PM

STARS MB suspended. Backup "plan"

"a helicopter from Conservation, with paramedics on board"

OK - so lets get this straight - from a 2 pilot EMS experienced crew in a dedicated engine IFR twin machine with an (inexperienced) flight RN / flight medic to a smaller ad-hoc single pilot VFR helicopter with a couple of street medics is a GOOD thing? Preferable to carrying on with the system they had but improving it?

Don't forget the 3 sentinel events were on a chopper that also had a MD on board. Maybe THAT's the problem. Not the STARS helicopter crew.

It has been my experience that unless the MD is a flight surgeon or has specific aeromedicine training, a specific airframe and crew/capabilities orientation of a few days and 5-10 missions AND flies regularly - they are a liability both from a medical and safety perspective. Especially if a resident or pulled from the ED/ICU.

And in support of my MD comment - if the regular crew has to divert time away from patient care or to alter the cabin configuration to accommodate a 3rd person or to babysit the MD (safety) or find/operate things (lack of equipment familiarity) or remind them of the time spent on scene -vs stay&play mindset or do all the watching/radio work etc etc the MD is a liability. Better to just sit there and offer advice if needed or asked
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Ken BHSc, RN, REMT-P

#8 ForeverLearning

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Posted 23 December 2013 - 01:44 AM

Not peds but on all NICU transfers (with isolate utilized) that I have accompanied a "team" I have never seen them utilize capnography. When I questioned the RT's and NP's and MD's why they never use waveform quantitative capnometry, they said there is no reason to, or we have SPO2, or some other bs reply. I guess it's not industry standard in the NICU world. I also have not seen it used in the NICU for that matter.

Unfortunately it has also been my experience, having an MD accompany the transport actually doubles the work and they are a nuisance rather than a helping hand. In the sending facility they are always rushing when there is no time urgency present, always want to travel lights and sirens both ways. I don't really care about them having equipment knowledge, you should know how to use your equipment and how many doctors have you actually seen run an IV pump, most will immediately look for a nurse. These magical doctors that can offer a helping hand only exists on EMCrit podcasts, none are actually found in the "wild".

Perhaps when it comes to legal matters you may need 2 consenting physicians or some other litigious matter. Or perhaps perform a certain procedure in the sending facility, I only seen that once.
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