mariomike said:
Spelled o r n g e. ( See attachment. )
Thank you! Reading that repeatedly was starting to make me itchy.
MedCorps said:
Ah, you missed the most important part of the MEDEVAC mission variable... the casualty! Again in reading the training that pilots from Orange get they might argue with you, especially if flying MEDEVAC versus CASEVAC. As dedidated "air ambulance" pilots they get instruction on planning flights for casualties with increased intraocular pressure, pneumothorax, decompression illness, violent tendencies, and intracranial bleeding for example. This involves a package on flight physiology, common patho-physiology which is exacerbated by flight, and ways to mitigate exacerbating these conditions by altering ones flying techniques and procedures.
Any chance you could provide a reference for where you read about this training package?
Pilot involvement in patient care is limited to a few areas. Their job is to determine if we can safely make the trip (weather considerations primarily but also duty day limits), and are there any limitations to how long they can stay on the ground before we have to leave the sending facility. Reasons for this are varied, but related primarily to weather and time limitations.
MedCorps said:
The medic / nurse and the pilot need to come up with an optimal flight profile for the casualty (who is the mission).
They need to know the weight of the patient and family escort as well as any special equipment we might need to bring for the call which would not routinely be on the aircraft. Examples which come to mind first are the incubator or the intraaortic balloon pump. They are also responsible for assisting with loading, offloading patients.
There are occasions where we may request certain altitude restrictions or other flying considerations such as a flight path to minimize turbulence. We do not discuss patient care details or the what and why of the request. We make the request, and if they can do it safely they always accommodate our request.
One example could be a college boy goes home to northern Ontario and his hipster attitude combined with talking when he should have been listening results in an attitude adjustment which leaves the left side of his face head and chest caved in. Positive halo sign from left ear and nare suggest cranial vault insult. Very large flail segment suggest potential to develop pneumothorax. Two hour flight time to receiving facility. We request field level cabin. This is achievable with an actual altitude anywhere up to 15,000 (ballpark, I'm not a zoomie). Pilatus PC12 is a great aircraft and can glide a long way with a dead engine, but flying field cabin altitudes over Lake Superior is a big risk. Pilots will get us a field cabin, but fly around the lake instead. In turn, we must plan accordingly (meds, fluids, oxygen, a snickers bar for when your partner turns into Betty White) for a longer flight
Another example could be buddy doing home renovations accidentally discharges his nail gun into his sternum, and he ends up with the a 2-inch nail buried to the head into his chest, and the tip lodged into the septum of his heart. Warm, humid local conditions with lots of forest fires in the area causing a very rough approach to the sending airport. Naturally we need to keep this guy very still, and the turbulence was rough on the approach. Not a lot we can do about the bumpy takeoff other than keep the patient as still as possible, but we would ask the pilots to find the calmest air between there and the destination. This could involve flying higher or lower, or flying around developing weather cells and other known areas of turbulence. This is not always possible but they do whatever they can to accommodate our request.
Another aspect of how it works is that the pilots get the call first, and they check weather and other pilot-ish stuff to determine if they can safely fly us to the sending location and then to the receiving location. No medical information other than patient and escort weight is provided at this point, and this is only provided for fuel planning and range considerations. Once the pilots accept the call, only then is the actual call info sent to the medics. This prevents any possibility of pilots feeling pressured to accept a call in questionable weather conditions, putting them in a situation that could put patient and crew at risk.
To answer a couple other questions...
How do you fly a 22 year old infantryman with a rib fracture and a small traumatic pneumothorax?
⁃ ask the pilots to fly with a field level cabin and for rotor airframes they fly close enough to ground level that the effect of pressure change is negligible.
The 65-year-old with a mild chronic obstructive pulmonary disease exacerbation and an oxygen saturation of 93% on room air?
⁃ since the therapeutic target for oxygen admin is 94% and up (some docs want >=95%), we would give a sniff of oxygen via cannula starting at 2Lpm and titrate to achieve target and desired effect. A mild COPD exacerbation can become a severe exacerbation pretty quickly for many reasons, so we would be monitoring ETCO2 and if we saw signs of ETCO2 rising outside the range that is normal for this patient we might consider serial blood gases with iStat and treat accordingly. Depending on how sick the patient is, existing comorbidities, anticipated clinical course and bed-to-bed out of hospital time, there may be a discussion with our docs about whether to tube and vent this patient.
The 8-year-old with otitis media?
⁃ Early antibiotics, appropriate analgesia, field level cabin, a Flyin' Lion (the Ornge mascot) stuffed animal, and lots of TLC.
Do you make a quick unplanned landing in flight to allow the Medics to decompress a chest with a chest tube, electrically shock a patient in V. Tach, or sort out a REBOA which as shifted or do you "push through to the MTF which is X minutes away?"
⁃ We would not make an unplanned landing for any of these reasons. If these interventions needed to be performed, they would be done so in flight. The only reasons I have heard of any crew making a landing en route to the receiving facility would be for fuel (planned), or in very rare instances arrangements were made for blood products to be delivered to a crew that had picked up a patient on a scene call, and that patient was in dire straits and would likely not survive the rest of the trip without blood products.
These are not always simple answers.
⁃ True, but we want those answer before we leave the sending facility. A big aspect of this type of transport medicine is considering anticipated clinical course, all the ways it can go sideways, and what we would need to do correct the situation during flight. Then take steps before we leave the sending facility to ensure that none of these things happens. This approach is effective 99% of the time. The other 1% is where flight medics get their war stories.
