• Thanks for stopping by. Logging in to a registered account will remove all generic ads. Please reach out with any questions or concerns.

Medevac

mariomike

Moderator
Staff member
Directing Staff
Subscriber
Mentor
Reaction score
671
Points
1,260
MedCorps said:
As does Orange in Ontario does when doing pediatric transport.

Again in reading the training that pilots from Orange get they might argue with you,

Spelled  o  r  n  g  e.  ( See attachment. )

Loachman said:
I don't know of anybody else that puts nurses on helicopters.

Q: I am a Registered Nurse and wish to pursue a career as an air ambulance flight nurse. What do I need to qualify?

A: As per the Ontario Ambulance Act and current regulations, air ambulance operators do not employ, nor are able to employ, flight nurses. All air ambulance medical flight personnel are flight paramedics that hold Advanced Emergency Medical Care Attendant (AEMCA) certification and are aero-medically certified at the pre-hospital level. While several nurses have their AEMCA and aeromedical theory qualifications, they are not utilized nor recognized as nurses but rather as flight paramedics.

In addition, Ontario legislation does not allow for nurses to be substituted for flight paramedics on air ambulance flights. If a sending facility provides a nurse escort for outgoing patient treatment, they might use a flight nurse procurement company on a per-need basis. However all air ambulance flights must have a flight paramedic in attendance with the patient at all times, even if there is a registered nurse escort accompanying the patient. The flight paramedic is trained in emergency procedures and been trained on the specific aircraft's emergency procedures.
http://www.health.gov.on.ca/english/public/program/ehs/edu/equiv_qa.html#7

Loachman said:
Do nurses ever crew wheeled ambulances?

Q: I am a Registered Nurse and wish to pursue a career as a paramedic. What do I need to qualify?

A: You would be required to attain certification as an Advanced Emergency Medical Care Assistant (AEMCA). Certification follows the successful completion of an Ontario paramedic program or by completing the Paramedic Equivalency process.

Registered Nurses in Ontario with at least 450 hours of land ambulance pre-hospital patient care experience are considered equivalent for the equivalency process. Registered Nurses with extensive experience in critical care areas (emergency, ICU) may receive up to 330 hours of credit towards the 450 hours of land ambulance pre-hospital experience. For more information please visit the Paramedic Equivalency section or contact the equivalency liaison.
http://www.health.gov.on.ca/english/public/program/ehs/edu/equiv_qa.html#6











 

Attachments

  • svMuR6X7.jpg
    svMuR6X7.jpg
    12 KB · Views: 1,778

RubberTree

Member
Reaction score
5
Points
180
Blackadder1916 said:
Perhaps someone more in the know may be able to provide an up to date perspective on the flight's current organization and activity.

The CF AE Flt is a lodger unit in Trenton belonging really to 1CAD in Winnipeg. Its complement is just a handful of nurses and techs as well as a PA as Sergeant Major and an HCA. They fly missions on a semi-regular basis (vague, I know) around Canada and the world transporting patients who have been injured/become sick on exercise, leave, training etc. They are supplemented by a physician on all of their flights and also have critical care teams on standby on a rotating schedule to augment the basic crew if required. They have a full kit of medical equipment, both basic as well as critical care which has been through the airworthiness process and has been approved for flight on the aircraft they fly on. 
 

Hunter

Member
Reaction score
0
Points
210
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.
 

mariomike

Moderator
Staff member
Directing Staff
Subscriber
Mentor
Reaction score
671
Points
1,260
Hunter said:
Thank you! Reading that repeatedly was starting to make me itchy.

Me too. Having worked on the ground with Ornge Flight Paramedics enough times, I learned how to spell their name.  :)
 

MedCorps

Sr. Member
Reaction score
68
Points
330
Hunter said:
Any chance you could provide a reference for where you read about this training package?

It was in a BN presented by the MEDEVAC Sub-Working Group to the CFHS 3rd Future Field Force Working Group. It looks like some of the members spent some time talking to Col (ret'd) Tien who is now the Chief Medical Officer of Ornge (apologies for my error in my above post, spell check got me I suspect). They may have also spoke with the former CFHS Gp COS who was a RCAF pilot and went on to become VP Operations (or some such title) at Ornge before going off to TC to become Chief of Flight Standards (where I think he is now). The BN also had sources from STARS in Alberta so some of the information might have come from there also.

I hope that helps.  Nothing says that the officers conducting the meeting understood correctly (or I read it wrong). It could also be something this is "on the books" but not done or something that might be in the pipeline to come in the future... who knows. I guess it was striking enough that I remembered reading it and thinking, wow that is operator / medic integration... good to see, might be a model worth emulating. 

Enjoyed your clinical examples (and Betty White reference)... a good read, thanks.

MC
 

MedCorps

Sr. Member
Reaction score
68
Points
330
Hunter said:
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.

I am not remotely considered knowledgeable of flight medicine, so do not take anything I say on this topic as authoritative. My reading of the various proceedings has been that the "CAF experts" seem to be concerned about some of these things. I am not sure I would want to put in a chest tube or mess with a REBOA in a Griffon while in flight, especially tactical flight. The configuration is just not designed for it, especially if the casualty is in the litter kit (limited casualty access) or the flying is under NVG. I am also not sure what 1 CAD / 1 Wing says about delivering electricity to a casualty in-flight, but that might be a concern". I guess that is the advantage of having a dedicated, purpose built air ambulance that you work in versus a military utility helicopter we dump casualties in.

Hunter said:
⁃ 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.

I think that is another difference in military forward air evac (rotary wing) medicine. The "sending facility" might be a few sections of mod on the side of a road located in a very tenuous tactical situation that does not allow much helicopter ground time, or might be hand over from a casualty collection point where the medics are working on other casualties and the combat arms guys "dump" the casualty (or casualties) on your helicopter under the direction of the CSM.

Good conversation. 

MC
 

Loachman

Former Army Pilot in Drag
Staff member
Directing Staff
Reaction score
452
Points
980
MedCorps said:
I think that is another difference in military forward air evac (rotary wing) medicine. The "sending facility" might be a few sections of mod on the side of a road

The "sending facility", from what I've seen, is much less than that - casualties are generally picked up from the site of injury.
 

MedCorps

Sr. Member
Reaction score
68
Points
330
I think there are two models the rotary wing MEDEVAC people are looking at (based on my read of the draft doctrine which is about to be promulgated) 

1) Forward Aeromedical Evacuation (Med Tech staffed)
- Move casualty from Point of Injury to medical treatment facility
- Move casualty from medical treatment facility to medical treatment facility.

Note: A medical treatment facility, in it's most primal form is a medical detachment, which is a few sections of mod tent. 

2) Critical care Forward Aeromedical Evacuation (Critical Care On route care - Critical Care Nursing Officer / Med Tech staffed).
- Move casualty from a medical treatment facility post-damage control resuscitation (DCR) to a medical treatment facility with damage control surgery (DCS) in order to meet NATO ratified timelines (ideally one, maximum two hours from DCR to DCS). There has been some good analysis by the Role 1 sub-working group and the Operational Medicine folk at DHSO looking at the requirement to have this capability. There is no use in doing forward DCR (blood, ventilation, advanced airway, advanced venous access, advanced medication, etc, etc) if you are going to turn the casualty over to a QL3 Med Tech in the back of an LSVW Amb and tell them to drive quickly to the field hospital so the guy gets surgery. Remembering that "these guys" are our brothers in arms and deserve the highest chance of survival should they find themselves shot up.   

Note: a medical treatment facility with DCR might be attached to a UMS under a few sections of mod tent.  The doctrine has been written and soon to be officially released (CFJP 4.10, if anyone cares). Now the wizards need to figure out how to operationalize these new doctrinal concepts (critical on-route care, DCR, DCS). That is part of the mandate of the Future Field Force Working Group. 

As mentioned earlier, there is also some highly debated talk about DCR at point of injury delivered by Chinook.  This is the UK MERT model.  We will see how these discussions go, but there are good arguments both for an against.  For video of the MERT see:

https://www.youtube.com/watch?v=KczXs6Lh4TY

Cheers,

MC
 
Top