best of med flight. landing zone preparation & communications why is this so important?
TRANSCRIPT
Best of Med Flight
Landing Zone Preparation &
CommunicationsWhy is this so important?
Undesignated / Spontaneous LZs
• High risk –espc at night
• Obstacles on approach Wires Cell Towers
• Ground hazards – signs, poles debris
• LZ security – people vehicles
• How well was it scouted out –we are 100% dependent on your eyes
Alternate LZs.You don’t have to land the helicopter
exactly at the accident scene
That’s why God put wheels on the ambulance
Designated LZs
Communication
• MF dispatch 608-263-3258
• Your county 911 dispatch
• Cell contact on scene
Initial Info
• Location – street and cross street
• Relationship to city, well known landmark
• Contact agency
• Cell contact on scene
• Contact frequency – Typically Marc 2
• Incident type and basic patient info
• Do you need more than 1 helicopter?
Radio contact
• MARC 2
• 5-10 minutes out
• Use vehicle radios – handheld have limited range
• Our #1 interest – LZ information
• VERY brief patient update
What to do if no radio contact ?
Common LZ Problems
• Personnel “marking” the LZ
• Personnel approaching aircraft before blades stop turning
• LZ security once helicopter lands
• LZ has to be secured 5 minutes prior to landing until 2 minutes after takeoff
• No vehicle, regardless of height within 50 ft of aircraft. Especially ambulances
Brownout / Whiteout
Large Patients
Im not afraid of heights
Im afraid of widths
Meanwhile in Germany…
A Slippery Slope..
• Car 1 looses control on ice at highway speeds
• Collides with car 2. Both go over 30 degree embankment
• Car 1 slides sideways, impacts tree into drivers door
• Car 2 T-bones Car 1 into passenger side
• 2 occupants of car 2 self extricate –minor injuries
• EMS arrives – Extensive damage toCar 1. Driver is obviously pinned. Talking but confused
• Walmart parking lot 200 yrds from scene
• Med Flight called – Landed within 15 minutes
• Significant intrusion on both passenger and driver doors
• Pt alert, confused, slightly agitated. Pinned by legs
• Complaining of chest/abd pain
• Collar placed. IV established, O2
• Initial VS 150/80 100 18
Wisconsin EMS Rule 11a
If it is Saturday night and you respond to an accident scene after
10pm and do not find a drunk-
Keep looking because you are missing a patient
CAR 1
CAR 2
Initial Approach
• Car 2 winched up towards highway exposing passenger side of Car 1
• Plan is to remove passenger door and top
Additional support personnel beamed down
from the Enterprise
The concept of “Holding the C-Spine”
Passenger side is no go
• Now at 50 minutes post incident
• Outside temp 35 F
• Patient becoming more agitated-yelling
• BP dropping 100/70
• Lets hold things for a minute..
Medical Interventions
•Given Ketamine 50 mg IVP
•IO placed in L humeral head
•Concern re internal bleeding –TXA
•Started PRBCs
• Pt BP improves slightly
• Dissociated state –protecting airway
• T= 50 mins Tree cut away
• Top removed
• Pt starts to vomit and vomit and vomit
EMS rules regarding vomit
• The volume of vomit always exceeds the size of the container be a factor of 2
• Standard suction is useless for Saturday night puke ( consists of McNuggets & partially chewed burritos pressurized by a pitcher of Milwaukee's Best) –you need a shop vac
• Always point the pt at the person you like least
Tailoring the Extrication (speed/spinal
precautions) to the patients condition &
environmental issues
Situation a little more urgent
• Pt quickly put in a KED
• Lifted out – put on long board
• Transferred to ambulance
Why don’t you just put him in the helicopter
and go?
In the Ambulance
• Initial GCS 13 –now 7
• Pt intubated using Glidescope
• Given 2 units of PRBCs
• 10 minute flight
• To the trauma bay….
In The Emergency Dept
• BP 90-100 systolic
• Labs –hgb 8.5 Etoh 0.19
• FAST exam with ultrasound positive
• CT scan of head/neck – negative
• CT Scan of abd/pelvis – extensive splenic laceration
What is a FAST exam?Focused Assessment by Sonography for Trauma
Taken to the OR
• Uneventful splenectomy
• Transfused total of 4 units PRBCs
• Discharged to home POD 5
Case #3
16 y/o healthy female
• Alone in the lap pool at waterpark
• Found unresponsive in 4 ft of water
• Immediately picked up on security video
• Submerged 3-4 mins MAX
• Park EMTs pull her from water, no pulse
• 911 called
• Start CPR, AED applied, shock advised
• Immobilized, C-collar
We have a pulse
• Local paramedic service arrives
• VS 110/60 HR 120 irreg
• Bagged on 100% O2 sats 85%
• No evidence of trauma
• Frothy sputum, bilat rales
• GCS 6-7 Pupils 4-5mm reactive
• IVs x 2
Prior to MF
• Pt intubated, high airway pressures
• Freq suctioning,
• 12 lead –freq multifocal PVCs, no STEMI
• MF lands at hospital helipad as ambulance arrives
Handoff
• Vital signs and Neuro status unchanged
• Pt sedated, paralyzed put on ventilator
• What is the history again??
• Uneventful flight Home
• Handoff to ED
• Evaluated in ED – head CT NL
• CXR – pulmonary edema
• Most labs and studies c/w drowning
• Admitted to PICU
• Its just another tragic drowning..
Whats the history again?
• 16 y/o healthy 5’ 7”
• No etoh, drugs, trauma
• Lap pool is 4’ deep
• Call to the water park – Can you pull the security videos?
• What about the initial AED?
Torsades de Pointes
• Polymorphic Ventricular Tachycardia
• Caused by:
• Congenital mutation of cardiac electrical system
• Electrolyte abnormalities
• Drugs
Radically changes treatment
• Not just a drowning
• It’s a drowning caused by syncope caused by cardiac arrhythmia
• Drowning similar to geriatric falls- What caused it? Primary vs secondary
Secondary Drowning
• Trauma / CHI
• Seizure
• Drugs/ETOH
• Cardiac Syncope
• Hot Tub issues
ICU Course
• Aggressive pulmonary support
• No electrolyte abnormalities
• Neuro status improved quickly
• Extubated on day #4
• No neuro deficits
• Cardiology consult
Electrophysiology Studies - EPS
Found to be at high risk for malignant arrhythmiasNext Step
AICD – Automatic Internal Cardiac Defibrillator
Discharged to home
• No Meds
• Normal activities
• No restrictions
In closing, Just two words
Altruism
Awesome
This is the official “You Are Awesome” notification from the UW Emergency Care Conference staff
indicating how awesome you actually are
Fini . .
@FLTDOC1