Transcript Air Ambulance Orientation

CANADIAN HELICOPTERSOrngeEMS
AIR AMBULANCE
Transport Medicine
AIR AMBULANCE
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Goals for Today
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Introductions
• Who are we, and why we are here
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Goals for Today
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Introduction to Air Ambulance
Structure of air program
Helicopter utilization
Introduction to aeromedicine
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
History of Air Ambulance
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First U.S. military presence in 1936
WW II - 1.5 million patients transported by
fixed wing aircraft
• Korea and Vietnam - utilization of
rotary wing aircraft
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
History of Air Ambulance
in Ontario
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First flight in 1977
Aircraft types
Base Locations
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
History of Air Ambulance
in Ontario
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Structure
• Ornge Program (OAABHP)
• Medical Air Transport Centre (MATC)
• • Operators
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
History of Ornge EMS
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Operating Air ambulance helicopters
in Ontario for 25+ years
Operating medical component since
1999
• Provides ACP(F) and
CCP(F) service
• 120+ Employees in Ontario
• 7 bases, 8 online aircraft,
11 available
• Also operates aircraft in
Nova Scotia
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Employment Opportunities
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OAABHP-Base Hospital
MATC
CHL EMS
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
OAABHP - Base Hospital
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Training
Certification
Defining Scope of Practice
Medical Direction
Quality Improvement
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Base Hospital - Training
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Distance Education
Human Patient Simulator
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Base Hospital - Training
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Aeromedical Course
PCP (F) to ACP (F) Course
ACP to ACP (F) Course
CCP (F) Course
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Base Hospital - Training
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PCP (F)
• EMCA
• Aeromedical Course
• SR / SAED Course
• CME
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Base Hospital - Training
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ACP(F)
• PCP(F) plus
• ACP(F) course
• CME
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Base Hospital - Training
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CCP (F)
• ACP (F) plus:
• CCP (F) course
• CME
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Base Hospital Certification
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Oral Board
OSCE
CME
Flight Rounds
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Base Hospital
Scope of Practice
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PCP (F)
• SR / SAED
• 12 Lead ECG
• ETCo2
• IV administration via Pumps
• BLS Trauma and Medical Care
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Base Hospital
Scope of Practice-ACP (F)
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ETT, LMA, RSI, needle cricothyrotomy
(Quick-Trach),
volume control mechanical ventilation, needle
thoracostomy,
chest tube drainage monitoring,
IV / IO initiation,
IV medications (bolus and infusion pump),
blood transfusion,
thrombolysis, other medications
NG/OG placement,
TCP, manual defibrillation / cardioversion,
urinary catheterization.
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Base Hospital
Scope of Practice-CCP (F)
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pressure control mechanical ventilation,
transvenous pacing,
invasive pressure monitoring (arterial and
PA catheters),
CCP (F) medications,
Intraaortic Balloon Pump
Critical care obstetrics and Neonates
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Plus everything else on previous slides
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Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Base Hospital
Medical Direction
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Base Hospital Physician on call 24/7
Standing Orders
Medical Directives
Patch Orders
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Base Hospital
Quality Improvement
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Chart Audits
Site Visits
Customer Service Inquiries / Incident
Report investigation
Paramedic Surveys
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Capabilities of the
Sikorsky S-76A
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2 stretcher patients, 4 attendants
Usual ambulance equipment
• Oxygen, suction, cabinets full of
“gear”
• Radio, satellite phone
• Electrical power
• 713 km range with 30 min. fuel
reserve
• 287 km/h cruise
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Why Air Ambulance?
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Goals of aeromedical transport
• On-scene response
• Rapid transport - “Golden Hour”
• Provide advanced life support
• Interfacility transfers
• Decreased out-of-hospital time
• Decreased depletion of resources
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Helicopter Utilization
Guidelines
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When to call
• Should meet one “Operational
Guideline” plus one “Clinical
Guideline”
• OR: IF DEEMED APPROPRIATE by
the paramedic or dispatcher
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Helicopter Utilization
Guidelines
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Operational Guidelines
• Land Ambulance >30min to scene
• Land Ambulance >30min from scene
to Lead Trauma Centre
• Pt needs ACP care which land medics
cannot provide
• Multiple patients
• Pt not easily accessed
• If deemed appropriate
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Helicopter Utilization
Guidelines
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Clinical Guidelines
• Field Trauma Triage Guidelines
• Medical Condition
• Environmental Condition
• Obstetrical Condition
• Unknown Condition with MOI
• If deemed appropriate
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Helicopter Utilization
Guidelines
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Scene selection
• Assign a Landing Site Coordinator
• Pilot has final say
• Generally prefer on the road
• 100ft x 100ft
• Clear of wires
• Flat surface
• no debris / gravel
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Helicopter Utilization
Guidelines
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Scene safety
• Stop vehicular and pedestrian traffic
• Close doors
• Secure equipment, stretcher
• Charge any hoses
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Helicopter Utilization
Guidelines
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Working around the helicopter
• Approaching the aircraft (Don’t!)
• Approach only from side
(NOT THE FRONT)
• Approach from downhill side
• Carry equipment horizontally, below
waist
• Secure clothing, blankets, equipment
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Helicopter Utilization
Guidelines
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Modified scene calls
Not to scene but either to helipad or
hospital and aircraft still comes
• Transport prior to aircraft arrival
• If a/c not visibly on final, depart
• Night utilization
• Must land at nearest airport /
helipad
Still gets patient to trauma center quicker
than if paramedics didn’t call
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Helicopter Utilization
Guidelines
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Helicopter limitations
• No SAR
• No freezing conditions
• No scene landings after dark
Weather / light decisions are up to the
pilot - don’t be afraid to make a request!
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Helicopter Utilization
Case Studies
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Accessibility - Pediatric GSW in field
Modified scene - 2y/o struck by tractor
trailer
Delay - Pt. trapped between dump truck
and tractor
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Helicopter Interaction
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Airport / heliport procedures
• Where to park
• Required equipment
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Aeromedical Physiology
Effects of flight
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Temperature
Vibration
Noise
Decreased Humidity
Fatigue
G Forces
Atmospheric pressure
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Aeromedical Physiology
Gas Laws
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Dalton’s Law
• The pressure of a gas mixture is
equal to the sum of the partial
pressures of its’ component gases...
• P=P1+P2+P3+P4…
• What are the implications?
• How do we compensate?
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Aeromedical Physiology
Gas Laws
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Boyle’s Law
• At a constant temperature, the
volume of a given mass of gas varies
inversely to its pressure...
• P1V1=P2V2
• What are the implications?
• How do we compensate?
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Aeromedical Physiology
Gas Laws
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Henry’s Law
• The quantity of gas dissolved in a
liquid is proportional to the partial
pressure of the gas in contact with
the liquid
• Open a bottle of pop
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Transport Medicine
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Preparation for flight
• Priority - Patient safety
• Provide care
• Package patient
• Cabin safety briefing
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Transport Medicine
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Providing care in flight
• Challenge: Atmospheric Pressure
• Challenge: Space
• Challenge: Noise
• Challenge: Vibration
• Challenge: Isolation
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Principles of Flight
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Bernoulli Effect
Bernoulli and the helicopter
Autorotation
Canadian Helicopters EMS
Introduction to Air Ambulance
Ontario’s Air Ambulance
Questions?
All photos courtesy of the staff
at Canadian Helicopters EMS
And Ornge.