Aero Medical Transport

1
Aero Medical Transport

• It ought to make a difference or dont go

2
Ken Harman M.D.CAPT, FS, USPHS USCG Aviation
Training CenterMobile, AL
3
Objectives

• Review Aero Medical Evacuation
• Discuss Risk Management Issues
• Define the role of the Coast Guard Flight Surgeon
• Discuss Best Practices approach

4
Aero Medical Evacuation

• Using an aviation asset to move an ill or
  injured person to a higher level of care.

5
Aero Medical Evacuation Assumptions

• Aero Medical Evacuation is faster than ground or
  surface platform transport
• In-flight interventions and earlier definitive
  treatment saves lives
• Aviation safety rules and regulations make these
  missions safe

6
Agencies Prosecuting Aero Medical Missions

• Civilian - Competitive multi-billion dollar
  industry in most western nations
• DoD Active Duty, National Guard and Reserve
  Components
• USCG About 1,100 Maritime and non-Maritime
  cases annually

7
Civilian air ambulance crashes have increased in
recent years
The Grand Rapids Press, May 29, 2008
8
National Transportation Safety Board (NTSB)
Statistics

• 14 air ambulance crashes in 2007, with 24 deaths
• 13 air ambulance crashes in 2006, with 10 deaths
• 61 air ambulance crashes between 2000 and 2006,
  with 54 deaths

9
Causes of Civilian Air Ambulance Mishaps

• Unplanned flight into instrument meteorological
  conditions (IMC)
• Influence of the mission on pilot judgment
• Competitive pressures to fly
• Pilot proficiency
• Pilot fatigue

10
Houston, we have a problem..

• "We've been struggling with these issues for as
  long as I've been in this business. The reasons
  we were having accidents 25 years ago are still
  the same reasons we're having accidents today."
• May 2007 Denver Post interview with Ed
  Stockhausen, Air Methods' director of safety.

11
(No Transcript)
12
USCG Aero Medical Transport Mission

• Emergency transport only.
• Carrier of last resort.
• To save life or limb and alleviate suffering.

13
Operational Risk Management

• The net sum of mission risk and mission gain.
• Aircraft Commanders and Operations Officers are
  the experts in the risk assessment.
• Flight Surgeons are the experts in the gain
  assessment.

14
Operational Risk Management

• The Flight Surgeon must provide specific, cogent
  and medically sound advice to the operations
  personnel.
• The data used to formulate this advice will be
  incomplete, inaccurate or both.

15
5 POINTS

• What do they have?
• What do they need?
• When do they need it?
• Where can they get it?
• Can we meet the window of opportunity?

16
(No Transcript)
17
Key Flight Surgeon Decision Elements

• Aero Medical Evacuation recommended?
• What is the gain life, limb or alleviation of
  suffering?
• How soon? Give an exact number of hours!
• Where do they need to go?

18
Key Flight Surgeon Decision Elements

• Test What treatment will be immediately
  provided at the destination that is reasonably
  certain to favorably affect the outcome?

19
FREQUENT SCENARIOS

• CPR IN PROGRESS
• CHEST PAIN/ ACUTE MI
• STROKE
• SEIZURE
• ABDOMINAL PAIN
• OVERDOSE
• CHF
• TRAUMA

20
CPR IN PROGRESS

• No survival after 10 minutes.
• Response time is too late to realistically expect
  to save a life.
• All that remains is risk.

21
CHEST PAIN

• How soon?
• When is too late?
• What can you do?

• lt 4 hours from onset
• gt12 hours (ACLS)
• Aspirin, oxygen, rest

22
STROKE

• How soon?
• What treatment?

• lt 3 hours from onset (ACLS)
• Thrombolytic therapy

23
(No Transcript)
24
SEIZURES

• When new in onset, associated with trauma or
  fever
• A history of seizures reduces emergent risk
• NPO, recovery position, nothing in the mouth.

• When is it an emergency?
• What can you do?

25
(No Transcript)
26
ABDOMINAL PAIN

• 40 discharged from ED without a diagnosis
• Most abdominal pain can wait 12 hours
• More dangerous if passing blood or associated
  with fever
• Remember ectopic pregnancy!
• Age gt 65 increases risk of vascular catastrophe

27
OVERDOSE

• Most OD cases need only supportive care
• Treatment of acetaminophen overdose can wait 12
  to 18 hours
• Few OD cases require dialysis

28
CHF

• Treatments?
• Why MEDEVAC?

• Diuretics, nitro, oxygen, digoxin and afterload
  reduction (ACE inhibitors)
• Aortic assist pumps or transplant.

29
(No Transcript)
30
TRAUMA

• Fractures, closed
• Fractures, open
• Amputations
• Falls from higher than your own height

• 7 days
• lt 6 hours reduces infection risk (ATLS)
• lt 6 hours (ATLS
• Carry increased risk of serious injury

31
TRAUMA

• Burns, partial thickness
• Burns, full
• thickness

• gt 20 Body Surface Area (BSA) needs referral to
  burn center
• gt 10 BSA for age lt 10 or age gt 50 needs burn
  center referral
• gt 5 any age needs a burn center (ATLS)

32
(No Transcript)
33
ALTITUDE RESTRICTIONS

• lt 1000 FEET ASL unless aircraft can pressurize to
  sea level

• CLOSED HEAD INJURY
• INTESTINAL OBSTRUCTION
• SCUBA DIVING EMERGENCY
• PNEUMOTHORAX

34
CAVEATS

• AS SOON AS POSSIBLE
• WHAT IF THEY GET WORSE?
• THEYRE GOING INTO SHOCK

35
QUESTIONS ?