AIR VERSUSGROUNDWITH TRAUMA: A COMPARISONOF PATIENTOUTCOMES
Paul S. &mink,
AirLife, HealthONESwedish Medical Center Introduction: This study compares outcomes of trauma patients transported from the scene of an accident to the nearest appropriate trauma center by air and by ground. Methods: Demographic data, severity and outcome data were collected over a 13-month period on trauma patients admitted to an emergency department (ED). Results: Mean Glasgow Coma Score (GCS) on scene for the air group (A) was 12.97 and 14.00 for the ground group (G); Wilcoxon Pvalue = 0.0072. Mean GCS in the ED for A was 11.93 and 13.99 for G; Pvalue = 0.0002. Similarly, mean Revised Trauma Score (RTS) on scene for A was 7.26 and 7.55 for G; P= 0.0082. Mean Injury Severity Score (ISS) for A was 14.26 and 9.54 for G; P= 0.0001. Using GCSand ISS as severity variables, the difference in number of ICU days (A = 1.29 adjusted mean, G = 1.20) was not statistically significant (P = 0.51). Hospital length of stay (A = 5.91 adjusted mean, G = 4.71, P= 0.07) and mortality rates (A = 9.2%, G = 3%) were not statistically different. Conclusion: The group of patients transported by air is more severely injured, and their scores worsen from the scene to the ED due largely to advanced procedures. After analysis, the difference in outcomes between the two groups was not statistically significant.
13:20 COMPARISONOF AIR VS. GROUNDTRANSPORTOF CARDIACPATIENTS Kathleen S. Berns, RN, Scott P. Zietlow, MD, Daniel G. Hankins, MD Mayo Air Medical Transport Service,Mayo Medical Center, Rochester, Minn. Introduction: Transport of cardiac patients is often the mainstay of helicopter programs. Controversy continues as to whether helicopter transport is beneficial. Methods: The flight log was accessedfor a g-month period (i/98-6/98); 546 records were reviewed retrospectively for cardiac patients transported by air and requested air transports that were turned down by air and came by ground ambulance. Records were reviewed for 1) type of MI, 2) level of pain, 3) treatments en route, 4) time to intervention, and 5) length of stay. Results: 92 air and 11 ground records were reviewed. The majority of transports were for Ml, chest pain, angina, and arrhythmias. Average out of hospital transport time for air was 32 min., for ground 95 min. Assessment and treatments en route were reviewed. Air transports had a reduced number of patients with chest pain on arrival to our hospital; ground transports had an increase. 40% of air patients went to the cath lab from the ER; 59% went the same day as transport. None of the ambulance transports went from the ER, and 18% went the same day as transport. Air patients spent an average of 1.8 days in the ICU, ground 2.7 days. Air patients spent 6.3 days in the hospital, ground 6.9 days. Conclusion: A larger sample would be beneficial. From this small sample, we conclude air transport benefits the cardiac patient with more treatments performed en route, decreased chest pain on arrival, shorter time to intervention, and shortened ICU and hospital stays.
1999 18:4 Air Medical Journal
COMPARISONOF THELARYNGEALMASKAIRWAYVERSUSBLIND ENDOTRACHEAL INTUBATION IN THE SIMULATEDENTRAPPEDPATIENT JD Polk, DO, Betty Kovach, RN, Scott Russell, RN, Charlene Mancuso, RN, William Fallon, MD Metro Life Flight, MetroHealth Medical Center, Cleveland,Ohio Introduction: The purpose of this study was to evaluate and compare the laryngeal mask airway to blind endotracheal intubation in emergency airway management. Methods: 22 prehospital providers participated in this prospective study. Scene conditions with a demolished automobile and a mannequin simulating an entrapped patient were set up. After minimal instruction and demonstration on blind endotracheal and laryngeal mask airway (LMA) insertion, the students attempted to place airways with the mannequin in the upright position in the automobile while sitting or lying on the hood. Eachstudent was tested on the insertions of the two airways on first attempts. Results: The blind endotracheal tube insertion attempts had a success rate of 12/22 (55%). Of the laryngeal mask airway attempts, 22/22 (100%) were successful. Training level had no bearing on success rates. Only half of all participants, regardless of level of education or training, were successful with blind endotracheal tube placement. All participants were successful on LMA placement. Conclusion: The LMA offers an alternative airway in those patients in which entrapment makes intubation with a laryngoscope impractical or impossible.
14:15 USEOFCAPNOMETRYIN THEAIR MEDICALSEI’TINGTO MAXIMIZEVENTILATORYSTATUS C Bacon, BSN, M Addis, BA, C Corriere, MSN, D Livingston, MD, R Lavery, MA NorthSTARAir Medical and the New Jersey Trauma Center, Newark, N.J. Introduction: To examine the air medical use of capnometry (end-tidal CO2 [ETCOa])to maximize ventilatory status in intubated (ETI) patients. Methods: Retrospective review of ETI patients where ETCOzmonitoring was done looking at both relative and absolute change in ETCO,values outside therapeutic threshold (30 to 35 mmHg) and in the critical range (< 25, > 45 mmHg). Initial and final ETCOa and pulse oximetty (SpOz)measurements were collected. We defined improvement as abnormal initial ETC02values moving toward therapeutic threshold at final exam. Values that showed no change or increased/decreased beyond the critical range were considered negative. Results: 114 patients were studied (66 inter-facility,48 scene). On initial ETCOzapplication, 83 (73%) of patients had values outside of therapeutic and 39 (34%) within the critical range. 22 (19%) patients with critical ETCO*values had a “normal” SpOaof 100%. Improvement on final ETCO,was noted in 29 patients (74%) with critical values (P= 0.001) and in 53 patients (64%) outside of therapeutic (P = 0.03). Conclusion: The ability to consistently monitor and improve ETCOain the field environment shows that we have the capability to improve the ventilatory status of the intubated patient. Therefore measurement of ETCOashould become an integral part of the air medical service advanced life support system.
14:35 CABINALTITUDEPRESSURERECOMMENDATIONSAND PULSEOXIMETRY William F. Rutherford, MD, Ian Curnow, RN, Jane Wynn, RN SBAir, Dallas,Texas Introduction: Current diagnosis-based recommendations for cabin altitude pressure (RCAP) range from 2000 to 8000 feet and are untested. ExceedingRCAPmay produce physiologic compromise. Methods: 92 consecutive fixed-wing ambulance patients were reviewed for RCAP,CAP,and adverse events, including decreased SpOz.Results were analyzed using chi-square analysis. Results: Of 20 patients where CAP> RCAP,15 exceeded RCAPby 2 1000 feet. 28 patients experienced some recorded adverse event; 18 experienced a decrease in SpOz sufficient to warrant intervention. In these 18, the only intervention necessary was to increase the FIO,. Decreasein Sp02 Maintained SpOp CAPsRCAP CAP>RCAP CAP> RCAPtlOOOfeet
10 8 8
62 12 7
Conclusion: While exceeding RCAPdoes increasethe risk of a decrease in SpOz(PC 0.05) 13.9% of patients transported within current recommendations experienced desaturation, although all were easily corrected. Current recommendations for CAPare inadequate to protect all patients from desaturation. New recommendations should be based on patient-specific parameters in addition to diagnosis. Sp02 should be monitored in all patients, regardless of diagnosis. Air
1455 NO MORETEARS:THE CHALLENGEOF NEONATALAN0 PEDIATRICPAINMANAGEMENT Mary Baker, RN, BSN,Scotti Floyd Edgar, RN, BSN, Robin Swetf Newberg, RN, MSN, ACNP Introduction: Neonatal and pediatric pain management awareness has increased, but the adequacy of types of medications and treatment practices during transport essentially remains unstudied. The purpose of this study is to explore the pain management practices of critical care transport programs in neonatal and pediatric patients. Methods: Studies were mailed to 191 U.S. AAMS critical care transport programs. Program data were requested by site survey. Four case studies reflecting neonate (2) and pediatric (2) patients in pain were utilized to extrapolate information regarding current pain management practices. Results: (67 program surveys, 942 case studies) Programs surveyed transported 12,271 pediatric and 6703 neonatal transports last year. Studies were answered by EMT-Ps (6%), RNs (87%), RRTs (4%), NPs (3%), and MDs (3%). Studies reflected 91% would medicate for painful injuries/procedures. However, many drug dosages were nontherapeutic. The most common medications utilizedfor painful procedures were fentanyl, morphine, and versed for both neonate and pediatric transports. Conclusion: Results indicate that nonnarcotic/nonanalgesic medications were utilized for pain. The most common reason for eliminating pain medications was protocol limitations. Researchersrecommend 1) revisions of existing protocols, 2) further education of critical care transport team members, and 3) encouragement that neonate and pediatric patients deserve pain medication for injuries and procedures as do adults.
AIR MEDICALCREWSAFETYWALKAROUND Kevin High, RN, CFRN,EMT, Jeanne Yeatman, RN, CEN,EMT Vanderbilt LifeFlight, Vanderbilt University Medical Center, Nashville,Tenn. Introduction: There have been several incidents within the air medical industry related to poor or absent preflight aircraft and equipment checks that resulted in inflight emergencies or emergency landings. An Air Medical Crew (AMC) Safety Walk Around was implemented at our program to further enhance our safety margin. Methods: With coordination between our pilots and medical crew, a safety walk around was developed that provides a consistent, organized method of performing preflight checks of the aircraft, equipment (shore lines, tie downs, etc.), and helipad. Key areas of the aircraft (cowling/door latches, etc.) were painted with bright orange paint to highlight their location and position to staff. Results: Utilization of the safety walk around provided the AMC with an efficient, thorough, but timely method to perform preflight checks. The method of the safety walk around is reviewed quarterly with staff. Each AMC now performs its walk around prior to each flight. Conclusion: Without a specific process to perform a walk around or any preflight checks, overall safety can be compromised. We have found this process to enhance our safety margin and further instill the importance of personal attention to all the safety details of our operation.
1999 18:4 Air Medical Journal