Now this is a job description!! TOP of the license for sure!!

[ventana]

 

[LT_Oneal_PAC]

Saw that. Wish I could take it.

[DarwinStarwin]

Something with the formatting of the link meeting tapatalk app on a samsung makes so i can't open the link OR copy and paste it. #forbiddenfruit

[TexasPA28]

Obviously it's a challening job.  But I have to wonder how much time are they taking away from transport to do all these advanced procedures?

There's some studies coming out showing that EMS delaying transport to do stuff like crics and cracking chests reduces survival rates.

The key question is this -- can you do RSI, U/S, crich, thoracotomy, REBOA while the helicopter is in flight?  If so, then go for it.  However my suspicion is that many of those procedures would slow down transport to the hospital and thus increase mortality, even if the practitioner is well-versed in those skills.

 

[MediMike]

2 hours ago, TexasPA28 said:

There's some studies coming out showing that EMS delaying transport to do stuff like crics and cracking chests reduces survival rates.

The key question is this -- can you do RSI, U/S, crich, thoracotomy, REBOA while the helicopter is in flight?  If so, then go for it.  However my suspicion is that many of those procedures would slow down transport to the hospital and thus increase mortality, even if the practitioner is well-versed in those skills.

 

I think if you look at the items listed, outside of U/S, they almost all fall within the realm of forced to act. If you have a patient with suspected tamponade or massive hemothorax then that individual needs a thoracotomy/thoracostomy. EMS has been RSIing for years and while the first pass success rates vary widely based on geographic regions, all in all it's a safe procedure when performed appropriately in the right situations, and oftentimes necessary because if you don't manage that airway prior to getting in flight you're going to have a hell of a time doing in en route. Same with crich, that's not something you're going to do unless you have to, definitely not an elective procedure.

These interventions should be performed prior to leaving the sending facility or on the ground and I'm sure they have a good idea of when to stay and play and when to load and go. EMS has been limited in their interventions in trauma situations, other than managing an airway, needle decompression and holding pressure there's not much they can do. With this HEMS service you are essentially bringing the resus bay to the patient. It's a model that is used in Australia, England and other countries with success in my understanding.

To touch quickly on the studies of EMS in trauma, it's kind of a tough nut to crack. There was a somewhat recent study released which showed a much higher mortality rate for ALS transports as opposed to BLS...But it also makes sense that those who are sicker are more likely to be transported ALS right? They use the ISS to determine how "sick" the patient is but that score can be skewed as it is based on anatomic regions. A score of 6 for extremity injuries receives the weight as a score of 6 for head trauma. They also looked at the city of Philadelphia which is unique in that law enforcement will just toss the patient in their cruiser and haul butt to the hospital, found that they and ALS both had worse outcomes than BLS, again bringing to mind whether it's a selection bias thing.

[kargiver]

Have to be familiar with all of these procedures as many times, when landing at critical access or other small facilities, you are performing the procedures before moving a patient.  I have run many side by side resuscitations with myself leading one and a member of a flight crew leading another.  Nature of the beast.

G