Air Ambulance Orientation
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CANADIAN HELICOPTERSOrngeEMS AIR AMBULANCE Transport Medicine AIR AMBULANCE Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Goals for Today • Introductions • Who are we, and why we are here Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Goals for Today • • • • 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 • • 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 • • • 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 • 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 • • 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 • • • OAABHP-Base Hospital MATC CHL EMS Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance OAABHP - Base Hospital • • • • • Training Certification Defining Scope of Practice Medical Direction Quality Improvement Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Base Hospital - Training • • Distance Education Human Patient Simulator Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Base Hospital - Training • • • • 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 • PCP (F) • EMCA • Aeromedical Course • SR / SAED Course • CME Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Base Hospital - Training • ACP(F) • PCP(F) plus • ACP(F) course • CME Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Base Hospital - Training • CCP (F) • ACP (F) plus: • CCP (F) course • CME Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Base Hospital Certification • • • • Oral Board OSCE CME Flight Rounds Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Base Hospital Scope of Practice • 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) • • • • • • • • • • 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) • • • • pressure control mechanical ventilation, transvenous pacing, invasive pressure monitoring (arterial and PA catheters), CCP (F) medications, Intraaortic Balloon Pump Critical care obstetrics and Neonates • Plus everything else on previous slides • Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Base Hospital Medical Direction • • • • 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 • • • • 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 • • 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? • 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 • 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 • 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 • 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 • 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 • 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 • 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 • • • 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 • • 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 • • • 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 • Airport / heliport procedures • Where to park • Required equipment Canadian Helicopters EMS Introduction to Air Ambulance Ontario’s Air Ambulance Aeromedical Physiology Effects of flight • • • • • • • 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 • 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 • 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 • 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 • 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 • 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 • • • 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.
