Best of Med Flight

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Best of Med Flight
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Landing Zone Preparation Communications

• Why is this so important?

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Undesignated / Spontaneous LZs

• High risk espc at night
• Obstacles on approach Wires Cell Towers
• Ground hazards signs, poles debris
• LZ security people vehicles
• How well was it scouted out we are 100
  dependent on your eyes

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Alternate LZs.You dont have to land the
helicopter exactly at the accident scene

• Thats why God put wheels on the ambulance

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Designated LZs
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Communication

• MF dispatch 608-263-3258
• Your county 911 dispatch
• Cell contact on scene

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Initial Info

• Location street and cross street
• Relationship to city, well known landmark
• Contact agency
• Cell contact on scene
• Contact frequency Typically Marc 2
• Incident type and basic patient info
• Do you need more than 1 helicopter?

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Radio contact

• MARC 2
• 5-10 minutes out
• Use vehicle radios handheld have limited range
• Our 1 interest LZ information
• VERY brief patient update

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What to do if no radio contact ?
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Common LZ Problems

• Personnel marking the LZ
• Personnel approaching aircraft before blades stop
  turning
• LZ security once helicopter lands
• LZ has to be secured 5 minutes prior to landing
  until 2 minutes after takeoff
• No vehicle, regardless of height within 50 ft of
  aircraft. Especially ambulances

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Brownout / Whiteout
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Large Patients

• Im not afraid of heights
• Im afraid of widths

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Meanwhile in Germany
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A Slippery Slope..

• Car 1 looses control on ice at highway speeds
• Collides with car 2. Both go over 30 degree
  embankment
• Car 1 slides sideways, impacts tree into drivers
  door
• Car 2 T-bones Car 1 into passenger side

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• 2 occupants of car 2 self extricate minor
  injuries
• EMS arrives Extensive damage toCar 1. Driver is
  obviously pinned. Talking but confused
• Walmart parking lot 200 yrds from scene
• Med Flight called Landed within 15 minutes

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• Significant intrusion on both passenger and
  driver doors
• Pt alert, confused, slightly agitated. Pinned by
  legs
• Complaining of chest/abd pain
• Collar placed. IV established, O2
• Initial VS 150/80 100 18

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Wisconsin EMS Rule 11a

• If it is Saturday night and you respond to an
  accident scene after 10pm and do not find a
  drunk-
• Keep looking because you are missing a patient

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CAR 2
CAR 1
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Initial Approach

• Car 2 winched up towards highway exposing
  passenger side of Car 1
• Plan is to remove passenger door and top

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Additional support personnel beamed down from
the Enterprise
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The concept of Holding the C-Spine
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Passenger side is no go

• Now at 50 minutes post incident
• Outside temp 35 F
• Patient becoming more agitated-yelling
• BP dropping 100/70
• Lets hold things for a minute..

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Medical Interventions

• Given Ketamine 50 mg IVP
• IO placed in L humeral head
• Concern re internal bleeding TXA
• Started PRBCs

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• Pt BP improves slightly
• Dissociated state protecting airway
• T 50 mins Tree cut away
• Top removed
• Pt starts to vomit and vomit and vomit

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EMS rules regarding vomit

• The volume of vomit always exceeds the size of
  the container be a factor of 2
• Standard suction is useless for Saturday night
  puke ( consists of McNuggets partially chewed
  burritos pressurized by a pitcher of Milwaukee's
  Best) you need a shop vac
• Always point the pt at the person you like least

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Tailoring the Extrication (speed/spinal
precautions) to the patients condition
environmental issues
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Situation a little more urgent

• Pt quickly put in a KED
• Lifted out put on long board
• Transferred to ambulance

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Why dont you just put him in the helicopter and
go?
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In the Ambulance

• Initial GCS 13 now 7
• Pt intubated using Glidescope
• Given 2 units of PRBCs
• 10 minute flight
• To the trauma bay.

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In The Emergency Dept

• BP 90-100 systolic
• Labs hgb 8.5 Etoh 0.19
• FAST exam with ultrasound positive
• CT scan of head/neck negative
• CT Scan of abd/pelvis extensive splenic
  laceration

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What is a FAST exam?Focused Assessment by
Sonography for Trauma
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Taken to the OR

• Uneventful splenectomy
• Transfused total of 4 units PRBCs
• Discharged to home POD 5

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Case 3
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16 y/o healthy female

• Alone in the lap pool at waterpark
• Found unresponsive in 4 ft of water
• Immediately picked up on security video
• Submerged 3-4 mins MAX
• Park EMTs pull her from water, no pulse
• 911 called
• Start CPR, AED applied, shock advised
• Immobilized, C-collar

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We have a pulse

• Local paramedic service arrives
• VS 110/60 HR 120 irreg
• Bagged on 100 O2 sats 85
• No evidence of trauma
• Frothy sputum, bilat rales
• GCS 6-7 Pupils 4-5mm reactive
• IVs x 2

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Prior to MF

• Pt intubated, high airway pressures
• Freq suctioning,
• 12 lead freq multifocal PVCs, no STEMI
• MF lands at hospital helipad as ambulance arrives

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Handoff

• Vital signs and Neuro status unchanged
• Pt sedated, paralyzed put on ventilator
• What is the history again??

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• Uneventful flight Home
• Handoff to ED
• Evaluated in ED head CT NL
• CXR pulmonary edema
• Most labs and studies c/w drowning
• Admitted to PICU
• Its just another tragic drowning..

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Whats the history again?

• 16 y/o healthy 5 7
• No etoh, drugs, trauma
• Lap pool is 4 deep
• Call to the water park Can you pull the
  security videos?
• What about the initial AED?

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Torsades de Pointes

• Polymorphic Ventricular Tachycardia
• Caused by
• Congenital mutation of cardiac electrical system
• Electrolyte abnormalities
• Drugs

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Radically changes treatment

• Not just a drowning
• Its a drowning caused by syncope caused by
  cardiac arrhythmia
• Drowning similar to geriatric falls- What caused
  it? Primary vs secondary

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Secondary Drowning

• Trauma / CHI
• Seizure
• Drugs/ETOH
• Cardiac Syncope
• Hot Tub issues

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ICU Course

• Aggressive pulmonary support
• No electrolyte abnormalities
• Neuro status improved quickly
• Extubated on day 4
• No neuro deficits
• Cardiology consult

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Electrophysiology Studies - EPS
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Found to be at high risk for malignant
arrhythmias

• Next Step

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AICD Automatic Internal Cardiac Defibrillator
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Discharged to home

• No Meds
• Normal activities
• No restrictions

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In closing, Just two words
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Altruism
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Awesome
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This is the official You Are Awesome
notification from the UW Emergency Care
Conference staff indicating how awesome you
actually are
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Fini . .
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_at_FLTDOC1 ma2_at_medicine.wisc.edu