Michael Schumacher HEMS Task

[Al Fentanyl]

A big thumbs up to the HEMS crew involved in the retrieval of retired F1 driver Michael Schumacher from the ski fields a few days ago.

Reports in the media suggest that from the time of the incident, he had Paramedics on scene within 2 minutes, a HEMS crew on scene in 8 minutes and was in hospital 10 minutes later. (if anyone can clarify those times please do)

From my perspective as a Flight Paramedic and EMS pilot, that time-frame is an outstanding example of both the positive contribution of the helicopter to minimising delays from injury to definitive care, and also of the excellent standards of clinical judgement for the clinicians who resisted the temptation to faf about at the scene but got the guy to a critical care facility in the most expeditious manner. Some of the systems in Australia could learn from this example!

Well done that team.:ok:

[Lima Oscar]

It was probably this helicopter ;)

Photos: Eurocopter EC-135T-1 Aircraft Pictures | Airliners.net (http://www.airliners.net/photo/SAF/Eurocopter-EC-135T-1/2226166/L/&sid=b9674e220bb7dfdc6926e23f6e399e44)

[Ian Corrigible]

Video here (http://www.pprune.org/rotorheads/243966-rotorheads-around-world-videos-54.html#post8240397).

I/C

[hueyracer]

Nothing special in Euro-land…

Especially in skiing-areas, the helicopters are never far away...

[206 jock]

I'm afraid I'm with Hueyracer. The only 'heroes' for me in all this are the pisteurs who got to him quickly and recognised the symptoms of brain trauma.

[malabo]

Can't tell from the photo or the video, but are there any bear paws on the skids? Done a few picks off ski hills, and when it starts to tilt back in soft snow you'll wish for that 135 fenestron.

[Lima Oscar]

This EC135 has snow skid, no bear paws ;)

[mickjoebill]

Reports in the media suggest that from the time of the incident, he had Paramedics on scene within 2 minutes, a HEMS crew on scene in 8 minutes and was in hospital 10 minutes later. (if anyone can clarify those times please do)

Is it normal practice for the helicopter shut down on a ski slope?
In the image below it is hard to be sure that the rotors are not running, the tips appear softer than the root.
For the paramedics to move across the snow make an assessment and presumably fit a neck brace then stretcher patient back to helicopter, depart scene and land at hospital all within 10 minutes is fast work.



http://i.dailymail.co.uk/i/pix/2014/01/01/article-2531537-1A5BAFF700000578-134_634x401.jpg



Mickjoebill

[Pappa Smurf]

HEMS crew on the ground in 8 minutes,then hospital 10 minutes later =18 minutes.

[rjtjrt]

Al wrote who resisted the temptation to faf about at the scene but got the guy to a critical care facility in the most expeditious manner

Well said. There can be a place for taking time, but the "scoop and run" is often a very good procedure. Amazing how time flies when dealing with a casualty, and everybody always feels what they are doing is vital to get done before moving the patient. Also a problem in the hospital casualty department (sorry, ER).

[Radgirl]

Surely the point we want to get across, assuming a common interest in promoting HEMS, is that other forms of transport would not have been possible and that the helicopter allowed the rapid provision of expert care.

I would be cautious about discussing or promoting scoop and run vs stabilise unless you were actually there and examined MS. Reports suggest a lucid period when transfer without intervention would have been ideal, but subsequent CT scans were reported as significant intracranial haematomata and in that situation elective anaesthesia on scene would have been indicated.

Sorry to go medical on a rotorheads thread, but scoop and run with an unconscious head injury is one of the few HEMS manoeuvres shown to be medically disadvantageous. We don't want an own goal

[DOUBLE BOGEY]

Rad girl - I agree with your post BUT you need someone on scene who can administer and manage an anaesthetised patient. If you do not have this your best option is clear WX and a helicopter to the nearest site that has.

DB

[skadi]

Rad girl - I agree with your post BUT you need someone on scene who can administer and manage an anaesthetised patient. If you do not have this your best option is clear WX and a helicopter to the nearest site that has.


According to some news reports they had some specialist on board, because they landed on the way to the hospital to intubate MS, obviously his condition deteriorated rapidly after the fast pickup, which is not unnormal after such head injuries.

skadi

[DOUBLE BOGEY]

Skadi intubation is a procedure that paramedics are normally authorised to perform. An anaesthetist is usually required to stabilised a serious head injury.

DB

[Al Fentanyl]

Was not actually promoting HEMS or anything else, but was acknowledging the excellent work done by this crew on this case - and by crew I include the 1st responders, the 1st paramedics, the HEMS team, the assisting bystanders, the receiving facility and all the ongoing specialist care.

I am not aware of any credible studies done anywhere in the world that show an improved outcome from unnecessary interventions on scene. The whole point of the exercise is to minimise the time between the injury and the definitive care, which for this patient was a neurosurgeon and a suitable hospital. Which is what happened. Ergo, again, well done that team. :ok:

Let's not tangent off into a esoteric discussion on the relative merits of what one system promotes by way of stabilisation against another system - or if that's of interest, take it to the Medical Forum. 'K? :)

[snchater]

I'm an anaesthetist with neurosurgical anaesthetic experience. However I would like to ask our Alpine flyers 'is it sensible to fly a predominently white helicopter in Alpine areas?'.

Safe flying

G-BHIB C182

[fly911]

because they landed on the way to the hospital to intubate MS
Why couldn't intubation be performed while airborne? Combative with brain bleed?

[902Jon]

intubation is a procedure that paramedics are normally authorised to perform.
No - a paramedic (UK) can only carry out an intubation if the patient is GCS3 - ie non responsive. An RSI requires the use of paralysing drugs that only a doctor can administer or be given under their supervision.

Why couldn't intubation be performed while airborne?

Too much noise, vibration and lack of space. A controlled RSI requires the doctor to be behind the patients head using the laryngoscope to position the tube.

[homonculus]

Getting a bit medical but

Intubation in flight is quite feasible if the aircraft is designed with the doctor at the head of the patient. However, the definitive treatment would not have been a neurosurgeon but an anaesthetist and anaesthesia. So if you are at 1000 feet over open ground it makes sense to land and intubate, if only so as to be able to lay out drugs and equipment with the certainty that they are not going to shoot off around the cabin. Once this is achieved you have bought significant time for imaging and if necessary the neurosurgeon!

[homonculus]

Getting a bit medical but

Intubation in flight is quite feasible if the aircraft is designed with the doctor at the head of the patient. However, the definitive treatment would not have been a neurosurgeon but an anaesthetist and anaesthesia. So if you are at 1000 feet over open ground it makes sense to land and intubate, if only so as to be able to lay out drugs and equipment with the certainty that they are not going to shoot off around the cabin. Once this is achieved you have bought significant time for imaging and if necessary the neurosurgeon!

It is gratifying to see a HEMS mission where it appears a life was truly saved. Lets hope the final outcome is not as bad as we fear.

[Flaxton Flyer]

If as stated it only took ten minutes to get to hospital there is no way in that time frame that the heli was landed and an RSI by a doctor using anaesthesia was undertaken. So if it was straight intubation to a low GCS patient, could that be done whilst airborne? Anyone know the crew composition / seating positions for this particular operation?

[Paracab]

The last head injured patient I dealt with that was RSId had a GCS of 3/15 but was given full anaesthesia prior to intubation; the airway was patent but needed full protection prior to transportation, although I dare say that that particular patient would have 'taken' a tube, but needed to be kept asleep for the flight, hence the drugs.

I would suggest that the layout of most HEMS cabs that I've seen would render intubation/RSI impractical if not impossible in-flight. The marked out kit dump sheet used for RSI could not be used within the confines of the aircraft either (that part of the procedure is obviously is subject massively to local variation however).

The reason that the UK HEMS model is geared towards delivering the critical care team to the scene by air followed by land transportation (predominately) is because of the difficulties of a patient deteriorating en route; it's a lot easier to pull over and deal with in a land ambulance than land a heli and deal.

In the mountains though... :uhoh:

However, as sketchy as things are, it sounds like they did a cracking job at getting him to definitive care rapidly. Kudos to that crew. Bread and butter mission? Maybe. Perhaps the overall time it took reflects that.

[birrddog]

I must say as others have said, the HEMS crews out there are pretty amazing.

Received a call in London from a friend in trouble snowboarding in France.

In short order he was picked up by helicopter after my call and vague location and medevac'd to hospital.

[HeliHenri]

.

So to clarify,

The standart crew of each HEMS in France is :

A pilot from one of the four operators doing that kind of job.

An emergency doctor from the hospital

An emergency nurse from the hospital

.

[Al Fentanyl]

Homunculus - the definitive tx for the AIRWAY may be anaesthesia & ETI, but the definitive care for the INJURY was the hospital & neurosurgeon.

Fly911 - yes, airway management is possible in flight, but usually regarded ad less than ideal; it becomes a balancing act between achieving an airway (vital) and getting to the hospital for definitive care of the injury in the absolute minimum time (equally vital). A useful compromise is the laryngeal mask airway - faster & easier applied than an endo tracheal tube, but with other shortcomings.

In brain injury it is critical to avoid hypotension, hypoxia & hypercarbia, and vital to get the bleeding / swelling & intracranial pressure controlled.

Management practices vary from country to country & even state to state inside the same country, regarding who can do what to whom and how it is done (paramedic, nurse, doctor, or any combination thereof), but the above is generally regarded as best practice.

This event appears (on the basis of the reports to date) to have been a good example of best practice.

[Exascot]

It is a pity that the French didn't act in the same manner with the late Princess of Wales. She would have almost certainly be still with us now.

[Al Fentanyl]

Exascot - I was actually going to cite that example but was unsure of how it would be viewed in the UK - but AFAIK you are absolutely correct!

[sky2000]

...he is getting well soon, but I wonder why didn´t the crew deside to got to Grenoble in the first place? It´s only about 20-25 minutes away from the scene. Just to be on the safe side.
:confused:
sky2000

[satsuma]

When you say 'the French' do you mean the entire nation of 66 million people or just the one or two people at the scene of the accident? Don't tar an entire nation with the actions of one or two people who for all you know may not have even been French and whose thought processes under intense pressure you cannot even begin to comprehend.

[Exascot]

For goodness sake Satsuma don't get your rotors in a twist. I was merely making the point that both accidents were in the same country. And, as for your comment about 'thought processes under intense pressure' - this is a 'Professional Pilots' forum most of us have been there. In my case with the very lady in question on board.

No more thread drift. Well done all involved - whatever nationality :rolleyes:

[fly911]

I've seen intubation done while I was flying and I was just wondered why it couldn't be done in some cases. All responses make a lot of sense. Thanks for explaining.

[satsuma]

Well done exascot. You must have been beaming with pride that day. No more unnecessary inflammatory xenophobic comments either please.

[triskele]

My 0.208p's worth...the most important bit is not the casualty but the safety of the aircraft. Irritable head injuries need flattening 'cos it is embarrasing to see the instrument panel being kicked to bits (single Bell many years ago). As it is a good thing to secure the airway with a tube in these anyway there is no problem. The skill was in the judgement. Do what you need on the ground so the flight was safe. My hospital was close and frequently we just scooped rotors running. Opening a box of kit on a windy mountain and seeing the contents fly off made you think if you really needed to do that. It is possible too much protocol driven training can narrow the view a bit these days but good airmed is an apprenticeship, hence judgement maketh the man.
Sorry to preach..very good posts here.