Michael Schumacher HEMS Task
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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?
Nice
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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...
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.
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...
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.
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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.
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.
.
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
.
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
.
Thread Starter
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.
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.
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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.
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I hope....
...he is getting well soon, but I wonder why didnīt the crew deside to got to Grenoble in the first place? Itīs only about 20-25 minutes away from the scene. Just to be on the safe side.
sky2000
sky2000
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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.
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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
No more thread drift. Well done all involved - whatever nationality
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Inflight intubation
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.
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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.
Sorry to preach..very good posts here.
