Defibrillator use in flight
 

I'm chasing info on defibrillator use in EMS machines. Anyone in the industry got any experience with heart starters while in flight?

I'm starting from scratch, so don't be shy: is it a good/bad idea, and if it can be done what precautions should accompany the practice?

Thanks in advance.

You should post this one on the military forum as the UK SAR force I believe carry them on board.

I know that they have been used on airlines - I presume without any problems. I have used them in aircraft on the ground, but not in flight.

The risks I can think of are:

Unable to insulate the patient from the airframe - ambulance stretchers have rubber wheels.

Risk of operator contact with the patient during defibrillation.

If I recall correctly a 200J shock is about 4700 volts...

Reef Rat.
Try asking the same question on the bulletin board at www.sarworld.com
If you PM me some more details I will post the question myself.
The RAF SAR Force have been using a Zol defibrillator on their Sea King HAR MK3 and Mk3A for some time now without any problems.

Defibrillators can be used in flight without causing disasters provided a few factors are considered. In my five or so years as a flight physician I only had to do it once.

Factors:
Equipment usability/efficacy
Safety of Patient
Safety of Crew

Equipment:
Two basic types of defibrillator - Manual operated and automatic (and versions which have both modes)

Automatic ones (the types that are found now in airliners, shopping centres etc can have problems sensing the rhythm because of vibration of aircraft etc. They may then either fire inappropriately or not fire when needed. This is because the rhythm which is the prime shockable rhythm is one which looks like a coarse wavy line on the ECG, just what vibration can induce in the leads if the contacts are not really good.
Poor contact and vibration may also cause the sensor error trapping routines of the microprocessor to not allow it to fire.
The manual ones don't have that problem. Press the buttons and it fires regardless. Problem is that your ECG from which you diagnose whether a shock is appropriate may be unusable because of same vibrations as discussed above.
But at least if you have all the other signs of cardiac arrest then it can be given on spec, as probably would be appropriate anyway.

Patient Safety:
If you don't have good contact with skin and moreso if you have to use multiple shocks patients can get burns from pads/paddles.
Getting a good contact is a bit more of a problem in the confines of a helicopter so it's a consideration.

Crew/Aircraft Safety:
It is absolutely true that if anyone else is in contact with the patient or pads/paddles etc then they will get a shock as well if there's a path through them to earth. I have seen a nurse get a bolt that threw him six feet up against the wall in our ICU when he contacted the paddles via conducting gel that he had on his hands (we used to use gel from a squeeze tube but now we have sticky gel pads so that problem isn't so bad) But if it happened in an aircraft there probably isn't a path to earth so I suspect it may not happen. However the answer is to judiciously insulate the patient from the aircraft and crew. Most times we had them off the floor on a plastic stretcher with plastic/foam padding, with cotton sheets and blankets etc which is enough to insulate them. If there is no other pathway the current can take it goes from one paddle to the other a distance of less than a foot in a fairly direct line with some rapid attenuation outwards.

Our SOPs were to treat the defib just as you would in the ICU/ward. Insulate and separate the patient, call "all clear" and press the buttons.



Dr. John Martin
Specialist Anaesthetist
Flight Physician (Retired)
Cairns Base Hospital/Qld Rescue Helicopter Service

Have had defibrillators used a few times in flight without any problems (S76A).

Isn't a problem, there is a EUROCOPTER paper some years ago. But the paper investigated only the use of Defibrillators onboard the older ships like BO 105 and BK 117 (up to C1) and no problem was detected. Meanwhile we have the first EC papers of equipment failure up to FADEC problems due to the use of GSM phones (suspect). On the newer "space ships" i wouldn't recommend the use of Defibrillators.

CQRESQ
 

I think CQRESQ in Queensland (Mackay) have a defrib machine in their helo (B407).

Not sure if it has been used in "anger"

The RFDS QLd have defibs in their B200's. The units use their own power (portable, I can check though). The patients use Lifeport/stretchers.

I dont think there is any extra bonding or insulation on the lifeports.

We use a Laerdal Heartstart FR2 on our EC135, but we use pads not paddles to hot wire the patient:\

Use on ones self while flying is discouraged. If you really need it, perhaps your doc shouldn't be renewing your ticket!

There's a dozen S76A's flying around Ontario, Canada using them on a regular basis. I flew with one for eight years and never had a problem with it's use.

We used them when I was flying in the U.S. Army doing MEDEVAC's with our UH-1V and never had any problems.

We have a Lifepack 12 fitted to our old Bolkow 105. It has been cleared for use in the air, although we haven't had to use it in the past 3 years

Reef rat

You may already have the answer to your question on use of Defibs in flight. I have personaly used several diffrent types of Defibs in flight and have never had a problem. We do asked that the pilot is informed prior to the discharge of the machine. Defibs like the LifePac 10 and 12 are certified for use in aircraft.:ok:

From the Count

ReefRat, as Spot 4 said, we use the Zoll defib on UK RAF SAR aircraft (Sea King). To date there have been no known problems either using them for real or when airborne resuss training but the winchman will always check with the pilots before zapping the casualty.

There was a recent (very rare) event in Connecticut (USA) where a spark from a Defibrillator caused a fire on the patient in an ambulance. This event would certainly be a concern in the confined area of a rotorcraft with a potentially oxygen rich environment around the patient. Perhaps procedures developed for use in flight could address (reduce) chance of sparking.

Details of the event are at the following links:

EMS Network

http://www.cnn.com/TRANSCRIPTS/0401/29/lol.02.html

Thanks all for the replies, they have been a help so far. I'll narrow the inquiry to wonder what the effects might be to EFIS equipped aircraft in IMC?

RR,

You will find a number of examples of EFIS aircraft in Oz that used defib. No known probles that I am aware of, no flight manual supplement restricting their use.

Every PC12 in oz used for Medivac is EFIS, and most of the B200s in the SE and WA parts of Oz used for medivac are EFIS.

The engineering managers of such organisations are normally more than happy to talk to people about their gear.

I work as a HEMS paramedic here in the UK on a Bolkow 105 and we carry a Medtronic (Physio Control) Lifepack 12 defibrillator which can be used in flight.

Although the Bolkow is not EFIS, many of our colleagues across the country use EC135's and use similar equiment.

The pilot would abviously be informed if shocks were going to be delivered, oxygen is supposed to be turned off (whenever you shock) and other common sense precautions taken.

Hope this helps somewhat.

(I'm new to this site and was trailing through past threads as I'm bored on nights!!!)