2 page APA article review on helicopter and patient safety due today
airmedic11
Hemssafety.pdf
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Transportation of Patients: Air Medical -- Maintaining Patient Safety Caple C, RN, BSN, MSHS; Woten M, RN, BSN Cinahl Information Systems, Glendale, CA Pravikoff D, RN, PhD, FAAN CINAHL Nursing Guide EBSCO Publishing, (Ipswich, Massachusetts), 2018 Apr 06. Nursing Practice and Skill - CEU English Aeromedical Transport Patient Safety Risk Management Critical Care; Education, Continuing (Credit); Nursing Role; Patient Education Flight Nursing Transportation of Patients: Air Medical -- Maintaining Patient Safety--CE Module 20100129 04/06/2018 T704597 Nursing Reference Center Plus
Nursing Practice and Skill
Transportation of Patients: Air Medical -- Maintaining Patient Safety
By: Carita Caple, RN, BSN, MSHS Cinahl Information Systems, Glendale, CA Mary Woten, RN, BSN Cinahl Information Systems, Glendale, CA Edited by: Diane Pravikoff, RN, PhD, FAAN Cinahl Information Systems, Glendale, CA
Link to Skill Competency Checklist
Link to Interactive Skill Competency Checklist
What is Air Medical Transportation?
Air medical transportation (AMT) refers to the transfer of a critically ill patient by helicopter—or less commonly,by airplane—to a healthcare facility that is appropriate to the level of care the patient needs (e.g., transfer to a Level I trauma center or a burn center). AMT is utilized by patients of all age groups (e.g., neonates, children, adolescents, adults, and older adults) who have a variety of severe and/or life- threatening conditions (e.g., patients requiring resuscitation, pregnant women with obstetric emergencies, preterm neonates) or injuries (e.g., patients who have severe trauma or burn injury)
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What: AMT involves the use of an aircraft that is equipped with medical supplies, advanced medical equipment (e.g., transport ventilators, quantitative end-tidal CO monitors), and clinicians who are specially trained in the care of critically ill patients who require air transport. The patient receives intensive emergency care and monitoring to maintain safety while onboard until he/she is transferred to the care of clinicians in the receiving facility. AMT can also involve evacuating patients from international sites following illness or injury
How: The AMT aircraft is flown with its crew to the site of an accident for emergency field evacuation of critically injured trauma victims or to a healthcare facility for interfacility transfer of a critically ill or injured patient to a healthcare facility that is equipped to provide the level of care the patient needs. Correct use of equipment, heightened patient monitoring, and strict adherence to protocols for patient care and aircraft safety are required during AMT to maintain safety of the patient
Where: AMT is used in both rural and urban areas
Who: Pilots, paramedics, respiratory therapists, and critical care nurses who have been specially trained in AMT serve as the crew during flights. Emergency care nurses are often responsible for arranging AMT and for deciding whether AMT or ground transportation will be utilized
What is the Desired Outcome of Air Medical Transportation?
The desired outcome of AMT is to safely transport critically ill or injured patients to specialty care centers using the most rapid means of transportation
Why is Maintaining Patient Safety During Air Medical Transportation Important?
Maintaining patient safety—including maintaining respiratory and hemodynamic stability—while receiving the patient, transferring the patient to and from the stretcher and the aircraft, during flight, and while transferring the patient to the receiving facility is important because it improves the chances of patient survival and optimal outcome
Facts and Figures
According to the Association of Air Medical Services (AAMS), 54% of AMT services are provided for interfacility transfer, 33% for field evacuation of critically injured patients, and 13% for other transportation needs, including transport of donated organs (AAMS, 2015)
Researchers who analyzed data on fixed-wing medical transport incidents from the National Transportation Safety Board Aviation Accident Incident Database found that rates of fatal outcomes (35.6% vs. 19.7%), aircraft fires (20.3% vs. 10.5%), and on-ground collisions (5.1% vs. 2.0%) were significantly higher with medical flights compared with commercial flights (Handel et al., 2011)
In a 2011 analysis of 98 requests for urgent or emergency interfacility AMT, investigators found that 42% contained at least one communication error. Eleven of the 65 total errors were classified as major; examples of major errors included incorrect diagnosis, failure to record that patients were intubated or required mechanical ventilation, and recording “no drug allergies” when a drug allergy was present (Vilensky et al., 2011)
In a study of the physical stressors of neonates during emergency transfer, researchers found that compared with ground ambulance, helicopter transport produces higher-level noise but more stable whole
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body dynamic exposure, and ambulance transport was associated with more dynamic effects related to braking, shock, and impulsive noise (Bouchut et al., 2011)
The authors of a literature review on risk factors in air transport found multiple disadvantages of air transport for patients, including stress during flight, oxygen concentration reduction that can worsen hypoxia, reduction in barometric pressure, cooler temperature, moisture reduction that potentially increased risk for dehydration, noise, excessive vibration, acceleration forces, and fatigue (Intas et al., 2013)
The U.S. Centers for Disease Control and Prevention (CDC) have developed guidelines specific to AMT of patients with Ebola. These guidelines are intended to promote the safety of patients as well as healthcare personnel, and are available at https://www-cdc-gov.chamberlainuniversity.idm.oclc.org/vhf/ebola/healthcare- us/emergency-services/air-medical-transport.html
A multidisciplinary panel attempting to develop evidence-based guidelines regarding the use of helicopter emergency medical services (HEMS) to transport critically injured trauma patients determined that there was insufficient evidence regarding the risks and benefits of HEMS to develop conclusive guidelines. The panel recommended that if the patient is assessed as being severely injured according to the 2011 CDC guidelines for field triage of injured patients, the patient should be transported using HEMS; in all other cases, the patient should be transported using ground emergency medical services (GEMS) as available (Thomas et al., 2014)
What You Need to Know Before Maintaining Patient Safety During Air Medical Transportation
Use of AMT depends on its availability, weather conditions, location, distance to destination, and cargo weight
Specialty care centers can house AMT aircraft and personnel, or services can be contracted through a local AMT company
Weather conditions can prohibit flight (e.g., low cloud cover, high winds, fog, lightning)
Accident scenes in mountainous terrain, heavily vegetated terrain, or congested urban areas can impede finding a safe landing area for AMT aircraft
The combined weight of the pilot, crew, patient, and equipment must be considered because of the maximum lift capacity of the aircraft; additional strategies might need to be initiated to reduce cargo load when carrying a patient who requires a larger, heavier stretcher or a patient whose weight exceeds 350 pounds
An AMT helicopter can travel a maximum distance of 250 kilometers (155 miles); longer flights require use of a fixed-winged aircraft
The level of care that is administered during AMT requires heightened monitoring and strict adherence to patient safety protocols
AMT crew members must be competent in providing various levels of care during AMT, as follows: Basic life support (BLS): The patient requires monitoring but minimal external life support
Advanced Cardiac Life Support (ACLS): The patient requires BLS functions as well as cardiac defibrillation, resuscitation, blood and drug administration, and/or intubation
Critical care: BLS and ACLS functions are required as well as the performance of critical care procedures such as chest decompression by needle or tube thoracostomy, central line placement, and portable point-of-care laboratory testing (e.g., using the I-stat handheld blood analyzer)
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Care given during AMT is often more quantitative and invasive than care that is given during ground ambulance transport, and AMT aircraft must be fully stocked with emergency medical supplies and control-tested equipment
Invasive procedures (e.g., thoracostomy, endotracheal intubation, central line placement, pericardiocentesis) and administration of blood products and antibiotics are common during AMT
Because a helicopter cabin is not pressurized, gases in the cabin expand during flight at normal altitudes of 7,000–8,000 feet. Patients with pneumothorax require thoracostomy prior to flight to avoid expansion of the pneumothorax caused by the higher altitude
AMT clinicians are capable of administering nearly 60 types of medication compared with ambulance personnel, who are capable of administering about 20 types of medication
Point-of-care laboratory kits are used during AMT to analyze blood gases, chemistry values, and hemoglobin and hematocrit
Both the AMT crew transporting the patient and the healthcare team receiving the patient should have protocols regarding patient handoff; these protocols should include requiring education about optimal communication during handoff for all team members
Preliminary steps that should be performed before initiating and maintaining patient safety during AMT include the following:
Review facility protocols for AMT, including those on medication administration, blood administration, resuscitation, invasive procedures, stretcher use, and electronic monitoring
Review the treating clinician orders for AMT, if available AMT can be requested by physicians, nurses, pre-hospital emergency care personnel, and law enforcement
Review the list of facility-required supplies for AMT and verify that the AMT aircraft is properly stocked, which typically includes the following:
Stretcher and mattress Verify that the stretcher has no broken, missing, or malfunctioning parts
Stabilization equipment: cervical spine collars, fracture immobilizers, wrist and ankle restraints
Vital sign equipment: electronic blood pressure monitor, thermometer, stethoscopes
Cardiovascular equipment: EKG and telemetry, electrodes, defibrillator with pads, external cardiac pacemaker, intra-aortic balloon pump, Doppler ultrasound
Ventilation and airway equipment: portable oxygen tanks, regulator, nasal cannula, bag-valve-mask system, intubation equipment, endotracheal tubes, oropharyngeal airways, tracheotomy kit, suction device with catheters and drainage collection unit, jaw wire cutter, capnography (CO2) monitor and pulse oximeter, nebulizer, airframe-compatible ventilator, continuous positive airway pressure (CPAP) system
Vascular access/invasive equipment: intravenous needles and tubing, syringes, multi-channel infusion device, intravenous fluid warmer, intraosseous needles, intravenous fluids, surgical kit, sharps disposal system, point-of-care laboratory kit, nasogastric tubes
Wound treatment supplies: bandages and dressings, cleaning and disinfection solutions
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Pediatric equipment: infant incubator with ventilator, infant delivery kit, fetal Doppler monitor, neonatal resuscitation kit
Obstetric equipment: prenatal monitoring equipment
Personal protective equipment/infection control: gloves, protective eyewear, masks, earplugs, waterless hand cleanser, biohazard bags, sharps container
Medication kit containing drugs for resuscitation, anxiety, air-sickness, infection control, and condition- specific treatment (e.g., thrombolytics, paralytics)
Refrigerated packed red blood cells
Battery packs for all electronic equipment (e.g., defibrillator, ventilator) and power inverter for use of the aircraft as a power source
Survival equipment: nutrition and hydration supplies, survival gear, satellite telephone, reference materials
Bedpan, urinal, emesis basin, and hygiene supplies
Sheets, pillows, and towels
Documentation supplies
Verify that electronic equipment has been quality control checked within the last 24 hours, and check expiration dates on medications, intravenous fluids, and blood products
Verify that all AMT crew members are available and that weather conditions are favorable
How to Maintain Patient Safety During Air Medical Transportation
Identify the patient using at least two unique identifiers according to facility protocol
Obtain written consent for AMT from the patient, if alert, or from a family member, if present
Obtain information related to the patient’s age, weight, medical diagnosis or injuries, level of consciousness, medications, and available health history and allergies prior to patient transfer
Obtain copies of medical records and the results of laboratory and other diagnostic tests that were performed, as available
To transfer the patient to and from the AMT aircraft via stretcher, secure all lines, tubes, and equipment and utilize 2–3 personnel to secure the patient to the stretcher using safety belts; adjust the height of the stretcher, as needed, and maintain control of the stretcher during movement
Combative or violent patients might require sedation as well as neuromuscular blockade (if mechanically ventilated) prior to and during transport to promote safety of the patient and transport crew
Determine if a family member can travel with the patient and prepare the family member for transport or provide the family member with directions to the receiving facility
During AMT, remain seated with shoulder harness fastened when not attending the patient, and encourage others to do the same; provide appropriate patient care based on medical diagnosis/injury
Monitor vital signs; assess all physiologic systems; maintain airway, breathing and circulation; and apply age-appropriate resuscitation techniques, if needed. Maintain continuous use of electronic monitoring equipment (e.g., telemetry, blood pressure monitor, pulse oximetry)
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If trauma is present or suspected, maintain use of a cervical collar and splinting of wounded extremities, control bleeding with application of pressure to wounds, and provide wound care (e.g., cleaning, dressing)
Administer medications and blood products, and implement invasive treatment (e.g., thoracostomy, intubation, pericardiocentesis) as needed; maintain aseptic technique while performing sterile procedures (e.g., central line placement)
Monitor for pain throughout transport and for complications of air travel, including nausea and anxiety; medicate for complications according to facility protocol
Verify that all nonessential equipment is secured to prevent injury to the patient and transport crew
On arrival at the receiving facility, hand off the patient to the appropriate healthcare personnel according to standard protocol
Provide a thorough report regarding the patient’s care and condition Information should be reported clearly and without distraction, and should be accompanied by written copies of the patient’s medical record, results of all laboratory and other diagnostic tests performed, and documentation of all care that has been provided at the referring facility and during AMT
Update the patient’s plan of care, as appropriate, and document the following information in the patient’s medical record:
Date and time of patient transport and mode of transportation
Time of patient arrival and names of receiving facility and clinician
Patient assessment findings during transport such as vital signs
level of consciousness
cardiorespiratory status
pain level before, during, and after AMT
patient’s tolerance of AMT
Interventions performed during AMT and patient outcomes
Any unexpected patient events, interventions performed, whether or not the treating clinician was notified, and patient outcome
All patient/family member education that was provided, including topics presented, response to education, plan for follow-up education, barriers to communication and learning, and techniques that promoted successful communication and learning
Other Tests, Treatments, or Procedures That May Be Necessary Before or After Air Medical Transportation
Prior to interfacility AMT, the patient might require diagnostic testing and stabilization procedures (e.g., I.V. fluid administration, administration of antiplatelet therapy, suturing of wounds)
What to Expect After Air Medical Transportation
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The patient’s hemodynamic stability will be maintained and the patient will be effectively handed off to healthcare personnel at a specialty care center
Red Flags
Many adverse events associated with AMT are related to improper stretcher use or to the use of broken, missing, or malfunctioning stretcher parts; resulting injuries can be sustained by the patient and by emergency personnel
AMT flights that are conducted at night and during inclement weather are at highest risk for crashing; nurses arranging AMT or working on an AMT crew can reduce the risk of crash-related injury and death
Note weather conditions in the field, including at the sending and receiving facilities
Avoid “helicopter shopping,” or placing requests to multiple AMT units to find a unit that will accept a flight when other units have declined because of inclement weather
Do not participate in AMT that you believe cannot be accomplished safely
What Do I Need to Tell the Patient/Patient’s Family?
Provide information about AMT and the indications for AMT
Inform family members that they cannot travel with the patient during AMT by helicopter if there are space limitations; a family member is usually able to accompany the patient during AMT using larger aircraft
Reassure family members that AMT flights are extensively equipped with medical equipment and are staffed with critical care specialists to provide safe and effective treatment during flight
Note
Recent review of the literature has found no updated research evidence on this topic since previous publication on April 29, 2016
References 1. Air Medical Physician Association (AMPA) Board of Trustees. (2012, January 9). Safe handoff of care in air/ground medical transport: Position statement of the Air Medical Physician Association. Retrieved March 29, 2018, from https://www.ampa.org/wp-content/uploads/2016/05/Safe-Handoff-of-Care-in-Air2.pdf (GI)
2. Association of Air Medical Services. (2015). Fact sheet and FAQs. Retrieved March 29, 2018, from http://aams.org/member-services/fact-sheet-faqs/ (GI)
3. Bouchut, J. -C., Van Lancker, E., Chritin, V., & Gueugniaud, P. -Y. (2011). Physical stressors during neonatal transport: Helicopter compared with ground ambulance. Air Medical Journal, 30(3), 134-139. doi:10.1016/j.amj.2010.11.001 (R)
4. Centers for Disease Control and Prevention. (2015, January 27). Guidance on air medical transport of patients with Ebola virus disease (EBV). Retrieved March 29, 2018, from http://www.cdc.gov.chamberlainuniversity.idm.oclc.org/vhf/ebola/hcp/guidance-air-medical-transport- patients.html (G)
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5. Greenwood, M. J. (2009). Helicopter shopping and the interfacility transfer of patients. ED Legal Letter, 20(7), 78-80. Retrieved from https://www-ahcmedia-com.chamberlainuniversity.idm.oclc.org/articles/113744- special-report-helicopter-shopping-and-the-interfacility-transfer-of-patients (GI)
6. Handel, D. A., & Yackel, T. R. (2011). Fixed-wing medical transport crashes: Characteristics associated with fatal outcomes. Air Medical Journal, 30(3), 149-152. doi:10.1016/j.amj.2010.11.007 (R)
7. Intas, G., & Stergiannis, P. (2013). Risk factors in air transport for patients. Health Science Journal, 7(1), 11- 17. Retrieved from http://www.hsj.gr/medicine/risk-factors-in-air-transport-for-patients.pdf (SR)
8. Thomas, S. H., Brown, K. M., Oliver, Z. J., Spaite, D. W., Lawner, B. J., Sahni, R., ... Lang, E. S. (2014). An evidence-based guideline for the air medical transportation of prehospital trauma patients. Prehospital Emergency Care, 18(Suppl. 1), 35-44. doi:10.3109/10903127.844872 (G)
9. Vilensky, D., & MacDonald, R. D. (2011). Communication errors in dispatch of air medical transport. Prehospital Emergency Care, 15(1), 39-43. doi:10.3109/10903127.2010.519817 (R)
10. Worley, G. H., St Mars, T., & Valdez, A. M. (2009). Helicopter air medical transport safety: What is the role of the emergency nurse? JEN: Journal of Emergency Nursing, 35(2), 152-153. doi:10.1016/j.jen.2008.11.007 (GI)
Reviewer(s) Eliza Schub, RN, BSN, Cinahl Information Systems, Glendale, CA
Lee Allen, RN, MS, Glendale Adventist Medical Center, Glendale, CA
Nursing Practice Council, Glendale Adventist Medical Center, Glendale, CA
Original document: 2010 Jan 29
Latest revision: 2018 Apr 06
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