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AHCP - Intro to Clinical Considerations in Aviation Medicine

Short lecture prepared for the candidates undertaking the South African Red Cross Air Mercy Service ' Intermediate Life Support Aviation Health Care Provider' Course, May 2012
by

Ross Hofmeyr

on 1 September 2015

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Transcript of AHCP - Intro to Clinical Considerations in Aviation Medicine

Introduction


Aeromedical evacuation has revolutionized the rapid transport of patients from areas where there are no or inadequate medical care or treatment facilities.
Areas of aeromedical utilisation
Battlefield medicine
Remote/Rural areas access & outreach
Long-distance interfacility transfers
Rapid transport
Rescue

Rotor-wing
Fixed-wing

Primary - initial response
Secondary - scene to facility transport
Tertiary - interfacility transport
Quarternary - international repatriation
Weight limitation
Weight and size limitations
Stretchers max. 136kg.
Must be able to strap patients in.
Baggage limitations
Weight distribution affects aircraft center of gravity.
Criteria for flight
Access to patient
Distance from care
Severity of the condition
Cost factor
Helicopter R15800/hr
Fixed wing R35/km
Costs reduced by decreasing the number of ambulances required for long-distance transfers
Additional information required to make the decision for aeromedical transfer as opposed to ground transfer
Flight Authorisation
Metro Doctor on call gives Provincial Authorization

Medical Aid Service provider Doctor gives authorization

Receiving facility must be confirmed
Medical Considerations
Patient must be "sufficiently sick"
Benefit of doubt vs. changing death certificate
Airway protected/secure
"Ventilatory leeway"
Air-filled cuffs must be inflated with sterile
saline
No T-piece oxygenation
Appropriately sedated, paralysed and intubated
Patients at risk of developing pressure sores or requiring spinal immobilisation should be packaged on a vacuum mattress
Catheters, NGTs, analgesia, extended duration antibiotics
Consider liberal use of fasciotomies / escharotomies
Wounds dressed for delayed primary closure
Reduce risk of aircraft contamination from blood
Fresh casts (<48 hours) must be bi-valved – or use backslab
Consider a cabin altitude restriction for the following
Penetrating eye injuries with intraocular air
Free air in any body cavity
Severe pulmonary disease
Decompression sickness and arterial gas embolism
Patient packaging
Patient’s IV lines, drainage devices, tubes are secured, accessible and patent
2nd IV line is preferable (Stable patients should at least have a heplock)
Syringe drivers and infusion pumps are recommended for each line
No toilet facilities on board – all stretcher patients to have a catheter
No glass bottles - Chest drains to have Heimlich valves or plastic bottles
No air splints
Ostomy patients: Vent collection bags to avoid excess gas dislodging the bag
Hearing protection
Plan for cabin temperature changes
Critical Initial Information
Detailed patient information and vital signs
Hb >8
Weight of the patient
Is the patient scared of flying?
No conscious psychiatric patients
Equipment required
Infusions
Pressure care (Vacuum mattress)
Monitoring
Incubator
Dr Ross Hofmeyr
MBChB (Stell) DipPEC (SA) DA (SA) MMed (Anaes)(UCT) FCA(SA)
ross@wildmedix.com
Aviation Health Care Providers Course
Full transcript