When you are in the air ambulance industry, it is natural that you come across different cases and incidents on a daily basis. You may often have to be part of missions in which the patient has been in a critical accident and is suffering from a serious injury. In such cases, there is a huge chance that they are suffering from a wound that is bleeding heavily. This makes it crucial for you stay updated with tips on how you can pack such wounds and provide better medical flight service and effective care for such patients.
Key Wound-Packing Tips for Medical Flight Paramedics
Take a look at the following useful tips in order to better improve how you pack wounds that are bleeding severely:
- Direct pressure – Applying direct pressure on the wound is the first step you will need to carry out. You can use a gauze, rag, hand, knee, or whatever is available to stem the flow as you prepare your supplies.
- Pushing in the wound – Now the next step is to push hard in the wound using your hand or finger so you can stop the bleeding.
- Proper packing – One of the most crucial steps for medical flight paramedics is to pack gauze (plain or hemostatic) into the wound. Keep doing this until no more gauze can go in.
- More pressure – Once you’re done with this step, apply firm pressure against the wound for about three minutes. This combined effort of wound packing and firm pressure usually does the trick to stop the bleeding.
After this, you will need to reassess the wound and see if the bleeding has stopped. If it has, you can then begin the transportation process but if it hasn’t, you will need to repeat the process.
If you are part of an air ambulance crew, it’s likely that you get through some days working overtime and having to respond to multiple calls in a day. While this is all part of the job, it’s important to remember that long shifts and over-exhausted can leave you feeling drained – both physically and mentally. The result will be impaired consciousness, which can prevent you from doing your job properly. This is why US air ambulance paramedics need to ensure that they get proper sleep whenever possible.
Signs US Air Ambulance Paramedics Should Watch Out For
Whether you work for an air ambulance or a ground ambulance, being an EMS provider means there is a high risk of chronic sleep deprivation. Maybe you are secretly proud of yourself for being able to perform well despite lack of sleep. While you may be able to do so for a few days, over time you’re just going to experience impaired consciousness. This can be dangerous for your job, for the lives of your patients, and for yourself.
As a US air ambulance paramedic, here are some signs you should watch out for telling you that you need to get some sleep ASAP:
- Inability to remember the last call you responded to
- Inability to distinguish one patient from the other
- More than normal illegible writing
- Strong smell of coffee and/or Red Bull while urinating
- Impaired ability to read patients’ vital signs
- Impaired ability to distinguish reality from dreams
These are just a few of the more common signs of impaired consciousness among EMS providers. It may be easy to be in denial, making it difficult for you to honestly assess yourself using these signs. Get help from a partner or a fellow crew member that you trust.
Acute coronary syndrome or ACS is a term used for describing different myocardial (heart) conditions caused by a sudden reduction of blood flow to the heart muscle. This could result in heart attacks, cardiac arrests, and more. The patients suffering from these conditions require immediate care, making ACS a time-sensitive condition. So as an air medical transport crew, you need to administer the necessary pre-hospital care aiming towards rapid reperfusion, which involves the suddenly blocked coronary artery.
Important Pre-Hospital ACS care Tips for Air Medical Transport Crew
When providing pre-hospital care to patients suffering from any kind of ACS, here are some important tips you can make use of:
- If the patient has a normal oxygen saturation level, it may be harmful to administer supplemental oxygen. So make sure you consider their SpO2 readings before you resort to supplemental oxygen use.
- If the patient doe not have an allergy towards aspirin or is suffering from active gastrointestinal bleeding, immediate administration of aspirin is highly recommended. In order to ensure that the aspirin enters the bloodstream more rapidly, make sure the pill is chewed instead of being swallowed whole.
- Although air medical transport crews can safely administer fibrinolytic therapy, it is not recommended if you can get the patient to a PCI center quickly. It is only recommended for use if the transport time is greater than 30 minutes.
- Transporting a cardiac arrest patient to a PCI center at least 24 hours after the arrest is essential for better chance of survival.
When you are a part of an in-flight medical crew, it’s highly likely that you’ll encounter patients with chest pain every now and then. This makes it crucial to educate yourself on the latest assessment and treatment guidelines for acute coronary syndrome.
Sepsis is commonly referred to as blood poisoning. It takes more lives than cancer and is more common than a heart attack. In fact, more than 4,000 children die in the U.S. every year because of sepsis. This makes it crucial for medical flight paramedics to proactively assess and care for patients with suspected sepsis. So here’s a brief guide to help you understand how to care for patients with this condition.
Initial Assessment for Septic Patients
Properly assessing a patient is crucial for medical flight paramedics and EMS providers alike. This speeds up the medical treatment process and also ensures the administration of appropriate care. In order to assess a patient suspected of having sepsis, it’s important to measure the body temperature accurately. A fever or a body temperature lower than normal may be detected if a patient has sepsis.
Fevers, chills, and body aches are some common symptoms of an infection. But not all patients may experience this especially when it comes to older individuals. Enquire about recent procedures like diagnostic tests or surgery, which may expose the patient to an infection risk. In addition, it’s important to measure the lactate level of a patient. If it’s greater than 4 mmols, it could be a strong indicator of sepsis.
To further confirm your suspicion of sepsis, it’s important to measure the exhaled carbon dioxide level of a patient. While a normal capnography reading may range between 35 and 45 mm Hg, a patient with sepsis generally exhibits a reading lower than 25 mm Hg. If this level of reading coincides with other vital signs that drove your suspicion of sepsis, the patient may be in need of immediate medical care.
Sepsis Treatment for Medical Flight Paramedics
It’s crucial to initiate sepsis treatment by administering large amounts of fluid to the patient. While you initiate antibiotic therapy, you may also need to maintain vascular tone through vasopressors like dopamine or norepinephrine.
Stroke is one of the top causes of death and long-term disability in the United States. Leaving a stroke untreated for one minute would result in about 1.9 million neurons being destroyed. If it’s untreated for an hour, the brain loses neurons equal to neuron loss occurring from 3.6 years of regular aging. This makes it crucial for a medical flight crew to conduct thorough assessment and provide necessary care for stroke patients or suspected stroke patients.
Detecting Symptoms of Stroke
If stroke is suspected, it is crucial to rush the patient to a facility that can rapidly assess and diagnose the condition in addition to providing treatment. However, many patients deny the symptoms. As a medical flight crew responding to a call in such cases, it’s important that you try to determine if the patient experienced or is experiencing some or all of the following symptoms:
- Sudden confusion
- Sudden vision trouble (one eye or both eyes)
- Sudden severe headache
- Sudden trouble with walking
- Sudden numbness or weakness around the face, arm, or leg
- Dizziness/loss of coordination
- Speech issues/trouble understanding
Providing Necessary Care to Stroke Patients as a Medical Flight Crew
Managing patients showcasing stroke symptoms requires team effort. With it being a time-dependent patient, you will need to have a protocol in place for providing organized and quick pre-hospital care to such patients. Although you may have a limited ability in terms of resources to provide care for a stroke patient, it would make a huge difference for you to alert a Stroke Team or make plans for rapid transportation to a stroke center.
During the transportation, try to carry out general neurological assessments as possible. Providing oxygen and, monitoring cardiac function, and drawing blood for labs, etc. should be quickly accomplished to streamline and expedite the care process.
With the responsibility of providing specialized emergency care to patients, air ambulances need to be staffed with the most competent and professional medical personnel. A typical air ambulance crew comprises of an air ambulance pilot, an in-flight doctor, an in-flight nurse, and a paramedic. The number of people assigned for each task may differ according to the air ambulance company and its needs.
Among the most crucial positions in an air ambulance crew is that of a critical care flight nurse, but not everyone is capable of becoming one. So read on to find out more about becoming a critical care flight nurse and see if you have what it takes to become one.
Basic Requirements to become a Critical Care Flight Nurse for Air Ambulances
Although different organizations and charities have varying requirements and standards for recruiting a critical care flight nurse, most air ambulances have the same basic requirements. You will need to check about the specific requirement set by the company you’re planning to apply at. However, take a look at the basic necessities first and see if you can proceed with your application:
- Licensed nurse with authorization to practice in that state you’re based in
- Experience in critical care or emergency medicine ER (minimum years of experience may differ according to organizations)
- High level of competency and proficiency with patient assessments
- High level of proficiency, expertise, and knowledge in transporting and caring for critically ill patients
- Ability to perform physical activities involved in performing aeromedical transport
- Good problem-solving skills with the ability to combine judgment and experience in coming up with a solution
Possession of current certifications for Advanced Cardiac Life Support Provider and International Basic Trauma Life Support Provider. Some companies may also require that you possess a certification for Advanced Pediatric Life Support Provider
When you’re in the medical field, there are a number of areas in which you may opt to specialize. If you’ve decided to become a respiratory therapist, there are a number of places in which you can work including in an air ambulance. You’ve met the necessary educational qualifications to pursue your licensure, but you’re not sure where to go from there. Just read on to find out more about how to obtain a license and operate as a respiratory therapist for air ambulances.
Meeting the Certification Requirements
The standard requirement for anyone to become a certified respiratory therapist is by obtaining a national license through the NBRC or National Board for Respiratory Care, Inc. It is the basis by which all other state boards will assess your qualification for a state licensure. So you will need to get through the Certified Respiratory Therapist or CRT examination.
Some respiratory therapists even pursue an advanced-level credential known as Registered Respiratory Therapist or RRT. While this may not be a prerequisite for licensure, it can boost your chances of being accepted as a certified respiratory therapist and provide your services at air ambulances. In fact, states like California and Ohio made it a mandate for respiratory therapists to obtain this license before gaining eligibility for a state license.
Meeting State Licensing Requirements and Working for Air Ambulances
Except for Alaska, every state within the U.S. requires that respiratory therapists also obtain state licensure. Although the process of gaining licensure may differ from state to state, the requirements are pretty much similar in all the states. This may include background checks, educational transcripts, and NBRC verifications in addition to application for licensure and application fees. It would do you well to study the requirements and procedures prescribed by the state licensing board in the state of your choice.
If you have Medicare coverage, you can get coverage for ambulance transportation to or from the hospital. The coverage also includes skilled nursing facility (SNF) or critical access hospital (CAH). It’s important to remember that Medicare will help you pay for ambulance services but only if other modes of transportation could be harmful for your health. This doesn’t necessarily mean you automatically quality for air ambulance transport either. First, let’s take a look at the medical necessity of availing ambulance transport.
Medical Requirement for Availing Ambulance Transport Under Medicare
Medicare will pay for the cost of emergency ambulance transportation in case of sudden medical emergencies with your health being in serious danger, provided that other modes of transportation like cars and taxi could endanger your health. You can get coverage for ambulance transportation if:
- You’re unconscious
- You’re bleeding heavily
- You’re in shock
- You require skilled medical treatment throughout the transportation
Requirements to Qualify for Air Ambulance Transport Under Medicare
The above-mentioned examples don’t necessarily qualify you fir air ambulance transport that is covered by Medicare. To be eligible for medical transport by air, your condition must require immediate and fast transportation that cannot be done through ground transportation. Medicare will cover for your expenses only if your condition fulfills the following requirements:
- Ground transportation can’t easily reach your location
- Obstacles like heavy traffic, long distances, etc. could prevent you from getting the immediate care that you require if you’re traveling by ground ambulance
There may even be a few but special instances wherein Medicare will cover for the cost of ambulance transport even in non-emergency cases. This is provided in case you have a doctor’s letter stating that your medical condition requires transportation with an ambulance.
As someone who provides air medical transport, you’re probably aware of how scary and challenging it can be to provide airway management. The task is especially daunting when you’re dealing with babies and children. Their smaller and delicate bodies make it extremely difficult for medical care providers to manage their airways effectively.
Important Facts and Tips about Pediatric Airway Management for Air Medical Transport Providers
Even when you’re a trained professional and have the necessary skills to carry out airway management, you may still make a mistake. This could be because of poor assessment, poor decision-making, fixation error, poor planning, or delayed fibreoptic incubation. Here are some useful facts you could make use of to help you carry out excellent pediatric airway management:
- Truly difficult laryngoscopy occurs rarely but the main issue is that you can’t intubate when the patient is awake. This can make your job especially daunting if the patient requires immediate airway management.
- In children, difficult laryngoscopy normally occurs if the child is younger than a year old with low BMI. It can also occur due to faciomaxillary and cardiac surgery, so it would be crucial for respiratory medical care providers to be aware of such incidences.
- In case of infants who are chubbier than normal, it may be tricky to determine the right IV access location during a gas induction. If it’s difficult to find IV access or to administer anesthetic for such infants, it would be ideal to have two experienced hands.
- Some infants may even experience laryngospasm, which is a common cause of hypoxia. It can occur due to various factors including secretions or blood in the airway, ENT and airway surgery, multiple attempts at airway instrumentation, and inexperienced anesthetist. It’s important for air medical transport providers to be aware of such incidents and avoid irritant volatiles.
Even the most experienced healthcare professionals can find airway management quite challenging. While it’s a fundamental skill for all EMS professionals, it’s an extremely daunting task that requires precision, skill, and expertise. As medical air transport providers, you may also come across patients who need airway management and depend on your competence for their future.
Important Tips for Medical Air Transport Providers in Airway Management
When providing medical care to patients who need airway management, make use of the following tips to help make your job easier:
- Remember the good airway management hallmarks – oxygenate, ventilate, and protect the airway. You will be attempting to accomplish two physiological tasks that are equally important. For proper oxygenation and ventilation, you need to ensure that the airway is clear from blood or secretions.
- Don’t forget to conduct a thorough assessment and remain vigilant for any early signs of respiratory issues. Measure airway patency by determining the patient’s level of consciousness. Ideally, you will need to be more aggressive with patients that have a Glasgow Coma Scale (GCS) that is lower than 8.Your assessment should include measuring the adequacy of the patient’s breathing, whether it’s too fast or too slow, whether their breathing is shallow or deep, etc. Try to listen for abnormal sounds like snoring, grunting, stridor, or wheezing. All of these factors can have a huge impact on the success or failure of your airway management efforts when providing medical air transport.
- As someone who provides medical care, you need to master the use of whatever equipment you need. Your equipment usage should be true to the principles of airway management mentioned in point #1. Ensure that your suction devices, BVMS, and oral and nasal airways are working properly and of the right size for the patient.