Episode 22 -
Air Medical Care
Air Medical Care
Released
June 2024
Hosts
Scott Wildenheim
John Hill
Guests
Kyle Schnarrs, RN
Nathan Brzytis, Paramedic, RN
Episode Videos
Helicopter Critical Care Transportation - Part of the EMS Team, Part 1
Helicopter Critical Care Transportation - Part of the EMS Team, Part 2
Helicopter Critical Care Transportation - Part of the EMS team, Part 3
Helicopter Critical Care Transportation - Part of the EMS team, Part 4 Live
Episode Audio
Show Notes
Introduction of Guests:
Kyle Schnarrs: Flight Nurse with UH Airmed.
Nathan Brazytis: Flight Paramedic and Nurse, practicing in the medic role on aircraft.
Career Paths and Backgrounds:
Kyle and Nathan share their journeys from traditional nursing and paramedic roles to becoming flight medical providers.
Discussion on the necessary experience and qualifications required for transitioning to air medical services, including critical care experience.
Personal Milestones:
Nathan recently completed his adult gerontology acute care nurse practitioner program and passed his boards.
The regulatory processes involved in transitioning to new roles, including DEA and NPI licensing.
Daily Operations in Air Medical Services:
Overview of typical 24-hour shifts, starting with drug exchanges, equipment checks, and morning briefings with pilots.
Importance of preparation, teamwork, and communication between medical crew and pilots to ensure mission readiness and safety.
Aircraft and Equipment:
Description of the EC-135 aircraft used by their program, including the layout and constraints of working in tight spaces.
Procedures for ensuring all medical equipment is securely stowed according to FAA regulations.
Challenges in Air Medical Services:
Addressing misconceptions about air medical transport, including weight and balance issues, patient loading challenges, and landing zone considerations.
The impact of weather and environmental factors on flight operations and patient transport.
Case Studies and Real-life Scenarios:
Sharing experiences from various missions, including dealing with soft ground landings, patient weight estimations, and the coordination required for safe patient transfer.
Learning and Adaptation:
Continuous learning culture within the team, sharing experiences and knowledge to improve practices.
Importance of humility and self-reflection in critical care environments.
Communication with Ground Teams:
Emphasizing the need for effective communication between air medical crews and ground EMS teams.
Specifics on providing accurate patient weight estimates and landing zone briefings for seamless operations.
Clinical Brief:
Essential information needed:
Patient's condition and mechanism of injury.
Age and status (adult vs. pediatric).
Airway status (e.g., need for intubation, oxygen levels).
Vital signs, especially critical ones (e.g., low blood pressure, high heart rate).
Blood sugar levels.
Importance of providing detailed information about interventions already performed (e.g., IV lines, tourniquets, medications).
Operational Considerations:
Weight and balance considerations for the aircraft.
Importance of precise weight estimates for patients and accompanying family members.
Specific procedures for loading and securing equipment and patients in the aircraft.
Airway Management:
Considerations for intubating patients in the air medical environment.
Situations requiring intubation for safety and airway protection.
The importance of not over-intubating and evaluating each case individually.
Landing Zone (LZ) Briefs:
Critical information needed: location, obstacles (e.g., poles, wires, trees), proximity to the accident site.
Importance of describing the scene layout and any potential hazards.
Pilots' use of visual cues (e.g., flags, windsocks) to determine wind direction and landing approach.
IFR vs. VFR:
Definitions and differences between Visual Flight Rules (VFR) and Instrument Flight Rules (IFR).
Conditions and procedures for flying under IFR, including reliance on air traffic control and instrument readings.
Importance of established fixed points for IFR approaches, usually limited to airports.
Inter-Facility Transports:
Majority of air medical flights are inter-facility transports, not scene flights.
Importance of speed in transporting critical patients (e.g., STEMI, stroke) to specialized care centers.
Role of air medical services in reducing out-of-hospital time for patients with complex medical devices (e.g., Impella, balloon pumps).
No Surprise Billing Legislation:
Impact of new laws on billing practices for air medical services.
Assurance that patients will not receive unexpected bills for air medical transport.
Emphasis on using air medical resources appropriately without financial concerns for the patient.
Career Pathways:
Importance of gaining experience in critical care settings before transitioning to air medical roles.
The educational and certification journey, including the completion of advanced degrees like Nurse Practitioner (NP).
Daily Operations and Shift Routine:
Typical 24-hour shift structure in air medical programs.
Morning routines include drug counts, equipment checks, and debriefs from the previous shift.
Interaction and coordination with pilots, including morning briefs on weather, weights, and fuel considerations.
Aircraft and Equipment:
Description of the EC-135 helicopter and its configuration.
Importance of proper stowage of equipment per FAA regulations.
Differences between various aircraft models and loading procedures (e.g., rear-loading vs. side-loading).
Weight and Balance Considerations:
Critical importance of weight distribution and balance in helicopter operations.
How fuel consumption, patient weight, and additional passengers impact flight planning.
Procedures for weighing in crew members and adjusting for seasonal changes in air density.
Landing Zone (LZ) Procedures:
Detailed explanation of what air medical crews look for during LZ orbit checks.
Importance of communication between ground EMS and air medical crews for safe landing and takeoff.
Real-life examples of challenges faced during landing and the importance of selecting optimal LZs.
Pediatric and Special Considerations:
Special considerations for transporting pediatric patients, including the importance of accompanying parents.
Adjustments made for transporting patients with special equipment (e.g., balloon pumps).
Communication and Coordination:
Importance of clear and detailed communication between ground and air medical teams.
Handling unexpected situations, such as moving LZs due to unforeseen obstacles.
The Protocols
From The Episode
Nathan describes the advantages of aircraft that can accept stretchers
Kyle describes how different aircraft have different weight restrictions
Dr. Hill discusses the need for interfacility flights
Scott recalls hearing the radio traffic from a scene call