Introduction of Guests:

1. • Kyle Schnarrs: Flight Nurse with UH Airmed.

   • Nathan Brazytis: Flight Paramedic and Nurse, practicing in the medic role on aircraft.

Career Paths and Backgrounds:

1. • 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:

1. • 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:

1. • 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:

1. • 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:

1. • 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:

1. • 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:

1. • 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:

1. • 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.