Air Medical Journal

2010-07-01

Editorial Board

2010-07-01

Jacqueline C. Stocking, RN, MSN, MBA, CMTE, CEN, CFRN, FP-C, CCP-C, NREMT-P, Corresponding Editor Air Methods Corporation

General Information

2010-07-01

Air Medical Journal (ISSN 1067-991X) is published bimonthly by Elsevier Inc., 360 Park Avenue South, New York, NY 10010-1710. Months of issue are January, March, May, July, September, and November. Business and Editorial Offices: 1600 John F. Kennedy Blvd., Suite 1800, Philadelphia, PA 19103-2899. Customer Service Office: Elsevier Health Sciences Division, Subscription Customer Service, 3251 Riverport Lane, Maryland Heights, MO 63043. Periodicals postage paid at New York, NY, and additional mailing offices.

Our Ethical Responsibilities

Eileen Frazer, Ralph Rogers — 2010-07-01

Organizations and individuals have inherent values that guide their purpose, how their mission is implemented, and how they deal with those external to themselves. Commission on Accreditation of Medical Transport Systems (CAMTS) values include fairness, ethics, consistency, accountability, and patient and safety focus. In my previous article, I raised some questions about ethical values and the challenges we have in trying to align our accreditation standards and policies within this dynamic healthcare delivery system called medical transportation. Dr. Ralph Rogers (chair of the CAMTS board of directors) and I collaborated on this article to address some questions regarding ethical responsibilities as they relate to CAMTS, medical transport services, and the public.

Thoracic Aortic Dissection in a 38-Year-Old Man

Peter Tilney — 2010-07-01

A few days before Christmas, a flight team was activated for an interfacility transfer of a 38-year-old man with a history of hypertension and spinal stenosis diagnosed with a thoracic aortic dissection. The patient was presented to a local community hospital complaining of nearly 5 days of left-sided rib pain. This afternoon when he stood up from a chair, he experienced a near-syncopal episode. Concurrently, he had an abrupt onset of a tearing sensation in his chest that radiated to thoracic spine in the region between his shoulder blades. Ground emergency medical services (EMS) was called, and the patient was transported to the community hospital. During the initial transport and evaluation by the emergency department (ED) staff, the patient was noted to be hypertensive, with a systolic blood pressure greater than 180 mmHg. In the ED, the patient received aspirin, morphine, and Lopressor. He underwent a chest x-ray () and computed tomography (CT) scan and was diagnosed with a type B thoracic aorta dissection, which was noted to start on the descending thoracic aorta distal to the left subclavian artery and extend to the level of the celiac trunk (). Despite the initial beta blockade, the patient was noted to be profoundly hypertensive, with initial blood pressure greater than 190 mmHg systolic. The flight team was activated for hemodynamic management and rapid transport to a facility capable of vascular and cardiothoracic surgery.

Certification Review

Jill Johnson — 2010-07-01

There are several basic types of radio systems. The system with the ability to transmit or receive in one direction at a time with two frequencies is known as which type?

What's in a Name?

John Clark — 2010-07-01

“What's in a name? That which we call a rose, by any other name would smell as sweet.” Medicine is heavily laden with terms of art and acronyms that define our “name.” In your program, does the name “transport nurse” mean the same as “flight nurse”? Does “critical care paramedic” mean the same thing in the state next door? Does it matter if the referring physician is “MD” versus “MD, FACEP” versus “DO”? Have you ever been handed a business card in which the owner's initials require that you turn over the card to finish the string?

Dopamine and Norepinephrine for Shock

Daniel Hankins — 2010-07-01

De Baker D, Biston P, Devriendt J, Madl C, Chochrad D, Aldecoa C, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med 2010;362:779-89. Levy JH. (Editorial) Treating shock—old drugs, new ideas. N Engl J Med 2010;362:841-3.

Keeping It Simple

Ed MacDonald — 2010-07-01

There have been rumors of regulations, rumors of congressional action, fury in the press, and lots of chatter. The latest rumored timetable of the alleged Federal Aviation Administration (FAA) Notice of Proposed Rule Making is now July 2010. This proposed set of regulations will purportedly address and make regulations of many of the past Advisory Circulars and National Transportation Safety Board recommendations that Congress and others have been pushing.

Concern Network

2010-07-01

While en route by ground, with lights and siren, from the Hillsboro-Portland Airport to the Oregon Health & Science University Hospital (OHSU) in Portland, OR, with a patient that had just been transported by fixed-wing aircraft, a Cal-Ore Life Flight ambulance was struck on the driver's side by a private vehicle while traveling through an intersection. The flight team members attending the patient in the back were unrestrained at the time of the collision. The weather was clear and not a factor.

Forum

2010-07-01

“I disagree strongly with what you say, but I will defend to the death your right to say it.” Voltaire As I write this, I have just returned from several meetings in Europe involving the European HEMS and Air Ambulance Committee (EHAC) and a conference put on by REGA, the Swiss air medical transport system. It is very apparent that we are all in the same boat as far as problems and concerns about critical care transport issues go. Part of the week was devoted to planning the AirMed 2011 conference to be held in Brighton, UK, from May 24-27, 2011. Go to http://www.airmed2011.com for details.

2010 Critical Care Transport Medicine Conference Abstracts

2010-07-01

Abstract: The following abstracts are from the poster presentations made at the 2010 Critical Care Transport Medicine Conference held April 12-14, 2010, at the Sheraton Gunter Hotel in San Antonio, Texas. The Scientific Forum is sponsored by the Air Medical Physician Association, Air and Surface Transport Nurses Association, and International Association of Flight Paramedics; the first place winner received an Outstanding Research Award from Golden Hour Data Systems, Inc. For more information, contact Pat Petersen at ppeter1111@aol.com.

Enloe FlightCare: Looking Forward to Another 25 Years

Judith A. Cline — 2010-07-01

When Enloe FlightCare completed its maiden mission to the scene of a car crash along a rural stretch of the Sacramento River in July 1985, it was impossible to predict what the future might hold. FlightCare, a hospital-based rotor-wing program at Enloe Medical Center in Chico, California, was the first air medical program north of Sacramento. The hospital saw the need for this newly evolving form of air transport service, especially in the vast rural region of upper northern California. Now a quarter of a century later, after completing more than 13,000 missions (and a few encounters with obviously suicidal ducks) and enduring a heartbreaking fatal crash—as well as shrinking (or non-existent) reimbursements and increasing (sometimes aggressive) competition by other providers—FlightCare remains cautiously optimistic about the future of the air medical industry. However, we look forward to another interesting 25 years.

The National EMS Memorial Service: a Beautiful Tribute to Those We've Lost

Jana Williams — 2010-07-01

Most in EMS simply aspire to help people. Some make “the ultimate sacrifice” losing their lives trying to help others. Many are touched personally by these losses and strive to honor the fallen.

Safety of Surfactant Administration before Transport of Premature Infants

Manoj Biniwale, Monica Kleinman — 2010-07-01

Abstract: Objective: To assess the safety of surfactant administration prior to transport of premature infants. Design/Methods: We performed a retrospective review of 24- to 34-weeks premature infants admitted to the Newborn Intensive Care Unit (NICU) between July 1, 1999 and September 30, 2004. Outcome measures were the presence of hyperventilation (PCO2 <40 mm Hg) and/or pneumothorax on admission to the NICU. Factors associated with the presence of hyperventilation and pneumothorax were identified. Results: 955 infants born at 24 to 34 weeks' gestation were admitted to the NICU during the study period. 217 (22.7%) received surfactant prior to transport within 48 hours of birth. The incidence of hyperventilation was 18.9%. Hyperventilated infants had longer transport times, lower birth weights, and lower PCO2 on blood gases obtained prior to transport. Pneumothorax occurred in six subjects (2.9%). Neonates with pneumothorax had lower APGAR scores. Conclusions: We found the administration of surfactant prior to transport to be safe as evidenced by a low incidence of pneumothorax. Pneumothorax was more likely to occur in infants who needed significant resuscitation at birth. The incidence of hyperventilation appeared to be high and was inversely associated with birth weight.

Air Medical Transport Personnel Experiences with and Opinions about Research

Jolene Fox, Frank Thomas, Judi Carpenter, Diana Handrahan — 2010-07-01

Abstract: Introduction: This study examined air medical transport (AMT) personnel's experiences with and opinions about prehospital and AMT research. Methods: A Web-based questionnaire was sent to eight randomly selected AMT programs from each of six Association of Air Medical Services (AAMS) regions. Responders were defined by university association (UA) and AMT professional role. Results: Forty-eight of 54 (89%) contacted programs and 536 of 1,282 (42%) individuals responded. Non-UA responders (74%) had significantly more work experience in emergency medical services (EMS) (13.5 ± 8.5 vs. 10.8 ± 8.3 years, P = .002) and AMT (8.3 ± 6.3 vs. 6.8 ± 5.7 years, P = .008), whereas UA responders (26%) had more research training (51% vs. 37%, P = .006), experience (79% vs. 59%, P < .001), and grants (7% vs. 2%, P = .006). By AMT role, administrators had the most work experience, and physicians had the most research experience. Research productivity of responders was low, with only 9% having presented and 10% having published research; and UA made no difference in productivity. A majority of responders advocated research: EMS (66%) and AMT (68%), program (53%). Willingness to participate in research was high for both EMS research (87%) and AMT research (92%). Conclusions: Although AMT personnel were strong advocates of and willing to participate in research, few had research knowledge. For AMT personnel, disparity exists between advocating for and producing research.

Cooper's Face and Heart

Janie Kofford Ford — 2010-07-01

The events of July 31, 2009, had me desperately trying to do anything to improve a devastating situation. My mother's voice on the other end of the phone told me things I could not emotionally process. My 4-year-old nephew, Cooper, had been run over and killed in his driveway by a car driven by his aunt. I fell to my knees and whispered, “No, why?” When we arrived at my brother's house, emergency medical services (EMS) were just finishing, and the news media were just beginning. We drove the gauntlet of eager reporters hungry for any evidence of the devastating effect of this tragedy. I was angry and disgusted at the public spectacle sitting just outside the home.

Air Medical Journal

Table of Contents

Editorial Board

General Information

Our Ethical Responsibilities

Thoracic Aortic Dissection in a 38-Year-Old Man

Certification Review

What's in a Name?

Dopamine and Norepinephrine for Shock

Keeping It Simple

Concern Network

Forum

2010 Critical Care Transport Medicine Conference Abstracts

Enloe FlightCare: Looking Forward to Another 25 Years

The National EMS Memorial Service: a Beautiful Tribute to Those We've Lost

Safety of Surfactant Administration before Transport of Premature Infants

Air Medical Transport Personnel Experiences with and Opinions about Research

Cooper's Face and Heart