Air Medical Journal

2012-01-01

Editorial Board

2012-01-01

Jacqueline C. Stocking, RN, MSN, MBA, CMTE, CEN, CFRN, FP-C, CCP-C, NREMT-P, Corresponding Editor University of California Davis Medical Center

General Information

2012-01-01

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.

Human Patient Simulators

Eileen Frazer — 2012-01-01

The Commission on Accreditation of Medical Transport Systems (CAMTS) accreditation standards, since the first edition, have specified initial and ongoing education criteria for medical personnel. In recent years, as there are more and more medical transport services that are not affiliated with hospitals, the standard that requires ongoing clinical experiences has been more difficult to achieve. Legal and contractual issues are involved when private services try to contract with a hospital for clinical experiences, and the CAMTS board understands these issues.

Experimental Studies in Air Medical Research

Scott T. Youngquist, Chris Gee — 2012-01-01

This article is the 18th in a multipart series designed to assist readers, particularly novices, in the area of clinical research. This article is focused on the process of developing a new research project. It provides tools to help those involved in beginning their own research projects.

Blast Lung Injury in a 20-Year-Old Man after a Home Explosion

Steven Buhrer, Peter Tilney — 2012-01-01

A large family home exploded after a propane leak ignited. Initial reports from the scene noted that 11 people were injured, with many sustaining critical injuries. Immediately, multiple helicopter emergency medical services aircraft were dispatched to respond to the scene, and ground emergency medical services (EMS) providers were en route. Of the five aircraft requested, only two were available to respond; one aircraft was out for maintenance, and two others were committed to other missions.

The Smoking Gun: Patient Confidentiality

John R. Clark — 2012-01-01

We departed the chaotic scene and within minutes were landing to deliver our patient to the trauma team. My partner needed a cigarette and left me to clean up as he walked outside for a smoke and directly into the microphones of the media. Intent on turning the patient we had transported into the breaking news story of the afternoon, the media asked some basic questions that he answered—condition, prognosis, injuries—and he walked away from the cameras. We buttoned everything up and flew back to our base, where we were met on the helideck by the program director and a very unhappy administrator.

Rocuronium Versus Succinylcholine for Rapid Sequence Intubation

Daniel Hankins — 2012-01-01

Seupaul RA, Jones JH. Does succinylcholine maximize intubating conditions better than rocuronium for rapid sequence intubation? Ann Emerg Med. 2011;57:301-2. Strayer RJ. Rocuronium versus succinylcholine: Cochrane synopsis reconsidered. (Corr.) Ann Emerg Med 2011;58:217-8.

Forum

2012-01-01

As I sit down to write to all of my fellow air medical and critical care transport professionals, it strikes me that this is a significant point in our “comindustry.” We have all recounted our history as to how AAMS and our comindustry have evolved to this juncture; what I want to write to you about is how we craft our future together. AAMS is at a crucial juncture in its progression, as our long-term executive director, Dawn Mancuso, has accepted a leadership position with another association, and we are engaged in a search to identify and bring on board a new CEO, a leader for our association. This will occur possibly as soon as the 2012 second quarter.

Concern Network

2012-01-01

The Concern Network shares verified information to alert medical transport programs when an accident/incident has occurred. Both air and ground programs are encouraged to participate. If you have questions, contact CONCERN Coordinator David Kearns at (800) 525 3712 or www.concern-network.org.

Certification Review

Jill Johnson — 2012-01-01

In which of the following conditions would you expect to see a delta wave?

The MedEvac

Mary Ann K. Melville — 2012-01-01

Into the blue, the black, the grey Into the skies of night, of day To cities, mountains, the towns big and small The Medevac goes to answer the call When lives hang in the balance, needing critical care These selfless providers quickly take to the air Expertly trained for their work, with skills tried and true They are the elite, the Air Medical Flight Crew Collective sighs of relief, when they arrive Heard softly through prayers, “Keep this patient alive.” Then they race through the sky, cheating death once again To the specialty care on this flight's other end Yet, sadly we know, these crews don't always come home This mission tonight is their final one flown On their way back, something went terribly wrong Now we gather together, and try to be strong They were lost in a moment, the three souls on that flight Warmly welcomed to heaven by God on that night They are fathers and mothers, wives, daughters and sons, Grandchildren DNA colleagues, a dear friend to someone We honor your service, we'll always be in your debt, Your kindness and care, we will Never Forget! Together, we remember John 15:13 “To lay down his life, no greater love hath thee…”

CCTMC Goes Back to Music City for 20th Anniversary

Monica Newman, Pat Petersen, Karen Wojdyla — 2012-01-01

You won't want to miss the 2012 Critical Care Transport Medicine Conference (CCTMC), to be held April 2-4 at the Loews Vanderbilt Hotel in Nashville—a premier critical care transport education opportunity. Join your peers for a spectacular 20th celebration. Find out who has attended every CCTMC and who has presented the most times. Bring photos of past conferences to share with the group.

Hypoxia Symptoms during Altitude Training in Professional Iranian Fighter Pilots

Babak Alagha, Shervin Ahmadbeigy, Seyed Ali Javad Moosavi, Seyed Mahmood Jalali — 2012-01-01

Abstract: Introduction: Susceptibility to hypoxia is influenced by a multitude of factors, including fatigue, physical activity, illnesses, ambient temperature, rate of ascent, destination altitude, medications, and alcohol. Anecdotally, several reports have been made regarding changes in the form of hypoxia presentation in Iranian fighter pilots in the absence of these factors. This study focused specifically on the effect of pilot age on susceptibility to hypoxia and its initial presentation. We assumed that a pilot's age may increase his susceptibility to hypoxia and consequently reduce the amount of time it takes for hypoxia to present. Because our literature review did not reveal any previous study addressing the possible relationship between age and susceptibility to hypoxia, the purpose of this study is to address and clarify this relationship. Method: In this retrospective study, we collected information from Iranian fighter pilots (n 5) 03 through an anonymous questionnaire in 2000. The form of hypoxia presentation of each subject was evaluated during five altitude chamber training (ACT) sessions that were conducted routinely from 1972 to 1984. To enhance the accuracy of the study's results, confounding factors such as prior hypoxia experience in an ACT session have been taken into consideration. Results: The results revealed a statistically significant relationship between age and a change in the form of hypoxia presentation in our subjects. Increased age reduced the amount of time before the first individual hypoxia symptom appeared (P, .000002). Although having previous hypoxia experience may help pilots to recognize their symptoms earlier, its effect was not statistically significant (P< .18). A few changes in the nature of individual symptoms were observed; however, we did not find a meaningful statistical correlation between pilot age and change in the nature of symptoms. Conclusion: Susceptibility ot hypoxia increases with pilot age.

Propofol Infusion for the Retrieval of the Acutely Psychotic Patient

Richard Chalwin — 2012-01-01

Abstract: Transporting acutely psychotic patients is hazardous because of the risks they present to themselves, escorting staff, and aircraft. Various strategies have been proposed, usually involving combinations of sedating drugs and physical restraint. Thus far, none guarantees safe retrieval while completely mitigating risks. This case proposes the use of propofol as an alternative to more traditionally used agents. An infusion facilitated the uneventful and safe retrieval of a patient who had demonstrated resistance and tolerance to other drugs. Discussion is also presented on the potential utility of propofol for the retrieval of acutely psychotic patients.

Medical Flight Crew Perceived Work-Related Musculoskeletal Symptoms and Related Characteristics

Sarah Cobb, Teresa Russo, Mary Kutash, Robyn Kellems — 2012-01-01

Abstract: Introduction: Flight crews who provide stabilization and care for patients during air medical flights represent a specialty group, with unique safety, physical environment, and weather concerns, as well as patient care challenges. The purpose of this study was to identify the self-reported prevalence, location, and severity (frequency, duration, and intensity) of perceived work-related musculoskeletal symptoms and associated characteristics among flight crews, and to correlate any age-related differences between participants. Method: This study used a descriptive, cross-sectional survey design. An internet-based questionnaire was made available through a link from the Flightweb.com listserv to Survey Monkey. A convenience sample of 462 flight crewmembers responded. Results: Significant differences were found by age group for two of four musculoskeletal symptoms (frequency and duration were significantly different by age group). Those 39 and older had a greater proportion of having been previously diagnosed with arthritis or osteoporosis (χ2 = 8.503, P = .004). Conclusion: Age-related differences were believed to be a factor that contributed to more musculoskeletal complaints for older flight crewmembers; however, the data from this study only partially support that hypothesis. Flight crewmembers face a number of unique challenges that require maintaining physical strength and endurance.

Myocardial Infarction Complicated by Ventricular Septal Rupture

Michael Sahjian, Rich Ventriglia, Lauri Bolton — 2012-01-01

Abstract: Transporting patients with an ST segment elevation myocardial infarction (STEMI) is a fairly common practice for most critical care transport teams. When a STEMI is complicated by ventricular septal rupture, the care can become more challenging, especially if the rupture is not yet diagnosed. This article describes such a transport and reviews the pathophysiology of the process along with treatment options.

Hypertrophic Pyloric Stenosis: It Can Take Your Breath Away

Cody R. Tigges, Michael T. Bigham — 2012-01-01

Hypertrophic pyloric stenosis (HPS) is a cause of vomiting in infants. Classically, infants with HPS present with nonbilious projectile vomiting resulting from progressive gastric outlet obstruction. Depending on the duration of symptoms, patients may present with dehydration or metabolic alkalosis. The mortality associated with HPS was as high as 14.4% in 1935, but improved to 0.5% in the late 1960s, where it has held at 0.4% in the modern era. A clear pathophysiologic understanding of HPS has been evasive, although the hypertrophied pylorus likely occurs as a downstream consequence of postnatal physiologic changes, abnormal pyloric innervations, genetic mutation(s), and unknown environmental influences. Scant reports of apnea in patients with pyloric stenosis occur in the literature. Herein we present a recent case of an infant with HPS with metabolic alkalosis and apnea.

Air Medical Journal

Table of Contents

Editorial Board

General Information

Human Patient Simulators

Experimental Studies in Air Medical Research

Blast Lung Injury in a 20-Year-Old Man after a Home Explosion

The Smoking Gun: Patient Confidentiality

Rocuronium Versus Succinylcholine for Rapid Sequence Intubation

Forum

Concern Network

Certification Review

The MedEvac

CCTMC Goes Back to Music City for 20th Anniversary

Hypoxia Symptoms during Altitude Training in Professional Iranian Fighter Pilots

Propofol Infusion for the Retrieval of the Acutely Psychotic Patient

Medical Flight Crew Perceived Work-Related Musculoskeletal Symptoms and Related Characteristics

Myocardial Infarction Complicated by Ventricular Septal Rupture

Hypertrophic Pyloric Stenosis: It Can Take Your Breath Away