EMS World

SEP 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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Page 21 of 51

EMSWORLD.com | SEPTEMBER 2018 21 to load the patients, and then another eight- hour flight back to Germany. Those flights will have extra crew due to the length of the mission. Nurses coming into the USAF first attend officer training for five weeks. Depending on their experience, they may start at a higher rank such as captain instead of the bottom as a second lieutenant. They complete wilderness and water-survival training in case their aircraft crashes. They then go through the medical train- ing needed to fly on USAF aircraft. AETs complete this same training with the nurses. It's helpful to have nurses and AETs in the same classes so they learn to work togeth- er from the beginning. Nurses then complete another four weeks of scenario-based train- ing on simulated and real aircraft with human patient simulators at Wright-Patterson Air Force Base in Ohio. AETs have very similar training except they usually have no medical background before they enter the USAF. They begin by becoming nation- ally registered EMTs and receive additional train- ing on nursing care, IVs, and drug administration. For the National Guard and Reserve, some AETs are EMTs or paramedics in the civilian world, obviously a big advantage. Every flight team staffs a lead flight nurse that determines patient care. AETs deliver most of the hands-on patient care during flight. They also physically set up the aircraft for patient care by installing the litter systems as well as working with the aircraft crew on oxygen and electrical needs. They can start IVs and push medications. The closest equivalent in the civil- ian world would be an Advanced EMT. In situations that fall outside of or don't fit protocols, AETs must rely on good clinical judg- ment and work as a team to quickly develop a treatment plan. They then can use a satellite phone to call the unit's flight surgeon to receive plan approval. "A big part of the preflight briefing for the medical team is talking about worst-case scenarios if the patient deteriorates and what we will do if it happens," explains Capt. Mela- nie Munns, a flight nurse with the 452nd AES. "In addition to medical situations, the preflight briefing discusses what will happen in case there's an emergency with the aircraft, such as a loss of power or a fire, so all the patients will be cared for appropriately and everyone knows what their role is." Mission Considerations A mission begins with a crew briefing to find out how many patients and what types of medical and/or trauma conditions they have. They cal- culate the amount of oxygen patients will need as well as the electrical load to ensure the type of aircraft can handle both patients and equip- ment. The lead flight nurse will assign patients to each member of the team and discuss what kind of care they will need during flight. The next step is to physically configure the aircraft for the patient load. The cargo area is bare, so they will set up vertical stanchions to support the litters as well as run oxygen and electrical lines to the litters. They double-check all equipment and supplies before and after loading the aircraft. Some aircraft have built-in liquid oxygen (LOX) tanks for patient care. If they are using another type of aircraft, the AES must bring oxy- gen with them; this consists of a LOX system that can hold 20 liters of liquid oxygen. Each liter of LOX provides approximately 800 liters of gaseous oxygen. Lighting can be challenging, especially when the aircraft is operating in a tactical environ- ment at night. The flight crew strives to keep lighting to a minimum during takeoffs and land- ings in potentially hazardous areas where lights might draw gunfire. AES crews usually work with headlamps with red or green bulbs. Cargo air- craft have very few windows, so they often use headlights even in daylight. Noise presents a formidable challenge; there is no sound insula- tion as you find on airliners. Using stethoscopes in flight is usually not an option. Vibration also plays a factor in patient care. Litters are essentially the same design used on the battlefield, with a two-inch foam pad under the patient. A large degree of vibration and movement of the aircraft occurs during flight. When operating from an airport with the poten- tial of hostile fire, the flight crew will make very steep approaches and departures with turns to throw off the aim of gunfire. These aircraft can also operate from dirt and gravel runways. Care in Flight Where patients are placed on the aircraft depends on their diagnosis. AES crews are very familiar with the aircraft they use; for example, patients with fractures are placed in locations with the least amount of vibration. Photos courtesy United States Air Force

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