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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22 SEPTEMBER 2018 | EMSWORLD.com COVER REPORT: AEROMEDICAL EVACUATION There are typically three tiers of patients on the stanchion system. The crew also have to anticipate patient needs and care during long flights to determine which tier is best for each patient. Another concern is that environmental controls—heating and cooling—are not well regulated in these cargo aircraft. Even how high the patient is above the cargo deck can result in a significant temperature differ- ence. Closer to the floor tends to be cooler, as fuel is often stored under the floor. Near the ceiling can be much warmer as the sun heats the skin of the aircraft. "We carry an iPad-like device called an electronic flight bag," says Tech Sgt. Sher- enda Fausnaugh. "This has information on all the different types of aircraft they might use for evacuation: how to set them up, how to access electrical power, oxygen, etc. It also has detailed directions on how to use different equipment. If they are going to use an aircraft they haven't trained on in a while, they can review procedures and equipment dur- ing the crew briefing to refresh everyone's knowledge. This device can be updated rapidly to incorporate lessons learned from other units as well as new protocols and other valuable information." "We transported a lot of orthopedic injuries from Iraq and Afghanistan and had to be very creative in patient packag- ing because of the aircraft vibration and movement," says Col. Jeanne LaFountain, commanding officer of the 349th AES. "When any of my people deploy, I give them a Gumby figure to remind them to be flexible and creative in making sure their patients receive the best care possible and aren't further injured during transport." The emotional toll on military caregivers is just as powerful as in the civilian world. LaFountain says they're careful to watch each other for signs of stress, particularly after difficult missions. One helpful strat- egy is to follow up on patient outcomes and visit their patients later if possible. There is also a formal mental health assessment form each crew member fills out before and after every deployment. Five follow- up contacts are conducted during the next two years. They also undergo regular men- tal health awareness training. Critical Care For more seriously ill or injured patients, AES personnel may be augmented with a critical care air transport team (CCATT). "CCATTs have three members: a critical care doctor, a critical care nurse, and a respiratory therapist (RT)," explains Staff Sgt. Arvin Jacinto, a CCATT RT. "We collec- tively help each other care for the patient during the flight. The team will go to the facility where the patient is being cared for, perform an assessment, and prepare the patient for transport. It is very similar to what civilian air ambulance crews do for an interfacility transfer. It can take up to two hours to assess and prepare the patient, depending on their condition. We work with the AES personnel before, during, and after the flight. The AES personnel are the bridge between the CCATT and the aircraft and its crew. "Members of CCATT teams are all very experienced with patient care and must be comfortable working with critical patients in a small team for many hours in a very austere environment. Some flights can last 10–12 hours. They have to carry everything they might need with them: equipment, drugs, blood products, etc. It is completely different than working in a hospital environ- ment—basically they're setting up an ICU in the back of a cargo plane. A CCATT can be augmented with specialists for certain types of patients such as burn victims. A special team will also augment a CCATT for ECMO patients." Training to be part of a CCATT consists of two parts, basic and advanced. Basic CCATT training is conducted at Wright- Patterson AFB in Ohio at the USAF School of Aerospace Medicine. Training for AE and CCATT teams includes the use of aircraft simulators that look exactly like the interior of several of the types of aircraft used for AE. They feature the same lighting, sound, and environmental controls as the real air- craft. The newest generation can move to simulate takeoff, landing, and turbulence. Advanced training is called CSTARS and is completed at one of three civilian Level 1 trauma centers contracted by the USAF. This intense two-week course tests a candidate's mental and physical ability to perform critical care in an austere set- ting. It involves actual patient care and scenarios using high-fidelity human patient simulators. All CCATT teams have the same equipment, training, and procedures, so any CCATT member can team up with mem- bers of other CCATTs to work together. Aircraft and human patient simulators deliver a real-life feel during specialized training of USAF aeromedical squadron personnel.

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