Emergency Medicine Services - Air Care and Mobile Care
EMS is a vital part of Emergency Medicine and one that demands rigor and respect. Below is the Air Care and Mobile Care Online Flight Physician Orientation which is a collection of blog posts, podcasts, and procedural videos that aim to teach the various duties of the flight physician on Air Care to the PGY-1 and early PGY-2 residents. Needless to say, there are learning points and lessons to be learned, for nurses, flight nurses, residents and attendings of all experience levels.
Interested in pursuing this as a career? Find out more about our EMS Fellowship
Archived Flight Cases
This curriculum has been designed to help prepare our rising R2's for their new responsibility as flight physicians. New, challenging cases are presented each year and discussed amongst our training flight docs. The resultant learning points from each case are then summarized in a blog post and/or podcast for later review. Below are the archived cases since 2015.
May brought the fourth case of our Air Care Flight Physician Orientation Case Series with the goal of preparing our first year residents for their roles as Flight Physicians. This is a monthly series that will continue through the R1’s Flight Physician Orientation Day in June. First year residents discuss the case and its associated questions on our internal asynchronous learning forum, Slack. This month, a case of sepsis. Should we just transfer the patient as quickly as possible, or are there other things we should do first? Read on to find out!
April brought the third case of our Air Care Flight Physician Orientation Case Series with the goal of preparing our first year residents for their roles as Flight Physicians. This is a monthly series that will continue through the R1’s Flight Physician Orientation Day in June. First year residents discuss the case and its associated questions on our internal asynchronous learning forum, Slack. This month, a case of STEMI, seemingly simple, right… but what happens next?
This is Case #2 of our Air Care Orientation Curriculum! This curriculum is designed to help prepare our rising R2's for their new responsibility as flight physicians. These cases are discussed amongst our training flight docs and this is the resultant learning points. In this case, we discuss a critical patient with a head injury. What interventions need to be performed? In what order? Who should do them? Read on to find out.
This is Case #1 of our Air Care Orientation Curriculum! This curriculum is designed to help prepare our rising R2's for their new responsibility as flight physicians. These cases are discussed amongst our training flight docs and this is the resultant learning points. In this case, we discuss a sick trauma patient that needs multiple interventions. But what interventions need to be done? In what order? And who should do them? Read on to find out!
Thanksgiving is over, now it's now to relive Halloween. Take another airway lesson from Dr. Carleton and his IC Cordes course. This episode he takes us through a terrifying Air Care case through the lens of the Difficult Airway Algorithm in a case of a bloody airway courtesy of a bullet through the oropharynx.
Welcome to the Final Recap of our “Flights” Case Series!
Thanks to all those who participated in the discussion and to those who tuned into the “Flights” cases throughout the spring and summer. The final "Flights" cases centered in on several challenging airway scenarios. Penetrating neck trauma with a tracheal injury; GSW to the face with significantly altered anatomy; and a tracheostomy displaced and a patient with critical hypoxia - airway management in the field requires a nimble mind and knowledge of one's own equipment. Take a look at our thoughts on the cases and see what you might do in similar situations.
Welcome to the Fourth Case in our Air Care and Mobile Care Flight Orientation Curriculum for 2016!
It is a beautiful sunny Memorial Day and you arrive early for your C-pod shift, energized by the knowledge that you will be getting out early with time to enjoy the day. Your patients are an enjoyable mix of pathology and acuity and everyone is quite polite and gracious. The tones drop just before it is time to hand over the radio to the dedicated flight doc and you can’t but marvel at your good fortune. You grab the blood and head up to the helipad for your flight...
Welcome to the Recap of the 3rd case in our Air Care and Mobile Care Flight Orientation Curriculum!
Approximately 1 month ago we presented and talked through a particularly challenging patient flight scenario. As a refresher, if you don’t recall, check out the post here. Following the posting of the case, I sat down with ACMC Medical Director Dr. Bill Hinckley and Resident Assistant Medical Director for Air Care, Dr. Andrew Latimer, and recorded a podcast with their reaction to the case and to some of the curveball scenarios posed in the question and discussion section.
It is late on a blustery grey and rainy day in November and you are the dedicated flight doc on Air Care One (the “UH”) nearing the end of your shift. Your pilot has had to turn down two flights already due to high winds and reduced visibility as bands of storms moved through the area. Against your better judgment, you are standing in the sushi line in the hospital cafeteria to grab dinner when you hear “Air Care One Pilot, weather check for a patient coming back to the U” squawk out over your portable radio. Your excitement rises as “we can do that” echoes over the radio and you hear the tones drop for your flight. You grab the blood cooler and meet your crew for takeoff on the roof...
It’s true that sometimes critical care transport missions to transport STEMI patients to PCI are fairly uneventful. But if we allow ourselves to get lulled into a “Milk Run” mindset, it will most definitely come back to bite us. The jovial, normotensive, fairly comfortable-appearing STEMI patient may be only a couple of minutes away from V Fib arrest or florid cardiogenic shock. When that occurs, if we have expected and prepared for such a complication, it’s likely that we’ll be able to manage it successfully.
It is early October and you are the flight doc in C-pod on a brisk but clear Saturday morning. The day starts out with several challenging patients with vague complaints and has just begun to ramp up in volume when a patient rolls into your pod by EMS, restrained face-down to the cot, covered in feces and urine, screaming about hearing voices. You begin to take report from EMS when, as if by divine intervention, the tones drop and you are dispatched for an inter-facility transfer. You gleefully (almost too gleefully…) give a brief patient sign-out to your staff, grab the blood cooler, and head to the roof...
A couple of weeks back, we kicked off our “Flights” portion of our Air Care Orientation Curriculum. Dr. Latimer outlined a challenging patient case for use to consider and an excellent discussion ensued. As a reminder of the case, here’s how it was posed:
Your patient is a 56 year-old male with unknown medical history who was an un-helmeted motorcyclist found in a ditch roughly 40 feet from his motorcycle which was discovered in the middle of the road by a passing motorist. The accident was un-witnessed, but the bike was found just beyond a sharp downhill curve in the rural farm road. EMS has BLS capabilities only and they have placed the patient on a backboard and loaded him into the unit.
It is mid July and your first shift as the coveted H2 Doc at Air Care 2 is finally upon you. It has been an especially warm and beautiful Saturday and you ponder the possible flights for the evening as you take the scenic drive to Butler County Regional Airport.
You finish checking the aircraft with the flight nurse and sit down to begin the 20:30 brief with the flight crew when the tones drop and you are dispatched for your first flight of the evening, a scene flight to Franklin County, Indiana for an “un-helmeted motorcyclist”. You grab the blood cooler, perform a safety walk-around the aircraft and strap yourself in back
Thanks to everybody who commented and contributed to the discussion on our final “Flight!” If you missed out on the case, check it out here. Below you’ll find a curation of the comments to each question and a podcast with expert commentary from Jenn Lakeberg, APRN. This was the final “Flight” for this spring/summer. Look for the cases to return again in January 2016 as we begin Flight MD Orientation with the next class of future Air Care Flight Docs.
You are sitting on the helipad during your UH shift talking with the flight nurse when the tones drop for a pediatric scene call. You gather yourself after you have that crap your pants moment that everyone has with pediatric scene calls and whip out your smart phone with your pediatric application of choice. You begin to write down doses and sizes on your tape on your leg based on the report of the patient’s weight from the providers on scene.
You land in an elementary school parking lot to the delight of the children at the local school. Cars begin to slow and pull over as you exit the helicopter and walk to the squad. You walk to the side door of the ambulance and find 6 EMTs crammed in the squad.
Thanks to everybody who chimed in on our last "Flight"! We had a great discussion on the management of the STEMI transfer patient. These aren't just "milk runs" as pointed out by Dr. Hinckley. The highlights of the discussion are below with additional commentary on the case by Dr. Bill Hinckley and Air Care Resident Assistant Medical Director Dr. Matt Chinn. Out final flight will be lifting off June 1 and it's a doozy - looking forward to the discussion!
You are the Pod doc overnight on a particularly quiet Sunday night. You have been looking for an excuse to leave the pod and do anything other than treat abdominal pain for the past several hours when the tones drop. You thank whatever celestial being you believe in and grab the blood and run out of the department full of glee. In route to the helipad you are told it is a Code STEMI. At this point, even that seems more interesting than sitting in C Pod.
You buckle into the helicopter and take a quick flight to the outside hospital. You grab a set of gloves and unload the cot carefully and walk inside.
Thanks to everybody who commented and contributed to the discussion on our last "Flight!" If you missed out on the case, check it out here. We had a great discussion which we have recapped here. Take a look below and a listen to the commentary provided by Dr. Bill Hinckley in the embedded podcast. Look for our next flight to lift off in the next couple of weeks!
What medications could be used in the care of this patient? If the patient loses his IV, how does your treatment strategy change?
This first question sparked quite a bit of debate within the community. Everybody agreed that this patient requires sedation, intubation, and more sedation. There was, however, some significant differences in how the providers would go about attaining adequate sedation.
You’re working as the Pod-Doc, having just taken the radio from the off-going UH-doc, you just finish admitting the patient in C40 for NSTEMI when the tones go off.
“Air Care 1 and Pod Doc respond to a scene for motorcycle crash, Northern Kentucky”
You call the B-Pod attending, sign out the pod, grab the blood from the blood cooler and head to the helipad. Flying over the river, landing at a local firehouse’s parking lot you hop out of the back of the helicopter and head to the awaiting squad.
Your patient is a 29 year-old male who was riding his motorcycle (without a helmet) on a local country road. Coming around a blind corner he unexpectedly found a car stopped in the middle of the road. Striking the car from behind at ~35mph, he flew over the handlebars and impacted the back of the car.
On EMS’s arrival he was initially unconscious, but since their arrival has become increasingly combative
Thanks to everybody who contributed to an excellent discussion of the care of the patient on our second “flight.” If you didn’t get a chance to check out the case and the discussion, check it out here. Below is the curated comments from the community and a podcast from Dr. Hinckley and Flight Nurse Practitioner Jason Peng
Q1 - Walk through your initial assessment of this patient. What are the critical aspects of the assessment of this patient?
In response to this question, most everybody wanted to first act on the bleeding wound in the patient’s right antecubital fossa. As explained by Dr. Renne, “I would want to be systematic but efficient, probably using a C-ABCD approach to these kind of critical patients, with the first C being any sort of life-threatening but "C"ontrollable hemorrhage.” Dr. Renne also had a fine point with regards to checking for other potential, as of yet unseen, injuries. This is a patient with multiple stab wounds, it is crucial to conduct a quick, but thorough search for stab wounds to the back, axilla, groin, and/or other locations where significant blood loss could be caused by a stab wound.
You are working overnight as the H2 doc based at Butler County Regional Airport. It’s bitter cold out (for Ohio that is). Its only 11 PM and already the temperature has dropped to 9 degrees fahrenheit on its way to a low of 0. You are in the lounge refamiliarizing yourself with the contents of the critical care cells when the tones go off: “Scene: stab wound – Hamilton Ohio”
You and the nurse grab your equipment, the blood cooler, and head to the helicopter. You put the critical care cells back in their spot in the rear of the helicopter and then buckle in for the short flight to the scene.
Your patient is a 23 year-old female who was in an argument with her boyfriend earlier in the evening. The verbal argument quickly escalated, her boyfrienf pulling a knife and stabbing her multiple times in the right arm and right chest. He fled the scene and she managed to call 911. The first responders found the patient with significant active bleeding from her arm as well as chest. She was initially responsive, but is now only awake to painful stimuli.
You meet the EMS crew in the back of the squad truck and assess the patient from the head of the bed.
Thanks to everyone who chimed in for our first ever "Flight"!! If you didn't get a chance to read the case, take a look here. There was some excellent discussion on how best to care for the blunt polytrauma patient. Below is the curated comments from the community and Dr. Hinckley's take on the questions posed to the community.
You are working as the UH-doc. Driving into your shift with the windows down and music playing, you figured the first warm day of the year would result in a busy day for you and the rest of the Air Care 1 crew. You arrive for your shift, grabbing the radio from the Pod doc when the tones go off for your first flight of the day. You grab the blood cooler head to helipad, checking your pager you find you’ll be responding to Southeastern Indiana for a “MVC rollover, entraped.”
You strap into the helicopter and fly over the city and to the rolling hills of Southeastern Indiana. Landing on the 4 lane divided state road, you unstrap and head to your patient who is waiting with the BLS squad.
You open the side door of the EMS truck and head to the head of the bed to assess your patient...