Category: CLINICAL

COVID-19 Reflections

By Bev Meade DNP/HSL, RN, MHA, CEN, CCRN, CFRN, CTRN, TCRN, EMT-P. Flight Nurse, MedFlight 3

“Be home before dark.” “Stay together!” “I want to know where you are.”

These were among the safety mantras that Mom always said before we left the house to play. As a child, I certainly never gave safety them much thought. As an adult, it is a different story as we become more aware of either the real, perceived, or potential threats to our home, health, and workplace safety.

Because of COVID-19, words like social distancing, isolation, and maintaining personal separation have become our new safety mantra. We are and will continue to feel the effects of this virus for some time to come and must learn to adapt to the “new normal” both at home and at work. We find ourselves practicing safety measures such as mask usage, frequent hand washing, and using hand sanitizer now more than ever before. You may now find yourself in conversations discussing the advantages of material face masks versus surgical masks. You may even head straight to the disinfectant aisle in your favorite grocery store to snag the last container of the coveted brand or store brand disinfectant wipes.

This added stress of change in our daily lives has potential to inhibit or deter our focused attention on safety in our surroundings, health (physical and mental), as well as our work. I suggest that we use this challenge of COVID-19 to direct us toward reflecting on how each of us can improve our safety outcomes one day at a time.

Perhaps Mom would have said “Come home safely, work together, wash your hands, and don’t forget to wear your gloves, mask, and eye protection!” Some things will never change. Be well, stay healthy, and be home before dark!

MedFlight’s COVID-19 Response

3/20/20

A Message from our President/CEO:

MedFlight and MedCare want to reassure our community partners that we are here and mission-ready for all of your patient needs.  That includes the critically-ill and injured patient as well as patients that are showing COVID-19 signs & symptoms, and/or positive or suspected diagnosis.  While information about this virus is ever-evolving, our care will remain consistent with any other respiratory or airborne infectious disease patients may experience.

We have been providing continuous training and updates for our partners regarding COVID-19 and are working hard to assure our teams are equipped with proper skillsets, medication, medical and personal protective equipment to take care of your patients.

In an effort to comply with Ohio Department of Health mandates on social distancing, we have elected to postpone in-person clinical & landing zone training and outreach events. This is important to assure the health and well-being of not only our crews and patients, but your coworkers and communities as well. Once the recommendations allow, we will resume in-person training and community outreach events.

These are challenging times, and we’re here to help.  If you have questions about our customized transport solutions, you are encouraged to contact MedFlight Administration at 614-734-8001, or our Communications Center (MedComm) at 1-800-222-5433 to activate a critical-care transport team.

MedFlight and MedCare are ready, and we’re here for you. We have ample resources on hand that can handle your patient transportation needs.

Below, you’ll find new updates on our service solutions, suggestions on CDC and Ohio Department of Health healthcare best practice, and more.  Make sure to check back of

Stay safe, stay healthy, and thank you for all you do. Partners For Life.

Tom Allenstein, President/CEO of MedFlight & MedCare

 

3/27/20

COVID-19 UPDATES & TIPS

As the COVID-19 pandemic continues to evolve, so does MedFlight and MedCare’s response to it.

MedFlight will transport any known or suspected COVID-19 patients by both air and ground.  Known or suspected patients who are not intubated should be masked prior to MedFlight transport.  Our clinicians will continue to wear the proper personal protective equipment.

We recognize that not every COVID-19 patient needs the speed or expense of helicopter transport.  Therefore, we will continue to offer critical-care ground transport as well upon request.

We recognize that this is a challenging time for us all, but we are dedicated to providing transport solution-ns for your patient. If you contact us for patient transport and suspect the patient may have signs of COVID-19, please inform our Communications Center so we can best ready our clinical teams.   MedComm can be reached at 1-800-222-5433.

 

COVID-19 UPDATES & TIPS

#FlattenTheCurve

We are blessed at MedFlight and MedCare to have an in-house Exposure Control specialist, who works continuously to provide education, training, and best practices from the Center for Disease Control for all MedFlight and MedCare partners.  This training is provided year-round and promotes best practices in mitigating the spread of any infectious disease before, during, and after patient care.

Here are some tips as you serve your patients:

1. Wash your hands frequently, scrubbing for a minimum of 20 seconds.

2. Sanitize all surfaces, including commonly-touched items in your ambulance, such as handles, radio knobs, seatbelts, medical equipment, and work surfaces.

3. Practice social distancing. If possible, keep a 6-foot span from others. MedFlight and MedCare will be interacting with our healthcare partners virtually and on the phone to help promote this practice, but we are still available for you 24/7.

4. Take your temperature and assess your own health before reporting to work. This is something we are also requiring of MedFlight and MedCare partners.

5. If you or a family member shows COVID-19 signs or symptoms, stay home.

6. Don the proper personal protective equipment when transporting patients showing respiratory symptoms, or if the patient needs airway management. This may include masks, gowns, gloves, and eye protection.

7. If you contact us for patient transport and suspect the patient may have signs of COVID-19, please inform our dispatch center so we can best ready our clinical teams.

The History of Mechanical Ventilation

Karen Swecker, RN, MedFlight Infection Control Liaison

Ventilators have become a common piece of equipment in healthcare, saving lives and providing respiratory assistance for those who may be depending on it to stay alive.  Like most equipment in healthcare someone saw a need and started work on coming up with a solution.

The ventilator has a history that begins in the 16th century by Andreas Vesalius, who at the age of 23 taught anatomy.  Due to his dissection of human cadavers, his ideas were greatly frowned upon by the church.  In 1543, Vesalius published a series of books on the human anatomy, describing a tracheotomy and blowing air into the hole to cause the lungs to “rise again”.  Prior to Vesalius, common belief was that the act of breathing caused the heart to beat.

In 1667, scientist Robert Hook demonstrated that blowing air into the lungs kept one alive.  However, it still wasn’t clear why people breathed or why they became pulseless.  The most common belief was that people became unconscious due to a lack of stimulation.  Treatment for this included rolling the person over barrels, putting them over a trotting horse, hanging them upside down, or using a fumigator that blew smoke up the rectum.

During the 1730s, a Scottish surgeon, Wm. Tossach successfully resuscitated a coal miner with mouth to mouth breathing, describing the process in medical literature.  The process included pinching the nose and blowing as hard as he could into the patient’s mouth.  Once the patient regained a pulse the doctor “pushed, pulled, and rubbed” the patient to stimulate circulation.  Mouth to mouth resuscitation became popular until oxygen was discovered in the 1770s.  The belief was that any exhaled air was depleted of oxygen therefore mouth to mouth was of no use to a person in respiratory distress.

Ventilators based on negative pressure were developed in the late 1800s.

v1
The patient sat in a box with the head exposed, a plunger device was used to decrease pressure inside the box causing inhalation, then reversing the process to cause exhalation.  Per the inventor, Alfred Jones, the box” cured paralysis, neuralgia, seminal weakness, asthma, bronchitis, dyspepsia” and many other diseases. 

In 1876, the first iron lung was developed and place along the Seine River to save drowning victims.  The first iron lung to treat polio victims was used in Boston in 1929.  One difficulty with the iron lung was figuring out how to access the patient’s body for care.  To solve this a respirator room was created where the patient’s body lay inside the room with the head sticking out.  Pistons were used to create pressure changes causing air to move in and out of the lungs.  Multi patient ventilation rooms were developed for use during polio epidemics.

v2
During the 1950s, epidemics of polio were occurring, at one point there were 50 patients a day being admitted to a Copenhagen hospital with respiratory muscle paralysis that had a mortality rate of more than 80%.  Tracheostomies and positive pressure respiration use dropped the death rate to 40%.  As there were no individual respirators patients were continuously hand bagged.  These patients were cohorted into the same room… thus creating the first ICU.

v3
Transporting a ventilated patient took a moving truck and a group of strong individuals.

During the 1940s and 1950s, positive pressure invasive ventilation was developed which provided volume controlled ventilation.  There were no alarms or monitors and no specific settings.  Total volume was measure separately.  Soon, a double circuit ventilator was used in both OR and ICU, it included monitoring for pressure and tidal volume, and machine triggered inspiration.   In the 1960s, PEEP became standard care.  By the early 1970s, second generation ventilators monitored tidal volume, respiratory rate and allowed patient triggered inspiration.  Improvements continued at a fast past, developing into the ventilators now in use.  Speculation of the future of ventilators include the ability of the ventilator to integrate with other bedside technology, smart alarms, and decision support.

The ventilator has come a long way in a short time.

v4

SM BLOG FOOTER

 

Measles 2019 Update

Karen Swecker, RN, MedFlight Infection Control Liaison

Per the CDC, there were 1276 confirmed cases of measles in 31 states.  The outbreak has finally slowed down but cases may still occur.

  • Majority of cases were in unvaccinated people
  • 124 people were hospitalized
  • 61 reported complications including pneumonia and encephalitis
  • Ohio reported 1 case of measles in an adult that was unvaccinated and traveled to a state with confirmed measles cases
  • If you are unvaccinated you have a 90% risk of being infected just being in the room with a measles patient
  • Measles can live up to 2 hours in the air where an infected person coughed or sneezed
  • You can contract the measles via airborne or contact with contaminated surfaces
  • People are infectious 4 days before to 4 days after the rash appears
  • 1 out of 20 children with the measles will get pneumonia (most common cause of measles related death)
  • 1 out of 1000 children with measles will develop encephalitis
  • 1 to 3 out of 1000 children infected with measles will die from respiratory or neurologic complications

The Threat Continues

In December the CDC received reports of measles infected persons traveling through at least 5 separate airports – Chicago O’Hare, Austin-Bergstrom Airport in Texas, Richmond International in Virginia, and the airport in Denver and LAX.

The known measles infected travelers included a person who traveled in Europe in late November and 3 infectious children visiting from New Zealand.  Typical time between exposure and symptoms is between 7 to 14 days.

As a reminder, the symptoms include: high fever, cough, runny nose, red, watery eyes, the rash typically begins 3 to 5 days after the first symptoms.

measles
Skin of a patient after three days of a measles infection.

 

SM BLOG FOOTER

Norovirus Update

Karen Swecker, RN, MedFlight Infection Control Liaison

Norovirus is a highly contagious infection that can be transmitted via an infected person, contaminated food or water and contaminated surfaces.  Approximately 20 million people are infected with norovirus each year resulting in 70,000 hospitalizations and 800 deaths.  Norovirus is the leading cause of foodborne illness in the US.

A person infected with Norovirus can shed billions of viral particles; however, it only takes around 18 viral particles to cause an infection.   An infected person can spread the disease beginning a few days before symptoms appeal, and continue to be infectious as the virus remains in the stool for 2 weeks or longer.

The symptoms of norovirus appear suddenly and include watery diarrhea, acute onset of nausea and vomiting, abdominal pain and may be accompanied with a fever, headache and body aches.  Symptoms typically appear within 12 to 48 hours after exposure and last 1 to 3 days.

There isn’t a vaccine for Norovirus, prevention relies on:

  • Thorough hand washing with soap and water – recommended over alcohol hand gel
  • Wash fruits and vegetables before preparing and eating
  • Cook shellfish thoroughly – Norovirus can survive temperatures up to 140o F
  • Keep the sick away from food preparation areas
  • If you are sick do not prepare food for others
  • If you are sick do not provide patient care
  • Clean surfaces with a bleach solution (1/3 cup bleach per gallon of water or 1TBSP +1/2 tsp per 32 ounces of water in a spray bottle) immediately after vomiting or having diarrhea. Surfaces should remain wet for 10 minutes to fully kill any pathogens.
    • IMPORTANT: wipe down surfaces with clean water after bleach disinfection
  • Close the toilet lid before flushing – flushing can aerosolize viral particles
  • Handle dirty laundry carefully wearing gloves – disinfect hands and reusable gloves after use

More information may be found at: https://www.cdc.gov/norovirus

SM BLOG FOOTER

 

Three Souls…


Three Souls” – Bev Meade, MSN, RN, MHA, CEN, CCRN, CFRN, CTRN, TCRN, EMT-P. Flight Nurse, MedFlight 3.

Our pilot completed his safety checklist and risk assessment, and contacted our Columbus, Ohio, Communications Center with the first radio traffic of the morning: “MedComm, this is MedFlight 3. We have 3 souls, 1 hour 30 minutes in fuel, 8 minute ETA.”.  This radio transmission is always given before we lift from our helipad to begin our mission.  The response was as expected from our experienced Communication Specialists watching over all of us… they monitor us flying and driving our patients “to and fro” for this company.  They acknowledged us with “Copy MedFlight 3… 3 souls, 1 hour 30 minutes in fuel, 8 minute ETA”, and we lifted into the cool, pre-dawn calm with our Night Vision Goggles (NVG’s) down and activated.

 

Our mission was to transport a patient with an ST -elevation myocardial infarction (STEMI) from a rural area in Ohio to the closest cardiac interventional facility… rapidly, efficiently, and safely.  As we landed at the remote landing zone (LZ), we did as we were taught and as we have done hundreds of times on landing… We focused our attention outside diligently, looking through and around the NVG’s for hazards that could mean disaster for the “three souls” on board.

 

Safety is and has always been a top priority for my company, and I am thankful that we are recognized as one of the most safety-conscious critical-care transport organizations in the state.  We communicated succinctly with the local fire department at the LZ, and were acutely aware that our safe landing could mean the difference between life and death for our patient, whom we have yet to meet, and, of course, for us as well.  Even though the “three souls” on board have thousands of safe arrivals, each landing and takeoff still makes me alert, tensed, & ever-vigilant for the unseen hazards that we all know are out there.

 

“MedComm, MedFlight 3.  We’re ‘skids down’ safely”  is what we all wanted to hear, and that is exactly what transpired.  As usual, I thanked my pilot for a safe landing and waited until the blades came to a complete stop before exiting the aircraft to retrieve the necessary equipment, supplies, and of course… my paramedic! As we walked to the waiting EMS vehicle,  I contemplated what we might find, what might need to be done quickly, and what a difference we can make in this person’s life.

 

After assessing and placing appropriate monitoring equipment on our patient, we departed the EMS vehicle in under 7 minutes to rapidly load & secure our patient for the lifesaving transport he desperately needed.  Our pilot once more pierced the airwaves with “MedComm, MedFlight 3.  Lifting from scene with 4 souls, 1 hour 20 minutes in fuel, 30 minute ETA” and we departed the rural hills of Ohio for the center of the state, where critical interventions awaited this patient.

 

After arriving at the receiving hospital and transporting the patient to the cardiac catherization lab, we became “3 souls” again… the team of 3 who answer the call of duty, who respond without hesitation to help the sick and injured, whose life’s work and studies have led each soul to this place, at this time. And I know that there are others just like us at MedFlight around the nation that are awake at 0200, answering the incoming radio or telephone call, responding just as quickly and safely to save the life of another soul. 

 

The mission was completed, the cardiac vessel reopened, and the patient was recovering to resume his life in southeastern Ohio.  As each of the “three souls” completed the post-flight tasks, readying the aircraft for the flight home… me completing the patient care chart and sending it to the receiving facility, the medic restocking the aircraft for another mission if needed, and our pilot refueling for the flight home or to another destination as needed…  I paused for a moment to consider what we had just accomplished.  All of us played a part in the outcome of this patient: Family, EMS, our Communication Center, all of our ancillary personnel, the flight crew, and receiving facility… Each entity relying on the other to do their jobs and save a life.

 

As we were enroute to our base, I considered the new day dawning as the sunrise peaked above the hills of southeastern Ohio where I call home.  I announced “goggles up”, and I contemplated how each of us have a pivotal role in this mission.  I am still in awe after 20 years serving others in critical-care transport how all of this happens almost seamlessly to improve the outcome of our patients.  But, perhaps, more importantly…  I looked to the right toward my medic, and in front of me to my pilot, and I am thankful that each one of the “three souls” are where they are supposed to be, doing what they are supposed to do, and that each of us bear the burden of safety and excellent patient care and quality transport so that we can hear once more “MedComm, MedFlight 3 is safe on deck with three souls” as we land at our helipad…  Mission accomplished.



	

Why A Nurse/Medic Crew Configuration?

Since the inception of air medical transport in the early 1970’s,  the “ideal” crew composition has been the subject of much discussion.  There has been a variety of team types: RN/MD, RN/RN, RN/Medic, RN/RRT, etc.  While each type of crew configuration offers many theoretical benefits, there is little scientific research to support any specific mix of medical crew members.  Most air medical programs in the United States operate with a RN/Medic crew.

MedFlight believes that critical care nurses and paramedics can be trained in skill performance to the level of a physician.  In addition to conducting ongoing quality reviews of the procedures performed by our crews, an annual competency program, and continuing education to enhance clinical skills, each MedFlight transport is supervised by an identified Medical Control Physician who is immediately available to the crew and who provides input regarding the care of the patient.  Each MCP has specialty training in adult emergency medicine, pediatrics, neonatology or high-risk obstetrical care, depending on the patient’s condition.

MedFlight crews are trained to perform and well-versed in, among other skillsets:

  • Rapid Sequence Intubation using paralytic agents
  • Oral and Nasotracheal Intubation
  • Surgical and Needle Cricothyroidotomy
  • Conversion of peripheral IV line to 8.5 Fr introducer for rapid fluid administration
  • IO insertion
  • Pericardiocentesis
  • Needle chest decompression
  • Intra-Aortic Balloon Pump management and transport
  • Ventilator management
  • Monitoring of arterial catheters and Swan-Ganz catheters
  • Monitoring of pulse oximetry and end-tidal CO2
  • Transcutaneous pacing
  • Maintenance of transvenous pacemaker
  • Burn escharotomy

Mobile ICU and Flight Teams also maintain several clinical certifications above and beyond their RN and Paramedic licensures.

The RN/Medic crew configuration offers the most cost-effective method of medical care delivery in the critical care transport environment.  MedFlight is committed to providing the highest level of care for the lowest cost to patients, receiving hospitals, and third-party payors.

We’re proud of the quality work and dedication our clinical crews produce daily.  There are decades of experience at each MedFlight base.  If you have additional questions regarding MedFlight and our capabilities, please visit our website or on social:  @MedFlightOhio.  Partners for Life.

Dr. Howie Werman, Medical Director of MedFlight & Emergency Physician at The Ohio State University Wexner Medical Center

 

 

20 Years: The MedFlight Mobile ICU Division

“It was 20 years ago today that I started as a Mobile ICU paramedic for MedFlight…they had just acquired the Riverside Methodist Hospital Critical Care Transport team where I had previously worked.  On October 20th, 1996, my last shift at Riverside, we were asked to bring the Mobile ICU vehicles to MedFlight as our final task.

I remember MedFlight leadership standing at the hangar door, welcoming us to MedFlight.  I think all of us were excited about this new chapter in our careers.

I have seen many changes through the last 20 years and worked with so many talented people that it boggles my mind.  Working for MedFlight has been awesome, and I wouldn’t have missed the experience for anything.”

~ Lou Hoyer, MedFlight Mobile ICU Paramedic for 20 Years

What a great resource our critical-care  Mobile ICU teams have been for Ohio patients.  This excellent division of MedFlight doesn’t get the limelight it deserves, but, without it, MedFlight would not be who we are today.  To all of our partners that have served and continue to serve on the Mobile ICU teams…. THANK YOU.  And congratulations on 20 great years of service.

~ Tom Allenstein, President and CEO of MedFlight

MedFlight Trialing Transport Telemedicine

telemedicine

MedFlight is beginning an exciting new venture!  Our Columbus-based Mobile ICU team, MedFlight 12, will be involved in a groundbreaking Critical-Care Transport Telemedicine trial.

For 60 days, our teams will partner with Ohio State University Wexner Medical Center physicians to further our over-arching goal of enhancing patient care. An interactive, handheld audio/visual device will be placed in the back of the Mobile ICU, and will be moved throughout the vehicle to test to effectiveness of the device on our transports.  Each time the Mobile ICU team contacts MedComm to be connected with the on-call Medical Control Physician (MCP), the physician at Wexner Medical Center will log into a computer and “beam in” to the telemedicine device.  The physician will get to see the patient in real-time and help guide the care based on both what the MedFlight team tells them and also what they visualize.

“Historically, when physician medical direction is needed, the physician speaks to the transport crew either on the phone or on the radio, limiting our patient assessment to a mental picture and voice communication,” states MedFlight Medical Director Dr. Howie Werman.  “This telemedicine device allows the physician to see the patient, their symptoms, and their reaction to treatment, allowing for a better overall assessment during the transport phase.”

We will be tracking and surveying transports that include transport telemedicine with our transport debrief system that occurs at the completion of each MedFlight patient transport.  This quick and easy 10-question survey will help the Telemedicine team at Wexner Medical Center evaluate the usefulness of this device in the intra-hospital transport setting.

We’re proud to work with The Ohio State University Wexner Medical Center on this venture.  This effort is only part of our constant drive to enhance patient care and recovery.  Partners for Life.

MedFlight is proudly owned and preferred by both The Ohio State University Wexner Medical Center and OhioHealth.

 

–  Caitlin Mazer, MedFlight Mobile ICU RN