Category: SAFETY MATTERS: An Online Magazine

“Safety Matters” is an online magazine created and authored by both MedFlight and HealthNet Aeromedical Services.

Long Term Pandemic Response: Recognizing Burnout & Maintaining Perspective.

By Justin Koper, M.S., GSP, MTSP-C, FP-C. Safety Officer, HealthNet Aeromedical Services

When COVID-19 began impacting our service areas in early March, it seemed that the number of confirmed cases were low, and we would have no issues combatting further spread. As more was learned about the virus, we quickly discovered that the scope of this pandemic will likely be measured in years rather than days, weeks, or months.

There is now a serious concern about the personal and performance-related consequences of “COVID burnout.” Symptoms of this burnout that impact the provider personally could be the impacts of constant PPE use, health effects of long-term stress, constant worry about the safety of their loved ones, and fear of personal exposure, among others. Work-related symptoms of burnout include a failure to adequately report details of COVID-19 related transports, complacency regarding PPE, non-compliance with facial covering requirements at base sites, and missed opportunities to control the spread of infection at the source (i.e. providing non-intubated patients with surgical masks and using HEPA-rated filters on intubated patients).

To mitigate the risk of burnout it is important to know where our organization currently is in this pandemic and the outcomes of everything that you as front-line healthcare workers have accomplished. As of August 14, 2020, our organization has performed 556 COVID-19 related transports which include persons under investigation for COVID-19, patients with pending COVID-19 test results, and known positive patients (Note: this data tracking started in early March). Of those 556 patients a total of 101 have been either positive at the time of transport or tested positive after transport (see figure 1 for a full breakdown). Out of all these transports we have had zero instances of providers contracting COVID-19 from a patient. Also, we have had zero workplace transmission of COVID-19 at any of our base sites. This is an important fact to remember as there have been numerous other healthcare entities within our service areas that have had significant outbreaks related to workplace exposure.

We are acutely aware that communication breakdowns are common in stressful situations which is why we have purposely designed our system to have multiple layers of redundancy so if there is a communication failure it does not adversely impact crew safety (i.e. we have designed the system to tolerate predictable failure without exposing team members to any risk of harm or exposure). When such countermeasures have been proven amid a pandemic, it is easy to see their importance.

As for where we are going with this pandemic it is nearly impossible to determine. Many of the large-scale models have come close but few have been accurately able to predict one important variable, human behavior. Until this variable becomes 100% predictable, it will be nearly impossible to create any data models with high confidence. Based on our organization’s data throughout this pandemic, we are reasonably anticipating a slight increase of COVID-19 related transports in the coming weeks with a higher percentage of these patients being known positives. This anticipated increase is due to a few factors such as community transmission rates, increased testing availability, and decreased turn-around times for test results. So, moving forward it will be important to remember one thing: “Be brilliant in the basics” (Ret. Gen. Mattis). Maintaining a high level of proficiency and attention to detail for each individual task will help eliminate preventable errors which can reduce undesirable outcomes.

If you are facing personal stressors in these difficult and unpredictable times it is important to remember the resources that are available to you.

The Journey Towards “Safer Practice”

By Gregory R. Schano, DNP, MBA, RN, CCRN, CFRN, CNML, CMTE, EMTP. Flight Nurse, MedFlight

The transfer of important data between caregivers and teams of caregivers represents an opportunity for information loss due to reasons that may include lapses in memory, ineffective delivery of a message, and not listening with intention. Besides these few very broad and general causes, there may also be other human, environmental, and structural barriers to an effective handoff (Riesenberg, Leitzsch, & Cunningham, 2010). Can you think of a few reasons from your own practice?

A culture designed to promote safety will consider barriers to effective handoffs and include strategies to mitigate the barriers (Lee, Phan, Dorman, Weaver, & Pronovost, 2016). The Central Ohio Trauma Systems (COTS) organization partnered with EMS agencies and hospitals to develop a standardized response for patient information sharing. In June 2020, partners with COTS contributed an online article “Collaboration: The Key to a Successful Patient Care Hand-Off” which you may find helpful in your journey to safer patient care.

View article here: jems.com/2020/06/23/the-key-to-a-successful-patient-care-hand-off/

References:

Lee, S-H., Phan, P., Dorman, T., Weaver, S., & Pronovost, P. (2016). Handoffs, safety culture, and practices: Evidence from the hospital survey on patient safety culture. BMC Health Services Research, (16)254. doi: 10.1186/s12913-016-1502-7

Riesenberg, L., Leitzsch, J., & Cunningham, J. (2010). Nursing handoffs:  A  systematic review of the literature. American Journal of Nursing, 110(4). Retrieved from: nursing.ceconnection.com/ovidfiles/00000446-201004000-00026.pdf

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!

Let’s Get Back to Basics.

by Karen Swecker, MedFlight Exposure Control Liaison

Did you know there are more than 23,000 deaths a year directly caused by healthcare acquired infections? That is equivalent to a 747 airplane crash every week for an entire year.

There are more than two million healthcare related infections (HAI) in the U.S. each year. One out of every 31 patients develop an HAI. How many patients did you personally take care of last year; How many developed a bloodstream infection from your IV start, developed ventilator pneumonia, or an infection with MRSA or VRE due to care provided in the time it takes to transport them?

Cell phones carry 10 times more germs than the average toilet seat. How many times did you touch a cell phone or radio dial to give report on a patient you were transporting? When is the last time you cleaned your phone or the radio knobs in the aircraft or mobile unit? Bacteria such as MRSA and VRE are viable and able to cause infections for more than 51 days from contaminated surfaces such as plastic cell phone covers and radio knobs. CRE (antibiotic resistant E. coli or Klebsiella) caused an estimated 13,000 infections and 1,100 deaths in 2017. C. difficile causes 12,800 deaths a year in the US.

Healthcare acquired infections are easy to prevent. Sanitizing your hands, equipment, and surfaces are a must. Remember to change gloves and cleaning wipes frequently as both become saturated with bacteria that is easily transmitted to and from surfaces and equipment to patients.

A 2014 study culturing 112 stethoscopes showed 47% of them were contaminated with 50 different potentially pathogenic bacteria (Leo- Lara, MD, Munoz, MD, & Campos-Murguia, MD, 2014). A study of the effectiveness of disinfecting wipes showed bacteria was moved from surface to surface due to increasing bacterial lodes on the wipes (Cheng, Boost, & Wai Yee Chung, 2011).

The COVID-19 pandemic has brought more attention to the need for increased hand and surface sanitizing. As healthcare workers we’ve been taught the importance of cleanliness but due to the pressures of critical care it’s easy to let this basic necessity slide. Once COVID-19 has been defeated, or at least contained, remember the lessons we’ve been taught. Hand hygiene and surface disinfecting must remain a priority in caring for patients. Do not let your patients be part of the 23,000 a year that succumb to healthcare acquired infections.

References:

Cheng, K., Boost, M., & Wai Yee Chung, J. (2011). Study on the effectiveness of disinfection with wipesagainst methicillin-resistant Staphylococcus aureus and implications for hospital hygiene. AJIC, 577-580.

Leo-Lara, MD, X., Munoz, MD, J., & Campos-Murguia, MD, A. (2014). Stethoscopes as Potential Intrahospital Carriers of Pathogenic Microorganisms. AJIC, 82-3.

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

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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.

 

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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

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#StaySafeOnline

Ball, Amandal
Amanda Ball, MedFlight Safety Officer

About a decade ago, while social media was still in its infancy for organizations like ours, I “took over the reigns” as administrator for MedFlight’s social accounts.  At that time, we had a presence on Facebook and Twitter, and had been posting friendly, benign messaging.  There was no real “training” to send me to at that time… I learned as I went, as most “social media experts” did (and still do), fitting the work in when I had the time between other work duties and real-life to-do lists.

After a few years of self-training, research, and a lot of real-life experience, successes and stumbles, I was able to find a FEMA/DHS-level social media course that focused on the usage of social media in disaster management.  To say that course opened my eyes would be an understatement.  Established and vetted public service social media administrators led the course and reiterated the importance of a consistent presence online during both “blue sky” and “gray sky” days, the importance of social media policy (internal and external), and the importance of protecting your online privacy.

I was hooked, and the class reiterated that my own “self-training” was paying off… MedFlight was ahead of the curve with a lot of these practices already in place.  A few months later, I became an instructor of the class, and now teach three FEMA-level social media courses to government and public safety personnel, nationwide.

Your online privacy and identity as a community member, and healthcare provider, are very important…  In this day and age, it does not take much for information posted online to go ‘viral’… perhaps seeping out of the post’s original context and creating a larger problem once shared without the accompanying story.  We recognize that social media can be a great communication tool and a great way for families and loved ones to connect… but it can also be a hub of misinformation and safety threats.  Because of this, we’ve always taken proactive steps at MedFlight to help protect our employee’s online presences.  Here are a few:    

Employee last names are not utilized in posts, their badges “pixelated” when possible to protect their identity.  “Photo credit” is not given to crew members if they take the photo and share it with me for organization use.   All photos shared on MedFlight accounts are reviewed and approved.  All social media posts are archived.  We drafted an internal social media policy.  Why do we go through so many steps?  To protect and respect the online identities of MedFlight team members. 

What you can do to stay safe online:

  1.  Don’t post anything to your social media accounts that you don’t want a stranger to know, you don’t want a partnering agency to see, etc.  Everything you post online (including comments, “likes” and pictures) can be recorded and shared… regardless of your privacy settings.  Could a screenshot of a direct message be shared outside of the private setting you thought it existed in?  Absolutely.
  2. Do not “tag” yourself, or team members, in agency posts or comments.  When you do this, you are opening yourself up to unwanted friend requests or “follows” from people you may not know, or want to know, outside of work.  Which leads to my third point…
  3. Do not accept friend requests from people you do not know personally and well.  An example: A member of one of our flight teams greeted the critically-ill patient’s family at the beginning of a transport and introduced herself.  The flight time was approximately 30 minutes to the receiving hospital, and, in that time, she had received a “friend request” on Facebook from a member of that patient’s family.  She declined the request once she saw it that evening.  Your account’s settings should ensure your page is as private as possible to those you are not connected with.
  4. Review your social media privacy settings often… the platforms often update your settings on your behalf as they add features to the platform, and you can change them back to ensure your privacy is protected.
  5. “Lock down” your account’s public content as much as you can.  Example: You publically list your address, phone number, and birthdate on your Facebook “About” section.  Your profile picture is a great selfie, and your cover photo showcases your home and children’s faces.  On Instagram and Twitter, you “check in” out of state at different vacation spots while you travel with your family.  A criminal now has a lot of information that confirms you are not at home.  You have also listed your last name, your hometown, your children’s approximate ages with the photo… would it take much work for a stranger to figure out which school they go to?  It does not take much for info you post to get into the wrong hands, and for chaos to ensue.
  6. Consistently review online safety with your coworkers and community leaders.  An internal policy and training program is vital.
  7.  Use two-factor authentification features to help protect your account from hackers, and sign out of your account on every device once you are done viewing it… including on your phone.
  8.  Steer clear of public wifi hotspots when accessing your personal information online.  There are less security measures on public wifi, allowing hackers to access your information quicker.

Remain “situationally aware” while navigating online, and your real-life information will remain as secure as possible.  Take an active role in your online safety!

Find out more about protecting your online privacy: staysafeonline.org/stay-safe-online/

HEAR or SEE a Manned Aircraft? Land the Drone.

Ball, Amandal
Amanda Ball, MedFlight Safety Officer, FAA Safety Team Representative

Unmanned Aerial Vehicles (UAV/UAS/drones) provide a great service when assessing damage in disasters, emergency scenes, and search missions.  This industry will aid first responders and emergency management personnel in ways we’ve not seen before, and at MedFlight, we proactively work to “Share the Air” with UAS enthusiasts and professionals with UAV pilot workshop opportunities, constant conversations with air medical and aviation organizations, and more.

We do ask that UAS pilots “Share the Air” as well.  Manned aircraft (any type of aircraft with a pilot inside and at the controls) have the right-a-away in almost any in-flight scenario you can think of.

While in-flight, our pilot and medical crews are constantly scanning the horizon and communicating risks they may identify to each other.  The helicopter itself is also scanning its surroundings for obstructions with the aid of several comprehensive awareness systems.  The crew also utilizes the customized Air Medical Resource Management training they receive throughout the year to help accomplish their goal of completing a safe mission.  These are just a few pieces of a large effort to remain situationally-aware in an ever-changing environment.

Consider this… on average, air medical helicopters cruise between 120-170 knots, depending on the airframe…around 2-3 miles a minute.  While cruising altitude for VFR flight averages around 1500 ft AGL, flight teams are often descending into destinations well-before they arrive there.  Think of the descent pattern for a commercial airplane when approaching the airport.  It’s the same concept, but over a shorter distance, and with more unpredictability.  Our flight requests differ from day to day, location to location.

How can you help?  If you launch a UAV under a professional OR recreational setting, land it immediately if you see or hear another manned aircraft in the area.  Deconflict the airspace by exiting it as soon as possible.

Manned aircraft teams have a harder time seeing your UAV than you do seeing them… UAVs often blend into the horizon when viewed from above… even with lights, bright colors, etc.

It’s always a good idea to remain situationally-aware while you fly.  We appreciate your efforts to keep our aviation community (including you) safe!

There is a ton of great information out there on safe flying practices.  The FAA has made it easy for UAS enthusiasts and professionals to learn more and stay safe:  Keep up to date on rules and regulations, register your drone, and receive on-going training at https://www.faa.gov/uas/ and https://faadronezone.faa.gov/#/

airspace_classes_large
Graphic courtesy of the FAA.

UAV

Respect Your Work-Life Balance

Perkins, Mike
Mike Perkins, Vice President of Operations at MedFlight

I recently returned from a week’s long vacation where I was able to totally disconnect, and I plan to do it again later this summer.  For those of you that don’t know me well, that’s an extremely difficult task.  Up until four years ago, work-life balance was a real struggle.  It wasn’t until my family moved to our small farm, started raising chickens, began mowing a ton of grass, and watched both my daughters head off to college that I finally “got it.”

While we need to continue working hard to ensure we are doing what’s best for our patients and the organization as a whole, we also need to be taking care and making time for ourselves.  It’s an old saying that in order to take care of others, we need to take care of ourselves first.

There has been a great deal of focus lately on providing support for caregivers. This support carries over to daily duties and interactions, not just during or after difficult events.  At MedFlight we initiated an internal Critical Incident Stress Debrief team (CISD) and Comfort Dog program to help provide that support both internally and externally.

A MedFlight communication specialist greets the organization's therapy dog, Ollie.
MedFlight Communication Specialist Paige D. greets the organization’s therapy dog, Ollie.

Equally important, information and education has been provided to MedFlight partners on how to recognize stress and teach preventative methods of reducing stressors in our lives.  We all have stress. The key is how we deal with that stress.  As we know, there are healthy ways to deal with the stressors like exercising, hobbies, and non-work-related outlets. Conversely, there are some not-so-healthy ways.

Unfortunately, stressors are a major part of this profession. We need to do our very best to stay healthy, both physically and mentally.  Many of you probably already do this.  For those that do, kudos to you!  Additionally, help keep an eye on your colleagues.  This includes making sure they find a support system and have an avenue to disconnect from work.  Encourage them to find a hobby or reconnect with family and friends and focus on what’s truly important.  For those of you that struggle with work-life balance like me, I encourage you to step back and really reflect on other aspects of your life.  Trust me, there is more to life than constantly working, checking email 24/7 (guilty), and being tethered to smart phones.

I encourage you to find your Zen outside of work.  Mine just happens to be taking care of our hobby farm and beekeeping. I suggest you find something that allows your mind to wander and requires very little brain power.  It’s truly therapeutic and will make you happier and healthier.  Stay safe.  Stay healthy.  Thanks for all you do.

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