Scene airway management before and after the introduction of a rapid sequence induction protocol

HELICOPTER

DISPATCH: Kevin

Authors:

Stanhope,

A TIME STUDY Robert

Falcone,

William

Quinlin,

Howard

Werman.

Columbus

MedFlight To quantitate and reasons

Purpose: (D/L)

times

This Data was collected on 197 consecutive

Methods:

actual Request to Lift for delay in an active

off air

(R/L) and Dispatch medical transport

was a prospective observational study blinded by the communications department over a four missions.

to Lift program

off

to crew and pilots. week period of time

Results: The Air Medical Helicopter Program services 25,000 square miles with four BK-117 helicopters staffed by a nurse/paramedic crew. During the study period R/L and D/L averaged 10.8 and 6.8 minutes respectively. One hundred and twenty-two flights had an R/L of 10 minutes or under for an average R/L of 8.6 minutes and D/L Seventy-five flights had an R/L of greater than 10 minutes. of 6.5 minutes. Reasons included: weather check - 21; standby by requester - 27; all ships in flight - 5; receiving facility delay - 4; mechanical problems - 4; original ship diverted - 2; additional fuel needed - 1; airport clearance - 1; and no specific reason given - 10.

The majority of variability occurred in R/L rather than D/L. Evaluating Request to Lift-off time not only provides a better indication of program activity but will identify the majority of delays. It appears reasons for delay are limited, which should allow the development of a concise plan to address them. Conclusions:

SCENE AIRWAY MANAGEMENT BEFORE AND AFTER THE INTRODUCTION INDUCTION PROTOCOL

Holley

Herron,

Introduction:

evaluate introduction

Robert

Falcone,

A change in airway scene airway management of a rapid sequence

OF A RAPID

SEQUENCE

Columbus

MedFlight

management protocol provided the by an air medical team before induction (RSI) protocol.

opportunity and after

Barb

Dean,

Howard

Werman.

to the

Study patients included those scene trauma patients whose airway was established primarily by the air medical crew during two study periods, April 1994 RSI) and April 1995 through March 1996 (Group through March 1995 (Group 1, before Data collected included: Demographics; type of airway, endotracheal 2, after RSI). (NT), cricothyrotomy (CRIC); Glasgow Coma Scale Score (GCS), (ET), nasotracheal ground time, and outcome.

Methods:

Group 1 included 148 patients averaging 31.6 years of age. They were Results: with an average GCS = 7.7. primarily male (79.7%) with blunt injury (92.6%), Group 2 was similar with 95 patients averaging 31.1 years of age, primarily male patients in Group (77.9%) with blunt injuries (94.7%) and a GCS = 8.6. Twenty-nine 2 underwent RSI for an average GT of 25.2 minutes. Airwav Outcome: Group 1 Group 2 P ET 19 36 0.003 NT 118 56 NS 6 CRIC 3 NS UNSUCCESSFUL 5 0 NS GROUND TIME 15.7 Min 20.1 Min 0.0012 Conclusion: RSI adds significantly to ground time without the intubation success rate or decreasing the cricothyrotomy scene of injury may not be appropriate. 128

significantly rate.

July-September

1996

Its

increasing use at the

15:3 Air Medical Journal