Choices in Intra-Facility Transfer Louis Scrattish Assistant Medical Director-UW Med Flight...
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![Page 1: Choices in Intra-Facility Transfer Louis Scrattish Assistant Medical Director-UW Med Flight University of Wisconsin School of Medicine and Public Health.](https://reader035.fdocuments.net/reader035/viewer/2022081520/5697c00a1a28abf838cc78b0/html5/thumbnails/1.jpg)
Choices in Intra-Facility Transfer
Louis Scrattish
Assistant Medical Director-UW Med Flight
University of Wisconsin School of Medicine and Public Health
December 3rd, 2015
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Overview:
Vehicle Options
Crew Configurations
Equipment Variation
Know Your Local Options
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Our Transport Mantra
• Right Vehicle• Right Crew• Right Equipment/Products• Right Destination
![Page 4: Choices in Intra-Facility Transfer Louis Scrattish Assistant Medical Director-UW Med Flight University of Wisconsin School of Medicine and Public Health.](https://reader035.fdocuments.net/reader035/viewer/2022081520/5697c00a1a28abf838cc78b0/html5/thumbnails/4.jpg)
Our Transport Mantra
• Right Vehicle• Right Crew• Right Equipment/Products• Right Destination
![Page 5: Choices in Intra-Facility Transfer Louis Scrattish Assistant Medical Director-UW Med Flight University of Wisconsin School of Medicine and Public Health.](https://reader035.fdocuments.net/reader035/viewer/2022081520/5697c00a1a28abf838cc78b0/html5/thumbnails/5.jpg)
Intra-Facility Transport Options
• Private Vehicle• BLS• ALS• Critical Care Ground• Air• Specialty Ground• Specialty Air
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Vehicle-Ambulance Advantages
• More Room– Larger Medical Crew– Larger Patient– Continuous CPR– Access to Whole Pt
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Eurocopter 135 Interior
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Ambulance Advantages
• Larger Weather Window
• Don’t Need a Helipad
• More of them-May be Closer
• No Issues with Elevation Changes
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Ambulance Advantages• Much More Affordable
– Ambulance $800-2500– HEMS $11,000-54,000
• Better Temperature Regulation– Pt Temp– Lines Freezing– Medication Issues (Mannitol)
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Helicopter Advantages
• Faster– Average Speed 140-150mph
• Must Figure Warm Up/Cool Down Time of HEMS
• Longer Transports Favor HEMS– If speed only concern:
» <20 min ground transport-drive» 20-30 grey zone» >30 min ground transport-air
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Helicopter Advantages
– Can Travel in a Straight Line• Traffic Jam?• Inefficient Route?• Going Through Large Urban
Area?
– Smoother Ride• Consider in Unstable Spinal
Injuries
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Helicopter Advantages
• Safety– 1993 Houston study: Ambulances 13x
more likely to get in an accident based on number of accidents per miles traveled
Ambulances 5x more likely to get in an accident that resulted in injuries
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Conditions Where Time Critical
• STEMI• Strokes where Lytics running, possible• Intracerebral Hemm
– Deterioration– Midline Shift
• Trauma’s Where Blood Products Infusing
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Timing Possibly Less Critical
• Digit amputations where implantation not an option
• Burns (without airway compromise)• Improving Sepsis
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Other Timing Considerations
• Crew Launch Time Critical– Varies Widely by Agency– For HEMS Longer at Night
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Our Transport Mantra
• Right Vehicle• Right Crew• Right Equipment/Products• Right Destination
![Page 17: Choices in Intra-Facility Transfer Louis Scrattish Assistant Medical Director-UW Med Flight University of Wisconsin School of Medicine and Public Health.](https://reader035.fdocuments.net/reader035/viewer/2022081520/5697c00a1a28abf838cc78b0/html5/thumbnails/17.jpg)
IFT Crew Configurations
• Most ambulance crews for IFT:– Mix of EMT-B, EMT-I, EMT-P– Critical Care Ground Often Includes Critical
Care Paramedic or RN
• Vast Majority of HEMS:– EMT-P/RN– A few EMT-P/EMT-P– <5% Physicians
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Specialty Crews
• Respiratory Therapy• Neonatal Provider • PICU Provider• OB provider• Perfusionist
• Can be utilized by ground and air
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In an Ideal World….
• Mode of Transport and Crew Completely Independent on Each Other
• Mix and Match
• Why doesn’t work?
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When can RN/Physician be helpful?
• On Board Medical Control• Airway Needed, Rescue Airway in Place• Advanced Ventilator Settings• Medication Infusions
– Ie Pressors, Flolan• Pt deteriorating• Pediatrics
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When can RN/Physician be helpful?
• On Board Medical Control• Airway Needed, Rescue airway in place• Advanced Ventilator Settings• Medication Infusions
– Ie Pressors, Flolan• Pt deteriorating• Pediatrics
![Page 23: Choices in Intra-Facility Transfer Louis Scrattish Assistant Medical Director-UW Med Flight University of Wisconsin School of Medicine and Public Health.](https://reader035.fdocuments.net/reader035/viewer/2022081520/5697c00a1a28abf838cc78b0/html5/thumbnails/23.jpg)
Overview:
Right Vehicle
Right Crew
Right Equipment/Products
Right Destination
Know Your Local Options
![Page 24: Choices in Intra-Facility Transfer Louis Scrattish Assistant Medical Director-UW Med Flight University of Wisconsin School of Medicine and Public Health.](https://reader035.fdocuments.net/reader035/viewer/2022081520/5697c00a1a28abf838cc78b0/html5/thumbnails/24.jpg)
ALS Equipment
• IV access• IVF• Many IV medications• Vital Sign Monitoring (incl SpO2)• Can Gain Airway if Needed (+/- VL)• +/- Ventilator
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Critical Care Ground
• ALS plus the following:– Ventilator– Broader Array of Meds (Pressors, Paralytics)
– Invasive Monitoring• Arterial Line• ICP
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HEMS
• ALS plus Critical Care plus:– pRBC’s– Video Laryngoscopy– +/- On Board Labs– On Board Chest Tubes– +/- TXA– Advanced Communications Centers
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Med Flight
• pRBC’s, TXA, FFP• On board labs (ePOC)• Glidescope, CMAC
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Overview:
Right Vehicle
Right Crew
Right Equipment/Products
Right Destination
Know Your Local Options
![Page 29: Choices in Intra-Facility Transfer Louis Scrattish Assistant Medical Director-UW Med Flight University of Wisconsin School of Medicine and Public Health.](https://reader035.fdocuments.net/reader035/viewer/2022081520/5697c00a1a28abf838cc78b0/html5/thumbnails/29.jpg)
Summary
• HEMS Speed Advantage not a Simple Calculation
• HEMS a Safe Alternative• Crew and Equipment Needs often
Overlooked• Local Knowledge of Agencies Critical
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Questions?