Choices in Intra-Facility Transfer Louis Scrattish Assistant Medical Director-UW Med Flight University of Wisconsin School of Medicine and Public Health December 3 rd, 2015

Overview: Vehicle Options Crew Configurations Equipment Variation Know Your Local Options

Our Transport Mantra Right Vehicle Right Crew Right Equipment/Products Right Destination

Our Transport Mantra Right Vehicle Right Crew Right Equipment/Products Right Destination

Intra-Facility Transport Options Private Vehicle BLS ALS Critical Care Ground Air Specialty Ground Specialty Air

Vehicle-Ambulance Advantages More Room –Larger Medical Crew –Larger Patient –Continuous CPR –Access to Whole Pt

Eurocopter 135 Interior

Ambulance Advantages Larger Weather Window Don’t Need a Helipad More of them-May be Closer No Issues with Elevation Changes

Ambulance Advantages Much More Affordable –Ambulance $ –HEMS $11,000-54,000 Better Temperature Regulation –Pt Temp –Lines Freezing –Medication Issues (Mannitol)

Helicopter Advantages Faster –Average Speed mph 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

Helicopter Advantages –Can Travel in a Straight Line Traffic Jam? Inefficient Route? Going Through Large Urban Area? –Smoother Ride Consider in Unstable Spinal Injuries

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

Conditions Where Time Critical STEMI Strokes where Lytics running, possible Intracerebral Hemm –Deterioration –Midline Shift Trauma’s Where Blood Products Infusing

Timing Possibly Less Critical Digit amputations where implantation not an option Burns (without airway compromise) Improving Sepsis

Other Timing Considerations Crew Launch Time Critical –Varies Widely by Agency –For HEMS Longer at Night

Our Transport Mantra Right Vehicle Right Crew Right Equipment/Products Right Destination

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

Specialty Crews Respiratory Therapy Neonatal Provider PICU Provider OB provider Perfusionist Can be utilized by ground and air

In an Ideal World…. Mode of Transport and Crew Completely Independent on Each Other Mix and Match Why doesn’t work?

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

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

Overview: Right Vehicle Right Crew Right Equipment/Products Right Destination Know Your Local Options

ALS Equipment IV access IVF Many IV medications Vital Sign Monitoring (incl SpO2) Can Gain Airway if Needed (+/- VL) +/- Ventilator

Critical Care Ground ALS plus the following: –Ventilator –Broader Array of Meds (Pressors, Paralytics ) –Invasive Monitoring Arterial Line ICP

HEMS ALS plus Critical Care plus: –pRBC’s –Video Laryngoscopy –+/- On Board Labs –On Board Chest Tubes –+/- TXA –Advanced Communications Centers

Med Flight pRBC’s, TXA, FFP On board labs (ePOC) Glidescope, CMAC

Overview: Right Vehicle Right Crew Right Equipment/Products Right Destination Know Your Local Options

Summary HEMS Speed Advantage not a Simple Calculation HEMS a Safe Alternative Crew and Equipment Needs often Overlooked Local Knowledge of Agencies Critical

Questions?