First Impella patient transport by rotor wing completed

Central Region
Illinois | Iowa | Missouri | Nebraska | Oklahoma | South Dakota | Texas
Q2 2012
First Impella patient transport
by rotor wing completed
By Amy Niewinski, Medical Manager
On March 8, 2012, AMC became a part of history. ARCH Air Medical
and Med Flight completed the first Impella patient transport by rotor
wing in this country, according to the manufacturer Abiomed.
What is an Impella you ask? It is an amazing advance in cardiac
and cardiothoracic medicine that has changed the future. A patient
can suffer severe damage to their heart muscle for many different
reasons. Some of these reasons may be congenital, a heart attack,
bad genes, viruses or many
other reasons. When the
heart can no longer effectively
supply blood to the rest of the
body’s tissues and vital organs
because of this damage, the
medical community has to
step in and help it out until the
heart can rest and recover
or the patient can get a heart
transplant. The newest and
least invasive device that is
currently available to do this is
called an Impella. It is classified as a type of Ventricular
Assist Device or VAD. It is a
small catheter that is placed
into the patient’s left ventricle
via the femoral artery. All it
takes is a needle stick, then
the physicians are able to
float the Impella device into
proper placement between the
pt’s left ventricle and the aorta, turn it on and the device can propel
the patient’s blood forward enough to provide a blood flow that is
equivalent to an undamaged heart. These patient’s typically end up
requiring less IV medicated drips to support their blood pressure
and typically require no systemic blood thinners. Therefore, these
patients have less of the negative side effects from receiving those
types of medications long term.
Since December, ARCH and Med Flight leadership has been
intensely working with the Cardiology/Cardiothoracic surgery staff
at Barnes Jewish Hospital and Washington University, as well as
the company Abiomed to get our Ventricular Assist Device transport
program up and running. All of the staff, from the communication
specialists, to the mechanics, to the med crews, pilots, and management, was an iatrical part of making this successful. To date we
have completed two of these Impella patient flights. These patients
are typically very sick and
have reached the end of the
resources available at the
hospitals they are at and need
to be sent to a tertiary facility,
like Barnes Jewish Hospital for
further management.
Our medical staff has all
gone through training with the
Abiomed nurses with hands on
time with the Impella device,
recurrent on line learning,
and receive bedside clinical
hours in the Intensive Care
Units where these patients are
being managed with Impellas
and other VAD devices in use.
Some of our staff has also had
an opportunity to be included
in some of the in operating
room education by Abiomed,
in conjunction with Washington University Physicians and Surgeons during the implantation of
the Impella and other VAD devices.
In the competitive market of air medicine and the ever changing
world of medicine in general, ARCH Air Medical and Med Flight are
proud to be able to offer the service of transporting this device via
our programs rotor wings and fixed wings. We are always striving for
better quality and quantity of life for our patients.
All in a Day’s Work
By Susan Cook, Area Business Manager, Oklahoma and Texas
Kent Schmidt is our newest addition to Business Development as the
local Business Development Manager for Mediflight of Oklahoma. He
transitioned from his paramedic position to the BD position in January
this year after Mediflight, transitioned from a HBS to a CBS program.
the gentleman out onto the road. He then asked the fire department
to get Mediflight in route. He looked up and seeing that an ambulance
had arrived, he asked the paramedic to grab the airway bag. Kent
again tried to manually open his airway without success. When the
medic returned with the airway kit, Kent inserted the oral airway and
attempted BVM ventilations but was unable to get chest rise. He then
intubated the patient
successfully on the
first attempt. Because
the ambulance on
scene was actually on a transfer and
had stumbled on the
scene, he asked FD
if they had and ETA
of the second ambulance. A few minutes
later, the ambulance
arrived and transported the patient
to a predetermined land zone where he was
transported by Mediflight to OU Trauma Center
in Oklahoma City.
Kent had only been on the job a few days when he and his wife, while
driving back from Oklahoma City to Ada where they live,
rounded a curve in the road and noticed a large amount of
dust and debris fly up from under a bridge. Kent and his wife
thought someone might have hit the underside of the bridge
so he made a U turn and drove down under the bridge to
investigate. There he found a one ton pickup lying on its top.
At the same time he pulled up, 3 teen aged girls ran down
from the road above screaming and crying that the truck
had flipped off the top of the bridge. Kent got out of his car
to take a closer look and as
he approached the truck he
could see through a 1 ½ foot
hole where the driver’s side
window once was, a male
upside down in the truck. The
rest of the cab was completely
flat with the hood and bed
of the pickup. After a quick
assessment Kent realized the
male was unresponsive in
agonal respirations, breathing approximately 3 times a
minute. He attempted unsuccessfully to get the side door
open while his wife tried to
calm down the 3 girls that had witnessed the accident. At this time, a
young man ran up and together he and Kent were able to get the door
open. Kent attempted to do a jaw thrust to open his airway but the
way he was trapped in the cab, it made it impossible. He asked if anyone had a knife and someone produced a pocket knife. By this time
the Shawnee Fire Department had arrived, he cut the lap belt and
shoulder strap and with the assistance of the fire department, pulled
Kent believes it was a miracle that everything
came together that day to help this patient. The
fact that Kent was there when the accident occurred, the timing of the EMS unit that stopped
at the scene with the needed airway equipment
and supplies, while the closest aircraft, Mediflight 2 only 8 minutes away, was out of service
that day, Mediflight 1 having just completed a mission, responded
from OU Medical Center which cut their response time to the scene in
half.
After a short time in the hospital and rehabilitation, the patient was
discharged to go home in April with no deficits or neurological side effects. The family continues to contact Kent regularly with updates.
Tulsa Life Flight recognized
Tulsa Life Flight was recently recognized by the Joplin Fire Department for their participation in the
May 22, 2011 Joplin tornado response. Tulsa Life Flight had two aircraft on the ground in Joplin a
few hours after the tornado ripped through town killing some 160 people and destroying one of the
two hospitals in the city. In all, Tulsa Life Flight provided an aerial platform for the Joplin City Manager and Fire Chief to assess the path of destruction and transported four critically injured persons
to hospitals in Kansas City, Mo and Tulsa. OK.
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Understanding Inadvertent Instrument
meteorological conditions (IIMC)
By Rob Nelson, Regional Aviation Manager
All of us have heard the term IIMC and have maybe even discussed it
during a briefing a time or two. There are a lot of very scary statistics
floating around that we have all probably heard at one time or another.
They range from the high percentage of fatal accidents that are a result of IIMC to the number of seconds the average VFR pilot can control an aircraft without outside visual reference. For a crew member
sitting in the back and not in control of the aircraft, these can be hard
statistics to swallow. There are two important considerations to keep
in mind when pondering ways to avoid ever having to experience this
phenomenon. Option “A” is avoidance. Simply avoid the bad weather,
Right? We all know this. It has been pounded into our heads at every
AMRM class and every briefing we have been in since we joined this
industry. This strategy has been hammered so hard, in fact, that it is
considered by some to be the only way to stay alive. Don’t get me
wrong. Avoiding bad weather is always going
to be the best solution, but how many of us
with any length of experience in this industry
can say that they have never been on a mission where the weather didn’t turn out quite
like it was expected? It might be easier for
some to count how many times the weather
did turn out like expected. Our experience
doesn’t always leave us with the feeling that
option “A” is always going to be 100% effective and with something as important as our
lives on the line we want something more
solid. This brings me to option “B”, embrace
it. These two techniques can be employed
in many situations. I tried to avoid moving
to Iowa from California 14 years ago, but at
some point I realized that I couldn’t. I had no
choice but to embrace Iowa, or let the winters
kill me. It took me a couple of years to figure
out how to embrace the Mid West’s winters
but I’ve done it. In a flying aircraft, we don’t
have this luxury of time. If we discover that
our avoidance techniques were ineffective
we need to embrace option “B” immediately.
I don’t think this option is discussed very
often outside of the pilot ranks and it would
be helpful for all team members to have a
firm understanding of what is involved with
this option so that they can embrace it along
with the pilot when the decision is made. I
flew for many years for a program where we
called this option, Option “A”. Not really, but
for the sake of this article let’s say we did.
We actually called it an IFR flight. I only say
this because it should be understood that
IMC (Instrument meteorological conditions)
in itself is not an emergency situation. Only
when you place the word “inadvertent” in front of it does it becomes
an emergency. So what’s the difference between an IFR program that
routinely flies IFR and a VFR program that only flies VFR. It’s not the
pilots. Every pilot in the company has an instrument-helicopter endorsement on their certificate and is fully capable of flying a helicopter in instrument meteorological conditions. There are some aircraft
differences but those differences are primarily there to allow sustained
and repetitive flight in IFR conditions. An autopilot is not what makes
IFR flight possible. It merely reduces the workload for the pilot and is
not required for IFR flight if there is a second pilot who can share that
workload. It can become quite tiresome for a single pilot to intentionally fly by reference to the instruments hour after hour, day after day.
If the difference in these types of programs is not the pilot and it’s not
the aircraft, then that leaves us with training. According to the FAA,
a pilot assigned to an IFR program is required to complete recurrent
training twice a year, whereas a VFR assigned pilot is only required to
complete recurrent training once a year. Under the old theory of VFR
pilots being able to magically avoid bad weather every time without
fail, this amount of training is perfectly acceptable. We as a company
know this is unrealistic and have placed
an extreme emphasis on the importance
of option “B” and have made our own
requirement to give VFR pilots training
twice a year as well. This additional training is focused entirely on how to handle
inadvertent flight into IMC. The company
has two mobile flight training devices that
are traveling the country now with the plan
to alternate each pilots training so that they
fly the simulator one year and their aircraft
the next. The simulator will allow instructors to put pilots into simulated dangerous situations that are not possible in an
aircraft. These scenarios can be reset and
carried out again and again without the
need for extended set up time as in with an
actual aircraft. Our goal with this training
is to make every pilot know that when all
other methods have been exhausted, there
is an option that can be used with confidence.
IIMC will always be an “emergency situation” but not because the pilots or aircraft
are not fully capable of handling it, but
because a clearance from air traffic control
was not received before entering these
conditions. The pilots train for this possibility constantly. This should be a topic during
the daily brief and discussion should take
place regarding what assistance the crew
can give should they find themselves in
this situation. Air Methods has a template
that is in every aircraft and available for
quick reference by the pilot when needed.
All crew members should familiarize
themselves with this template. If the pilot asks for assistance, a crewmember should be able to quickly locate this template and be able to
read off the appropriate information for the pilot. Being prepared, as a
team, for any situation will lead to a safe operation. Remember that it
is not our circumstances that determine our choices. It is our choices
that determine our circumstances.
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Recognizing “unsung heroes”
Steelville Ambulance and ARCH team for STEMI transport
Submitted by Keith Chisamore, Medical Manager
On December 1, 2011, Steelville Ambulance responded to a 911
call from the daughter of a 70-year-old man who was complaining
of chest pain. Upon arrival, the EMS team assessed the patient,
secured him to a stretcher and placed him in an ambulance for
further assessment when he became unresponsive, going into
cardiac arrest. After paramedics successfully resuscitated him, a
12-lead electrocardiogram (ECG), was completed revealing an
ST-elevation myocardial infarction (STEMI). Arrangements were
made by Steelville EMS to meet Arch Air Medical to fly the patient
to St. Clare Hospital, Fenton, MO. for an emergency cardiac catheterization.
In route, the flight team repeated the 12-lead ECG confirming the
diagnosis of an acute myocardial infarction. St. Clare’s Emergency
Department was immediately notified of the incoming STEMI, and
the Cardiac Cath heart team was activated. SSM – St. Louis facilities trust the paramedics’ interpretation of the 12-lead in determining activation of the Cath Lab. Field activation allows the EMS to
bypass the Emergency Department and go directly to the Cath Lab
for treatment.
Upon arrival at St. Clare, the helicopter was met by the ED staff
and Cardiac Cath Lab Heart Team. The patient was emergently
taken to the Cardiac Cath Lab where Dr. Michael Wood opened the
100% blocked artery, re-establishing blood flow to the heart. Doorto-balloon time was 12 minutes. The patient received comprehensive heart care and was discharged just two days later.
“I initially didn’t think I needed to go to the hospital, but am so
grateful the team advised me to go,” the patient said “Because they
cared, I am alive today.”
On February 20, St. Clare presented seven lifesaver awards in recognition of the Steelville EMS and Arch Air Medical personnel who
provided care that day. The proper assessment and treatment delivered by the crew helped ensure a positive outcome for the patient.
Pictured far right are Flight Nurse Pam Perkins and Flight Paramedic Keith Nordike. Perkins and Nordike fly out of ARCH’s Sullivan, MO
base. Not pictured is Clay Richards, Pilot
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Air Waves is published quarterly by Air Methods’ Central Region. We encourage article contributions, content ideas, and feedback.
Please direct inquiries/comments/suggestions to Chris Payton at 913-397-9335 or [email protected].