Training of flight nurses on fixed-wing air ambulance services

Introduction: The purpose of this study was to determine the background of fixed-wing air ambulance nurses, what level of training they receive before assignment as a flight nurse, and how closely supervised these fixed-wing air ambulance programs are by their medical directors.

Methods: In 1993, a retrospective statistical questionnaire was sent to 113 fixed-wing air ambulance programs. Chief flight nurses for all 113 fixed-wing air ambulance transport companies were requested to complete a written survey consisting of 17 multiple choice and fill-in-the-blank questions about previous experience, flight nurse qualifications, and content covered in their initial training program.

Results: Of 113 surveys, 72 (64%) responded. The majority (87%) of the flight crew were 30 to 39 years of age. The crew mix is RN/EMT-P in 49%, RN/RN in 25%, and RN/RT in 25%. Experience before flying showed emergency department/intensive care unit in 87% with 13% specialized to a specific type of patient care. The initial training in classroom hours was less than 21 hours in 50% of programs. Training programs were taught by the chief flight nurse in 75%, the medical directors in 74%, and outside organizations in 30%. Fifty-five percent of programs use pilots or other flight crew members to supplement initial training. Only eight of the programs did not have yearly refresher classes. Programs providing more extensive training appear to be affiliated with hospital-based services. Medical directors were involved with the everyday running of air medical transports in 35 of the pro grams (50%), 20 medical directors (28%) did monthly chart reviews only, and 12 (17%) were not involved with their programs. There were three responses to “Other” and two with no responses.

Conclusions: Although fixed-wing flight nurses appear to be medically experienced personnel with previous intensive care unit or emergency department experience, this survey would suggest that fixed-wing flight programs are variable in the amount of initial training, level of instructors, ongoing medical education, and involvement of the medical director. This survey indicates the need for increased standardization of continuing education, as well as increased involvement of medical directorship in fixed-wing air ambulance services.     

Trauma and nontrauma cardiopulmonary arrest: a national survey

INTRODUCTION: This survey attempts to identify the current standard of care for the air medical transport of the patient in cardiopulmonary arrest. METHOD: An Association of Air Medical Services/National Flight Nurses Association-approved survey by a single mailing with an anonymous response. SETTING: All rotor-craft programs with current memberships in AAMS. RESULTS: Fifty-three of the 178 questionnaires mailed were returned. Program demographics, crew composition and transport volumes were typical of other reported national experiences. The majority of programs (84%) had standing operational protocols for trauma and non-trauma cardiopulmonary arrests. The indications for not initiating or discontinuing CPR, the transport of the patient in cardiopulmonary arrest, triage and financial considerations varied widely between air medical programs. CONCLUSIONS: This study provides some insight on the current air medical management of the patient in cardiopulmonary arrest. National practice guidelines should be developed and tested prospectively in future studies.     

The effectiveness of esophageal stethoscopy in a simulated in-flight setting

Purpose: Previous research has confirmed the inability of flight nurses in an airborne BO-105 helicopter to hear breath sounds using normal or amplified transthoracic stethoscopy. The purpose of this study was to determine whether esophageal stethoscopy enabled effective auscultation of breath sounds in a simulated in-flight environment.

Methods: The cabin-sound environment of an in-flight BO-105 was recorded and recreated in an audiology laboratory, where five flight nurses were evaluated listening to taped breath sounds via an esophageal stethoscope. This audiotape model, validated in a previously published study, used a tape consisting of 24 20-second segments. Each segment, the beginning of which was marked with a beep signal, consisted of 20 seconds of silence or breath sounds. The distal (esophageal) end of the esophageal stethoscope was attached to the tape recorder; the intensity level of breath sounds heard at the stethoscope earpiece was calibrated to equate the sound level of actual esophageal breath sounds recorded on a volunteer.

Results: All nurses correctly identified the 24 taped segments as silent or including breath sounds 100% of the time.

Conclusion: In the simulated environment tested, esophageal stethoscopy enabled 100% accuracy in identification of breath sounds, as compared with previously reported 0% efficacy for standard transthoracic auscultation. Study in the actual patient-care environment is indicated to confirm the usefulness of esophageal stethoscopy in the in-flight setting.     

Criminal gunshot wound and iatrogenic tension pneumothorax detected by post-mortem computed tomography

Post-mortem imaging at autopsy is gradually increasing in popularity among forensic practitioners. The objective of the present paper was to demonstrate that it is essential to survey the cadaver using computed tomography (CT) before autopsy. This case report presents an iatrogenic tension pneumothorax caused by left subclavian vein puncture undertaken during treatment for a gunshot-related wound. The victim, a 64-year-old woman, was shot by her husband at home, and transferred to the hospital emergency unit. Before surgical procedures were carried out, left subclavian vein puncture was performed; however, during the operation, the victim experienced sudden cardiac arrest. Subsequent intensive resuscitation was unsuccessful. The clinical cause of death was recorded as traumatic shock caused by the gunshot injury. However, before the legal autopsy took place, CT clarified the existence of tension pneumothorax not on the same side as the gunshot wound, but on the side of the iatrogenic subclavian vein puncture. Because of this information gained prior to legal dissection, a typical dissection procedure for tension pneumothorax could be performed. Post-mortem imaging prior to regular dissection is essential as an adjunct diagnostic tool.     

Influence of the helicopter environment on patient care capabilities: flight crew perceptions

INTRODUCTION: Flight crew perceptions of the effect of the rotary-wing environment on patient-care capabilities have not been subject to statistical analysis. We hypothesized that flight crew members perceived significant difficulties in performing patient-care tasks during air medical transport. METHODS: A survey was distributed to a convenience sample of flight crew members from 20 flight programs. Respondents were asked to compare the difficulty of performing patient-care tasks in rotary-wing and standard (emergency department or intensive care unit) settings. Demographic data collected on respondents included years of flight experience, flights per month, crew duty position and primary aircraft in which the respondent worked. Statistical analysis was performed as appropriate using Student's t-test, type III sum of squares, and analysis of variance. Alpha was defined as p < 0.05. RESULTS: Fifty-five percent of programs (90 individuals) responded. All tasks were significantly rated more difficult in the rotary-wing environment. Ratings were not significantly correlated with flight experience, duty position, flights per month or aircraft used. CONCLUSIONS: We conclude that the performance of patient-care tasks are perceived by air medical flight crew to be significantly more difficult during rotary-wing air medical transport than in hospital settings.     

常用氦氧常规潜水减压表比较

海洋资源开发和军事作业中,常常需要在超出空气潜水允许的深度采用氦氧混合气进行常规潜水作业。目前,许多国家针对氦氧常规潜水制定了本国的减压表,比较著名的是美国海军和法国Comex公司减压表。我国早期先后引进了前苏联减压表和Comex减压表,随后对这些表进行修订,制定了我国的两种减压表。该文对5种氦氧常规潜水减压表进行比较和分析,为继续优化和新研制安全、高效的减压表进行积累,满足深潜水作业的迫切需求。     

A neuroinformatics database system for disease-oriented neuroimaging research

Clinical databases are continually growing and accruing more patient information. One of the challenges for managing this wealth of data is efficient retrieval and analysis of a broad range of image and non-image patient data from diverse data sources. This article describes the design and implementation of a new class of research data warehouse, neuroinformatics database system (NIDS), which will alleviate these problems for clinicians and researchers studying and treating patients with intractable temporal lobe epilepsy. The NIDS is a secured, multi-tier system that enables the user to gather, proofread, analyze, and store data from multiple underlying sources. In addition to data management, the NIDS provides several key functions including image analysis and processing, free text search of patient reports, construction of general queries, and on-line statistical analysis. The establishment of this integrated research database will serve as a foundation for future hypothesis-driven experiments, which could uncover previously unsuspected correlations and perhaps help to identify new and accurate predictors for image diagnosis.     

Meniscus surgery: Indications for repair

Several basic sciences studies have laid the foundation for successful meniscal repair. There are currently four techniques for meniscal repair that are popular: open, “inside-out,” “outside-in,” and “all-inside.” Because of near universal development of late osteoarthritis after total and even partial meniscectomy, there has been increased emphasis on preserving the meniscus whenever possible, and greater interest in expanding the indications for meniscal repair. This article suggests several indications for repair and summarizes the key components of each technique. The use of “enhancing” techniques, such as fibrin clot, fibrin glue, and various grafting techniques, may expand future indications for meniscal repair.     

Ossifying fibroma in the nasopharynx a case report

Ossifying fibroma localized in the nasopharynx of a 35-year-old man with histopathologic and radiologic findings has been reported. Because of its rarity, the subject has been presented and discussed.     

CT of carcinoma of the pancreas: Different mode of spread according to lesion site

Thirty-seven patients were evaluated on computed tomography concerning the different modes of spread (peripancreatic vascular invasion and peritoneal implanting) in the pancreatic carcinoma arising in the four anatomic segments. Each was graded from 0 to 3. The median diameter of the adenocarcinomas was 4.5 cm. It was found that high propensity for vascular invasion occurred in the carcinomas of the body and neck, probably due to the anatomical proximity of the these structures, and the high incidence of intraperitoneal seeding in the carcinomas of the tail was found probably because of its intraperitoneal location.     

Mission, staffing, and budget data of flight programs in the United States

INTRODUCTION: Manage care and other health care reform initiatives have forced all hospitals to evaluate their work processes. In this era of cost containment, many flight programs are examining the structure of their programs to determined whether they are functioning in an efficient, cost-effective fashion. METHODS: A survey was sent to the chief flight nurse of 240 flight programs in the United States. RESULTS: Eighty-five programs (35.4%) responded. Data were collected on demographics, management structure, mission information, staffing issues, and budgets. Results in each program varied widely. CONCLUSION: Benchmark data are available against which programs can compare themselves. Such comparisons may allow the discovery of opportunities to enhance program efficiency and cost-effectiveness.     

Integrating emergency medicine residents into a well-established helicopter program

INTRODUCTION: The institution of an emergency medicine residency in a university-affiliated Level 1 trauma center in July 1993 provided a challenge to develop a curriculum and on-line learning experience for emergency medicine residents in a well-established helicopter program. The purpose of this study was to survey flight crew members, emergency medicine at tending physicians, and emergency medicine residents on the anticipated roles and educational experience of integrating the emergency medicine residents from a new emergency medicine residency into the flight crew of a well-established helicopter program. METHODS: A survey consisting of multiple choice, Likert scale, and open-ended questions was distributed to flight crew members (RN, RT, pilots, communication specialists, EM attendings, and EM residents [n=72]). RESULTS: 92% of surveys were returned. These surveys identified specific issues of concern and those areas believed to be of academic importance for the emergency medicine residents. CONCLUSIONS: The results of this study allowed for the creation and implementation of a progressive flight experience for EM residents that incorporates increasing responsibility on the flight crew as experience is gained.     

Aortic dissection presenting as acute pancreatitis: CT diagnosis

A 42-year-old male developed epigastric pain and elevation of serum amylase of 2045 U/L. A contrast-enhanced abddominal CT disclosed inflammatory changes involving the pancreas and peripancreatic tissues and findings indicative of aortic dissection. The possibility of aortic dissection should be considered in the management of patients with acute pancreatitis.     

Femoral hernia: clinical significance of radiologic diagnosis

A retrospective study of 18 patients with femoral hernia assessed by herniography is presented. Although a palpable lump was present in 11 patients (61%), the diagnosis of a femoral hernia was not made before herniography. Surgical exploration was performed in 12 patients and a femoral hernia was found and repaired with beneficial outcome in 9 of them. In conclusion: herniography is of value for the diagnosis of a femoral hernia in patients with obscure groin pain.