Air. Currents. Care of the Patient With Hypothermia. By Tanya Fowler, RN

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1 Air Issue Currents caption Care of the Patient With Hypothermia By Tanya Fowler, RN Along with winter and colder temperatures come added challenges to patient care. Hypothermia can be a complication, or a problem in and of itself. Recognizing cold emergencies can make a difference in our patient s outcome, thus it is important to be familiar with the causes, the process, and the protocols regarding hypothermia. Whether transporting a patient from a scene or picking them up from a referring hospital, there are important things to know in the care and transport of our patients during the colder months. continued on next page

2 Limmer, O Keefe: Emergency Care 11th Edition: New Jersey, Hawk, CareFlight Clinical Protocols 3rd Edition: Ohio, pg. 36 It is important to note that cold injuries can occur at temperatures above and below freezing, and are categorized as two different types. Hypothermia includes generalized injuries resulting from exposure to cold temperatures, whereas frostbite includes localized injuries. It is also important to note that some patients are more susceptible to hypothermia. Those patients that are dehydrated, suffering from shock, intoxicated, or involved in trauma are predisposed to hypothermia. Elderly and pediatric patients are also more prone to suffer ill affects from colder temperatures. Hypothermia occurs when the patient s environment is too cold and body heat is lost faster than it can be generated. It is defined as a core temperature less than 35 degrees Celsius or 95 degrees Fahrenheit. During the initial exposure, the body attempts to adjust by reducing perspiration and circulation to the skin. This prevents the body from ridding itself of excess heat. Shivering begins and food is burned faster to produce more heat. After an extended period of time, shivering will decrease or cease and the patient will become irrational or lose consciousness. Pulse and respiratory rate slows and cardiac dysrhythmias may develop. This becomes a life threatening situation and needs to be corrected. Per CareFlight protocols, initial patient care is focused on ABC s and conducting a thorough patient assessment. Rapid rewarming of body parts affected with frostbite is essential. Wet or frozen clothing should be removed, taking care to move the patient as gently as possible while preventing re-exposure to cold. A warming blanket and/or warm packs should be utilized in all patients with potential cold injuries. A warm environment should be provided and warmed fluids infused. If the patient stops breathing and/or becomes pulseless CPR should be initiated. Initial ACLS drugs should be held until the patient s core temperature is >30 degrees Celsius. If the core temperature is possibly above 30 degrees Celsius then ACLS drugs may be given per protocol and continued as the temperature rises. If the patient has areas that are suffering from frostbite, blisters should be covered with sterile dry dressings. Morphine or Fentanyl may be given for pain. It is important to know that the prognosis for patients suffering from uncomplicated hypothermia in the absence of cardiac arrest or associated illness is generally good. Fast transport to a controlled environment is an essential part of their recovery. One final note: Please remember that although this article is focused on cold injuries during winter months, our patients can also suffer from hypothermia during the warmer months if they are wet or exposed to the environment for an extended length of time. Interestingly enough, the majority of these cases occur in temperatures close to room temperature. We can make a difference by what we do. Recognizing hypothermia and frostbite, and knowing how and when to treat them are key factors in providing the best care possible as a CareFlight team. Miami Valley Hospital Earns HealthGrades Cardiac Excellence Award By Kathy Bennett, RN Miami Valley Hospital The Region s Leader MVH received the HealthGrades Cardiac Excellence Award for This award is presented for overall cardiac services, including the treatment of heart attack, heart failure, and coronary intervention procedures. Working cooperatively with local EMS services is one of many ways that patient survival rates have improved. The utilization of advanced monitoring equipment combined with activation of the Cardiac Alert Program ensures that patient care can be expertly managed prior to their arrival at the hospital. Awarded a 5 star rating for cardiac excellence, MVH was ranked 1st for overall cardiac care in the Dayton area, 4th in the State of Ohio, and is in the top 5% of hospitals nationwide.

3 Helpful Hints for EMS Dispatchers When Requesting CareFlight for a Scene Response By Pam Dershem and Adam Tanner, Communication Specialists 1. Don t hesitate to put us on standby. This will allow the pilot and crew time to get their gear and get to the aircraft. This also allows the pilot time to do his pre-flight checks. This way, the aircraft is ready to lift as soon as the crews on scene give the go ahead. There is no charge to your department or to the patient for standby requests. 2. When you call, we need: Your dispatch center s name and call back number. The EMS department handling the call. The frequency (not channel name for example not OPS 47) that the on scene units will be using to talk to the crew for landing zone information. The crew needs to make contact with the ground crews for information about the landing zone (i.e. any possible hazards) prior to landing. The specific person who will be talking to the aircraft on that frequency. Have that person switch to that frequency ASAP so that they are ready when the crew makes contact. They will attempt to do so when they are still a few minutes out. 3. When giving us the location we also need the nearest city or village. This helps us start the search in our mapping program which has the entire United States. The location is narrowed down by city, then we can zoom in to get a specific address or intersection in order to plot the heading, distance and GPS coordinates for the pilot. On the topic of GPS coordinates, there are several different formats. Aviation protocol requires coordinates in the Degrees, Minutes format. If your mapping system or 911 GIS system displays them in Decimal degrees (which most seem to use), we can convert them, but it is important that we know which format you are using. Examples: Miami Valley Hospital s coordinates are: N /W in Degrees and Minutes. In decimal degrees they are N /W As always, questions about requesting our aircraft can be directed to anyone in the dispatch center at any time. In addition, tours of CareFlight and our dispatch center can always be arranged by calling (937) Aircraft Safety Sessions: New for 2009 By Meredith Penn, RN and John Crosby, CareFlight Pilot CareFlight still encourages EMS and Fire Departments to schedule safety sessions with the aircraft. Some changes to note during the safety session will include information and hands-on training for a hot load procedure (helicopter running). This is an opportunity for the Fire/EMS personnel to experience loading a patient into the aircraft while the aircraft is running. As many of you may have recently noticed with scene flights, a CareFlight crew member has been asking for the assistance of one of the scene personnel to visually guard the tail of the aircraft while still running. This assistance is needed by the pilot when the flight crew may be unable to maintain visual contact with the aircraft while rendering patient care inside the EMS vehicle. An important consideration to remember is the limited view the pilot has of the entire aircraft, specifically the rear of the aircraft. The best location for the visual assistant is off the nose of the aircraft, outside of the turning rotor blades, and in direct visual contact with the pilot. You will also notice one minor change at safety sessions and at public relations events that utilize the aircraft. Upon landing, the flight nurses will exit the aircraft while the blades are still turning and will act as the visual tail rotor guard during shut down and start up procedures.

4 The APC s of Bleeding: Aspirin, Plavix and Coumadin By Andrew Hawk, MD Medical Director, CareFlight Air and Mobile It used to be the ABC s of patient care. Now you can add the APC s for the patient at risk for bleeding. Aspirin, Plavix (Clopidogrel), and Coumadin (Warfarin) are three oral anticoagulation medications that are commonly used. Aspirin, as an over-the-counter drug, has even wider use in our society. Don t get me wrong - all three are important medicines used for a variety of medical conditions. But they also carry (to different degrees) the risk of developing unwanted bleeding. And once this bleeding begins, they also contribute to the difficulty in stopping it. Both Aspirin and Plavix affect the blood s platelets, making them less sticky and less able to form clot. Coumadin exerts its effects on a portion of the blood s coagulation cascade, slowing the blood s ability to clot. A fourth medicine, Lovenox (Enoxaparin), is an injectable anticoagulant relative of Heparin that is also used in the outpatient setting, but usually for a short defined time. Individually or in combination, all four are valuable medications and should be used and continued as instructed by a physician. The specific indications for their use are varied and beyond the scope of this article. The important message to the EMS community: Aspirin, Plavix, Coumadin, and Lovenox are commonly used and may be associated with unwanted bleeding. Therefore, it is important for the EMS provider to understand the importance of discovering and documenting their use and communicating this on arrival to the hospital. This will allow the hospital caregivers to consider and, if indicated, begin the process of reversing their anticoagulant effects. Andy Hawk, MD In summary, what specifically can the EMS provider do to help? 1. Identify any trauma patient that is on any of these medicines specifically ask of them by name. 2. Beware of the patient that presents with an altered mental status that is on one of these medicines, especially Coumadin they are at risk for cerebral bleeding (oftentimes they are elderly and can present without a known traumatic event). 3. Identify the medical patient that presents with unwanted bleeding (GI or otherwise) that is on one of these four medicines. 4. Get in the habit of practicing your APC s (+ Lovenox) in addition to your ABC s! Important safety tips to remember: Once safely on the ground, the flight crew will come to the patient location so that a quick assessment may be performed prior to departing the scene. CareFlight crew members must be with the Fire/EMS personnel when approaching the running aircraft with the patient. Never approach the aircraft without a crew member with you. Visual contact must be made with the pilot, and a thumbs up approval will be given when it is safe to approach the aircraft. CareFlight Air and Mobile Air Currents

5 Beth Newman-Hill Outreach Update Annual Fire Chief Dinner Our Fire Chief dinner was held on Oct. 15, 2008 and was a huge success with 140 in attendance. Candy Skidmore, Director of CareFlight Air and Mobile, discussed safety and landing zone information. On the Road Over 50 participants attended the On the Road presentation on Nov. 1, 2008 at New Bremen High School in Auglaize County. Presentations included Airway by Dr. Andy Hawk, Pediatric Trauma by Lisa Schwing, and Surviving Change in EMS by Frank L. Giampetro. The next On the Road program is tentatively scheduled for March Information will be mailed out closer to the date. EMS Symposium The 2008 EMS Symposium held on Oct. 4, 2008 at Sinclair Community College was attended by 85 participants. Marilyn Bourn, RN, MSN, EMT-P, discussed OB, Pediatrics, and Trauma topics. Mark the date for the next EMS Symposium which is scheduled for Oct. 24, More information will follow closer to the date and Save the Date cards will also be mailed out at a later date. Trauma and Critical Care Update Mark your calendars for the next Trauma and Critical Care Update which is scheduled for May 15, Drive Smart Drive Smart programs for 2009 are now being scheduled. More than 40 Drive Smart programs were presented in Because of the anticipated large volume of requests, we will be unable to reschedule any Drive Smart programs that are cancelled due to weather issues. To schedule your program for 2009 contact Jennifer McQuality at (937) Safety Sessions CareFlight still encourages Fire and EMS agencies to schedule safety sessions with the aircraft. Contact Jennifer McQuality at (937) to schedule all safety sessions and public relations events. Sim Man Labs CareFlight still offers medical lectures and Sim Man (Human Patient Simulator) labs with the Difficult Airway lecture. Sim Baby is also available. Please contact Beth Newman-Hill, Outreach Coordinator, to schedule at (937) Ride-along program Once again CareFlight Air and Mobile Services would like to extend an invitation to physicians, nurses, paramedics, EMTs, firefighters, dispatchers, respiratory therapists and police officers to fly or ride with us from March 30, 2009 to May 22, Riders will have the opportunity to observe for two eight-hour shifts on one of our aircrafts or Mobile Intensive Care Units at Miami Valley Hospital or a remote base. Beginning March 1, those interested may leave a message with their name and phone number at (937) so that they may be contacted by a committee member to schedule their shifts. Trauma Case Reviews As part of our Performance Improvement process and to provide followup and continuing education to those in our service area, any department or referring hospital may request case reviews of their patients transported to Miami Valley Hospital. These reviews are coordinated by Beth Newman-Hill, Dr. Andy Hawk and the Trauma Program. To set up a Trauma Case Review, Beth can be reached at (937) Miami Valley Hospital The Region s Leader

6 CareFlight Air and Mobile One Wyoming St. Dayton, Ohio Non-Profit Organization U.S. Postage Paid Permit Number 79 Dayton, Ohio The Region s Leader EMS Spotlight: Houston Rescue By Angi Gooslin, RN Houston, Ohio is a small rural community in Shelby County. This past summer CareFlight had the opportunity to do a mock accident with Houston Rescue as part of their annual Junior Rescue Campout. During this event the Junior Rescue Team was responsible for coordinating care of accident victims in several mock scenes. Many of the local Fire and EMS participated in this training event, with the main goal of recruiting and preparing teens who are interested in the field of pre-hospital care. Their annual campout is a fun time of camping, swimming and some much needed training. It brings to end a year of hard work and fosters closeness of all members, old and new. Their Junior Rescue Team was started back in May, 2006 and is run primarily by Ken Werling, EMT-B. Ken stated that members in the program range in age from years old and come from as far as 30 minutes away to attend monthly trainings. Each year more members are added. Several of their past members have gone on to join a department and say that the experience they received with the Junior Rescue Team has had a positive impact on their New Employees Pictured with the Careflight crew and one of our back up aircrafts. Left to Right, back row: Dave Fitch, Austin Folck, Bryan Freshour, Brandon Curl, Ryan Curl and Zach Freshour. Front row: Wayne Werling, Kelly Luedeke, Michelle Grillot, Tim Dover, William Pummill and Gunner Francis. Kneeling: Chief Pat Luedeke and Ken Werling. performance in the field. According to Werling, training is made as real life as possible, even to the point of appointing officers at the junior level, each with their own respective responsibilities. Werling, Chief Pat Luedeke and the rest of the members of Houston Rescue take a personal interest in the training of these young members so that their experience will be valued for a long time to come. Miami Valley Hospital One Wyoming Street Dayton, Ohio CareFlight (800) Mary Boosalis President and Chief Executive Officer Candy Skidmore, RN CareFlight Program Director Marcia Roemer, RN Editor Cindy Ratermann Photography Kelly Spitler Graphic Design Miami Valley Hospital Mission We will build healthier communities with others who share our commitment to provide high-quality, cost-effective health care services. Aviation services provided by Air Methods Corporation. Dennis Broering, Master Scheduler Mary Cure, RN Paul Gyorgfi, RN Jennifer McQuality, Program Assistant

AirCurrents. Mobile Intensive Care Unit Marks Twenty Years of Service. Connect With Us. In This Issue

AirCurrents. Mobile Intensive Care Unit Marks Twenty Years of Service. Connect With Us. In This Issue AirCurrents Fall 2017 Mobile Intensive Care Unit Marks Twenty Years of Service By Jennifer Schueler, RN November 3, 2017, is a special date for the Mobile Intensive Care Unit of CareFlight Air and Mobile