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

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AirCurrents Fall 2017 Mobile Intensive Care Unit Marks Twenty Years of Service By Jennifer Schueler, RN

and began its legacy of transporting patients.

Ohio and quite often into or out of surrounding states.

clinical team to transport high acuity patients between Good Samaritan and Miami Valley hospitals.

from randomly hopping on board a private ambulance to transfer the patient to another facility.

using a strict protocol guideline under the watchful eye e of a Miami Valley-based program medical

Providing continuity of care during patient transport was and remains a 24-hour-a-day, seven-day-a-week

Within a few years of the introduction of the MICU, it soon became widely sought by other facilities,

1 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 Services. Twenty years ago, in 1997, the first Mobile Intensive Care Unit (MICU) for Premier Health rolled out and began its legacy of transporting patients. Since that time, the MICU has logged millions of miles transporting patients throughout the state of Ohio and quite often into or out of surrounding states. The original concept for a Mobile Intensive Care Unit revolved around dedicating a critical care clinical team to transport high acuity patients between Good Samaritan and Miami Valley hospitals. This novel approach to transport spared a staff nurse in an emergency department or intensive care unit from randomly hopping on board a private ambulance to transfer the patient to another facility. The MICU also provided a critical care hospital-based transport service in which crew members operate using a strict protocol guideline under the watchful eye e of a Miami Valley-based program medical director. Providing continuity of care during patient transport was and remains a 24-hour-a-day, seven-day-a-week operation. Within a few years of the introduction of the MICU, it soon became widely sought by other facilities, creating the opportunity for the MICU to begin transporting from outlying facilities into both Miami Valley and Good Samaritan hospitals. Today, the MICU is requested frequently by many different hospital systems and is dispatched upon transfer request to any and all service regions within a 75-mile radius of Miami Valley Hospital. Electronic record keeping of MICU transports began in To date, the MICU has logged 23,020 transports, or an average of 300 MICU transports each month. Since the inception of one Miami Valley Hospital-based MICU ambulance 20 years (continued on next page) In This Issue What Do All Those Lines Mean? EMS Star of Life Award Safety First MVH Physician Scene Response Connect With Us premierhealth.com

CareFlight team members demonstrate the complex critical care of a patient during a ground transport inside one of Premier Health s six mobile intensive care units (MICUs).

Currently, Miami Valley Hospital serves as home for two of the six MICUs; the other four vehicles are individually housed at Good Samaritan North Health Center, Miami Valley Hospital South in

Decentralization of those four MICUs from the central core area expanded the quick availability of the skilled MICU crew to expeditiously transport patients to their definitive care facility.

Each MICU is staffed with a MICU/ flight registered nurse, critical care paramedic and emergency medical technician (EMT) who serves as the vehicle s driver.

management, central line and chest tube insertion, and pericardiocentesis techniques. All MICU vehicles are operated and maintained by Med Trans Inc., which employs 33 MICU-trained drivers.

Often you will see them washing and hand waxing the MICU, a task that requires dedication and a lot of elbow grease!

As of today, there are 80 clinical crew members, including both MICU paramedics and MICU/flight nurses that staff the vehicles of Miami Valley Hospital CareFlight Air and Mobile Services.

Of the original 14 MICU personnel, one crew member has remained with the program for the past 20 years and continues to function as a MICU critical care paramedic!

2 CareFlight team members demonstrate the complex critical care of a patient during a ground transport inside one of Premier Health s six mobile intensive care units (MICUs). ago, the fleet has grown to six Mobile Intensive Care vehicles. Currently, Miami Valley Hospital serves as home for two of the six MICUs; the other four vehicles are individually housed at Good Samaritan North Health Center, Miami Valley Hospital South in Centerville, Jamestown Emergency Center, and Atrium Health Center in Mason. Decentralization of those four MICUs from the central core area expanded the quick availability of the skilled MICU crew to expeditiously transport patients to their definitive care facility. Configuration of the MICU crew has remained the same during the past two decades. Each MICU is staffed with a MICU/ flight registered nurse, critical care paramedic and emergency medical technician (EMT) who serves as the vehicle s driver. The training of the critical care nurse and paramedic involves an intense 12-week orientation period, which includes learning many advanced skills such as performing surgical procedures in airway management, central line and chest tube insertion, and pericardiocentesis techniques. All MICU vehicles are operated and maintained by Med Trans Inc., which employs 33 MICU-trained drivers. Each driver must be an EMT and is an integral component of the transport team. MICU drivers take pride in maintaining the daily safety requirements of transporting crews and patients. Often you will see them washing and hand waxing the MICU, a task that requires dedication and a lot of elbow grease! Twenty years ago, 14 dedicated MICU crew members were hired specifically to train and staff the only critical care MICU in the region. As of today, there are 80 clinical crew members, including both MICU paramedics and MICU/flight nurses that staff the vehicles of Miami Valley Hospital CareFlight Air and Mobile Services. All critical care crew members receive the same intense training, and some flight nurses rotate between air and ground to work a few MICU shifts during each six-week schedule. Of the original 14 MICU personnel, one crew member has remained with the program for the past 20 years and continues to function as a MICU critical care paramedic! She has seen many changes, one being the requirement for all MICU paramedics to obtain a paramedic-level critical care certification. Professional certification requirements also extend to each MICU/flight nurse who must obtain either a certification in flight nursing, transport nursing, emergency nursing or critical care nursing. Conjointly, all clinical direct patient care MICU crew members are required to obtain and maintain a professional certification to retain employment. Throughout the years, the MICU has continued to excel in its mission to provide safe critical care ground transport. A very important and prestigious accomplishment is that the MICU is accredited by the Commission on Accreditation of Medical Transport Services (CAMTS). This assures that the service of the MICU adheres to strict industry wide standards for providing quality and safe patient care and transport. The integrated team of MICU transport professionals is proud to continue the tradition set forth 20 years ago of becoming a well known and respected entity of patient care. Year after year, the MICU has been at the forefront in providing critical care patient transport when other modes of transport are unavailable due to inclement weather or geographic location. The MICU is the workhorse within the transport industry. We at Miami Valley invite you to join in the celebration as the MICU marks 20 years of critical care ground transport service.

3 EMS Star of Life Award By Erin Rodgers, RN The Ohio Division of Emergency Medical Services and the Ohio Chapter of the American College of Emergency Physicians recently presented their 2017 EMS Star of Life awards in Columbus. This honor is given to agencies for their remarkable life-saving efforts and exceptional patient care performed during a particular call in the state of Ohio. Among the award recipients this year is the Macochee Joint Fire District, whose officials were recognized for their life-saving care of a man involved in a farm trauma incident. In August 2016, Scott Boyd of West Liberty was severely injured by a Bush Hog while mowing his lawn. Macochee EMS personnel responded with rapid, expert medical interventions and called CareFlight Air and Mobile s helicopter. In addition to requiring advanced medical procedures at the scene, Mr. Boyd also required multiple rounds of CPR and ACLS before and during his flight to Miami Valley Hospital. In a situation where seconds count, the CareFlight crew utilized the direct to operating room option to save valuable time and deliver the patient to the definitive Members of the Macochee Joint Fire District and Premier Health recently accepted an EMS Star of Life award in Columbus from the Ohio Division of Emergency Medical Services and the Ohio Chapter of the American College of Emergency Physicians. Patient Scott Boyd holds the award. trauma surgical care he needed at Miami Valley Hospital. After two months of inpatient care and physical rehabilitation, Mr. Boyd overcame great odds and returned to his wife and son at home, where he continues to recover. was honored to receive this award along with Macochee Joint Fire District and other Star of Life recipients. For more information, or to see a full list of 2017 honorees, please visit ems.ohio.gov/ links/ems-star-program-2017.pdf Outreach By Mandy Via, RN, Outreach Manager Safety First: Safety Sessions for Scene Responders As the summer of 2017 winds down, CareFlight is in full Safety Session mode. In late spring, our program sent out a letter to all agencies urging them to schedule a safety session with our program. Of all the education that our program provides, a safety session is one of the most important. The twohour session consists of one hour of classroom education and a second hour of hands-on skills with the aircraft that work to mitigate unsafe situations when Members of the Ludlow Falls Fire Department in Miami County stand at a safe distance from a CareFlight helicopter s landing and takeoff zone.

4 Miami Valley Hospital Physician Scene Response: We Are Ready! By Andrew C. Hawk, MD The Miami Valley Hospital Physician Scene Response (MVH/PSR) is the formalization and expansion of the hospital s long-standing Level I trauma program s field amputation plan. A physician from the hospital s emergency department performed the last known local jurisdiction field extremity amputation in the 1980s. The evolution of trauma and disaster care has led to the development of this expanded two-tiered physician scene response. The MVH/PSR is primarily for field amputation in extreme situations. It may be secondarily activated for a significant mass casualty incident or similar extreme casualty situation. As noted above, the main indication for a MVH/ PSR request is the requirement for a field extremity amputation (when all other extrication maneuvers have been unsuccessful and no alternative exists). This response can be requested by the on-scene fire or EMS incident commander by calling the CareFlight Communications Center directly at (800) 251-CARE (2273). Once activated, the MVH/PSR will bring physician resources, along with field amputation equipment and blood products, directly to the scene via CareFlight helicopter or MICU. The second tier MVH/PSR may be requested if the scene incident commander or referral medical facility is faced with a significant MCI or local facility internal/external disaster that would benefit from physician scene response. Hopefully, the MVH/PSR will never be needed. But if the situation arises, we are ready! As always, please feel free to contact me with questions or comments. ANDY HAWK, MD Medical Director Phone: (937) achawk@premierhealth.com a helicopter lands in a landing zone. We understand that scenes can be complex and dynamic; that s why we provide this education free of charge to allow for increased knowledge and comfort when landing a helicopter at a scene. Safety has always been and will always remain job No. 1. If your department would like to schedule a safety session, please contact Mandy Via at alvia@premierhealth.com. Keeping you Connected Be on the lookout at Premier EMS rooms for charging stations. Stop by and recharge your phone and yourself with a snack. At Premier Health, we understand how important it is to keep you connected and mission-ready. For any questions, or if you would like to schedule education, please contact: MANDY VIA, BSN, RN, CEN Outreach Manager Phone: (937) Fax: (937) alvia@premierhealth.com

5 What Do All Those Lines Mean? By Keith Shivers, Program Aviation Manager This question has been asked numerous times, whether by an innocent bystander or architects who are responsible for designing and building hospital heliports (or, as some refer to them, helipads). While it is not necessary for hospital staff or crews to know all of the construction requirements for hospital helipads, it is important to understand why the markings are there and why is it important that they are present for the pilots who land on them. The picture below depicts the critical markings that both rooftop and ground-level hospital helipads should have. The specific size of each of the areas will vary depending on the size of the helicopter that the helipad will support. So let s discuss these different markings, beginning with a couple of key abbreviations: the TLOF and the FATO. TLOF stands for the Touchdown and Lift Off Area. It is the center of the helipad and in the figure below is shown as the gray area surrounding the red square. The TLOF should be at least as large as the rotor diameter of the largest helicopter that services the hospital, but no smaller than 40 feet by 40 feet (the AS-365 has a rotor diameter of feet). The traditional H in the center should be contrasted Lighted Wind Cone to the cross in the center of the TLOF as well and is used by the pilot for alignment to center the aircraft in the TLOF. The FATO is the next dashed line area outside the TLOF. FATO stands for Final Approach and Take Off area. It should be a minimum of 1.5 rotor diameter of the aircraft servicing the hospital, which for the Dauphin is 60. This area provides the pilot the room within the terminal part of the approach as well as takeoff for some drift and adjustment during the critical near ground phases of arrivals and departures. Finally, the safety area is the outermost marking and is typically another 20 feet outside the FATO. This safety area is a boundary that ground personnel should use as their boundary if there is not a safety fence in place. Pilots use this safety area when conducting their overhead check to ensure the landing area is clear of all obstacles, equipment or people. It provides pilots with the assurance that the landing area is clear. These primary markings are the critical safety and operational markings required by air ambulance operations. Hopefully by understanding the why for the lines, the hospital and medical support team members can help ensure their helipads provide the proper markings needed for safe air ambulance operations. Heliport Beacon FATO Raised TLOF 5 ft. (1.5 M) Wide Safety Net Safety Area Flush TLOF Lighting Ramp

6 Operated By Miami Valley Hospital One Wyoming St. Dayton, Ohio Nonprofit Organization U.S. Postage Paid Permit Number 79 Dayton, Ohio Connect With Us Premier Health and Premier Health EMS are on Facebook. Want to keep up with CareFlight Air and Mobile? Now you can! Just like and follow us on Facebook. This page is geared toward our community members who are interested in learning more about our program and our air medical services. Premier Health facebook.com/premierhealthcareflight Exclusively for EMS If you are looking for specific training announcements or topics geared toward first responders, like and follow the Premier Health EMS page. Premier Health EMS facebook.com/groups/emspremierhealth Be the first to know about unique trainings offered in the area and stay connected with other providers in your region. Miami Valley Hospital One Wyoming Street Dayton, Ohio CareFlight (800) Candy Skidmore Vice President Service Integration Emergency/ Trauma/CareFlight Beth Calcidise, RN CareFlight and Premier Transportation Director Mandy Via, RN Outreach Manager Angela Sebald, RN Editor Andrew C. Hawk, MD Erin Rodgers, RN Jennifer Schueler, RN Keith Shivers Mandy Via, RN Contributing Writers Kelly Spitler Graphic Design Miami Valley Hospital Mission We will improve the health of the communities we serve with others who share our commitment to provide high-quality, cost-effective health care services. M-C-EMS /17

Oswego County EMS. Multiple-Casualty Incident Plan

Oswego County EMS. Multiple-Casualty Incident Plan Oswego County EMS Multiple-Casualty Incident Plan Revised December 2013 IF this is an actual MCI THEN go directly to the checklist section on page 14. 2 Index 1. Purpose 4 2. Objectives 4 3. Responsibilities