Cases in Pre-Hospital and Retrieval Medicine - Case Study Example

399050 Title: Aero medical Retrieval Assignment 2. Introduction. With the increase in health care services complication there has been increased need for the transfer of ill patients from one hospital to the other. In addition to that there has also been a need to transport the critical ill patients accompanied with specialists who have appropriate and adequate equipments. Distance involved in transfers has triggered the use of aerial transportation of patients as well as for the retrieval teams. On the other hand patients transport has increased mobility and mortality, though Aero-medical mode of transport can be challenging and hazardous. Major difference between the modes of transport for ill patients is the attitude effect. According to the Dalton’s law increase in attitude would lead to decrease in pressure of oxygen. Boyle’s law states that increase in attitude would lead to increased air volume and when the air volume is restricted it brings about increase in air pressure which could be dangerous to the ill patient (Beyer, Land & Zaristsky 1992). There is also decrease in temperature when the attitude increases and water pressure reduces leading to decreased air humidity. Therefore environmental factors not only have clinical issues but also determine the equipment to be used. Factors which led to the death of the patient were due to delay and failure to administer the right care at the right time possible. Aero medical transport modes are always supposed to be equipped but the helicopter had not been tasked when the passing motorist provided information about the scene (Beyer, Land & Zaristsky 1992). It waited until the time they got the confirmation code from the local ambulance team. Another factor is that the helicopter was not accompanied by the professional aero medical; professional hence the patient was not attended completely before transportation. Minimal increase in attitude should have led to the death of patient due to increased pressure and temperatures as a result of reduced water in air. Poor communication coordination led to the death of the patient as the helicopter delayed as it could not rely on the passing motorist message. The retrieval team members did not have clear communication. In addition to that the retrieval team did not do risk benefit analysis to assess weather and patients issues with regard to the impact weather had to air transport. The helicopter might not have had the required equipment and specialist staffs that could take care of the patient as was on critical condition (Beyer, Land & Zaristsky 1992). Lastly the issue could have been due to poor contingency plan and poor identification of transport routes. The problem could have been prevented by ensuring that there is proper communication coordination between the retrieval teams and transport systems. This could be achieved by ensuring that teams work closely with each other and have adequate communication skills to assist them in dealing with stressful conditions, which enhances the way they perform their tasks resourcefully in a limited transport environment. Transport routes should also be identified before the departure as failure would result to delay. The staffs involved in transportation should be aware of the environment, transport process and should be familiar with the equipment (Beyer, Land & Zaristsky 1992). The staffs should possess the required skills and knowledge to manage and attend the ill patient independently and in dealing with the emergence issues during transits. In addition to that non staffs should be extensively trained and should always be briefed about the contingency plan. To add on that equipment should always be on the correct order: it should be regularly serviceable and checked, with adequate power supply, secury transported, and relevant to the patient’s clinical requirements. Equipment should be set in standardized manner and should be monitored adequately to make sure they are in good order. Lastly there need to be auditing of the transportation process to enhance transport quality and framework. The system in charge of providing the aero medical retrieval services should have staffs that are well trained to be familiarized with equipment, retrieval practices and principles and ensure that new staffs are accompanied by other staffs. The staffs should also get periodic training to train them on emerging issues (Duke & Green, 2001). Continued training and development is necessary for the proper governance of the aero medical systems. There is also need for the conferences to review cases which have occurred and identify their successes and failures as it will assist in taking corrective measures. To add on that, pilots should also be trained on how to react to the emergency cases as the delay is anticipated to have caused the death. However this implies that there need to be extra resources which could enhance the interventions (Duke & Green, 2001). Inadequate resources would hinder the retrieval teams from getting the required training possible hence leading to poor adjustment to emergencies. Other emergency service resources require being deployed like rapid rotary wing which is faster that helicopter. Aero medical retrieval requires different types of emergence services depending on the distance to be covered, patient’s critical conditions. When there is long distance to be covered it is necessary to use rotary services as opposed to fixed wing services as it takes long time for patient to arrive at the destination hospital (Duke & Green, 2001). Crew mix will also be necessitated especially when different patients are to be travelled at different distances. For the distance near the major hospital it is necessary to use the ambulance as opposed to rotary wing or fixed wing services. For long distances it is advisable to use the wing services and should be accompanied by the multidisciplinary teams including physicians, nurses, paramedics or other special cases doctors incase their need arises. The teams should be familiar with aero medical environment. Time of the day will also affect the strategy to be employed as it could be easier to use vehicle as opposed to wing services in case of aero medical retrieval at night (Duke & Green, 2001). On the other hand travelling above the sea level to reduce the impact of attitude on patient may not be applicable in some cases it is limited by the fact that it requires extensive equipment monitoring and aggressive management. Case 2. Limited access to the Aero medical retrieval services led to the death of the patient as emergency care was not delivered at the required time possible. Failure to conduct the aero medical retrieval services led to the delay as the patient could have been travelled to major hospital as opposed to what happened as the patient was first taken to the nearest hospital with a single nurse. (Beyer, Land & Zaristsky 1992).The road ambulance was not working properly which led to the delay on the way. The vehicle ambulance was not in good order and the equipment instilled was not working properly. In addition to that in emergency there need to be minimum of two physicians accompanying the patient. In this case only nurse accompanied the patient hence it was impossible for her to conduct all emergency activities to the patient. The nurse could not multitask and the motor vehicle might not have had the required equipments which were necessary in attending the patients’ emergence issues. On top of that lack of qualified specialized physician in the vehicle who could attend the patient special cases as his pressure was increasing and medication were administered once as the patient was no well monitored leading to cardiac arrest. On the other hand the event should have been prevented from occurring by ensuring that after the accident aero medical retrieval team was conducted earlier as possible to ensure the patients emergency needs are met adequately. (Beyer, Land & Zaristsky 1992).The issue could have also been prevented by ensuring that the vehicle was in good order and equipments are well serviced to avoid improper functioning of the equipment when offering emergency care to the patients. To add on that the patient should have been taken direct to the major hospital instead of being taken to peripheral hospital which had inadequate facilities. The patient should have been monitored extensively as he had higher blood pressure which could pose threat to the patient’s life. Lastly local hospitals should have specialists who are familiar with equipments and who could accompany the patient to ensure that as a team they could work closely in enhancing the patients’ health by monitoring them. There is need for the intervention on the aero medical services system by first ensuring that all the nursing staffs in the peripheral hospitals are trained on emergency issues and needs for the patients. (Beyer, Land & Zaristsky 1992).They should also be trained on how to provide emergency needs to critical ill patients and more so when they are accompanying retrieval patients under emergency cases. In addition to that there need to be a standardized set of equipment in the vehicles to ensure that patients are monitored effectively. The vehicle should also be well fitted and well serviced to ensure that it is always in good order incase of emergency. Nursing staffs should be well trained to be conversant with emergency cases especially when aero medical services should be contacted under critical patients’ issues and retrieval practices and principles (Beyer, Land & Zaristsky 1992).They should also be trained on the need for the hyperbaric facility for the patients with decompression issues and that when the facilities are far away from the patients’ retrieval services are necessary. New personnel should always be accompanied by the specialists. Lastly the local peripheral hospitals should have adequate facilities which are necessary for attending to emergency cases as major local hospitals are far away. The intervention implies that there is a need for the proper documentation of retrieval services which should always ensure that patients’ emergency cases are attended to adequately. Retrieval service department should use extra resources in educating and training staffs to ensure that they are aware of all emergency cases are they are ever prepared to handle them (Duke & Green, 2001) Different equipments should also be purchased and be fitted on ambulances to ensure that the equipments are available for administering to the patients when in en route and especially attending and monitoring their health condition to take right measures possible. In addition to that different wings should be provided to ensure that patients under critical conditions are attended to with the right transport service possible to avoid death associated with delay. Staffs should be well trained and familiarized with the equipment usage to ensure that they are conversant with them and improve the way they monitor the patients in flight. lastly more resources are required to be installed in minor local hospitals to have adequate resources necessary for attending critical patients incase Aero medical services are not available or delays due to time of event occurrence as well as distance. Life threatening cases requires serious intervention which is increasingly impacted by time of the day, crew mix, and distance as well as travelling above the sea level. For the long distance which take >60-90 minutes by road when using helicopter or >120 minutes by road fixed wing should be considered. In case the issue is critical there should be the use of rotary wing service which is faster than fixed wing (Ellis & Hooper, 2010). Travelling above the sea level should be anticipated for the patients who are in critical condition and whose pressure is very high as increase in attitude increases pressure leading decrease in oxygen level which could impact patients’ blood circulation leading to death. Crew mix will also impact the strategy depending on the patients’ condition and the contingency plan as the pan indicates all the mix that should be adapted on different patients conditions. Time of the day impacts the strategy to be used as some strategies can’t be effective at night like use of rotary wing and fixed wing services which would be more effectively used during the day. References. Ellis, D & Hooper, M. (2010).Cases in pre-hospital and retrieval medicine. London: Elsevier Duke G. J, & Green J. V. (Aug 2001). Outcome of critically ill patients undergoing inter hospital transfer. Medical journal; 174:122-125. Beyer A. J Land, G. &, Zaristsky A. (1992). Non-physician transport of intubated Paediatric patients: a system evaluation. Crit Care Medical; 20:961-966. Faculty of Intensive Care, Australian and New Zealand College of Anaesthetics, Australian College of Emergency Medicine. (1996). Minimum standards of transport of the critically ill. Policy Document IC-10. Read More