> The helicopter crew wanted to transfer the more seriously injured patient,
> because it would only be 9 mins flying time. The patient's airway was
> compromised so I had to do a RSI at the roadside. I ordered the crew to take
> the other patient who was maintaining his airway, but still needed rapid
> attention. Does anyone else have this problem with helicopters? Speed is not
> everything!
Helicopters are difficult to use effectively. HEHS is the ideal, Stornoway
coastguard usually carry a doctor as do some other helicopters. However,
most are paramedic based and there can be problems when the case outstrips
the airway skills of the paramedic on board. Their only option in these
cases is to GLF back to the hospital, which is what they wanted to do in
your case I think.
However, as your rightly point out a 9 minute ride with a compromised airway
in a helicopter = dead (or nearly dead) patient on arrival. Depending on
the crew and your relationship with them, it can be difficult on occasions
to overcome their desire to follow their normal path.
I handed over an OD patient to a helicopter crew that I did not know last
year. She had been a can't ventilate/can't intubate case and I had used a
combitube and had a secured airway. The paramedic was unhappy with the
combitube and wanted to intubate prior to takeoff. I explained why I had
used the combitube, but he didn't know me and I think he thought I was a bit
of an idiot (not uncommon!). So out came the combitube and after 2 minutes
of a blue patient that neither of us could ventilate or intubate, back in
went the combitube.
The key is to try and cross-train with these paramedics before an incident
and discuss the skills you have and when and why you use them. It's best to
discuss these points during the day than at night in bad weather up a hill
somewhere with rotor noise.
Having said that, another option would be for the helicopter to have waited
a few minutes for you to do the RSI (this depends on circumstances -
severity of other patients, space on board, land transport time, desire to
stay with patient etc..).
> Second problem does anyone know of any machine that provides REALLY good
> suction at the roadside?... please
Martyn's mentioned that I have a review of handheld suction units on my site
(http://www.coull.net/suction.html). None of them are that good, battery
ones I also find disappointing. Oxygen driven ones may be better (I have
little experience of them) but they have the problem of using up your
precious o2 supply.
Robbie Coull
email: [log in to unmask] website: http://www.coull.net
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