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Aeromedical Retrieval > Module One > Flashcards

Module One Flashcards

1
Q

At an altitude of 10,000 feet, what will the arterial oxygen saturation level be in normal people?

A

87%

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2
Q

What is the normal composition of air at sea level?

A

Nitrogen 78%, oxygen 21%, CO2 0.03%, and other 1%

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3
Q

When temperature is constant, what effect will a decrease in pressure have on volume?

A

An increase of volume of a gas, because volume change is inversely proportional to pressure change.

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4
Q

What is a “sit. rep.” ?

A

Situation report - passing on clinical/logistic info from the scene or patient bedside to other distant personnel.

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5
Q

With ascent from sea level to 18,000 feet in an unpressurised environment, by what factor will a gas change its volume?

A

A factor of 2.0

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6
Q

Which war has been associated with the introduction of helicopters performing regular AMEs?

A

Korean War.

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7
Q

What does SAR mean?

A

Search and rescue. Primary mission where casualties are yet to be located/identified. Usually in response to emergency beacon/distress call. USAR: urban SAR.

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8
Q

In which of these situations is AME least likely to improve outcomes?
a.) Acute MI
b.) Major trauma
c.) Cardiac arrest
d.) Early labour in pregnancy

A

Cardiac arrest - as unless there is ROSC, the patient will have had prolonged no flow state.

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9
Q

Name the term that refers to the force that is generated when moving through the air.

A

Drag.

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10
Q

Why is demand for AME growing? (11 reasons)

A

Population growth, deskilling of rural workforce, demands of equity of access, growth of adventure sports, population spread, centralisation of services, increased leisure time, growth of tourism, increased demand for ICU beds, expansion and funding of retrieval services, technology advances.

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11
Q

What are the advantages of using fixed wing instead of rotary wing for medium to long range modified primary retrieval? (7 reasons)

A

Speed over longer distances, lower cost, pressurised cabins, safety, access - more room, less noise and vibrations, greater temperature control.

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12
Q

What are the limitations of using fixed wing instead of rotary wing for medium to long range modified primary retrieval? (3 reasons)

A

Need for airports and ground transfer, safety of remote airstrips, inability to winch if required.

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13
Q

What would you task to an unstable cardiac patient 25km from facility?

A

Road ambulance.

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14
Q

What would you task to an MVA 100km from facility?

A

Rotary wing.

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15
Q

What would you task to a stroke patient 175km from facility?

A

Rotary wing.

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16
Q

What would you task to a multi trauma patient 750km from facility?

A

Fixed wing.

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17
Q

What would you task to a patient in pre-term labour 60km from facility?

A

Road or rotary wing ambulance.

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18
Q

What are the main controversies experienced within the AME?

A

Whether AME add benefit to patients, and if they do, how does the model or system used impact this?

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19
Q

What variables need to be considered when weighing up whether AME is beneficial? (10)

A

Clinical outcomes, impact of transport, exposure to altitude, economic costs (mission costs, total system costs, opportunity costs), safety of patient and crew, patient populations, operating platforms, models of care, patient selection and immediate survival bias, accurate outcome comparisons.

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20
Q

What features should characterise outcomes in AME? (3)

A

Outcomes should be consistent, predictable, and able to be described and monitored.

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21
Q

Define patient retrieval.

A

The utilisation of medical, nursing, and/or paramedical personnel to facilitate the clinical management and safe transport of a patient/s from one location to another. (Transport medicine in USA).

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22
Q

In the AME context, what are the tasks of clinical coordination? (List six).

A

Logistics, advice, triage, organising retrieval, clinical oversight, sometimes bed finding.

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23
Q

What is the justification for transporting trauma patients from R&R facilities? (4 reasons).

A

Rural injuries are associated with 2-3 times higher mortality; avoidable errors are higher in rural hospitals; morbidity and mortality are decreased by direct transport to a major trauma centre; complex healthcare can’t be provided in R&R centres.

24
Q

Describe three roles of retrieval services.

A

1.) Transport without a lower (and hopefully better) level of clinical care.
2.) Allow equal access to resources and standards of care.
3.) Optimum management earlier (limit therapeutic vacuum).

25
Q

What is the treatment standard for AME?

A

The level of care provided during transport must aim to at least equal that at the point of referral and must prepare the patient for admission to the receiving service.

26
Q

What does safe AME require? (3 things).

A

Deployment of appropriately trained staff; essential equipment; effective liaison between referring, transporting, and receiving staff at a senior level.

27
Q

What is the general philosophy of AME?

A

The risk of the transport should be less than the potential benefit from the receiving hospital.

28
Q

Why is research in AME often difficult to interpret?

A

Because of the multitude of variables involved.

29
Q

In what ways can the need for AME be decreased? (3)

A

Telemedicine, increased training and resources in R&R areas, and retention of skilled R&R staff.

30
Q

What is the impact of increased demand for AME? (5)

A

Increased requirements for assets, e.g. aircraft, crew with appropriate knowledge and skills, equipment, robust communication between multiple people, and higher costs.

31
Q

How do primary and secondary retrievals differ? (3 ways).

A

Resources, crew mix, and tasking info - very limited info in primary retrievals.

32
Q

Define primary retrieval.

A

The assessment and management of a patient at the scene of an incident prior to transport to a healthcare facility (prehospital scene to hospital).

33
Q

What are the characteristics of primary retrievals? (4)

A

Mostly trauma.
Unfamiliar environment for hospital-based clinicians.
Unknown injuries.
Helis mainly used as can land at site and/or winch.

34
Q

Define modified primary retrieval.

A

Retrieval of a patient from a remote location with poor resources. Primary assessment and management is undertaken by bystanders and/or remote HCWs. Usually health care clinic or single nurse post.

35
Q

Define secondary retrieval.

A

The transport of a patient from one facility to another. Also known as Interfacility transport / inter hospital transport / transfer. Reasons: resources, skill mix, expected level of care.

36
Q

What are the characteristics of secondary retrievals? (3)

A

Occur for a variety of reasons; may incorporate specialty teams - NICU, PICU, ECMO; usually injuries are known.

37
Q

Define clinical coordination in the AME context.

A

The process whereby appropriately skilled and experienced nursing, paramedical, and medical coordinators are involved in the direct supervision of the aeromedical transport of patients to optimise safe and efficient use of expensive services.

38
Q

What does clinical coordination in the AME context involve? (List 6).

A

Clinical consultancy/governance
Determining level of clinical escort - authorisation and tasking
Deciding transport vehicle
Deciding priority of response
Deciding receiving hospital’s ED/ crit care bed
Ongoing communication with referring, retrieval, and receiving staff.

39
Q

Define “dust-off”.

A

Military equivalent to a primary retrieval. Usually heli rotors are still spinning for a very rapid load and departure.

40
Q

Define fixed-wing aircraft.

A

All airplanes. Can be subdivided into prop or turboprop (with propellors) and jet (jet engine).

41
Q

Define “hot un/load”.

A

Process of loading/unloading patient/staff onto heli while rotor blades are still turning and engine is running.

42
Q

Define “hot refuel”.

A

Re-fuelling heli while rotor blades and engine are going.

43
Q

Define instrument flight rules (IFR).

A

Regulations and procedures for flying aircraft by referring only to the aircraft instrument panel for navigation. Can fly without looking outside cockpit window.

44
Q

Define M-CAT.

A

Military critical care aeromedical team (Aus military).

45
Q

Define CCATT.

A

Critical care aeromedical transport team (US military).

46
Q

Define movement “up the chain”.

A

The aim to deliver the same/higher level of care that the patient has already had at the point of referral.

47
Q

What does scene response refer to?

A

Primary retrieval (American).

48
Q

Define land-on primary.

A

The aircraft has landed at the scene.

49
Q

Define winch primary.

A

The team has been winched to the patient from a hovering heli.

50
Q

Define rotary wing aircraft.

A

All helicopters.

51
Q

Define scoop and run.

A

Minimal interventions and rapid transport to a receiving facility/definitive care (load and go).

52
Q

Define stay and play.

A

Doing all the interventions at the scene prior to transport.

53
Q

Define strategic transport.

A

Military equivalent of tertiary retrieval. Patients transported long distances, usually back to home country for ongoing rehab/surgery. May still be critical care patients.

54
Q

Define tactical transport.

A

Military equivalent of secondary retrieval.

55
Q

Define tertiary retrieval.

A

Form of secondary retrieval. Transport of a patient from one healthcare facility to another. Usually overseas/long-distance/insurance cases/repatriation. Usually more time to plan and patients less acute.

56
Q

Define visual flight rules.

A

Set of rules that allow a pilot to operate an aircraft in weather conditions clear enough to see out the cockpit window.

Aeromedical Retrieval (16 decks)

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