Air medical journal
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Critical care transport (CCT) is provided in a unique and challenging out-of-hospital environment. The workplace and salaries for CCT staff are similarly unique and distinct within the health care industry. An industry-specific workplace and salary survey was conducted under Federal Safe Harbor guidelines to update information for 2012. As safety is a key concern for CCT workers and organizations, the survey elicited industry best practices under safety management system (SMS) categories.
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Air medical journal · Jul 2012
Emergent interfacility evacuation of critical care patients in combat.
During the Second Iraq War (Operation Iraqi Freedom), high-intensity, low-utilization medical and surgical services, such as neurosurgical care, were consolidated into a centralized location within the combat zone. This arrangement necessitated intra-theater air medical evacuation of critically ill or injured patients from outlying combat support hospitals (CSH) to another combat zone facility having the needed services. A case series is presented of intratheater transfer of neurosurgical patients in Iraq during 2005-06. ⋯ None of the patients died during evacuation. Intratheater and interfacility transfer of critical care patients in the combat theater often involves severely head-injured and other neurosurgical cases. Current Army staffing for helicopter transport in these case requires a nurse or other advanced personnel to supplement the standard EMT-B flight medic.
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A 4-month-old, 7-kg girl with a 3-day history of mild diarrhea was brought into a rural emergency department (ED) by private vehicle. The patient's parents reported that the child was in her usual state of health until the past several days, when she began having multiple loose stools. After an extensive interview, the family said she was born full term without any complications. ⋯ Family also stated emphatically that there was no alteration in her formula concentration and intake before her presentation. Approximately 30 minutes before her arrival, her parents noticed "shaking of the extremities" consistent with seizure activity. Concurrently, they noted she had irregular respirations and was not acting at her baseline.
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Upper airway obstruction is responsive to the reduction in airflow turbulence provided by helium/oxygen (heliox) admixture. Our pediatric critical care transport team (PCCTT) has used heliox for children with upper airway obstruction from croup. We sought to describe our experience with heliox on transport and hypothesized that heliox-treated children with croup would show a more rapid clinical improvement. ⋯ Heliox added to standard transport treatment for critically ill children with croup provides a more rapid improvement in croup scores. Heliox for croup during transport does not prolong intensive care unit stay. A prospective clinical trial is warranted to evaluate heliox in pediatric transport.