Longer term goals.

[chbare]

This is a scenario based on a medical evacuation I just completed. I would like to ask the "old farts" here to hold back a bit and let some of the novice members throw in their thoughts. This is a bit different from my typical "zebra" scenario; however, I think it is nice to see a patient through more than just the acute phases of their illness. In addition, I will throw in other factors that some of us in the the US may not consider on a daily basis. Here goes:

You are the member of an international medical evacuation team working in Afghanistan. You are on call with a physician. The physician has family practice experience without any significant emergency, transport, or critical care exposure. You have been called to transfer a patient out of a small rural clinic in Northern Afghanistan to Wellcare hospital in Dubai UAE. The working diagnosis at the moment is chest pain. The clinic is small and manned by a single nurse with very limited equipment and diagnostic capabilities. You will be flying a King Air 200 into a small airfield about 8 kilometers from the clinic. In addition, you expect at least 40-50 knot head winds en-route to Dubai. After picking up the patient, you will have a 1.5 hour flight to Kandahar where you will land and refuel. After refuel, you can expect a four hour flight to Dubai. Total transport time including refuel is approximately, 6 hours. (Not including time spent packaging the patient and transport to and from the rural clinic.)

Take it from here.

Take care,

chbare.

[firedoc5]

A KingAir 200, oooh, nice.

OK, I'll hold back.

[mobey]

I think being an "Intermediate Care Paramedic" and Advanced student I should fit the bill.

What does the patient look like? (Distress, colour etc)

What has the hospital done? 12 lead? Lab work? Troponin? X-Rays etc....

[Mateo_1387]

I will give it a go.

We know we have a 6 hr flight ahead of us, so it is important to start collecting information on the ground.

Things I will want to know or do will be....

What assessments, diagnostics, and treatments has the clinic already done? What were their findings? Did the patient improve with any treatments?

An assessment will be in order before we leave. How does the patient present? Current vitals? Will want to listen to heart tones before we take off, as I assume they will be difficult to hear while flying.

What kind of equipment do we have for diagnostics?

[chbare]

Good, we want to gather pre-mission information. The patient is a 41 year old female complaining of chest and back pressure along with near syncope. Vital signs include: 92/54, 50 and irregular, 22 unlabored, 98% on 2 lpm, 36.9 C, BGL-6.5 mmol/l, pain -10/10. The nurse is a bit stressed and unable to give you additional information. She only has an AED without monitoring abilities. No labs and no radiology.

Your equipment is a typical EMS paramedic kit. Good monitor, meds, and the ability to RSI. Limited diagnostic capabilities.

Anything else to consider prior to taking off? Think about how you will get to the clinic and what about landing at a small airstrip in Northern Afghanistan?

Take care,

chbare.

[iMac]

Being an EMT I'd be useless for this one.

Keep this guy continuously monitored (q5 mins). Do my head to toe.

Do we have any medical Hx? pre-existing conditions? (family Hx etc)get a thorough Hx.

When did this start? has it happened before? Where's the pain? radiation? N/V, any dyspnea? etc etc.

Has the 02 made a difference to him? has he been given anything (medications) prior to take off? what are the directives for this guy? were breath sounds clear?

I'd continue monitoring his vitals, I wouldn't mind starting at least 1 line, TKVO. (would be concerned about going down the nitro route with his BP sitting where it is already) Consider bumping up his 02 if he finds it made him a diff.

Can we hook up to a 3 lead (keeping all cables close on hand)? what does it show(for my own info).

Is there any recent trauma?

Pull a barf bag out for both him and I.

[chbare]

Before we get too far into patient contact, any other considerations regarding the situation? Think about the situation and the scene.

The nurse is able to give you a little more history before you take off:

No Known Allergies.

No past surgical or medical history.

No regular use of medications.

Social History: Smoker 1PPD times 25 years.

Discomfort started suddenly 2 hours ago.

Complaints of mild nausea without vomiting, no dyspnea, and complaints of a couple of near syncopal episodes.

The nurse has given the patient supplemental oxygen, 300 mg of ASA, and placed an IV medlock.

Have you covered on the barf bag. I actually have terrible motion sickness. I generally pre-medicate with Antivert and use Dimenhydrinate for break through nausea. Off topic, but I had motion sickness so bad one time, I hyperventilated my self into carpal pedal spasms. Very hard to barf into the bag when you cannot even hold it. A mess to say the least. So, I always medicate if I roll on a fixed wing.

Take care,

chbare.

[Mateo_1387]

Anything else to consider prior to taking off? Think about how you will get to the clinic and what about landing at a small airstrip in Northern Afghanistan?

Yea, how will we do all that? :wink:

Some things to consider.....

Fuel for a six-hour flight.

Enough medical supplies and medications for a six-hour flight.

Food for a six-hour flight.

Where we land to pick up the patient. How to move the patient.

Interpreter.

Hostilities in the area.

Protection.

Information for family.

Fighter jets to escort

[spenac]

I definitly want a bathroom break before we leave.

Call in what ever agency you use to schedule proper transportation and security.

[chbare]

Good, is the field secure and how will we get from the field to the clinic and back? You are able to arrange security at the field and an escort to and from the clinic.

Good call on the bathroom, I always bring an extra urinal. Weak bladder and all.

Upon arrival you note an anxious patient obviously experiencing some sort of distress.

Take care,

chbare.