On-Scene Patient Packaging

Information that you will need to provide when you are calling includes the following.

• Referring agency name, caller's name and call-back number
• Call location. If an exact landing zone location is not available at the time LIFESTAR is requested, the nearest city, community or known location will assist in navigation until an exact location can be coordinated.
• Number of patients needing transport and approximate ages
• Nature of incident (MVA, fall, assault, drowning, etc.)
• Contact unit and operating frequency

Preparing the Patient

A primary benefit of air medical transport is rapid access to tertiary care. Optimal patient preparation can allow the flight team to spend only minutes at your location. Our goal is rapid, safe transport. Any assistance you can provide in patient preparation before the team arrives will help reach the goal of short patient bedside times.

If possible and if time permits, we ask that the following patient preparations be made.

• Airway management and oxygen therapy. Patients with a compromised or potentially compromised airway need to have their airways secured before transfer. When in doubt, intubate. Due to altitude physiology considerations, aggressive airway management is encouraged.

  Feel free to contact the LIFESTAR Communications Center at 865.305.9112 and speak with a flight crew member or with one of the medical control physicians, either prior to lift-off or while the helicopter is enroute to your hospital.

  Upon arrival, the flight crew also can assist you with any necessary airway needs. The flight crew will frequently utilize Rapid Sequence Induction to facilitate immediate intubation in the patient requiring an emergent airway.

• Oxygen therapy. Cardiac and medical patients need a minimum of 2 to 4 liters oxygen administered by nasal cannula. Trauma patients or any unstable patient will need 10 to 15 liters of oxygen by nonrebreather mask.

• Intravenous lines. Due to the potential of accidental dislocation of an intravenous line in the transport environment, it is recommended that at least two intravenous lines be established.

  Trauma patients should have at least two large-bore intravenous lines—14 gauge or 16 gauge—to facilitate rapid infusion of crystalloid and/or blood products, if needed.

  Medical patients should have at least two intravenous lines. One intravenous line can be attached to an IV set with an appropriate solution, and any additional lines may be turned into INTs for transport.

  If patients are on medications that require IV pumps, please inform the flight coordinator. This will allow the flight crew to bring syringe pumps into your facility.

  All intravenous lines should utilize extension sets. This facilitates switching to blood sets, trauma tubing or the receiving hospital’s intravenous sets without contaminating the IV site or risking accidental dislocation of the catheter.

  Tape, tape and more tape. Intravenous lines should be secured with additional amounts of tape to help prevent dislocation. Tegaderms, Veni-Gard’ and other commercial intravenous site protectors are fine, but reinforce them with tape.

• Tubes. Altitude physiology causes gases to expand at altitude, increasing the potential for vomiting or enlargement of a pneumothorax. A nasogastric tube should be placed to prevent gastric dilatation and subsequent respiratory compromise.        Remember to place an orogastric tube if there is a possibility of facial fractures. Critical trauma and medical patients need a Foley catheter to monitor urinary output. If the patient has a significant pneumothorax a chest tube should be placed.

• Spinal immobilization. Keep all immobilization equipment in place, even if the X-rays are completed. Spinal immobilization is vitally important in the trauma patient and allows for immobilization of other injuries, regardless of whether there is an associated spinal injury. If possible, pad all pressure points on the spine board for patient comfort.

• Splinting. Do not use air splints. Altitude will cause splints to tighten during transport. If special splinting is required, let the flight coordinator know so that the crew can bring special splinting materials.

  Space limitations on the aircraft preclude the use of certain splints. It is preferred that if long bone fractures can be adequately splinted in gutter, vacuum or other types of splints that you use them. If a traction splint is in place, it only should be minimally extended. If the patient’s height plus the addition of the traction splint presents a problem, the flight crew will assist you with alternate splinting options.

• Restraint / sedation / antiemetics. Due to safety considerations, the flight crew will make judicial use of chemical as well as physical restraint on all patients that present combative. Of particular concern are patients with head injuries and drug/alcohol ingestion. These patients will be physically and/or chemically restrained.

  Anxious patients (particularly cardiac) may be sedated prior to arrival of the flight crew, if not contraindicated.

  If patients are prone to air sickness or have complained of nausea at any time during their care, antiemetics should be given.

• Records. Provide copies of patients’ treatment records, pertinent history, labs and X-rays. If these materials are not immediately available, they can be faxed to the LIFESTAR Communications Center at 865.305.8868. If you are unable to complete these tasks before the flight team arrives, they will assist you in any way necessary to prepare the patient for transport. Helpful to the flight crew, but not essential, is to enclose two copies of the face sheet on all transfers. Please call the receiving facility’s inpatient unit with a report so it can prepare medications drips, ventilators, etc., prior to arrival of the flight crew.

• Family. The flight crew will make every attempt to speak with the family members to explain what it is doing and answer questions if the patient’s condition allows.

  Family cannot fly on the helicopter. A family member’s reaction to the flight environment and medical procedures cannot be predicted and could detract from or interfere with patient care.

  The patient’s valuables and clothes should remain with the family, if present.

• Assisting the team. The LIFESTAR flight crews welcome your assistance with patient preparation and movement. Each crew has established routines that aid them in efficient and safe patient transport. Please allow the crew to direct you in lending assistance. The flight crew may exit the aircraft before the blades have stopped turning—do not take this as a signal to approach the helicopter.
  • Assist the flight crew by ensuring that non-essential personnel do not approach the helicopter. No one should approach the aircraft until signaled to do so by a flight crew member.
  • NEVER approach the aircraft from the rear or hold items such as IV bags above your head as this could result in contact with the aircraft’s rotor system.
  • During single-patient loads, the patient will be loaded feet first through the left cabin doors. Two-patient loading sequences will vary depending on patient(s’) acuity, size and other considerations.
  • Do not place items in the helicopter; give equipment or packs to a flight team member familiar with proper placement and securing.
  • Only flight team members will open or close doors to the aircraft.
  • As soon as patients and equipment are loaded into the helicopter, all personnel, equipment or vehicles should be moved away from the landing zone so that preparation can be made for a quick departure.
  • Be sure all loose objects such as papers, linen and clothing are secured before the rotors start to turn to prevent anything from flying up into the blades.

LIFESTAR offers outreach programs on patient preparation and aircraft loading/unloading safety. To arrange an in-service, contact the public relations officer. If LIFESTAR is unavailable for your request or transport is for a distant location, referrals to other appropriate services will be provided to you by our communication specialists. For additional information, you may contact the communications center at 865.305.9112.