Ventilatory choices for intubated patients during helicopter stretcher winching.

INTRODUCTION: The winching of intubated patients on a stretcher into a helicopter is a rare event. Intermittent positive pressure ventilation is mandatory, which can either be performed manually with a self-inflating bag, or automatically using a portable ventilator. Theoretically automatic ventilation would provide improved oxygenation, more stable arterial carbon dioxide levels and a reduced risk of airway disconnection. Furthermore, the stretcher attendant may better perform winching procedures with higher situational awareness, contributing to crew and patient safety. However ventilator failure, and the diagnosis and management of such, is of concern. OBJECTIVE: The aim of this study is to compare automatic against manual ventilation during intubated helicopter stretcher winching. METHOD: The trial had two phases. Initially a static winch on a hoist simulator was performed, followed by live winching into a helicopter. All stretcher attendants performed two winches with an intubated manikin. During one winch, the manikin was manually ventilated, and an automatic ventilator was used for the other. Airway pressures were measured. RESULTS: Automatic ventilation did not fail. Compared with automatic ventilation, manual ventilation displayed significant pauses, inconsistent rates and both high and low airway pressures. Automatic ventilation permitted better situational awareness and performance in winching manoeuvres. One airway disconnection occurred during manual ventilation. CONCLUSIONS: During helicopter winching, automatic ventilation is superior in providing controlled, consistent and reliable ventilation for intubated patients. The stretcher attendant is also able to provide more attention to the winching manoeuvres with subsequent safety gains. The risk of automatic ventilator failure is low.

Patient Litter System Response in a Full-Scale CH-46 Crash Test.

U.S. Military aeromedical patient litter systems are currently required to meet minimal static strength performance requirements at the component level. Operationally, these components must function as a system and are subjected to the dynamics of turbulent flight and potentially crash events. The first of two full-scale CH-46 crash tests was conducted at NASA's Langley Research Center and included an experiment to assess patient and litter system response during a severe but survivable crash event. A three-tiered strap and pole litter system was mounted into the airframe and occupied by three anthropomorphic test devices (ATDs). During the crash event, the litter system failed to maintain structural integrity and collapsed. Component structural failures were recorded from the litter support system and the litters. The upper ATD was displaced laterally into the cabin, while the middle ATD was displaced longitudinally into the cabin. Acceleration, force, and bending moment data from the instrumented middle ATD were analyzed using available injury criteria. Results indicated that a patient might sustain a neck injury. The current test illustrates that a litter system, with components designed and tested to static requirements only, experiences multiple component structural failures during a dynamic crash event and does not maintain restraint control of its patients. It is unknown if a modern litter system, with components tested to the same static criteria, would perform differently. A systems level dynamic performance requirement needs to be developed so that patients can be provided with protection levels equivalent to that provided to seated aircraft occupants.

[Concrete pain prevention measures regarding hospital internal transport in a cancer center]. / Mesures concrètes de prévention des douleurs provoquées par les opérations de brancardage dans un institut de cancérologie.

Iatrogenic pain is a common problem for cancer patients, including those due to hospital internal transport. An original prospective study conducted in 2006 allowed risk factor identification, and from 2007, a pluri-annual progress plan was implemented. Its actions were systematically evaluated and all phases of transportation reconsidered: preparation, patient transport to and care in medicotechnical units. Measures applied to anticipate these pains help improve the quality of hospital care. All professionals involved in the patient transportation system need to be made aware of this and not only hospital porters.

Sports prehospital-immediate care and spinal injury: not a car crash in sight.

The prehospital management of serious injury is a key skill required of pitch-side medical staff. Previously, specific training in sports prehospital-immediate care was lacking or not of a comparable standard to other aspects of emergency care. Many principles have been drawn from general prehospital care or in-hospital training courses. This article discusses sports prehospital-immediate care as a niche of general prehospital care, using spinal injury management as an illustration of the major differences. It highlights the need to develop the sport-specific prehospital evidence base, rather than relying exclusively on considerations relevant to prolonged immobilisation of multiply injured casualties from motor vehicle accidents, falls from height or burns.

A biomechanical and subjective assessment and comparison of three ambulance cot design configurations.

Effects of ambulance cot design features (handle design and leg folding mechanism) were evaluated. Experienced ambulance workers performed tasks simulating loading and unloading a cot to and from an ambulance, and a cot raising task. Muscle activity, ratings of perceived exertion, and performance style were significantly affected by cot condition (p < 0.05). Erector Spinae activity was significantly less when using Cot-2's stretcher-style handles. Shoulder muscle activity was significantly less when using Cot-2's loop handle. During loading and unloading, operators allowed the cot to support its own weight most often with Cot-2's stretcher-style handles. Preference for Cot-2 (either handles) over Cot-1 (with loop handle) was consistent across tasks. Handle effects were influenced by operator stature; taller participants received more benefit from Cot-2's stretcher-style handles; shoulder muscles' demands were greater for shorter participants due to handle location. Providing handle options and automatic leg folding/unfolding operation can reduce cot operator's effort and physical strain. Practitioner Summary: Paramedics frequently incur musculoskeletal injuries associated with patient-handling tasks. A controlled experiment was conducted to assess effects of ambulance cot design features on physical stress of operators, as seen through muscle activity and operator's perceptions. Differences between cots were found, signalling that intentional design can reduce operator's physical stress.