Accuracy of Critical Care Transport Team Estimation of Patient Height and Weight in Scene Responses.

Estimates of clinically relevant information, such as height, weight, blood loss, and burn area, have consistently been fraught with error in the health care setting. Seemingly little has been done in health care education to improve estimate outcomes. Standardized tools, most often in pediatric populations, have become commonplace to guide acute care management when misestimation of data points like height or weight would likely have its biggest impact on patient care and outcome. This article is a retrospective study of a critical care transport team's abilities to estimate patient height and weight in scene responses using the Glasgow Coma Scale score as an indicator for the likelihood of patient input. Ultimately, height was removed as a variable because of the paucity and unreliability of the collected data. The expected outcome with respect to weight estimates was observed; with decreased patient Glasgow Coma Scale scores, the discrepancy in provider estimate increased from 8% to 12%. Although statistically significant, it does not represent the level of aberrancy noted in other studies, which has been reported to be as high as 40%.

A 20-Year-Old-Male with Hemorrhagic Shock.

Hemorrhagic shock from trauma is a leading cause of morbidity and mortality and commonly encountered by HEMS agencies. Understanding of the management of patients in hemorrhagic shock transported from the scene and interfacility transfers is important for all critical care providers.

Blast lung injury in a 20-year-old man after a home explosion.

A large family home exploded after a propane leak ignited. Initial reports from the scene noted that 11 people were injured, with many sustaining critical injuries. Immediately, multiple helicopter emergency medical services aircraft were dispatched to respond to the scene, and ground emergency medical services (EMS) providers were en route. Of the five aircraft requested, only two were available to respond; one aircraft was out for maintenance, and two others were committed to other missions.

Is it really a STEMI or Takotsubo cardiomyopathy?

The goal of this column is to provide a case that is pertinent to the medical transport industry and provides teaching points for crewmembers who are actively involved in out-of-hospital transport, whether by air or by other means. In this issue, we have the opportunity to examine two similar cases from a single crew (nurse/paramedic) that occurred within several months of each other and to describe a moderately rare condition that mimics a common diagnosis encountered by critical care personnel.

Intractable seizures in a 4-month-old girl.

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. She had never been hospitalized and was up to date on all of her immunizations. 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.

A tracheal disruption in an 89-year-old female after a fall.

A crew from a northeastern flight program was activated in early February for a scene call in rural New York for an elderly female patient with multisystem trauma after a fall. The weather was marginal in the area that evening, necessitating an extensive weather check by the pilot to ensure appropriate flying conditions. This evaluation delayed liftoff several minutes. While en route, the flight team received further details concerning the patient. Ground emergency medical services (EMS) reported that her husband found the patient at the bottom of the cellar stairs. He had immediately called 9-1-1 for emergency response.