Nurse Practitioners in Critical Care Transport.

The inclusion of nurse practitioners (NPs) in critical care transport teams has the potential to enhance patient care and improve team operations. NPs can manage complex clinical situations during transport and excel in various roles such as leadership, education, mentoring, research, quality improvement, and clinical expertise. As we navigate the evolving landscape of critical care transport, it is crucial to explore the potential benefits offered by NPs. Their distinct skills and experiences effectively position them to improve patient outcomes, enhance team performance, and contribute to health care's financial sustainability. This article discusses the role of NPs in critical care transport, providing insight into their current uses, and recommendations for optimal use.

Usefulness of a Simulated Helicopter Transport Experience for Medical Resident Training.

OBJECTIVE: This study evaluated the usefulness of a medical transport simulation to increase residents' understanding of medical transport. METHODS: Twenty-four medical residents participated in an intensive half-day medical transport simulation experience. Two questionnaires were administered, a pre/postsimulation questionnaire containing 11 questions that assessed the impact of the simulation training and a questionnaire that assessed realism of the flight simulator. RESULTS: There were statistically significant differences between the pre/postsimulation questions assessing perceived level of knowledge, experience, and training of transferring a patient in a helicopter with a mean change of 25 points on a 0 to 100 scale (P ≤ .001) and awareness of obstacles to treating patients during air transport exhibiting a mean change of 28 (P ≤ .001). The mean stress level for all participants increased from 32 (0-100 scale) before the start of the simulation to 47 during the simulation and decreased to 31 after the simulation (F2,46 = 20.67, P ≤ .001). CONCLUSION: The findings from this study provide evidence that the air medical simulation experience increases residents' perceived awareness of the context and difficulties of transferring a patient by helicopter and that the experience would influence their medical decision making in their future practice related to patient transfers.

Pericardiocentesis in an Ambulance: A Case Report and Lessons Learned.

There are few procedures performed in the prehospital setting as intimidating as pericardiocentesis. We report a case in which lifesaving pericardiocentesis was performed in the back of an ambulance after temporizing measures of volume resuscitation and vasopressor therapy failed. Fluid accumulation within the pericardial sac can increase pressures around the heart and lead to cardiac tamponade. Helicopter emergency medical service crews may be called to transport patients with cardiac tamponade physiology to definitive care where removal of the pericardial fluid can be achieved. Pericardiocentesis is indicated as an emergency procedure in patients with hemodynamic compromise secondary to cardiac tamponade.1 Because most HEMS crews do not routinely perform pericardiocentesis because of the rare need or crew scope of practice limitations, the general approach to management in the prehospital setting is volume resuscitation, to overcome decreased preload, and vasopressor support. Here, we report a case in which lifesaving pericardiocentesis was performed in a ground ambulance after temporizing measures of volume resuscitation and vasopressor therapy failed.

Response of Flight Nurses in a Simulated Helicopter Environment.

OBJECTIVE: The purpose of this study was to determine if a helicopter flight simulator could provide a useful educational platform by creating experiences similar to those encountered by actual flight nurses. METHODS: Flight nurse (FN) and non-FN participants completed a simulated emergency scenario in a flight simulator. Physiologic and psychological stress during the simulation was measured using heart rate and perceived stress scores. A questionnaire was then administered to assess the realism of the flight simulator. RESULTS: Subjects reported that the overall experience in the flight simulator was comparable with a real helicopter. Sounds, communications, vibrations, and movements in the simulator most approximated those of a real-life helicopter environment. Perceived stress levels of all participants increased significantly from 27 (on a 0-100 scale) before simulation to 51 at the peak of the simulation and declined thereafter to 28 (P < .001). Perceived stress levels of FNs increased significantly from 25 before simulation to 54 at the peak of the simulation and declined thereafter to 30 (P < .001). Perceived stress levels of non-FNs increased significantly from 31 before simulation to 49 at the peak of the simulation and declined thereafter to 25 (P < .001). There were no significant differences in perceived stress levels between FNs and non-FNs before (P = .58), during (P = .63), or after (P = .55) simulation. FNs' heart rates increased significantly from 77 before simulation to 100 at the peak of the simulation and declined thereafter to 72 (P < .001). CONCLUSION: The results of this study suggest that simulation of a critical care scenario in a high-fidelity helicopter flight simulator can provide a realistic helicopter transport experience and create physiologic and psychological stress for participants.