Common accreditations
CAMTS- commission on accreditation for medical transport systems
CAPCE- commission on accreditation for prehospital continuing education
Nursing- American nurses credentialing center(National) and Kentucky Board of nursing(47/50 states)
HIPAA(health insurance portability and accountability act)
HIPAA consists of 5 titles- put fourth by President Clinton
— title 1– healthcare access, portability, and renewability
— title 2 - preventing healthcare fraud and abuse
— title 3 - tax related health provisions(HSA accounts)
— title 4 - group health insurance requirements(Cobra laws)
— title 5 - revenue offset governing tax deductions for employers
JUST culture
long-term relationship between the employer and the employee
— if you were doing your job well you should be recognized
— if you make an honest mistake, you should be supported
— if you violate procedure due to perceived as a justifiable risk, you should be trained and coached to do it better next time
— if you are caught taking shortcuts for personal gain or taking reckless action without regard for consequences, you should be disciplined.
GAMUT Metrics
- ground and air medical quality in transport
> establishes strict definitions for quality metrics that are relevant
> database for tracking and reporting for performance comparison to other programs
> easy to identify best practices of high-performing, transport teams and programs.
Ethical considerations
> respect for patient autonomy
-Informed consent
-Shared decision-making
confidentiality
honesty and decency toward the patient and family.
PTSD and suicide risk
- critical incident stress debriefing CISD
> know you are not alone
> trauma is a normal human response to an abnormal situation
> trauma is an injury to the brain rather than an illness
> connect with others and share experiences
> help change culture— talk
CAMTS terminology
VFR- visual flight rules
VMC- visual meteorological conditions
IFR- instrument flight rules
IMC- instrument meteorological conditions
Flight following
> 15 min rule- if an IFR or VFR flight plan has not been filed time between communications must not exceeded 15 minutes if it means to communicate directly or indirectly is available.
> 45 min rule- time between communication must not exceed 45 minutes while on the ground unless ground ambulance, continuous tracking software is used.
> post accident policy will be implemented 15 minutes after an aircraft fails to give a position report or is overdue to arrive
Shift requirements
24 shifts
-not required to perform duties beyond transport services
-Access to uninterrupted rest
-Can call “timeout”
-fatigue risk management system utilized
Exceeding 24 hour shifts
-Programs base averages <one transport per day
-Provides at least 10 hours of rest in each 24 hour Period.
-Location of base or program is remote(One-way commutes are >2 hrs)
Protective equipment
- hearing protection
- Clothing based on environment conditions(required)
- Boots or sturdy footwear(required)
- Helmet
- Reflective material(strongly encouraged)
- Flight suit with no more than 1/4inch between skin and flight suit
Minimum equipment
- Patient securing – three restraint belts
- Two sources of oxygen
- Two suction sources
- Defibrillation capabilities
-ETCO2 waveform capnography. Transcutaneous ETCO2 monitoring is acceptable for neonatal transport teams.
Specialty transport teams
-Specialty transport teams will be accompanied by at least one regularly scheduled light crew member or
- Betrayed on the companies CRM, safety, survival, and aircraft operations.
- must hold C–NPT based on spec specific specialty transport team capability(neonatal)
Training requirements
Annual didactic and clinical training are required
Pilot qualifications
- Minimum of 4 flight ready pilots assigned per single aircraft which is available 24 hours/Day
- commercial/instrument rated
- 2000 total flight hours
- 1200 flight hours rotor
- 1000 PIC in rotor(may include 500 hours in tilt rotor)
- 100 hours as night PIC
- 500 hours turbine time(1000 hours of turbine time strongly encouraged)
** airline transport pilot(ATP rating) is required within five years of higher**
Pilot training
- Initial terrain and weather
- Hospital orientation
- Infection control
- Medical on aircraft
- Loading/unloading
- EMS
- Instrument
- Weather
- Five hours area orientation with two hours at night as PIC
- part 135
- IMC(inadvertent meteorological conditions)
- instrument IFR
Flight safety and emergency
- Sterile cockpit
- Eyes out
- Hazard identification
- FMC — safety
- Seatbelts
- Weather
FAA VFR minimums
Range from 800’— 2 miles to 1500’—5 miles depending in terrain and day/night w/or w/o NVG’s
In flight emergency
- Lay patient flat
- Secure patient straps
- Turn off oxygen
- Secure equipment
- Secure yourself
- Helmet visor down
- Crash position
Post crash procedure
- emergency transmit on 800MHz frequency 406(121.5 is old). Needs to be in arms reach of pilot.
- ELT activation – 4g’s
- Disengage – throttle, fuel, and battery. Rotor break is always last.
- Exit rotor blades stop
- Exit and meet at 12 o’clock position
- Secure shelter, water, and food.
Radio transmission
> Simplex system
- Single channel for transmission
- Aircraft: air – air
- Marine radio
- Old radio systems
- transmitter and receiver
Duplex system
- Transmit and receive on different channels
- Needs repeater or tower
- Portable radio – half duplex
- cell phones – full duplex
Ambulance operations
Based on KKK 1822
> poor conditions or crash procedure
- Move to the curb
- Water flooding roadway
> warning device: >35 MPH
- 30 meters(100ft) in both front and rear
- Obstruction from Hill within 30 meters(100ft) the second warning device needs to be activated
> fuel capacity minimum of 175 miles
- Must be able to operate between -30 and 122°F
> road hazard equipment
- Flashlight
- Flares(road marker)
- Tools
- leather gloves
> EVOC/CEVO certified
> operator driving record verified every year
-
Flight Physiology29
-
Oxygenation Physiology18
-
Acid-Base Blitz20
-
Lab values33
-
Respiratory Emergencies33
-
Advanced Airway Management13
-
Mechanical Ventilation34
-
Endo, Hemato, Renal, and Sepsis21
-
Neuro Emergencies30
-
Cardiac Physiology49
-
Advanced Hemodynamics26
-
IABP Therapy26
-
Trauma Management30
-
Environmental-Toxicology48
-
OB/GYN Emergencies31
-
Neonatal Emergencies44
-
CAMTS21
