Imperial Valley Pediatric Trauma: Air Transport

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Imperial Valley Pediatric Trauma Air Transport

• Sean Rogoff, EMT-P
• REACH Air Medical Services

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REACH Air Medical Services

• We will be available and prepared to provide
  customer-oriented, high-quality patient care, in
  a safe and efficient manner.
• In every situation, we will do what is right for
  the patient.

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Medicine in Motion

• REACHs goal is to get our pediatric trauma
  patients to definitive care rapidly and safely.

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Community Involvement

• Active local EMS Agency and local hospital
  involvement
• Committed to building relationships with our
  primary sending and receiving facilities
• OutREACH services and injury prevention
  activities
• Volunteer staffing in non transport positions
  during sand season
• Increased staffing during sand season to meet the
  needs of the community

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Preparation for Success

• It is not enough to do your best, you must
  prepare to be your best.
• REACH exceeds EMSC standards for pediatric
  equipment and training.
• Dedicated pediatric clinical educators and
  pediatric intensivist on staff.
• Relationships with pediatric tertiary care
  facilities to allow for clinical rotations and
  collaborative CQI.

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Scene Call Management

• Focus is on rapid primary assessment to identify
  life threatening injuries.
• Perform only the care that must occur on scene
  prior to loading in the aircraft.
• Most patient care is provided while en-route to
  the pediatric trauma center.

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Case Study

• Pediatric MVC

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• 1948 - REACH 9 dispatched for a pedestrian
  struck
• EC-135 helicopter staffed with Flight RN and
  Flight Paramedic
• Patient transported directly to REACH 9 base at
  Imperial County Airport via ALS ambulance
• 1957 - Patient contact made
• 2-year-old
• Average-sized female patient
• 13 kg
• Broselow tape utilized

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• Patient was standing behind family pick-up truck
  when mother backed vehicle, striking patient with
  rear bumper at low speed
• Witnesses initially reported to EMS that patient
  was not run over however, it was discovered
  later that the patient did in fact go under the
  rear tire of the truck
• Patient sustained closed head injury, presented
  with bleeding from left ear, positive for CSF, no
  other injuries noted

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• Ground paramedic at scene initiated full c-spine
  precautions and obtained intravenous access x 2
  (22 gauge)
• Initial contact with flight crew
• Patient conscious but disoriented
• GCS 7 (Eyes 2, Verbal 1, Motor 4)
• Revised Trauma Score 10
• (RR 30, SBP 121, GCS 7)
• Pupils equal, round and reactive to light
• BP 128/79, HR 132, RR 30, SPO2 99
• Spontaneous respirations

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• Base hospital contact was initiated with El
  Centro Regional Medical Center
• Flight crew directed to transport patient to Rady
  Childrens Hospital in San Diego (all critical
  pediatric trauma patients are directed out of
  county)
• At 2028 - REACH 9 lifted with approximately 50
  min flight time

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• At 2055 - approximately 20 minutes out from
  Rady, patient noted to have unequal pupils and
  described as obtunded
• Patient condition
• BP 105/73, RR 24, HR 125, SPO2 99
• GCS 6 (Eyes 1, Verbal 1, Motor 4)
• R pupil 2 mm, L pupil 4 mm
• Flight crew made decision to intubate patient in
  flight to protect patient airway due to change in
  LOC
• Patient pre-medicated with lidocaine and atropine
  intravenously, per REACH medical protocol

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• 2101 - RSI procedure initiated
• Amidate (etomidate) and succinylcholine chloride
  administered intravenously
• Patient intubated with 4.0 mm cuffed ETT
• ETT confirmed (vocal cords visualized during
  placement, CO2 detector with positive color
  change, condensation in tube, and end tidal CO2
  with opening value of 38 mm Hg noted)
• Post RSI medication
• Norcuron (vecuronium bromide) and Midazolam
  (versed)

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• Patient not placed on ventilator due to aircraft
  on final approach to Rady at time of procedure
  completion
• Patient manually bagged with good compliance
• SPO2 99
• 2123 - Patient transferred to Rady trauma team
• Transfer of care vital signs
• BP 122/84, RR 28, HR 128, SPO2 99, EtCO2 39 mm Hg

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Conclusion

• Critical success factors in managing pediatric
  trauma
• Community involvement
• Focus on preparation
• Rapid transport to definitive care
• Collaboration with tertiary care facilities
• Commitment to continuous quality improvement