Additional Information
Book Details
Abstract
Whether you’re caring for patients on the ground or in the air, this trusted, one-of-a-kind resource is an essential tool for your success in transport nursing. The 4th edition has been extensively revised to keep you up to date with the latest technological advances and help you meet the ever-changing needs of this critical nursing field. Comprehensive overviews familiarize you with the most common diseases and injuries encountered in practice, accompanied by important management considerations to help you ensure the most effective communication and the safest patient care in all transport settings.
- Case studies presented at the end of each clinical chapter demonstrate how to apply concepts to scenarios similar to those you’ll encounter in practice.
- Special Populations Unit helps you meet the unique care needs of pregnant, neonatal, pediatric, and military patients.
- Competencies listed at the beginning of each chapter help you identify key components of effective patient care.
- Collaborative, multidisciplinary focus meets the educational and reference needs of all transport health care providers and emphasizes the importance of teamwork in ensuring successful patient outcomes.
- 3 new chapters highlight emerging trends in transport care: The Use of Technology During Transport, including ventricular assist devices, a chapter devoted to Mechanical Ventilation, and Military Transport with EnRoute care.
- Updated content throughout provides a balance of ground and air coverage and reflects the recently published Flight and Ground Transport Nursing Core Curriculum to help you prepare for the CTRN or CFRN examination. Expanded disaster management coverage addresses front-line response to major disasters.
- Expanded disaster management coverage addresses important concerns for improving front-line response to major disasters.
- Additional pathophysiology content helps you better understand the effects of diseases and injuries on the body’s normal physiologic processes.
- Clear instructions for reading radiographs and CT scans simplify the use of these diagnostic tools and help you improve related outcomes.
- Information based on the latest updates from the Federal Aviation Association and the National Transportation Safety Board alerts you to important safety regulations.
- Obesity considerations included in the Patient Assessment and Preparation for Transport chapter outline special challenges and possible solutions for the care of obese patients.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Astna Patient Transport Principles and Practice | iii | ||
| Copyright Page | iv | ||
| Contributors | v | ||
| Reviewers | vii | ||
| Dedication | xi | ||
| Preface | xiii | ||
| Foreword | xv | ||
| Acknowledgments | xvii | ||
| Contents | xix | ||
| Chapter 1: History of Patient Transport | 1 | ||
| Patient Transport By Ambulance | 1 | ||
| Patient Transport By Airplane | 2 | ||
| Patient Transport By Helicopter | 3 | ||
| The History of Nursing In Critical Care Transport | 4 | ||
| Paramedics in Critical Care Transport | 7 | ||
| Summary | 8 | ||
| References | 8 | ||
| Chapter 2: Preparation for Practice | 11 | ||
| Qualifications for Transport Practice | 11 | ||
| Transport Nurse | 11 | ||
| Transport Paramedic | 12 | ||
| Preparation For Practice | 13 | ||
| Adult Learning Principles | 14 | ||
| Competency-based Education | 14 | ||
| Continuing Professional Development | 15 | ||
| CAMTS Recommendations | 16 | ||
| Clinical Decision Making | 16 | ||
| Reflective Practice | 16 | ||
| Summary | 17 | ||
| References | 17 | ||
| Chapter 3: Certification | 18 | ||
| Transport Nursing Certification | 19 | ||
| Flight Paramedic Certification | 20 | ||
| Summary | 23 | ||
| References | 23 | ||
| Chapter 4: Members of the Transport Team | 24 | ||
| The Transport Nurse (Flight, Prehospital, Surface) | 24 | ||
| Paramedics | 27 | ||
| Critical Care Paramedic | 27 | ||
| Flight Paramedic | 28 | ||
| Respiratory Therapist | 29 | ||
| Physicians | 29 | ||
| Flight Physician Crew Member | 30 | ||
| Physician Medical Control | 31 | ||
| Physician Medical Director | 31 | ||
| Establishing Medical Protocols | 33 | ||
| Ensuring Adequate Training | 34 | ||
| Oversight of Medical Control Physicians | 34 | ||
| Quality Assurance Oversight | 34 | ||
| Psychologic Support of Medical \nCrew Members | 34 | ||
| Resolving Conflict with the Referring \nor Receiving Physician | 34 | ||
| Communication Specialists | 35 | ||
| Pilot Crew Member | 35 | ||
| Pilot-in-Command Qualifications | 35 | ||
| Program Director | 36 | ||
| Summary | 37 | ||
| References | 37 | ||
| Chapter 5: Transport Physiology | 39 | ||
| The Gas Laws | 39 | ||
| Boyle’s Law | 40 | ||
| Dalton’s Law (Law of Partial Pressure) | 40 | ||
| Charles’ Law | 41 | ||
| Gay-Lussac’s Law | 41 | ||
| Henry’s Law | 41 | ||
| Graham’s Law (Law of Gaseous Diffusion) | 42 | ||
| Stresses of Transport | 42 | ||
| Hypoxia | 42 | ||
| Four Stages of Hypoxia | 42 | ||
| Types of Hypoxia. | 43 | ||
| Effective Performance Time and Time of Useful Consciousness. | 44 | ||
| Causes. | 44 | ||
| Characteristics. | 44 | ||
| Early Signs and Symptoms. | 44 | ||
| Treatment. | 45 | ||
| Hyperventilation | 45 | ||
| Treatment | 45 | ||
| Barometric Pressure | 46 | ||
| Middle Ear | 46 | ||
| Barotitis Media. | 46 | ||
| Delayed Ear Block. | 47 | ||
| Barosinusitis (Sinus Block) | 47 | ||
| Barodontalgia | 48 | ||
| Gastrointestinal Changes | 48 | ||
| Thermal Changes | 49 | ||
| Decreased Humidity | 49 | ||
| Noise | 50 | ||
| Vibration | 51 | ||
| Fatigue | 52 | ||
| G Force | 52 | ||
| Aircraft Motion | 53 | ||
| Long-Duration Positive Acceleration. | 54 | ||
| Long-Duration Negative Acceleration. | 54 | ||
| Long-Duration Transverse Acceleration. | 54 | ||
| Cabin Pressurization | 55 | ||
| Decompression | 56 | ||
| Decompression Sickness | 57 | ||
| Additional Stresses of Transport | 58 | ||
| Spatial Disorientation | 58 | ||
| Flicker Vertigo | 59 | ||
| Fuel Vapors | 59 | ||
| Summary | 59 | ||
| Transport Physiology | 59 | ||
| References | 60 | ||
| Chapter 6: Extrication and Scene Management | 62 | ||
| Scene Management | 63 | ||
| Extrication\r | 64 | ||
| Air Bags | 64 | ||
| Aircraft Crash | 65 | ||
| Bus Crash\r | 65 | ||
| Stopping the Engine | 65 | ||
| Entering the Coach | 65 | ||
| The Air Suspension System | 66 | ||
| Electrical Emergencies\r | 66 | ||
| Metal or Conducting Fences | 66 | ||
| Hazardous Materials Emergencies\r | 67 | ||
| Decontamination | 69 | ||
| Explosive Materials Emergencies\r | 70 | ||
| Radioactive Material Emergencies\r | 70 | ||
| Liquified Petroleum Gas Leak: \nno Fire | 70 | ||
| Reaction Vessel Emergencies | 71 | ||
| Construction Site Emergencies | 72 | ||
| Railroad Incidents | 72 | ||
| Grade-Crossing Accident | 72 | ||
| Stopping the Train | 72 | ||
| Underground Emergencies | 73 | ||
| Mine Emergency | 73 | ||
| Cave Emergency | 73 | ||
| Preemergency Activities | 73 | ||
| Care for an Injured Person During \nCave Rescue | 73 | ||
| Trench Collapse\r | 73 | ||
| Well Emergencies | 74 | ||
| Law Enforcement–Related Situations | 75 | ||
| Bomb Threat | 75 | ||
| Firearm Emergency | 75 | ||
| Evidence Preservation\r | 75 | ||
| Crime Scene Evidence | 76 | ||
| Vehicle Crash Scene Evidence | 76 | ||
| Law Enforcement Officer | 76 | ||
| Summary | 76 | ||
| References | 76 | ||
| Chapter 7: Disaster Management | 77 | ||
| Types of Disasters | 78 | ||
| Natural Disaster | 78 | ||
| Disease-Related Disaster (Either Natural or Manmade) | 79 | ||
| Manmade Disaster | 80 | ||
| The Hospital Incident \nCommand System | 81 | ||
| Incident Command System/Unified Command | 82 | ||
| Triage | 84 | ||
| Secondary Triage | 84 | ||
| Air/Ground Transport \nTeam Structure | 85 | ||
| Recent Disasters and \nLessons Learned | 85 | ||
| September 11, 2001 | 85 | ||
| Lessons Learned | 86 | ||
| Hurricane Katrina | 86 | ||
| Summary | 89 | ||
| References | 89 | ||
| Bibliography | 89 | ||
| Chapter 8: \rCommunications | 90 | ||
| Communication Centers | 90 | ||
| The Communications Specialist | 91 | ||
| Roles and Responsibilities | 91 | ||
| Selection | 91 | ||
| Training | 92 | ||
| Testing | 92 | ||
| Dress Code | 93 | ||
| Communications Operations | 93 | ||
| Operational Control | 93 | ||
| Roles and Responsibilities | 93 | ||
| Communication Environment | 93 | ||
| Location | 93 | ||
| Seismic Stability | 93 | ||
| Security | 93 | ||
| Emergency Electrical Power | 93 | ||
| Wiring Access | 94 | ||
| Lighting | 94 | ||
| Heating, Ventilation, and Air Conditioning | 94 | ||
| Console Layout and Design | 94 | ||
| Acoustic Insulation | 94 | ||
| Restroom Facilities | 94 | ||
| Lounge Areas | 94 | ||
| Crew Rest Area | 94 | ||
| Kitchen Equipment | 95 | ||
| Storage | 95 | ||
| Decoration | 95 | ||
| Alternative Sites/Backup Equipment | 95 | ||
| Equipment | 95 | ||
| Telephones | 95 | ||
| Radios | 95 | ||
| Radio Use | 97 | ||
| Phone-Radio or Radio-Phone Patch | 97 | ||
| Squelch Control | 97 | ||
| Continuous Tone Controlled Subaudible Squelch. | 97 | ||
| Pagers | 97 | ||
| Headsets, Microphones, and Foot Switches | 98 | ||
| Logging Recorders | 98 | ||
| Short-Term Playback Devices | 98 | ||
| Computers and Peripherals | 98 | ||
| Mobile Data Terminals | 99 | ||
| Weather Radar | 99 | ||
| Fax Machines | 99 | ||
| Uninterruptible Power Supply | 99 | ||
| Closed-Circuit Television/Web Cameras | 99 | ||
| Clocks | 99 | ||
| Status Board | 99 | ||
| Maps | 100 | ||
| Rolodex | 100 | ||
| Cardex | 100 | ||
| Reference Material | 100 | ||
| Service Contracts | 101 | ||
| Policies and Procedures | 101 | ||
| Communicating | 101 | ||
| Radios | 101 | ||
| Language | 101 | ||
| Speaking | 101 | ||
| Telephones | 102 | ||
| Medical Direction | 102 | ||
| Face-to-Face | 103 | ||
| On Paper or Online | 103 | ||
| With the Media | 104 | ||
| Emergency Procedures | 104 | ||
| Postaccident Incident Plan | 104 | ||
| Mass-Casualty Incidents | 104 | ||
| Unscheduled Events | 104 | ||
| Drills | 104 | ||
| Critical-Incident Stress Management | 104 | ||
| Aircraft Radios | 104 | ||
| Portable Units | 105 | ||
| Summary | 105 | ||
| References | 105 | ||
| Chapter 9: Safety and Survival | 106 | ||
| Definition of Safety | 107 | ||
| Hazards in the Transport Environment | 107 | ||
| Air Medical Accidents | 107 | ||
| Ground Ambulance Accidents | 109 | ||
| Reducing the Risks | 109 | ||
| Critical Thinking, Decision Making, \nand the Human Factor | 109 | ||
| Weather Minimums | 109 | ||
| Mission Planning and Risk Assessment | 110 | ||
| Declined Missions | 110 | ||
| Air Medical Resource Management | 110 | ||
| Helicopter Shopping | 111 | ||
| Safety Technologies | 112 | ||
| Instrument Flight | 112 | ||
| Night Vision Goggles | 112 | ||
| Terrain Awareness and Warning Systems | 112 | ||
| Satellite Tracking and Position Reporting | 112 | ||
| Crashworthy Aircraft and Vehicle Systems | 112 | ||
| Industry Safety Initiatives | 113 | ||
| Air and Surface Transport Nurses Association | 113 | ||
| The Commission for Accreditation of Medical Transport Systems | 114 | ||
| The Air Medical Safety Advisory Council | 114 | ||
| Vision Zero | 114 | ||
| Voluntary Safety Reporting | 114 | ||
| Safety Management | 114 | ||
| The Safety Committee | 115 | ||
| Safety Training | 115 | ||
| Operational Safety Training | 115 | ||
| Clinical Safety Training | 115 | ||
| Aircraft Safety Training | 115 | ||
| Ground Ambulance Safety Training | 115 | ||
| Occupational and Workplace \nSafety Training | 115 | ||
| Outreach Safety Education | 116 | ||
| Safety in the Transport Environment | 116 | ||
| Personal Safety | 116 | ||
| Fitness Standards | 116 | ||
| Fatigue Policies | 116 | ||
| Pregnancy | 116 | ||
| Personal Protective Equipment | 116 | ||
| Helmets | 117 | ||
| Fire-Resistant Clothing | 117 | ||
| Protective Footwear | 117 | ||
| Hearing Protection | 117 | ||
| Patient Safety | 117 | ||
| Operational Safety | 118 | ||
| Aircraft Safety | 118 | ||
| Helicopter Safety | 118 | ||
| Fixed-Wing Aircraft Safety | 118 | ||
| Ground Ambulance Safety | 119 | ||
| Daily Preflight Procedures | 119 | ||
| Dispatch/Communications | 119 | ||
| Helipad/Airport Safety | 120 | ||
| In-Flight Safety | 120 | ||
| Situational Awareness | 121 | ||
| Flight Following | 121 | ||
| Securing Patients and Equipment | 121 | ||
| Scene Safety | 122 | ||
| Landing Zone Selection and Safety | 122 | ||
| Multiple Aircraft Response | 123 | ||
| On-Scene Safety | 123 | ||
| Hazardous Materials | 123 | ||
| Postmission Debriefings | 123 | ||
| In-Flight Emergencies | 123 | ||
| Aircraft Mechanical Emergencies | 124 | ||
| Aircraft Fire Emergencies | 124 | ||
| Emergency Communications | 124 | ||
| Emergency Locator Transmitter | 125 | ||
| Emergency Landings | 125 | ||
| Emergency Egress | 125 | ||
| Forced Water Landings | 126 | ||
| Before Impact with the Water | 126 | ||
| After Impact with the Water | 126 | ||
| Ground Vehicle Emergencies | 126 | ||
| Postcrash Responsibilities | 127 | ||
| Crew Responsibilities | 127 | ||
| Missing or Overdue Aircraft or Ground Vehicle Procedure | 127 | ||
| Postaccident Incident Plan | 127 | ||
| Critical Incident Stress Management | 127 | ||
| The Safety Attitude Revisited | 127 | ||
| Survival Basics | 127 | ||
| Preparation and Priority Setting | 128 | ||
| Psychologic Preparation | 128 | ||
| Physical Preparation | 128 | ||
| Clothing and Personal Equipment | 128 | ||
| Priority Setting | 128 | ||
| Survival Skills | 129 | ||
| Shelter | 129 | ||
| Fire Building | 129 | ||
| Hydration | 130 | ||
| Signaling | 132 | ||
| Food | 133 | ||
| Overland Travel and Navigation | 133 | ||
| Specific Environmental Considerations | 133 | ||
| Water Landings and Open Water Survival | 133 | ||
| Desert Survival | 134 | ||
| Cold Weather Survival | 134 | ||
| International Survival Concerns | 134 | ||
| Patient Care in a Survival Situation | 134 | ||
| Survival Equipment | 134 | ||
| Summary | 135 | ||
| References | 135 | ||
| Chapter 10: Patient Assessment and Preparation for Transport | 138 | ||
| Indications for Patient Transport | 139 | ||
| Trauma Patients | 139 | ||
| Patients with Cardiovascular and Medical Emergencies | 139 | ||
| Pregnant Women \nand Neonates | 140 | ||
| Appropriate Patient Transfer | 140 | ||
| The Decision to Transport | 143 | ||
| Communication | 143 | ||
| Consent | 145 | ||
| A Twenty-First Century Patient Transport Challenge | 145 | ||
| Patient Assessment | 146 | ||
| Assessment of the Patient in the Prehospital Care Environment | 146 | ||
| Scene Assessment | 146 | ||
| History | 147 | ||
| General Principles of History Gathering | 147 | ||
| Trauma History | 148 | ||
| History Related to Medical Illness | 149 | ||
| Diversity Assessment | 149 | ||
| Primary Assessment and Critical Interventions | 149 | ||
| Airway | 149 | ||
| Pharmacologic Adjuncts for Airway Management. | 150 | ||
| Breathing | 150 | ||
| Circulation | 151 | ||
| Disability: Neurologic Assessment | 151 | ||
| Exposure | 151 | ||
| Equipment Assessment | 152 | ||
| Secondary Assessment | 152 | ||
| Pain Assessment | 152 | ||
| Scoring Systems | 152 | ||
| Preparing the Patient \nfor Transport | 153 | ||
| Airway Management | 154 | ||
| Ventilation Management | 154 | ||
| Circulation Management | 154 | ||
| Gastric Decompression | 157 | ||
| Wound Care and Splinting | 157 | ||
| Patient Safety | 157 | ||
| Pain Management | 158 | ||
| Patient Preparation: The Family | 158 | ||
| Documentation | 159 | ||
| Preparation for the Transport \nof the Bariatric Case | 159 | ||
| Selection of an Appropriate Vehicle | 160 | ||
| Patient Assessment and Intervention Differences in the Bariatric Patient | 160 | ||
| Preparation for Transport | 161 | ||
| Laboratory and Diagnostic Testing Interpretation | 161 | ||
| Laboratory Tests | 161 | ||
| Chest Radiograph Interpretation | 161 | ||
| Computed Tomographic Scan Interpretation\r | 162 | ||
| Patient Assessment during Transport | 163 | ||
| Fixed-Wing Patient Transport | 164 | ||
| Preflight Preparation | 165 | ||
| Federal Aviation Regulations | 165 | ||
| Weather Minimums: Visual and Instrument Flight Rules | 166 | ||
| Weight and Balance | 166 | ||
| Lifeguard Status | 167 | ||
| Ambient Temperatures | 167 | ||
| Additional Considerations | 167 | ||
| Preparation for Patient Transport | 168 | ||
| Transferring and Accepting \nPhysician and Facility | 168 | ||
| Oxygen Requirements | 168 | ||
| Patient Medical Equipment Requirements | 168 | ||
| Patient Care Supplies and Medications | 169 | ||
| Bedding and Linens | 169 | ||
| Nutrition and Fluid Requirements | 170 | ||
| Disposal of Contaminated Wastes | 170 | ||
| Required Ground Ambulance Capabilities | 170 | ||
| Patient “Packaging” \nfor Transport | 170 | ||
| Preparation | 170 | ||
| Loading Considerations | 171 | ||
| Immobilization Equipment | 171 | ||
| In-Flight Factors That Influence Patient Care | 171 | ||
| Limited Space | 171 | ||
| Air Conditioner and Heater | 171 | ||
| Extended Flight Times | 171 | ||
| Diversions | 172 | ||
| Air Medical Personnel Resources | 172 | ||
| Medical Control | 172 | ||
| Communication | 172 | ||
| In-Flight Codes | 172 | ||
| “Do Not Resuscitate” Orders | 173 | ||
| Safety and Emergency Procedures | 173 | ||
| International Transport Issues | 173 | ||
| Air Medical Service International Transports | 173 | ||
| Preflight Preparation and Logistics | 174 | ||
| Documentation | 174 | ||
| Language Barriers | 174 | ||
| Patient Location | 175 | ||
| Ground Transport Times | 175 | ||
| Ground Ambulance Resources | 175 | ||
| Pilot and Air Medical Personnel \nDuty Times | 175 | ||
| Medical Equipment and Supplies | 176 | ||
| Escort and Medical Assist Transports on Commercial Airliners | 176 | ||
| Commercial Air Carrier Regulations | 177 | ||
| Documentation | 177 | ||
| Airline Oxygen Requirements | 177 | ||
| Oxygen Adapters | 177 | ||
| Electrical Power and Adapters | 177 | ||
| Privacy | 177 | ||
| Nonstop Flight | 177 | ||
| Summary | 178 | ||
| References | 178 | ||
| Chapter 11: Airway Management | 181 | ||
| Pathophysiology | 182 | ||
| Indications for Intubation | 182 | ||
| Selected Pathophysiology Related to Airway Management | 183 | ||
| Assessment | 185 | ||
| Intervention | 187 | ||
| Basic Life Support Airway Interventions | 187 | ||
| Bag-Mask Ventilation | 189 | ||
| Airway Management Techiques | 189 | ||
| The Larynx | 189 | ||
| Tracheal Intubation | 190 | ||
| Orotracheal Intubation | 191 | ||
| Nasotracheal Intubation | 195 | ||
| Digital Intubation | 198 | ||
| Airway Rescue Devices | 198 | ||
| Endotracheal Tube Introducer | 198 | ||
| Lighted Stylet | 199 | ||
| Supraglottic Airway Devices | 199 | ||
| Combitube | 200 | ||
| Classic Laryngeal Mask Airway | 201 | ||
| Laryngeal Mask Airway ProSeal | 203 | ||
| Laryngeal Mask Airway–Fastrach | 203 | ||
| Laryngeal Mask Airway CTrach | 203 | ||
| King Laryngeal Tube | 204 | ||
| The I-Gel | 205 | ||
| Video-Assisted Laryngoscopy | 205 | ||
| McGrath Videolaryngoscope | 207 | ||
| Pediatric Management | 207 | ||
| Anatomic Differences \nin Children37 | 208 | ||
| Invasive Airway Management | 210 | ||
| Needle Cricothyrotomy | 211 | ||
| Surgical Cricothyrotomy | 212 | ||
| Rapid Four-Step Cricothyrotomy Technique | 213 | ||
| Cricothyrotomy: Seldinger Technique | 213 | ||
| Pharmacology Of Advanced Airway Management | 214 | ||
| Rapid-Sequence Intubation | 215 | ||
| Neuromuscular Blocking Agents | 215 | ||
| Nondepolarizing \rAgents | 217 | ||
| Reversal of Neuromuscular Blockade | 218 | ||
| Medication-Assisted Intubation | 219 | ||
| Overview | 219 | ||
| Plan | 219 | ||
| Prepare | 220 | ||
| Preoxygenate | 221 | ||
| Premedicate | 221 | ||
| Induction and Paralysis | 222 | ||
| Monitoring Airway Management and Ventilation During Transport | 223 | ||
| End-Tidal Carbon Dioxide Detection | 223 | ||
| Capnography | 224 | ||
| Pulse Oximetry | 225 | ||
| Esophageal Intubation Detection | 226 | ||
| Summary | 227 | ||
| References | 230 | ||
| Chapter 12: Mechanical Ventilation | 234 | ||
| Transport Ventilator Selection | 234 | ||
| Program Considerations | 237 | ||
| Mission Type | 237 | ||
| Budget | 237 | ||
| Training | 238 | ||
| Ventilator Considerations | 238 | ||
| Guidelines | 238 | ||
| Durability and Safety | 238 | ||
| Oxygen Consumption | 238 | ||
| Power | 238 | ||
| Selection Process | 239 | ||
| Ventilator-Induced Lung Injury | 239 | ||
| Barotrauma | 239 | ||
| Volutrauma | 239 | ||
| Cyclic Atelectasis | 240 | ||
| Oxygen Toxicity | 240 | ||
| Classification Of Positive Pressure Ventilation | 240 | ||
| Volume-Targeted Ventilation | 240 | ||
| Continuous Mandatory Ventilation | 241 | ||
| Assist-Control Ventilation | 241 | ||
| Synchronized Intermittent \nMandatory Ventilation | 241 | ||
| Pressure-Targeted Ventilation | 241 | ||
| Pressure-Controlled Ventilation | 242 | ||
| Pressure-Support Ventilation | 242 | ||
| Invasive Continuous Positive \nAirway Pressure | 242 | ||
| Noninvasive Positive Pressure Ventilation | 242 | ||
| Advanced Ventilatory Modes | 243 | ||
| High Frequency Ventilation | 243 | ||
| High Frequency Jet Ventilation | 243 | ||
| High Frequency Oscillatory Ventilation | 244 | ||
| Inhaled Nitric Oxide | 244 | ||
| Helium-oxygen mixture | 244 | ||
| Ventilator Settings | 245 | ||
| Tidal Volume | 245 | ||
| Peak Inspiratory Pressure | 245 | ||
| Rate, Breaths per Minute, \nand Frequency | 245 | ||
| Fractional Concentration \nof Oxygen in Inspired Gas | 246 | ||
| Positive End-Expiratory Pressure | 246 | ||
| Inspiratory-to-Expiratory Time Ratio and Flow Rate | 247 | ||
| Flow Pattern | 248 | ||
| Trigger-Sensitivity | 248 | ||
| Ventilation Strategies | 248 | ||
| Permissive Hypercapnea | 248 | ||
| Recruitment Maneuvers | 249 | ||
| Troubleshooting | 249 | ||
| Monitoring | 249 | ||
| Ventilator Alarms | 249 | ||
| Ventilator Asynchrony | 250 | ||
| Summary | 251 | ||
| References | 253 | ||
| Chapter 13: Technology in Transport | 255 | ||
| Communications | 255 | ||
| Satellite Phone Systems | 255 | ||
| Twelve-Lead \nElectrocardiographic Transmissions | 256 | ||
| Digital Patient Charting Systems | 256 | ||
| Tracking Systems | 257 | ||
| Satellite Tracking | 257 | ||
| Traffic Alert Systems | 257 | ||
| Infrared Technology | 257 | ||
| Aviation Systems | 258 | ||
| Wide Area Augmentation System | 258 | ||
| Night Vision Goggles | 258 | ||
| Real-Time Weather | 258 | ||
| Active Noise Suppression | 258 | ||
| Cabin Airflow | 259 | ||
| Future Systems | 259 | ||
| Tilt Rotor | 259 | ||
| Emergency Care Practitioner | 259 | ||
| Summary | 259 | ||
| References | 259 | ||
| Chapter 14: Shock Management | 260 | ||
| Etiology | 261 | ||
| Pathophysiology | 261 | ||
| Systemic Inflammatory Response Syndrome | 261 | ||
| Multiple Organ Dysfunction Syndrome | 263 | ||
| Cellular Response | 263 | ||
| Body Systems Response | 263 | ||
| Stages | 264 | ||
| Compensatory | 265 | ||
| Progressive | 265 | ||
| Irreversible | 265 | ||
| Patient Assessment and Shock Management | 266 | ||
| Assessment | 266 | ||
| Inspection | 266 | ||
| Auscultation | 266 | ||
| Percussion | 266 | ||
| Palpation | 267 | ||
| Radiographic Studies | 267 | ||
| Other Studies | 267 | ||
| Laboratory Studies | 267 | ||
| Management | 268 | ||
| Correction of Hypoxia | 268 | ||
| Fluid Resuscitation | 269 | ||
| Pneumatic Antishock Garment | 270 | ||
| Tourniquet Use | 270 | ||
| Pharmacologic Management | 270 | ||
| Other Interventions | 270 | ||
| Clinical Monitoring | 271 | ||
| Selected Causes of Shock | 271 | ||
| Hemorrhage | 271 | ||
| Description | 271 | ||
| Indicators | 272 | ||
| Predisposing Conditions | 272 | ||
| Causes | 272 | ||
| Internal Hemorrhage | 272 | ||
| External Hemorrhage | 272 | ||
| Fluid Loss | 273 | ||
| Chapter 15: General Principles of Trauma Management | 291 | ||
| Injury Dynamics | 292 | ||
| History | 292 | ||
| Mechanism of Injury | 292 | ||
| Kinematics of Trauma | 294 | ||
| Blunt Injuries | 294 | ||
| Motor Vehicle Crashes | 294 | ||
| Head-on Collisions. | 294 | ||
| Rear-end Collisions. | 295 | ||
| Chapter 16: Neurologic Trauma | 310 | ||
| Traumatic Brain Injury | 310 | ||
| Types of Traumatic Injuries: Pathologic and Clinical Considerations | 311 | ||
| Skull Fracture | 311 | ||
| Diastatic and Basilar Skull Fractures | 311 | ||
| Depressed Skull Fracture | 312 | ||
| Hemorrhage | 312 | ||
| Subdural Hematoma | 312 | ||
| Epidural Hematoma | 313 | ||
| Cerebral Contusion | 313 | ||
| Intracerebral Hematoma | 314 | ||
| Traumatic Brain Injury: Diffuse Axonal Injuries | 314 | ||
| Penetrating Injuries | 314 | ||
| Gunshot Wounds | 314 | ||
| Physical Assessment: Traumatic Brain Injury | 315 | ||
| Level of Consciousness | 315 | ||
| Examination of the Pupils | 316 | ||
| Brain Stem and Cranial Nerves | 317 | ||
| Motor Examination | 317 | ||
| Respiratory Pattern | 317 | ||
| The Glasgow Coma Scale | 318 | ||
| Reexamination | 319 | ||
| Interventions and Treatment | 319 | ||
| Spinal Cord Injury | 321 | ||
| Etiology and Incidence Rate | 321 | ||
| Initial Assessment | 322 | ||
| Airway | 322 | ||
| Breathing | 322 | ||
| Circulation | 322 | ||
| Secondary Assessment | 322 | ||
| Lower Spine Injuries | 323 | ||
| Cervical Spine Injuries | 323 | ||
| Sensory Examination | 323 | ||
| Neurologic Examination of the Unconscious Patient | 323 | ||
| Interventions and Treatment | 323 | ||
| Classification of Cervical Spine Injuries by Mechanism \nof Injury | 324 | ||
| Flexion Injuries | 324 | ||
| Flexion-Rotation Injuries | 324 | ||
| Extension-Rotation Injuries | 324 | ||
| Vertical Compression | 325 | ||
| Extension Injuries | 325 | ||
| Thoracic and Lumbar Spine Injuries | 326 | ||
| Summary | 327 | ||
| References | 328 | ||
| Chapter 17: Thoracic Trauma | 330 | ||
| Life-Threatening Thoracic Injuries | 331 | ||
| Tension Pneumothorax | 331 | ||
| Etiologic Factors | 331 | ||
| Pathophysiologic Factors | 331 | ||
| Assessment | 331 | ||
| Interventions | 331 | ||
| Evaluation | 332 | ||
| Massive Hemothorax | 332 | ||
| Etiologic Factors | 332 | ||
| Pathophysiologic Factors | 332 | ||
| Assessment | 332 | ||
| Interventions | 332 | ||
| Chapter 18: Abdominal Trauma | 340 | ||
| Abdominal Trauma | 341 | ||
| Anatomy of the Abdomen | 341 | ||
| Classification of Injuries | 341 | ||
| Patient History | 342 | ||
| Physical Examination | 342 | ||
| Diagnostic Procedures | 343 | ||
| Use of Ultrasound Scan Before and During Transport | 343 | ||
| Patient Assessment, Treatment, and Transport | 344 | ||
| Specific Abdominal Organ Injuries | 345 | ||
| Diaphragm | 345 | ||
| Incidence and Mechanism of Injury | 345 | ||
| Assessment and Symptoms | 345 | ||
| Treatment | 345 | ||
| Liver and Spleen | 345 | ||
| Incidence and Mechanism | 345 | ||
| Chapter 19: Orthopedic Trauma | 355 | ||
| Musculoskeletal System | 355 | ||
| Definition | 356 | ||
| Classification of Orthopedic Injuries | 356 | ||
| Fractures | 356 | ||
| Dislocations | 356 | ||
| Mechanisms of Injury | 358 | ||
| Assessment of an Orthopedic Injury | 358 | ||
| Management of Orthopedic Injuries | 359 | ||
| Wound Management | 359 | ||
| Splinting | 359 | ||
| Soft Splint | 360 | ||
| Rigid Splint | 360 | ||
| Traction Splint | 360 | ||
| Splinting Fractures of the Upper Extremities | 361 | ||
| Splinting Dislocations of the Upper Extremities | 362 | ||
| Splinting Fractures of the Lower Extremities | 362 | ||
| Splinting Dislocations of the Lower Extremities | 363 | ||
| Pelvic Fractures | 364 | ||
| Traumatic Amputations | 364 | ||
| Fat Embolism | 365 | ||
| Compartment Syndrome | 365 | ||
| Summary | 365 | ||
| References | 365 | ||
| Chapter 20: Burn Trauma | 367 | ||
| Etiology and Epidemiology | 367 | ||
| Pathophysiology of Burn Wounds | 368 | ||
| Thermal Burn Injury | 368 | ||
| Electrical Injury | 369 | ||
| Assessment | 371 | ||
| Thermal Burns | 371 | ||
| Inhalation Injuries with Thermal Burns | 372 | ||
| Electrical Injuries | 374 | ||
| Lightning Injuries | 375 | ||
| Chemical Burn Injuries | 376 | ||
| Radiation Burn Injuries | 376 | ||
| Management of Burn Injury | 376 | ||
| Scene Safety | 376 | ||
| Airway/Breathing/Inhalation Injury Management | 377 | ||
| Circulation/Fluid Resuscitation | 377 | ||
| Burn Wound Management | 378 | ||
| Pain Management | 379 | ||
| Other Transport Considerations | 379 | ||
| Electrical Injury Management | 380 | ||
| Lightning Injury Management | 380 | ||
| Chemical Injury Management | 380 | ||
| Radiation Injury Management | 380 | ||
| Evaluation | 381 | ||
| Impact of Transport | 382 | ||
| Summary | 382 | ||
| References | 384 | ||
| Chapter 21: Neurologic Emergencies | 386 | ||
| Neurologic Pathophysiology | 386 | ||
| Pressure-Volume Relationships | 387 | ||
| Cerebrospinal Fluid Volume | 388 | ||
| Cerebral Blood Volume | 388 | ||
| Brain Volume | 389 | ||
| Neurologic Examination | 389 | ||
| Neurologic Emergencies | 391 | ||
| Stroke | 391 | ||
| Assessment | 392 | ||
| Plan and Implementation | 392 | ||
| Evaluation | 393 | ||
| Seizures | 393 | ||
| Assessment | 394 | ||
| Plan and Implementation | 394 | ||
| Evaluation | 395 | ||
| References | 396 | ||
| Chapter 22: Cardiovascular Emergencies | 398 | ||
| Alterations of Cardiovascular Physiology at High Altitudes | 399 | ||
| Special Considerations for Cardiopulmonary Resuscitation in the Transport Environment | 400 | ||
| Defibrillation during Transport | 400 | ||
| Coronary Artery Disease | 401 | ||
| Definition and Pathophysiologic Factors | 401 | ||
| Pathophysiologic Factors \nof Coronary Ischemia | 401 | ||
| Chronic Stable Angina | 402 | ||
| Unstable Angina | 402 | ||
| Silent Ischemia | 403 | ||
| Continuum of Acute Coronary Syndromes | 403 | ||
| Chronic Stable Angina: Assessment, Diagnosis, and Treatment. | 404 | ||
| Acute Coronary Syndromes: Diagnosis, Assessment, and Treatment. | 405 | ||
| Acute Myocardial Infarction: Assessment, Diagnosis, and Treatment | 406 | ||
| Diagnosis of Acute Myocardial Infarction | 407 | ||
| Therapy for Acute Myocardial Infarction | 408 | ||
| Dysrhythmias | 409 | ||
| Pathophysiologic Factors | 409 | ||
| Assessment, Diagnosis, and Treatment | 409 | ||
| Tachyarrhythmias/Tachycardias | 409 | ||
| Atrial Tachycardia. | 409 | ||
| Supraventricular Arrhythmias. | 410 | ||
| Premature Atrial Contractions. | 411 | ||
| Sinus Tachycardia. | 411 | ||
| Ventricular Arrhythmias. | 411 | ||
| Premature Ventricular Complexes or Ventricular Premature Beats. | 411 | ||
| Paroxysmal Supraventricular Tachycardia. | 411 | ||
| Ventricular Tachycardia. | 411 | ||
| Ventricular Fibrillation. | 412 | ||
| Accelerated Idioventricular Rhythm. | 412 | ||
| Bradyarrhythmias | 412 | ||
| Bradycardia. | 412 | ||
| External Pacing. | 413 | ||
| Temporary Pacing. | 413 | ||
| First-Degree Atrioventricular Block. | 413 | ||
| Second-Degree Atrioventricular Block. | 413 | ||
| Third-Degree Atrioventricular Block or Complete Heart Block. | 414 | ||
| Cardiogenic Shock | 414 | ||
| Pathophysiologic Factors | 414 | ||
| Assessment and Diagnosis | 414 | ||
| Management | 415 | ||
| Pharmacologic Therapy | 415 | ||
| Intraaortic Balloon Counterpulsation | 416 | ||
| Ventricular Assist Devices | 416 | ||
| Congestive Heart Failure | 417 | ||
| Definition and Pathophysiologic Factors | 417 | ||
| Assessment and Diagnosis | 417 | ||
| Management | 418 | ||
| Cardiomyopathy | 418 | ||
| Dilated Cardiomyopathy | 418 | ||
| Pathophysiologic Factors | 418 | ||
| Assessment and Diagnosis | 418 | ||
| Management | 419 | ||
| Hypertrophic Cardiomyopathy | 419 | ||
| Pathophysiologic Factors | 419 | ||
| Assessment and Diagnosis | 419 | ||
| Management | 420 | ||
| Restrictive Cardiomyopathy | 420 | ||
| Pathophysiologic Factors | 420 | ||
| Assessment and Diagnosis | 420 | ||
| Chapter 23: Mechanical Circulatory Support Devices in Transport | 435 | ||
| Historic Perspective | 435 | ||
| The Basics | 437 | ||
| Acute Cardiogenic Shock Devices | 440 | ||
| Intraaortic Balloon Pump | 441 | ||
| Patient Assessment | 443 | ||
| Transport Considerations of the Patient with an Intraaortic Balloon Pump | 443 | ||
| Management of Common Intraaortic Balloon Pump Emergency Procedures | 444 | ||
| Future Trends | 444 | ||
| Abiomed Circulatory Support Systems: BVS Blood Pump and AB5000 Ventricle | 444 | ||
| Thoratec Paracorporeal and Implantable Ventricular Assist Devices | 447 | ||
| TandemHeart System | 450 | ||
| CentriMag Blood Pump | 452 | ||
| Transport Consideration and Assessment of Acute Ventricular Assist Devices for Interfacility Transports | 453 | ||
| Chronic Refractory Severe Heart Failure Device | 455 | ||
| Artificial Hearts | 455 | ||
| AbioCor Implantable Replacement Heart | 455 | ||
| Long-Term Ventricular \nAssist Devices | 457 | ||
| First-Generation Volume-Displacement Long-Term Ventricular Assist Devices | 458 | ||
| HeartMate XVE Left Ventricular Assist System. | 458 | ||
| Second-Generation Axial Flow \nRotary Pumps | 460 | ||
| HeartMate II Left Ventricular Assist System. | 460 | ||
| Jarvik 2000. | 461 | ||
| DeBakey Left Ventricular Assist Device. | 462 | ||
| Third-Generation Centrifugal Flow Rotary Pumps | 463 | ||
| VentrAssist Left Ventricular Assist Device. | 464 | ||
| DuraHeart Left Ventricular Assist System. | 465 | ||
| HeartWare Left Ventricular Assist System. | 465 | ||
| Interfacility or Scene Transport Consideration of Long-Term Ventricular Assist Devices | 466 | ||
| Summary | 468 | ||
| References | 468 | ||
| Reference Manuals | 469 | ||
| Chapter 24: Pulmonary Emergencies Reneé Semonin Holleran | 471 | ||
| Anatomy and Physiology Overview | 471 | ||
| Anatomy | 471 | ||
| Airway | 471 | ||
| Thoracic Cage | 472 | ||
| Muscles of Ventilation | 472 | ||
| Volumes and Capacities | 472 | ||
| Physiology | 472 | ||
| Alveolar-Capillary Membrane | 474 | ||
| Ventilation-Perfusion | 474 | ||
| Transportation of Gases | 474 | ||
| Oxygen-Hemoglobin Dissociation Curve | 474 | ||
| Oxygen Consumption | 476 | ||
| Carbon Dioxide | 476 | ||
| Respiratory System Support | 477 | ||
| Oxygen Therapy | 477 | ||
| Ventilatory Support | 477 | ||
| Respiratory Monitoring Methods | 477 | ||
| Acute Respiratory Failure | 478 | ||
| Acute Respiratory Distress Syndrome | 478 | ||
| Etiology | 478 | ||
| Pathophysiologic Factors | 478 | ||
| Assessment | 479 | ||
| Intervention | 479 | ||
| Chronic Obstructive Pulmonary Disease | 480 | ||
| Asthma | 480 | ||
| Etiology | 480 | ||
| Pathophysiologic Factors | 480 | ||
| Assessment | 480 | ||
| Intervention | 481 | ||
| Evaluation | 481 | ||
| Chronic Bronchitis | 481 | ||
| Etiology | 481 | ||
| Chapter 25: Abdominal Emergencies | 492 | ||
| Esophagus | 492 | ||
| Esophageal Obstruction | 493 | ||
| Assessment | 493 | ||
| Subjective Data. | 493 | ||
| Objective Data. | 493 | ||
| Diagnostic Tests | 493 | ||
| Plan and Implementation | 493 | ||
| Intervention | 493 | ||
| Esophageal Varices | 493 | ||
| Assessment | 494 | ||
| Subjective Data. | 494 | ||
| Objective Data. | 494 | ||
| Plan and Implementation | 494 | ||
| Intervention | 494 | ||
| Esophageal Rupture | 495 | ||
| Assessment | 495 | ||
| Plan and Implementation Priorities | 495 | ||
| Stomach | 495 | ||
| Acute Gastric Occurrences | 495 | ||
| Intervention | 495 | ||
| Gallbladder and Biliary Tract | 496 | ||
| Chapter 26: Infectious and Communicable Diseases Russell D. MacDonald | 500 | ||
| Transport personnel and the patient | 500 | ||
| Communicable Disease Transmission and Prevention | 500 | ||
| General Approach and Patient Assessment | 501 | ||
| Specific Disease Conditions by Presenting or Chief Symptom | 502 | ||
| Respiratory Infections | 502 | ||
| Febrile Respiratory Illness. | 503 | ||
| Cough | 503 | ||
| Pneumonia. | 503 | ||
| Pertussis. | 503 | ||
| Influenza. | 504 | ||
| Avian Influenza. | 505 | ||
| Tuberculosis. | 505 | ||
| Severe Acute Respiratory Syndrome. | 506 | ||
| Rash | 507 | ||
| Methicillin-Resistant Staphylococcal aureus | 507 | ||
| Measles. | 507 | ||
| Rubella. | 508 | ||
| Varicella. | 508 | ||
| Bites | 509 | ||
| Animal Bites. | 509 | ||
| Human Bites. | 509 | ||
| Rabies. | 509 | ||
| Tetanus. | 510 | ||
| Altered Mental Status, Neck Stiffness, Headache | 510 | ||
| Diarrhea | 511 | ||
| Jaundice | 513 | ||
| Hepatitis A. | 513 | ||
| Hepatitis B. | 513 | ||
| Hepatitis C. | 514 | ||
| Biologic Weapons | 514 | ||
| Anthrax. | 514 | ||
| Botulism. | 515 | ||
| Plague. | 516 | ||
| Smallpox. | 517 | ||
| Tularemia. | 518 | ||
| Viral Hemorrhagic Fevers. | 518 | ||
| Occupational Health and Safety | 519 | ||
| Hand Hygiene | 519 | ||
| Personal Protective Equipment | 520 | ||
| Sharps Safety | 522 | ||
| Patient Transport Accommodation | 522 | ||
| Routine Equipment Cleaning and Disinfection | 522 | ||
| Routine Vehicle Cleaning and Disinfection | 525 | ||
| Additional Precautions | 525 | ||
| Summary | 525 | ||
| References | 526 | ||
| Chapter 27: Cold-Related Emergencies | 527 | ||
| Hypothermia Defined | 528 | ||
| Classification | 528 | ||
| Mortality | 529 | ||
| Normal Temperature Regulation | 529 | ||
| Methods of Heat Loss7 | 529 | ||
| Physiologic Response to Hypothermia | 532 | ||
| Metabolic Derangements | 532 | ||
| Oxygenation and Acid-Base Disorders | 533 | ||
| Central Nervous System | 533 | ||
| Cardiac Arrhythmia | 534 | ||
| Circum-Rescue Collapse | 535 | ||
| Frostnip and Frostbite | 535 | ||
| Epidemiology | 536 | ||
| Infants | 536 | ||
| Older Patients | 536 | ||
| Alcohol and Other Toxic States | 537 | ||
| Trauma Patients | 537 | ||
| Recreational Activities | 537 | ||
| Central Nervous System Dysfunction | 537 | ||
| Rewarming Techniques | 537 | ||
| Passive External Rewarming | 538 | ||
| Active External Rewarming | 538 | ||
| Active Internal Rewarming | 538 | ||
| Management During Transport | 538 | ||
| Gentle Handling | 539 | ||
| Prevention of Further \nHeat Loss | 539 | ||
| Active Internal Rewarming | 539 | ||
| Monitoring Vital Signs | 540 | ||
| Airway | 540 | ||
| Cardiac Resuscitation | 540 | ||
| Pharmacologic Therapy | 541 | ||
| Special Considerations | 541 | ||
| Documentation | 541 | ||
| Summary | 541 | ||
| References | 543 | ||
| Chapter 28: Heat-Related Emergencies | 545 | ||
| Incidence and Causative Factors | 545 | ||
| Pathophysiologic Factors | 548 | ||
| Normal Thermogenesis | 548 | ||
| Methods of Heat Loss | 548 | ||
| Physiologic Compensation | 549 | ||
| Heat Pathophysiology | 549 | ||
| Assessment Parameters | 550 | ||
| Heat Cramps | 550 | ||
| Heat Exhaustion | 551 | ||
| Heatstroke | 551 | ||
| Patterns of Heatstroke Presentation | 552 | ||
| Intervention and Treatment | 553 | ||
| Priorities | 553 | ||
| Equipment | 553 | ||
| Interventions: Mild to Invasive | 553 | ||
| Transport Care | 554 | ||
| Malignant Hyperthermia | 555 | ||
| Other Causes of Hyperthermia | 556 | ||
| Summary | 556 | ||
| References | 558 | ||
| Chapter 29: Diving Emergencies | 560 | ||
| Diving Principles | 561 | ||
| Boyle’s Law | 561 | ||
| Henry’s Law | 561 | ||
| Dalton’s Law | 561 | ||
| Pathophysiologic Factors | 561 | ||
| Decompression Illness | 562 | ||
| Arterial Gas Embolization | 563 | ||
| Clinical Manifestations | 564 | ||
| Decompression Sickness | 564 | ||
| Pulmonary Decompression Illness | 565 | ||
| Arterial Gas Embolism | 565 | ||
| Management | 565 | ||
| Air Medical Transport | 566 | ||
| Summary | 566 | ||
| References | 567 | ||
| Chapter 30: Toxicologic Emergencies | 569 | ||
| Intentional and Unintentional Poisoning | 570 | ||
| General management of the poisoned patient | 570 | ||
| Initial Management | 571 | ||
| Assessment | 571 | ||
| History | 571 | ||
| Symptoms of Poisoning and Toxic Exposures | 572 | ||
| Physical Examination | 572 | ||
| Laboratory Studies | 573 | ||
| Removal, Elimination, or Disruption of the Toxin | 573 | ||
| Supportive and Emotional Care of the Poisoned Patient | 574 | ||
| Safety Issues in the Transport of the Poisoned Patient | 574 | ||
| Summary | 574 | ||
| Pharmacologic properties of drugs | 574 | ||
| Toxicity and Treatment of Poisoning by Specific Drugs | 576 | ||
| Acetylsalicylic Acid | 576 | ||
| Acetaminophen | 576 | ||
| Antidepressants (Tricyclics) | 577 | ||
| Benzodiazepines | 577 | ||
| Digitalis | 578 | ||
| Other Drugs | 578 | ||
| Cocaine | 578 | ||
| Hallucinogens | 579 | ||
| Alcohol | 580 | ||
| Ethylene Glycol | 581 | ||
| Carbon Monoxide | 581 | ||
| Snakebites | 582 | ||
| Recognition of Venomous Bites | 583 | ||
| Initial Management \nof Snakebites | 583 | ||
| Transport Care of Patients with Snakebite | 584 | ||
| Summary | 584 | ||
| References | 586 | ||
| Chapter 31: The Pregnant Patient | 587 | ||
| Determination of team Composition for Transport of The Pregnant Patient | 590 | ||
| General Strategies for Transport | 591 | ||
| Inferior Vena Cava Syndrome | 592 | ||
| Fetal Monitoring Before and During Transport | 592 | ||
| Baseline Assessment | 593 | ||
| Fetal Heart Rate Abnormalities | 593 | ||
| Variability | 593 | ||
| Periodic Changes/Episodic Changes | 595 | ||
| Acceleration. | 595 | ||
| Variable Deceleration. | 596 | ||
| Late Decelerations. | 597 | ||
| Early Decelerations. | 598 | ||
| Sinusoidal. | 599 | ||
| Bradycardia. | 599 | ||
| Tachycardia. | 600 | ||
| Contributing Factors to Fetal Distress | 600 | ||
| Normal Physiologic Changes in Pregnancy | 602 | ||
| Complications of Pregnancy and Delivery | 603 | ||
| Amniotic Fluid Embolism/Anaphylactic Syndrome \nof Pregnancy | 603 | ||
| Etiology and Pathophysiologic Factors | 603 | ||
| Assessment | 604 | ||
| Strategies for Transport | 604 | ||
| Delivery Complications | 604 | ||
| Breech Presentation | 604 | ||
| Etiology and Pathophysiologic Factors | 605 | ||
| Assessment. | 605 | ||
| Strategies for Delivery. | 605 | ||
| Hemorrhagic Delivery Complications | 606 | ||
| Postpartum Hemorrhage | 606 | ||
| Etiology and Pathophysiologic Factors. | 606 | ||
| Assessment. | 607 | ||
| Strategies for Transport. | 607 | ||
| Uterine Inversion | 608 | ||
| Etiology and Pathophysiologic Factors | 608 | ||
| Assessment | 608 | ||
| Strategies for Transport | 609 | ||
| Uterine Rupture | 609 | ||
| Etiology and Pathophysiologic Factors | 609 | ||
| Assessment | 610 | ||
| Strategies for Transport | 610 | ||
| Precipitate Delivery | 610 | ||
| Retained Placenta | 610 | ||
| Shoulder Dystocia | 611 | ||
| Etiology and Pathophysiologic Factors | 611 | ||
| Assessment | 611 | ||
| Strategies for Delivery | 611 | ||
| Umbilical Cord Prolapse | 612 | ||
| Etiology | 612 | ||
| Assessment | 612 | ||
| Strategies for Transport | 612 | ||
| Diabetes in Pregnancy | 612 | ||
| Etiology and Pathophysiologic Factors | 612 | ||
| Assessment | 613 | ||
| Strategies for Transport | 614 | ||
| Hemorrhagic Complications | 614 | ||
| Placental Abruption | 614 | ||
| Etiology. | 614 | ||
| Pathophysiologic Factors. | 614 | ||
| Placenta Previa | 615 | ||
| Etiology. | 615 | ||
| Pathophysiologic Factors. | 615 | ||
| Assessment of Placental Abruption and Placenta Previa | 616 | ||
| Uterine Assessment (Placental Abruption). | 616 | ||
| Uterine Assessment (Placenta Previa). | 617 | ||
| Assessment of Blood Loss (Placental Abruption). | 617 | ||
| Assessment of Blood Loss (Placenta Previa) | 617 | ||
| Ultrasound Scan. | 617 | ||
| Assessment of Vital Signs. | 617 | ||
| Assessment of Fetal Heart Tone. | 618 | ||
| Assessment of Urinary Output. | 618 | ||
| Assessment of Coagulopathy. | 618 | ||
| Assessment for Impending Shock. | 618 | ||
| Strategies for Transport (Abruption \nand Previa) | 618 | ||
| Disseminated Intravascular Coagulation | 618 | ||
| Multiple Gestation | 619 | ||
| Etiology | 619 | ||
| Pathophysiologic Factors | 619 | ||
| Assessment | 619 | ||
| Strategies for Transport | 620 | ||
| Pregnancy-Induced Hypertension and Related Disorders | 620 | ||
| Etiology | 620 | ||
| Pathophysiologic Factors | 620 | ||
| Uteroplacental Changes | 621 | ||
| Renal Changes | 621 | ||
| Hematologic Changes | 621 | ||
| Hepatic Changes | 621 | ||
| Cerebral Changes | 621 | ||
| Retinal Changes | 622 | ||
| Pulmonary Changes | 622 | ||
| Complications | 622 | ||
| Eclampsia | 622 | ||
| HELLP Syndrome | 623 | ||
| Assessment | 623 | ||
| Hypertension | 623 | ||
| Edema | 624 | ||
| Proteinuria | 624 | ||
| Strategies for Transport | 624 | ||
| Magnesium Sulfate | 625 | ||
| Labetalol | 626 | ||
| Hydralazine | 626 | ||
| Benzodiazepines | 626 | ||
| Preterm Labor and Related Issues | 627 | ||
| Etiology | 627 | ||
| Pathophysiologic Factors | 627 | ||
| Assessment | 628 | ||
| Cervical Dilation/Effacement Patterns | 628 | ||
| Spontaneous Rupture of Membranes | 630 | ||
| Strategies for Transport | 631 | ||
| Trauma In Pregnancy | 632 | ||
| Perimortem Cesarean Section | 632 | ||
| Summary | 633 | ||
| References | 634 | ||
| Chapter 32: Care and Transport of the Neonate | 635 | ||
| Fetal Circulation and Transition | 636 | ||
| Initial Priorities: Delivery Room Management | 637 | ||
| Assessment of the Infant | 637 | ||
| Clearing the Airway | 638 | ||
| Initiation of Breathing | 638 | ||
| Chest Compressions | 639 | ||
| Drug Support | 639 | ||
| Maintenance of Body Temperature | 641 | ||
| Glucose Requirements | 641 | ||
| Evaluation | 641 | ||
| Noninitiation or Discontinuation of Resuscitation | 641 | ||
| Detailed Assessment and Ongoing Stabilization | 642 | ||
| Gestational Age Examination | 642 | ||
| Physical Examination | 642 | ||
| Respiratory Management: General Considerations | 643 | ||
| Blood Pressure and Perfusion | 644 | ||
| Thermoregulation | 645 | ||
| Fluids, Calories, and Electrolytes | 646 | ||
| Pathologic Conditions of the Neonate | 647 | ||
| Respiratory Disorders | 647 | ||
| Diaphragmatic Hernia | 647 | ||
| Meconium Aspiration Pneumonia | 648 | ||
| Surfactant Deficiency | 648 | ||
| Pneumonia | 648 | ||
| Pulmonary Air Leaks | 649 | ||
| Persistent Pulmonary Hypertension in the Newborn | 649 | ||
| Neonatal Heart Disease | 650 | ||
| Nonductal-Dependent Lesions | 651 | ||
| Gastrointestinal Disorders | 652 | ||
| Esophageal Atresia | 652 | ||
| Intestinal Obstructions | 652 | ||
| Necrotizing Enterocolitis | 653 | ||
| Omphalocele/Gastroschisis | 653 | ||
| Neonatal Infections | 653 | ||
| Neurologic Disorders | 654 | ||
| Cranial Enlargement | 654 | ||
| Neural Tube Defects/Encephaloceles | 654 | ||
| Seizures | 654 | ||
| Equipment | 655 | ||
| Summary | 657 | ||
| References | 659 | ||
| Chapter 33: The Pediatric Patient | 661 | ||
| A Developmental Approach to Pediatric Assessment | 661 | ||
| Pediatric Resuscitation | 663 | ||
| Pediatric Airway Management/Respiratory Distress | 663 | ||
| Pediatric Airway Anatomy | 663 | ||
| Initial Management of Respiratory Distress/Arrest in the Pediatric Patient | 665 | ||
| Advanced Management of Respiratory Distress in the Pediatric Patient | 665 | ||
| Endotracheal Intubation | 665 | ||
| Needle Cricothyroidotomy | 668 | ||
| Selected Diagnoses with Respiratory Distress in the Pediatric Population | 669 | ||
| Asthma | 669 | ||
| Clinical Presentation | 669 | ||
| Treatment | 669 | ||
| Croup | 670 | ||
| Chapter 34: Military Patient Transport | 696 | ||
| Levels of Care | 697 | ||
| Point of Injury Care | 698 | ||
| Level I | 698 | ||
| Level II | 698 | ||
| Level III | 701 | ||
| Level IV | 701 | ||
| Level V | 702 | ||
| Military Patient Transportation | 702 | ||
| Intratheater: Level I to \nLevel III | 702 | ||
| Point of Injury Care Providers | 702 | ||
| Casualty Evacuation | 706 | ||
| Ground Transportation | 706 | ||
| Medical Evacuation | 707 | ||
| Airmedical Evacuation | 707 | ||
| How Patient Transport is Initiated | 708 | ||
| Intratheater | 708 | ||
| Intertheater | 708 | ||
| Training | 709 | ||
| Point of Injury Care Providers | 709 | ||
| Ground Transport | 709 | ||
| Rotor-Wing Transport | 709 | ||
| Fixed-Wing Transport | 709 | ||
| Special Operations | 710 | ||
| Department of Homeland Security | 710 | ||
| US Coast Guard | 710 | ||
| US Immigrations and Customs Enforcement | 710 | ||
| Peacetime Operations | 710 | ||
| Military Operations Other Than War | 710 | ||
| Local Agreements | 710 | ||
| Summary | 711 | ||
| References | 711 | ||
| Chapter 35: Evidence-Based Practice, Research, and Quality Management | 712 | ||
| Evidence-Based Practice | 712 | ||
| Research | 714 | ||
| Quality Management | 717 | ||
| Definition of Terms: Quality Assurance versus Continuous Quality Improvement | 717 | ||
| Quality Management Model for Air Medical Transport | 718 | ||
| Assignment of Accountability: The Staff-Based Approach to Quality Management | 719 | ||
| The Quality Management Committee | 719 | ||
| Quality Management Program Organizational Strategies | 719 | ||
| Identification of Important Aspects | 719 | ||
| Indicator Development | 720 | ||
| Thresholds and Benchmarks | 720 | ||
| Establishment of Priorities for Monitoring and Evaluation | 720 | ||
| Utilization Appropriateness | 720 | ||
| Legal Considerations for Quality Management | 721 | ||
| Summary | 722 | ||
| References | 722 | ||
| Chapter 36: Legal Issues | 723 | ||
| An Overview of the Law | 723 | ||
| Elements of Malpractice | 724 | ||
| Statute of Limitations | 724 | ||
| Types of Liability | 725 | ||
| Intentional Torts or Criminal Acts | 725 | ||
| Quasiintentional Torts | 725 | ||
| Vicarious Liability | 725 | ||
| Product Liability | 725 | ||
| Abandonment | 725 | ||
| Consent Issues | 726 | ||
| Documentation | 726 | ||
| Health Insurance Portability and Accountability Act | 727 | ||
| Consolidated Omnibus Budget Reconciliation Act/Emergency Medical and Active Labor Act | 728 | ||
| Clarification of Hospital Helipads | 728 | ||
| Diversion | 728 | ||
| Medical Direction During Interfacility Patient Transfers | 729 | ||
| Scope of Practice | 729 | ||
| Summary | 733 | ||
| References | 733 | ||
| Chapter 37: Ethical Issues | 735 | ||
| Ethical Decision Making in the Transport Environment | 736 | ||
| To Transport or Not \nto Transport | 736 | ||
| Summary | 737 | ||
| References | 740 | ||
| Chapter 38: The Family and Transport | 741 | ||
| Family Issues Relating to Transport of the Patient | 742 | ||
| Referring Facility | 742 | ||
| Receiving Facility | 743 | ||
| Transporting Family Members | 743 | ||
| Family Presence During Resuscitation | 746 | ||
| Family Presence Program | 747 | ||
| Implications for Patient Transport | 748 | ||
| Bereavement After Sudden Death in the Field | 749 | ||
| Summary | 751 | ||
| References | 752 | ||
| Chapter 39: Marketing the Transport Program | 754 | ||
| Mission Of The Transport Program | 755 | ||
| Identification And Segmentation Of The Market | 756 | ||
| Creation Of An Effective Marketing Plan | 756 | ||
| Market Research | 757 | ||
| Competition | 757 | ||
| Internal Environmental Support | 758 | ||
| External Market Strategies | 759 | ||
| Community Involvement | 759 | ||
| Public Relation Events And Actions | 764 | ||
| Publicity | 764 | ||
| Methods of Publicity | 764 | ||
| Press Releases | 765 | ||
| Feature Articles | 765 | ||
| Press Conferences | 765 | ||
| Trade Shows | 765 | ||
| Public Speaking Engagements | 765 | ||
| Press Relations Day | 765 | ||
| Advertising | 765 | ||
| Evaluation of Results in a Public Relations Program | 766 | ||
| The Marketing Process | 766 | ||
| Summary | 766 | ||
| References | 767 | ||
| Chapter 40: Accreditation for Air and Ground Medical Transport | 768 | ||
| History of The Joint Commission | 768 | ||
| The “White Paper” Calls For Improved Emergency Medical Services | 769 | ||
| Accreditation Organization Founded For Air Medical Transport | 770 | ||
| Accreditation Standards | 770 | ||
| Site Surveyors | 771 | ||
| Past And Future Challenges | 771 | ||
| Summary | 773 | ||
| References | 773 | ||
| Chapter 41: Stress and Stress Management | 775 | ||
| Stress in Transport Medicine | 775 | ||
| The History of Stress | 776 | ||
| Categories of Stress | 777 | ||
| How Stress Affects the Body | 777 | ||
| Effects of Stress on Body Systems | 778 | ||
| Neurologic | 778 | ||
| Endocrine | 778 | ||
| Cardiovascular | 778 | ||
| Respiratory | 778 | ||
| Musculoskeletal | 778 | ||
| Gastrointestinal | 778 | ||
| Immune System | 779 | ||
| Reproductive | 779 | ||
| Psychologic | 779 | ||
| Causes of Stress | 779 | ||
| Personal Stressors | 779 | ||
| Environmental Stressors | 779 | ||
| Stress in the Workplace | 779 | ||
| Self-Imposed Stressors | 780 | ||
| Critical Incident Stress | 781 | ||
| Posttraumatic Stress Disorder | 781 | ||
| Critical Incident Stress Management | 783 | ||
| Mitigating Stress | 785 | ||
| Diet | 786 | ||
| Exercise | 786 | ||
| Laughter | 787 | ||
| Verbalization of Feelings | 787 | ||
| Sleep | 787 | ||
| Alternative Methods | 787 | ||
| Summary | 787 | ||
| References | 788 | ||
| Appendix A Post-Accident Resource Document | 790 | ||
| Introduction | 790 | ||
| Phase I: The First Few Hours: Initial Shock And Reaction | 790 | ||
| Post-Accident Incident Plan | 790 | ||
| Role of Program Leadership | 790 | ||
| Family Member Notification | 791 | ||
| Dealing with the Media | 791 | ||
| Decision to Remain in Service | 791 | ||
| Critical Incident Stress Management | 791 | ||
| Phase II: The First 24 Hours: Initial Development of A Plan | 792 | ||
| Management of the Media | 792 | ||
| Interaction with Family Members | 792 | ||
| Keeping Leadership Informed | 792 | ||
| Communication with the Air Medical Team | 792 | ||
| Legal Issues | 793 | ||
| Phase III: Days 2 To 5: Implementation and Modification | 793 | ||
| Care of the Injured Victims | 793 | ||
| Human Resources | 793 | ||
| Replacement of the Aircraft | 793 | ||
| Psychologic Support for Staff | 793 | ||
| Funeral Planning | 793 | ||
| Memorial Services | 794 | ||
| Request for Memorials | 794 | ||
| Delayed Issues | 794 | ||
| Formal Investigation | 794 | ||
| Evaluate Program Safety | 794 | ||
| Legal Issues | 794 | ||
| Final Outcome of Lawsuits | 795 | ||
| Emotional Support for Program Leadership | 795 | ||
| Anniversaries | 795 | ||
| Bibliography | 795 | ||
| Appendix B Medical Condition List and Appropriate Use of Air Medical Transport | 797 | ||
| Background | 797 | ||
| Ampa Position Statement | 797 | ||
| Air Medical Transport Guidelines, Detailed As Appropriate By The Medical Condition List\r | 798 | ||
| Index | 807 |