Patient Transport - E-Book

BOOK

Patient Transport - E-Book

(2017)

Additional Information

Book Details

ISBN: 978-0-323-47900-4
Edition: 5
Language: English
Pages: 656
Subjects: Nursing
Accident & emergency nursing

Abstract

Whether you’re caring for patients on the ground or in the air, Patient Transport: Principles & Practice, 5^th Edition is an essential tool for your success in transport nursing. Developed by ASTNA, this trusted, one-of-a-kind resource 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 conditions 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. In addition, expanded content on bariatrics are featured throughout the book, along with 350 online questions and answers mapped to the CRFN/CTRN® exams.

Expanded coverage of injuries commonly encountered in flight and ground nursing includes pathophysiology, assessment, planning, implementation, and evaluation discussions.
Information based on the latest updates from the Federal Aviation Association and the National Transportation Safety Board alerts you to important safety regulations.
Meets the needs of all healthcare providers dedicated to expert care delivery in transport, including paramedics, physicians, respiratory therapists, pilots, mechanics and communication specialist.
Detailed coverage of management issues includes scene management, communication, safety, disaster management/triage, quality management, and marketing/public relations.

NEW! Extensive revisions throughout text includes detailed objectives for every chapter, expanded content on bariatrics, and updates to chapters including Scene Operations and Safety, Neurologic Trauma, Patient Safety, and Shock.
NEW! Real-life scenarios with updated technology demonstrate how to apply concepts to scenarios similar to those you’ll encounter in practice.
NEW! Focus on interprofessional and collaborative nature of transport, emphasizes the importance of teamwork in ensuring successful patient outcomes.
NEW! Evolve site with 350 questions and answers mapped to the CRFN/CTRN® provide additional online preparation.

Section Title	Page	Action	Price
Front Cover	Cover
Contents	ES3
Front matter	i
Patient transport principles & practice	i
Copyright	iv
Contributors	v
Reviewers	viii
Dedication	x
Preface	xi
Foreword	xii
Acknowledgments	xiii
SECTION I History and the Current Role of Air and Ground Transport Personnel	1
1 History of patient transport	1
Introduction	1
Origins of patient transport	1
Origins of air medical transport	3
Fixed-wing transport	3
Patient transport by helicopter	4
Air medical program models	6
Nursing in critical care transport	7
Paramedics in critical care transport	8
Recent patient transport history in the 20th and 21st centuries	9
Associations	9
Association of air medical services	9
Air and surface transport nurses association	9
International association of flight and critical care paramedics	10
Commission on accreditation of medical transport systems	10
International association of medical transport communications specialists	11
Air medical physician association	11
National emergency medicine service pilots association	11
Summary	11
Bibliography	11
2 Members of the transport team	13
Transport team members (air and surface)	13
Physicians	14
Physician medical director	14
Identify medical protocols	15
Ensure adequate training	15
Oversight of medical control physicians	15
Continuous quality improvement	15
Resolving conflict that arises during the transport	15
Communication specialists	15
Pilots	16
Pilot-in-command qualifications	16
Emergency vehicle operators	16
Program manager	16
Other members of the transport program	17
Summary	17
References	17
3 Preparation for practice	18
Qualifications for transport practice	18
Transport nurse	18
Transport paramedic	18
Respiratory therapist	19
Physicians	19
Preparation for practice	19
Adult learning principles	20
Competency-based education	22
Continuing professional development	23
Commission on accreditation of medical transport systems recommendations	23
Clinical decision making	23
Reflective practice	23
Certification	24
Transport nursing certification	24
Flight and critical care paramedic certification	24
Summary	26
References	26
SECTION II General Principles of Practice	27
4 Transport physiology	27
Competencies	27
Gas laws	27
Boyle’s law	27
Dalton’s law (law of partial pressure)	28
Charles’ law	28
Gay-lussac’s law	29
Henry’s law	29
Graham’s law (law of gaseous diffusion)	29
Fick’s law	29
Stresses of transport	29
Hypoxia	30
Four stages of hypoxia	30
Types of hypoxia	30
Effective performance time and time of useful consciousness	31
Causes	31
Characteristics	31
Early signs and symptoms	31
Treatment	31
Hyperventilation	32
Treatment	32
Barometric pressure changes	33
Middle ear	33
Barotitis media	33
Delayed ear block	33
Barosinusitis (sinus block)	34
Barodontalgia	34
Gastrointestinal changes	34
Thermal changes	35
Decreased humidity	35
Noise	35
Vibration	37
Fatigue	37
Gravitational force	37
Aircraft motion	38
Long-duration positive acceleration	38
Long-duration negative acceleration	38
Long-duration transverse acceleration	38
Cabin pressurization	39
Decompression	40
Decompression sickness	40
Additional stresses of transport	42
Spatial disorientation	42
Flicker vertigo	42
Fuel vapors	42
Summary	42
References	43
5 Scene operations and safety	44
Competencies	44
Scene management	44
Prearrival/en route considerations	44
Approach to the incident	45
Incident command system	46
Hazardous materials emergencies	47
Decontamination	48
Radioactive material emergencies	49
Transportation emergency scenes	49
Vehicle extrication	49
Downed aircraft	50
Railroad incidents	51
Motor coach crashes	51
Electrical emergencies	51
Rescues from unique locations	52
Wilderness rescue	52
Confined spaces	52
Construction site emergencies	52
Trench collapse	52
Law enforcement–related situations	53
Explosive materials emergencies	53
Active shooter	53
Firearms	54
Evidence preservation	54
Summary	54
References	54
6 Communications	55
Competencies	55
Communication centers	55
Communications specialist	55
Roles and responsibilities	55
Selection	56
Training	56
Communications operations	57
Operations control centers	57
Roles and responsibilities	57
Alternative sites/backup equipment	57
Telephones	58
Radios	58
Radio use	59
Phone–radio or radio–phone patch	59
Squelch control	59
Continuous tone-controlled subaudible squelch	59
Pagers	59
Headsets and foot switches	59
Communication recorders	60
Computers and peripherals	60
Computer-aided dispatch systems	60
Weather radar	61
Closed-circuit television/web cameras	61
Maps	61
Policies and procedures	62
Communicating	62
Radios	62
Language	62
Speaking	62
Portable units	63
Aircraft radios	63
Effective communication	63
Sensitive radio traffic	63
Telephones	64
Electronic communication	64
Medical direction	64
With the media	64
Emergency procedures	65
Postaccident incident plan	65
Drills	65
Critical incident stress management	65
Satellite communication	65
Summary	66
References	66
7 Teamwork and human performance	67
Introduction	67
Knowing the enemy: The problem of human error	67
Slips and lapses	67
Knowledge-based errors	67
Rule-based errors	67
Combating human error	68
Teamwork	68
Value of teamwork	68
Foundation of teamwork: Leadership and followership	69
Managing boundaries	69
Establishing group norms	70
Utilizing appropriate authority	70
Teamwork barriers in the tenerife disaster	70
Formation of group norms in the tenerife disaster	70
Task saturation and barriers to teamwork in flight 173	70
Origins of crew resource management	70
Operationalizing teamwork: Crew resource management	71
Problems crew resource management had to solve	71
Workload management and delegation	71
Effects of high and low workloads	71
Task saturation	72
Task saturation and filtering effects in the tenerife disaster	72
Maintaining situational awareness	73
Feeding into a common situational awareness	74
Recognizing lost situational awareness, and recovering it	75
Recognizing lost situational awareness in the blood pressure control error	75
When and how to communicate within a team	75
Barriers to communication	76
Nonassertive behavior and lack of confidence	76
Task preoccupation	76
Rank and experience differences	76
Overcoming the barriers: The practice of assertiveness within a team	77
Sharing the mental model	77
Lack of shared mental model in the blood pressure control error	77
Recognizing decision-making hazards	77
Strength of an idea	77
Groupthink	77
Seeking the perfect solution	78
Leadership	78
Use of all available resources	78
Human performance	78
Task performance and external stress	78
Responses to external stressors	79
Effects of workload	79
Thermal stress	79
Effects of noise	79
Effects of fatigue	79
Responses to acute stress	80
Stress and heart rate	80
After the adrenaline	80
Improving performance under stress	80
Emotional awareness	80
Stress inoculation	80
Training fine motor tasks with stress in mind	80
Tactical breathing	81
Focusing through the parasympathetic surge	81
Conclusion	81
References	81
8 Patient safety	83
Organizational characteristics associated with patient safety	83
Provider readiness	85
Communication tools: Checklists and handoffs	86
At the bedside	90
Conclusion	91
References	91
9 Operational safety and survival	93
Competencies	93
Definition of safety	93
Air medical safety survey	93
Hazards in the transport environment	94
Air medical accidents	94
Ground ambulance accidents	95
Reducing the risks	95
Critical thinking, decision making, and the human factor	96
Weather minimums	96
Mission planning and risk assessment	96
Declined missions	96
Air medical resource management	96
Helicopter shopping	99
Safety technologies	99
Instrument flight	99
Night vision goggles	99
Terrain awareness and warning systems	100
Satellite tracking and position reporting	100
Crashworthy aircraft and vehicle systems	101
Industry safety initiatives	101
Air and surface transport nurses association10	101
The commission for accreditation of medical transport systems	102
Vision zero	102
Voluntary safety reporting	102
Safety management	102
Safety committee	102
Safety training	103
Operational safety training	103
Clinical safety training	103
Aircraft safety training1,10,11,13,16,17,19,23,25,27-29,31,33,42	103
Ground ambulance safety training	103
Occupational and workplace safety training	103
Outreach safety education	103
Safety in the transport environment1,10,11,13,16,17,19,23,25,27-29,31,33,42	103
Personal safety	103
Fitness standards	103
Fatigue policies2,13,15,30,33	104
Pregnancy15,21	104
Personal protective equipment	104
Helmets	104
Fire-resistant clothing	104
Protective footwear	104
Hearing protection	104
Patient safety	105
Operational safety	105
Aircraft safety	105
Helicopter safety	105
Fixed-wing aircraft safety	105
Ground ambulance safety	105
Daily preflight procedures	106
Dispatch/communications	106
Helipad/airport safety	106
In-flight safety	107
Situational awareness	107
Flight following	107
Securing patients and equipment	108
Scene safety	108
Landing zone selection and safety	108
Multiple aircraft response	109
On-scene safety	109
Hazardous materials	109
Postmission debriefings	109
In-flight emergencies	109
Aircraft mechanical emergencies	110
Aircraft fire emergencies	110
Emergency communications	110
Emergency locator transmitter	110
Emergency landings	110
Emergency egress	111
Forced water landings	111
Before impact with the water	111
After impact with the water	111
Ground vehicle emergencies	111
Postcrash responsibilities	112
Crew responsibilities	112
Missing or overdue aircraft or ground vehicle procedure	112
Postaccident incident plan	112
Safety attitude revisited	112
Survival basics11,12,17,18,20,23,25,28,32,35,41	112
Preparation and priority setting	113
Psychological preparation	113
Physical preparation	113
Clothing and personal equipment	113
Priority setting	113
Survival skills	113
Shelter	113
Fire building	114
Hydration	116
Signaling	116
Food	117
Overland travel and navigation	117
Specific environmental considerations	117
Water landings and open water survival	117
Desert survival	117
Cold weather survival	117
International survival concerns	118
Patient care in a survival situation	118
Survival equipment	118
Summary	118
References	119
SECTION III Patient Care Principles	120
10 Patient assessment	120
Competencies	120
Indications for patient transport	120
Trauma patient	121
Patients with cardiovascular, cerebrovascular, and medical emergencies	121
Pregnant women and neonates	122
Appropriate patient transfer	122
Decision to transport	123
Communication	124
Consent	124
A twenty-first-century patient transport challenge	125
Patient assessment	125
Prehospital assessment	125
Scene assessment15,26	126
History	126
General principles of history gathering	126
Trauma history	127
Diversity assessment	127
Primary assessment and critical interventions	128
Airway	128
Pharmacologic adjuncts for airway management	128
Breathing	129
Circulation1,8,9,47	129
Disability: Neurologic assessment1,8,9,47	130
Exposure1,8,9,47	130
Equipment assessment	130
Secondary assessment	130
Pain assessment	131
Scoring systems	131
Preparing the patient for transport	131
Airway management	133
Ventilation management	134
Circulation management	134
Gastric decompression	135
Wound care and splinting	135
Patient safety46	135
Pain management	135
Patient preparation: The family	136
Cardiopulmonary arrest during transport1-10,43,51	136
“do not resuscitate” or “allow natural death” orders	137
Documentation	137
Preparation for the transport of the bariatric patient	137
Selection of an appropriate vehicle	138
Patient assessment and intervention differences in the bariatric patient	138
Preparation for transport	139
Laboratory and diagnostic testing interpretation	139
Laboratory tests	139
Chest x-ray interpretation1,24,66	139
Computed tomographic scan interpretation1,24,66	141
Focused assessment with sonography52	142
Patient assessment and reassessment during transport	142
Federal aviation regulations	143
Weather minimums: Visual and instrument flight rules	144
Weight and balance	144
Lifeguard status	144
Ambient temperatures	144
Additional considerations	145
Fixed-wing patient transport	145
Preflight preparation	145
Preparation for patient transport	146
Transferring and accepting physician and facility	146
Oxygen requirements	146
Patient medical equipment requirements	146
Patient care supplies and medications	147
Bedding and linens	147
Nutrition and fluid requirements	147
Disposal of contaminated wastes	147
Required ground ambulance capabilities	147
Patient “packaging” for transport	148
Preparation	148
Loading considerations	148
Immobilization equipment	148
In-flight factors that influence patient care	148
Limited space	148
Air conditioner and heater	148
Extended flight times	148
Diversions	149
Air medical personnel resources	149
Medical control	149
Communication	149
Safety and emergency procedures	149
International transport issues	149
Air medical service international transports	149
Preflight preparation and logistics	149
Documentation	150
Language barriers	150
Patient location	150
Ground transport times	150
Ground ambulance resources	151
Pilot and air medical personnel duty times	151
Medical equipment and supplies	151
Escort and medical assist transports on commercial airliners	151
Commercial air carrier regulations	152
Documentation	152
Airline oxygen requirements	152
Oxygen adapters	152
Electrical power and adapters	152
Privacy	152
Nonstop flight or flight with minimal plane changes	152
Summary	153
References	153
11 Airway management	156
Competencies	156
Patient assessment	156
Primary and secondary assessment surveys	156
Indications for airway management	157
Physical examination in anticipation of a procedure	157
Difficult bag-valve-mask ventilation: Roman	157
Difficult direct laryngoscopy: Lemons	158
Difficult extraglottic device: Rods	158
Difficult cricothyrotomy: Smart	159
Physiologic examination and considerations associated with airway management	159
Hypoxemia	159
Hypotension	160
Severe metabolic acidosis	160
Intervention	160
Basic life support airway interventions	160
Advanced airway management techniques	162
Tracheal intubation	162
Anatomy	162
Potential complications	164
Direct laryngoscopy	165
Video-assisted intubation	166
Intubation without a device	167
Nasotracheal intubation	167
Digital intubation	168
Extraglottic devices	168
Supraglottic airway devices	168
Laryngeal mask airway	168
I-gel	168
Retroglottic devices	168
Surgical airway	169
Needle cricothyrotomy	169
Surgical cricothyrotomy	170
Pediatric management	171
Medication-assisted airway management	173
Premedications	173
Sedation	174
Neuromuscular blocking agents	175
Succinylcholine	175
Nondepolarizing agents	176
Monitoring airway patency during transport	176
End-tidal carbon dioxide detection	177
Esophageal aspiration devices	177
Pulse oximetry	178
Summary	179
References	179
12 Mechanical ventilation	182
Transport ventilator selection	182
Program considerations	184
Mission type	184
Budget	184
Ventilator considerations	184
Guidelines	184
Durability and safety	184
Oxygen consumption	184
Power	185
Selection process	185
Training	185
Ventilator-induced lung injury	185
Barotrauma	185
Volutrauma	186
Cyclic atelectasis	186
Oxygen toxicity	186
Classification of positive pressure ventilation	188
Volume ventilation	188
Pressure ventilation	188
Pressure-regulated volume-controlled ventilation	188
Continuous mandatory ventilation	188
Assist-control ventilation	189
Synchronized intermittent mandatory ventilation	189
Pressure support ventilation	189
Invasive continuous positive airway pressure	189
Choosing a mode	189
Noninvasive positive pressure ventilation	190
Advanced ventilatory modes	190
Airway pressure release ventilation	190
High-frequency ventilation	191
High-frequency jet ventilation	191
High-frequency oscillatory ventilation	191
Inhaled nitric oxide	191
Helium-oxygen mixture	192
Ventilator settings	192
Tidal volume	192
Peak inspiratory pressure	192
Rate, breaths per minute, and frequency	192
Fractional concentration of oxygen in inspired gas	193
Positive end-expiratory pressure	193
Inspiratory-to-expiratory time ratio and flow rate	193
Flow pattern	194
Trigger sensitivity	194
Ventilation strategies	194
Obstructive lung disease	194
Ards	194
Permissive hypercapnia	195
Trauma patients	195
Troubleshooting	195
Monitoring	195
Ventilator alarms	195
Ventilator asynchrony	196
Summary	197
References	197
13 Shock	198
Physiology	198
Cellular respiration	198
Oxygen-carrying capacity and delivery	198
Physiologic response to shock	199
Diagnosis	204
Management	204
Volume	204
Ventilation	205
Vasopressors	205
Hypovolemic shock	205
Distributive shock	207
Septic shock	208
Neurogenic shock	208
Anaphylaxis	208
Cardiogenic shock	209
Obstructive shock	210
Pulmonary embolism	210
Cardiac tamponade	210
Tension pneumothorax	211
Conclusion	211
References	211
SECTION IV Trauma	214
14 General principles of trauma management	214
Competencies	214
Injury dynamics	214
History	214
Mechanism of injury	215
Kinematics of trauma	216
Blunt injuries	216
Motor vehicle crashes	216
Head-on collisions	216
Rear-end collisions	216
Side impact	216
Rollovers	216
Motorcycle crashes	218
Head-on collisions	218
Side impact	218
Laying down the motorcycle	218
Falls	218
Penetrating trauma	218
Stab wounds	218
Firearm injuries	219
Pathophysiologic factors	220
Primary and secondary assessment	222
Primary assessment	222
Airway	222
Breathing	222
Circulation	223
Disability/neurologic	223
Exposure/environmental control	224
Secondary assessment	224
Full set of vital signs, focused adjuncts, and family presence	224
Give comfort measures	224
History	224
Inspect the posterior	224
Scoring of trauma patients	224
Prospective scoring	225
Trauma score	225
Mechanism, glasgow, age, and arterial pressure	225
Retrospective scoring	226
Abbreviated injury scale	226
Injury severity score	226
Trauma and injury severity score	227
Field triage	227
Triage patient transport	228
Emerging trends in trauma care	228
Summary	228
References	229
15 Neurologic trauma	231
Competencies	231
Traumatic brain injury	231
Types of traumatic injuries: Pathologic and clinical considerations	232
Skull fracture	232
Diastatic and basilar skull fractures	232
Depressed skull fracture	232
Hemorrhage	232
Subdural hematoma	232
Epidural hematoma	232
Subarachnoid hemorrhage	232
Cerebral contusion	232
Intracerebral hematoma	232
Traumatic brain injury: Diffuse axonal injuries	234
Penetrating injuries	234
Gunshot wounds	234
Physical assessment: Traumatic brain injury	235
Level of consciousness	235
Examination of the pupils	237
Brainstem and cranial nerves	237
Motor examination	237
Respiratory pattern	237
Glasgow coma scale	238
Reexamination	238
Interventions and treatment	239
Maxillofacial trauma	242
Spinal cord injury	242
Etiology and incidence rate	243
Initial assessment	243
Airway	243
Breathing	243
Circulation	243
Secondary assessment	243
Lower spine injuries	244
Cervical spine injuries	244
Sensory examination	244
Spinal cord syndromes	244
Neurologic examination of the unconscious patient	244
Interventions and treatment	244
Classification of cervical spine injuries by mechanism of injury	245
Flexion injuries	245
Flexion-rotation injuries	245
Extension-rotation injuries	245
Vertical compression	245
Extension injuries	245
Thoracic and lumbar spine injuries	246
Summary	247
References	248
16 Thoracoabdominal trauma	250
Competencies	250
Airway obstruction	250
Assessment	250
SECTION V Medical Problems and Environmental Emergencies	287
19 Neurologic emergencies	287
Competencies	287
Introduction	287
Neurologic pathophysiology	287
Pressure-volume relationships	287
Monro-kellie doctrine2,4,5,7	287
Cerebrospinal fluid 2,4,5,7	287
Volume-pressure relationship2,4,5,7	288
Compliance2,4,5,7	288
Cerebral blood volume and flow2,4,5,7	288
Application of neurologic pathophysiology to cerebral perfusion pressure and mean arterial pressure1,4,5,7,9	289
Neurologic examination2,7	289
Overview of neurologic emergency treatment	291
Stroke: Epidemiology, types, and initial treatment	291
Pathophysiology of stroke	291
Assessment of the stroke patient	292
Planning care of the stroke patient	292
Intracerebral hemorrhage events	293
Seizures	293
Assessment	294
Planning of care of seizure patient	294
Evaluation	295
Summary	295
Assessment	296
Transport	296
Outcome	296
References	296
20 Cardiovascular emergencies	298
Competencies	298
Alterations of cardiovascular physiology at high altitudes	298
Special considerations for cardiopulmonary resuscitation in the transport environment	299
Cardiopulmonary resuscitation and defibrillation during transport	299
Defibrillation during transport	299
Temporary pacing during transport	300
Transcutaneous pacing	300
Transvenous pacing	300
Targeted temperature management	301
Acute coronary syndromes	301
Pathophysiologic factors	301
Acute coronary syndromes: Diagnosis, assessment, and treatment	301
Acute myocardial infarction: Assessment and diagnosis	302
Acute myocardial infarction: Management	303
Dysrhythmias	304
Pathophysiologic factors	304
Dysrhythmias originating in the sinoatrial node	304
Sinus tachycardia	304
Sinus bradycardia	304
Dysrhythmias originating in atria	305
Supraventricular arrhythmias	305
Atrial tachycardia	305
Atrial flutter	305
Atrial fibrillation	305
Treatment of supraventricular tachycardia	305
Dysrhythmias originating in the atrioventricular node	305
First-degree atrioventricular block	305
Second-degree atrioventricular block	305
Third-degree atrioventricular block or complete heart block	306
Dysrhythmias originating in ventricles	306
Ventricular arrhythmias	306
Ventricular tachycardia	306
Ventricular fibrillation	306
Pulseless electrical activity and asystole	306
Cardiogenic shock	307
Pathophysiologic factors	307
Assessment and diagnosis	307
Management	307
Pharmacologic therapy	308
Intraaortic balloon pump counterpulsation	308
Heart failure	308
Definition and pathophysiologic factors	308
Assessment and diagnosis	309
Management	309
Acute pericarditis	309
Assessment and diagnosis	310
Management	310
Cardiac effusion and tamponade	310
Pathophysiologic factors	310
SECTION VI Selected Patient Populations	429
28 Gynecologic and obstetric emergencies	429
Competencies	429
Determination of team composition for transport of the pregnant patient	431
General strategies for transport	431
Inferior vena cava syndrome	433
Fetal monitoring before and during transport17,18	434
Baseline fetal heart rate assessment	434
Fetal heart rate abnormalities17,18	434
Variability	434
Periodic changes/episodic changes	435
Acceleration	435
Variable deceleration	435
Late decelerations	435
Early decelerations	435
Sinusoidal	435
Bradycardia	435
Tachycardia	435
Contributing factors to fetal distress	440
Normal physiologic changes in pregnancy	441
Complications of pregnancy and delivery	442
Amniotic fluid embolism/anaphylactic syndrome of pregnancy	442
Etiology and pathophysiologic factors	442
Assessment	442
Strategies for transport	443
Delivery complications	443
Breech presentation	443
Etiology and pathophysiologic factors	443
Assessment	443
Strategies for delivery	443
Hemorrhagic delivery complications	444
Postpartum hemorrhage	444
Etiology and pathophysiologic factors	444
Assessment	444
Strategies for transport	444
Uterine inversion	446
Etiology and pathophysiologic factors	446
Assessment	446
Strategies for transport	446
Uterine rupture	447
Etiology and pathophysiologic factors	447
Assessment	447
Strategies for transport	447
Precipitate delivery	448
Retained placenta	448
Shoulder dystocia	448
Etiology and pathophysiologic factors	448
Assessment	448
Strategies for delivery	448
Umbilical cord prolapse	449
Etiology	449
Assessment	449
Strategies for transport	449
Diabetes in pregnancy	449
Etiology and pathophysiologic factors	449
Assessment	450
Strategies for transport	450
Hemorrhagic complications	450
Placental abruption	450
Etiology	450
Pathophysiologic factors	450
Placenta previa	451
Etiology	451
Pathophysiologic factors	451
Assessment of placental abruption and placenta previa	452
Uterine assessment (placental abruption)	452
Uterine assessment (placenta previa)	452
Assessment of blood loss (placental abruption)	452
Assessment of blood loss (placenta previa)	452
Ultrasound scan	452
Assessment of vital signs	452
Assessment of fetal heart rate	452
Assessment of urinary output	452
Assessment of coagulopathy	453
Assessment for impending shock	453
Strategies for transport (abruption and previa)	454
Disseminated intravascular coagulation	454
Multiple gestation	454
Etiology	454
Pathophysiologic factors	454
Assessment	455
Strategies for transport	455
Hypertensive disorders of pregnancy	455
Etiology	455
Pathophysiologic factors	456
Uteroplacental changes	456
Renal changes	456
Hematologic changes	456
Hepatic changes	456
Cerebral changes	456
Retinal changes	456
Pulmonary changes	456
Complications	457
Eclampsia	457
Hellp syndrome	457
Assessment	457
Hypertension	458
Edema	458
Proteinuria	458
Strategies for transport	458
Magnesium sulfate	459
Labetalol	459
Hydralazine	460
Benzodiazepines	460
Preterm labor and related issues	460
Etiology	460
Pathophysiologic factors	460
Assessment	461
Cervical dilation/effacement patterns	461
Spontaneous rupture of membranes	462
Strategies for transport	463
Trauma in pregnancy	464
Perimortem cesarean section	464
Gynecologic emergencies	465
Ovarian torsion	465
Pathophysiology7	465
SECTION VII Professional Issues	573
32 Professional issues	573
Competencies	573
Legal issues	573
An overview of the law	573
Elements of malpractice	574
Statute of limitations	574
Types of liability	574
Intentional torts or criminal acts	574
Quasiintentional torts	574
Vicarious liability	574
Product liability	575
Abandonment	575
Consent issues	575
Documentation	575
Health insurance portability and accountability act	576
Consolidated omnibus budget reconciliation act/emergency medical treatment and active labor act16	577
Clarification of hospital helipads	577
Diversion	577
Medical direction during interfacility patient transfers	578
Scope of practice	578
Ethical issues	578
Ethical decision making in the transport environment	578
To transport or not to transport	579
The family in transport	579
Family issues relating to transport of the patient	580
Referring facility	580
Receiving facility	580
Transporting family members	581
Family presence during resuscitation	582
Family presence program	582
Implications for patient transport	583
Bereavement after sudden death in the field	583
Research	584
Evidence-based practice	586
Quality management	587
Definition of terms: Quality assurance versus continuous quality improvement	587
Just culture: Quality care without blame	588
Quality management model for air medical transport	588
Assignment of accountability: The staff-based approach to quality management	589
Quality management committee	589
Quality management program organizational strategies	589
Identification of important aspects	590
Indicator development	590
Thresholds and benchmarks	590
Establishment of priorities for monitoring and evaluation3,56	590
Utilization appropriateness	590
Legal considerations for quality management	591
Summary	591
References	592
33 Accreditation for air and ground medical transport	594
History of the joint commission	594
The white paper calls for improved emergency medical services	594
Accreditation organization founded for air medical transport	595
Accreditation standards	596
Site surveyors	596
Past and future challenges	596
Other accreditation bodies	598
Summary	599
References	599
34 Wellness	600
Competencies	600
Introduction	600
Components of a healthy lifestyle	600
Diet	600
Exercise	601
Laughter	601
Verbalization of feelings	601
Sleep	601
Preventative care	601
Immunizations	601
Stress in transport medicine	601
Critical incident stress	602
Critical incident stress management	602
Summary	603
References	603
Appendix A Post-accident resource document	604
Introduction	604
Phase I: the first few hours: Initial shock and reaction	604
Post-accident incident plan	604
Role of program leadership	604
Family member notification	604
Dealing with the media	604
Decision to remain in service	605
Critical incident stress management	605
Phase II: the first 24 hours: Initial development of a plan	605
Management of the media	605
Interaction with family members	605
Keeping leadership informed	606
Communication with the air medical team	606
Legal issues	606
Phase III: days 2 to 5: Implementation and modification	606
Care of the injured victims	606
Human resources	606
Replacement of the aircraft	606
Psychologic support for staff	606
Funeral planning	606
Memorial services	607
Request for memorials	607
Delayed issues	607
Formal investigation	607
Evaluate program safety	607
Legal issues	607
Final outcome of lawsuits	607
Emotional support for program leadership	608
Anniversaries	608
Bibliography	608
Index	611
A	611
B	613
C	614
D	617
E	617
F	619
G	620
H	620
I	622
J	623
K	623
L	623
M	624
N	625
O	626
P	627
Q	630
R	630
S	631
T	633
U	635
V	635
W	636
Y	636
Z	636

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