Howard Rodenberg

Influence of the helicopter environment on patient care capabilities: Flight crew perceptions

INTRODUCTION Flight crew perceptions of the effect of the rotary-wing environment on patient-care capabilities have not been subject to statistical analysis. We hypothesized that flight crew members perceived significant difficulties in performing patient-care tasks during air medical transport. METHODS A survey was distributed to a convenience sample of flight crew members from 20 flight programs. Respondents were asked to compare the difficulty of performing patient-care tasks in rotary-wing and standard (emergency department or intensive care unit) settings. Demographic data collected on respondents included years of flight experience, flights per month, crew duty position and primary aircraft in which the respondent worked. Statistical analysis was performed as appropriate using Students t-test, type III sum of squares, and analysis of variance. Alpha was defined as p < 0.05. RESULTS Fifty-five percent of programs (90 individuals) responded. All tasks were significantly rated more difficult in the rotary-wing environment. Ratings were not significantly correlated with flight experience, duty position, flights per month or aircraft used. CONCLUSIONS We conclude that the performance of patient-care tasks are perceived by air medical flight crew to be significantly more difficult during rotary-wing air medical transport than in hospital settings.

Correlation of the RTS and RAPS in rotor-wing prehospital care

Abstract Introduction: The Rapid Acute Physiology Score (RAPS) has been applied to patients transported by air, but not correlated with commonly used prehospital indices. The authors desired to determine the correlation between RAPS and Revised Trauma Score (RTS). Correlations between RAPS and RTS in patients with non-trauma ills were also investigated. Methods: Eight-hundred forty-four consecutive patients transported by helicopter were retrospectively evaluated. Demographics, origin of transport, nature of illness, RTS and RAPS were recorded. RTS vs. RAPS scores were graphed using sunflower technique and correlation was calculated using Spearman Rank-Order Correlation Coefficients (SCC). Alpha was set at ≤.05. Results: Sunflower plots revealed wide ranges of RAPS at like RTS values in less severely ill or injured patients. SCC analysis revealed statistically significant (p Conclusions: We conclude that RTS and RAPS scores exhibit significant correlation in a variety of patient populations. The wide range of RAPS seen at like RTS values suggests that RAPS may be a more sensitive indicator of physiologic status in patients transported by air.

Space shuttle operations at the NASA Kennedy Space Center: the role of emergency medicine

The Division of Emergency Medicine at the University of Florida coordinates a unique program with the NASA John F. Kennedy Space Center (KSC) to provide emergency medical support (EMS) for the United States Space Transportation System. This report outlines the organization of the KSC EMS system, training received by physicians providing medical support, logistic and operational aspects of the mission, and experiences of team members. The participation of emergency physicians in support of manned space flight represents another way that emergency physicians provide leadership in prehospital care and disaster management.

The modified clove hitch: A technique to maintain endotracheal tube position in the intubated patient

We describe the technique of using a modified clove hitch made of nasal cannula tubing as a means of insuring the position and security of an endotracheal tube in the intubated patient. Our experience indicates that this tie works well in both the prehospital and emergency department settings. We suggest that the modified clove hitch is a valuable adjunct to emergency airway management.

Part 5: Choosing a consultant

The Role of the Consultant The initial step in selecting a business advisor is to define your own expertise and needs. You may be an attorney beginning your own general practice but lack experience in such specific areas as corporate and employment law. You may have bookkeeping experience but have not previously filed corporate tax returns. The nature of the advisor’s profession also may play a role in assessing your needs. For example, malpractice attorneys for large insurers labor under a poor reputation for settling cases rather than litigating on behalf of the accused paramedic, nurse, or physician. If you are the type of individual who demands final control over your legal affairs, an attorney or advisor representing an outside party may be a poor choice. An advisor must be knowledgeable. Consultants should possess a minimum of a bachelor’s degree in their chosen field. They also may hold advanced level qualifications (MBA, JD, etc.) and additional certification, such as a certified public accountant (CPA), certified management accountant (CMA), or certified life underwriter (CLIP) . Certified specialists often are required to attend continuing education activities. These seminars and workshops keep their knowledge current and enhance their value to clients. Realize that you do not have all the right questions, and the advisor does not have all the right answers. An advisor who indicates what he or she doesn’t know may be more valuable than one who offers an immediate answer to every query. As the relationship evolves, your questions will become more defined, and the advisor will learn to anticipate your needs so that answers become more accessible and accurate. The fact that your advisor helps you formulate your questions does not mean you are a passive, helpless member of his or her audience. Working with your consultant to define your needs only helps you use the input provided more productively.

Part 4: Bringing financial statements to life

Reprint no. 74/l/96135 Forty years ago, the Walt Disney company released a series of nature films. With such titles as The Living Seas and l7te Living Desert, these pioneering reels demonstrated that areas often considered barren and empty in fact were teeming with life. In a similar fashion, completed business plans and financial statements often are considered lifeless pieces of paper. In fact, however, they are living documents that hold the keys to your financial success. The utility of the budget begins with its method of construction. In composing the business plan, we suggested that pro jetted sales and expenses be recorded in painstaking detail, a process that results in financial projections with reality-based roots. This approach allows the entrepre neur to later compare these projections with actual income and costs in evaluating the business’ financial health. The comparisons between anticipated and actual sales and costs have more than face value. The ability to match actual to projected values is crucial when presenting your financial statements to a bank, investors, or others outside the business. This ability is equally true whether your documents reflect profits or problems. In the former case, you can identity the most effective elements of the business and capitae in the latter, the exact nature of losses can be isolated and plans formulated for correction. Follow-up of later financial state ments is required to demonstrate prob lem resolution, continued growth, new challenges, and new opportunities. An example serves to demonstrate this unexpected benefit of financial state ments. Your company has budgeted funds for making 10 sales calls each day. A certain percentage of these calls has been shown to predictably close sales. Actual sales numbers are greater than were budgeted. Although this result is positive, cash supplies are being depleted (recall our statement that most businesses fail not because of lack of assets but a lack of ready cash). Your sales may be listed as “accounts receivable” (sales for which you are to be paid in the future, such as with future billing and installment payments). While your sales costs mount, the cash to recoup these expenses does not immediately follow the sale. Thus the business becomes “cashpoor” despite its sales success. Cash flow problems should be discussed with your accountant, bank, or other investors. In this instance, the added sales indicate you would be a good candidate for a loan or additional investment. The cash input received from the loan or investment then can be used to pay immediate expenses or expand sales while waiting for sales funds to arrive.