Flight Nurses Research Articles

The Effect of Shift Length on Fatigue and Cognitive Performance in Air Medical Providers

Objective. To employ a battery of previously validated surveys and neuropsychological tests to compare changes in fatigue and cognitive abilities of air medical providers after 12- and 24-hour shifts. Methods. A convenience sample of 34 flight nurses and flight paramedics employed by one air medical service completed the Pittsburgh Sleep Quality Index (PSQI) and the Chalder Fatigue Questionnaire (CFQ) to determine fatigue before and after 12-hour (n = 16) and 24-hour (n = 19) shifts. A battery of neuropsychological tests, including the University of Southern California Repeatable Episodic Memory Test (USC-REMT), Paced Auditory Serial Addition Test (PASAT), Trail Making Test (TMT), and Stroop Color–Word Test were administered before and after the shift to measure changes in cognition. We compared the change in scores stratified by shift length using t-tests, Wilcoxon signed-rank test, and Fisher's exact test. Results. Participants in the 12- and 24-hour shift groups were aged 36 ± 8 years (12-hour shifts) and 39 ± 6 years (24-hour shifts) (mean ± standard deviation) and were preponderantly male (62% 12-hour shifts; 63%, 24 hour shifts). The PSQI scores identified 50% of both 12-hour and 24-hour shift subjects as having poor sleep quality. Preshift fatigue was described as a median 2/10 (interquartile range [IQR] = 2–4) and fatigue declined by the end of the shift to a median 1/10 [IQR = 1–2], p = 0.006. Providers averaged 6.8 hours of sleep during 24-hour shifts and 1 hour of sleep during 12-hour shifts. Changes in cognitive scores did not differ between groups. Conclusions. This study identified no changes in cognitive performance following 12- and 24-hour shifts in air medical providers. This suggests that 24-hour shifts in an air medical service with low to moderate utilization do not have a detrimental effect on cognition as measured by this test battery, and are comparable to 12-hour shifts in terms of impact on cognitive function.

Compreensão de enfermeiros de bordo sobre seu papel na equipe multiprofissional de transporte aeromédico

Trata-se de um estudo qualitativo descritivo que objetivou identificar a compreensão de enfermeiros de bordo sobre seu papel na equipe multiprofissional de transporte aeromédico. Realizou-se entrevista semiestruturada com oito enfermeiros de bordo de Curitiba-PR, de junho a agosto de 2009. Os discursos foram submetidos a análise de conteúdo, emergindo três categorias. A primeira descreve as atribuições do enfermeiro de bordo como gestor da missão aeromédica, planejando o antes, o durante e após o transporte e incluindo o preparo da aeronave e o conhecimento do caso do paciente. Na segunda categoria são abordados aspectos deste profissional como prestador de assistência ao paciente aerorremovido; e, na terceira, descrevem-se a comunicação e o trabalho em equipe como competências fundamentais ao enfermeiro de bordo. Conclui-se que o enfermeiro no transporte aeromédico articula gerenciamento e cuidado em sua prática profissional por meio do uso de competências.

Impact of critical care–trained flight paramedics on casualty survival during helicopter evacuation in the current war in Afghanistan

The US Army pioneered medical evacuation (MEDEVAC) by helicopter, yet its system remains essentially unchanged since the Vietnam era. Care is provided by a single combat medic credentialed at the Emergency Medical Technician - Basic level. Treatment protocols, documentation, medical direction, and quality improvement processes are not standardized and vary significantly across US Army helicopter evacuation units. This is in contrast to helicopter emergency medical services that operate within the United States. Current civilian helicopter evacuation platforms are routinely staffed by critical care-trained flight paramedics (CCFP) or comparably trained flight nurses who operate under trained EMS physician medical direction using formalized protocols, standardized patient care documentation, and rigorous quality improvement processes. This study compares mortality of patients with injury from trauma between the US Army's standard helicopter evacuation system staffed with medics at the Emergency Medical Technician - Basic level (standard MEDEVAC) and one staffed with experienced CCFP using adopted civilian helicopter emergency medical services practices. This is a retrospective study of a natural experiment. Using data from the Joint Theater Trauma Registry, 48-hour mortality for severely injured patients (injury severity score ≥ 16) was compared between patients transported by standard MEDEVAC units and CCFP air ambulance units. The 48-hour mortality for the CCFP-treated patients was 8% compared to 15% for the standard MEDEVAC patients. After adjustment for covariates, the CCFP system was associated with a 66% lower estimated risk of 48-hour mortality compared to the standard MEDEVAC system. These findings demonstrate that using an air ambulance system based on modern civilian helicopter EMS practice was associated with a lower estimated risk of 48-hour mortality among severely injured patients in a combat setting.

Acute airway access and maintenance during anatomy dissection: An interprofessional teaching exercise integrating basic and clinical sciences

INTRODUCTIONAcute airway access and management is a critical skill for healthcare professionals. Majority of healthcare professional trainees are classically taught on manikin and animal models, but rarely on human tissue. The objective of this study is to investigate whether the access and management of temporary airways could be taught during an anatomy course.METHODSLiterature search was conducted on journals, texts, and websites regarding temporary access and maintenance of emergency airway management using cadavers during the first year anatomy course. Medical students conducted surgical airway access, maintenance and intubations on cadavers. Upon course completion, a questionnaire was used to assess the efficacy of the activity.RESULTSLiterature search revealed no studies addressing airway acquisition and management to first year medical students (MS1) during anatomy cadaver lab. Anatomy faculty, flight surgeons, paramedics and flight nurses provided airway tutorials and demonstrations to 108 MS1's.DISCUSSIONAirway management is a critical skill. In this study, students reported that airway access and management was one of the most intimidating procedures. MS1's successfully acquired airway access and management under supervision of the emergency experts.CONCLUSIONThis study suggests that airway management should be taught to first year medical students during cadaver lab.

Knowledge Assessment and Preparation for the Certified Pediatric Emergency Nurse Examination

January 2009 marked the start of the Certified Pediatric Emergency Nurse (CPEN) examination. In support of this certification, three times a year JEN features this column supplying questions similar to those in the CPEN examination to assist in preparation for the examination. Questions, rationale for the correct answers, and references are provided here for your self-evaluation. January 2009 marked the start of the Certified Pediatric Emergency Nurse (CPEN) examination. In support of this certification, three times a year JEN features this column supplying questions similar to those in the CPEN examination to assist in preparation for the examination. Questions, rationale for the correct answers, and references are provided here for your self-evaluation. Scott DeBoer is Flight Nurse, University of Chicago Hospitals, Chicago, IL, and Founder, Peds-R-Us Medical Education, Dyer, IN. Michael Seaver is Senior Healthcare Informatics Consultant, Vernon Hills, IL.

Knowledge Assessment and Preparation for the Certified Pediatric Emergency Nurse Examination

The review questions that are featured in each of the issues of the JEN are based upon the Emergency Nursing Core Curriculum and other pertinent resources to emergency nursing practice, pediatric and adult. These questions offer emergency nurses an opportunity to test their knowledge about their practice. These questions appear in each issue and are either online and in print, or online only. The review questions that are featured in each of the issues of the JEN are based upon the Emergency Nursing Core Curriculum and other pertinent resources to emergency nursing practice, pediatric and adult. These questions offer emergency nurses an opportunity to test their knowledge about their practice. These questions appear in each issue and are either online and in print, or online only. Scott DeBoer is Flight Nurse, University of Chicago Hospitals, Chicago, IL, and Founder, Peds-R-Us Medical Education, Dyer, IN. Michael Seaver is Senior Healthcare Informatics Consultant, Vernon Hills, IL.

Prehospital Pediatric King LT-D Use: A Pilot Study

Objective. To determine whether prehospital providers can successfully place a pediatric King laryngeal tube (LT-D) and ventilate a Laerdal SimBaby pediatric simulator during a respiratory arrest simulation. Methods. We studied the ability of 45 paramedics and flight nurses to place the pediatric King LT-D in a SimBaby manikin. For the purposes of this study, paramedics and flight nurses were considered equivalent, because in this air medical system they have the same scope of practice in regard to airway skills. Because the participants had previous training and field experience with the adult King LT-D, we limited pediatric King LT-D training to our standard adult training plus selecting the correct size and inflation volumes for the device. Outcomes included rate of successful pediatric King LT-D placement, number of attempts to correctly place the tube, and time to first adequate ventilation. The subjects were evaluated on airway management using an 11-point skill test. A score of 8 or greater (≥73%) was considered passing. The subjects indicated their perceptions and preferences for the pediatric King LT-D using a five-point Likert scale. Data were analyzed using descriptive statistics. Results. Crew members successfully placed the pediatric King LT-D 95.5% (43/45) of the time. The median number of attempts was one. Four subjects required a second attempt; two of these subjects failed at placement. Mean time to placement was 34 seconds (95% confidence interval [CI]: 26.4–67.3 sec). Ninety percent of the participants (40/45) successfully completed the skill test, with a mean score of 78.2% (95% CI: 73.6–82.7). The subjects strongly agreed that their previous training on the adult King LT-D and using it in the field had adequately prepared them to use the pediatric King LT-D. The subjects agreed that the pediatric King LT-D was easier to place than a pediatric endotracheal tube; they strongly agreed that they would use the pediatric King LT-D as an alternative airway. The participants disagreed that they would prefer the pediatric King LT-D as a primary means of securing pediatric airways. Conclusions. The pediatric King LT-D was quickly and reliably placed. Providers perceived the pediatric King LT-D to be easier to use than pediatric endotracheal intubation in this setting.

Endocrine Emergencies

January of 2009 marked the start of the Certified Pediatric Emergency Nurse (CPEN) examination. In support of this new certification, three times a year JEN will feature this new column supplying questions similar to those in the CPEN examination to assist in preparation for the examination. Questions, rationale for the correct answers, and references are provided here for your self-evaluation. January of 2009 marked the start of the Certified Pediatric Emergency Nurse (CPEN) examination. In support of this new certification, three times a year JEN will feature this new column supplying questions similar to those in the CPEN examination to assist in preparation for the examination. Questions, rationale for the correct answers, and references are provided here for your self-evaluation. Scott DeBoer is Flight Nurse, University of Chicago Hospitals, Chicago, IL, and Founder, Peds-R-Us Medical Education, Dyer, IN. Michael Seaver is Senior Healthcare Consultant, Vernon Hills, IL. Thank YouJournal of Emergency NursingVol. 38Issue 1PreviewPlease accept my thanks—both as a physician and as a diabetic—for your outstanding “Endocrine Emergencies,” published in the May 2011 issue of JEN, volume 37, issue 3, pages 161-162. Truly outstanding! Full-Text PDF

Comparison of Bougie-Assisted Intubation with Traditional Endotracheal Intubation in a Simulated Difficult Airway

Objective. To compare the success and ease of bougie-assisted intubation (BAI) with those of traditional endotracheal intubation (ETI) in a simulated difficult airway (20.4 seconds for BAI vs. 16.7 seconds for ETI, p == 0.102). Methods. This was a prospective, randomized, crossover, single-blind study comparing BAI with ETI in a simulated difficult airway. The 35 participants included paramedics, flight nurses, and emergency medicine resident physicians. Participants were already experienced in ETI and received a brief demonstration of BAI. A simulated difficult airway was created using a Laerdal adult intubation manikin. Cervical motion was mechanically limited to provide a grade III Cormack and Lehane glottic view. Participants performed ETI and BAI in randomized order. Successful placement in the trachea and time to successful placement were recorded for both techniques by each participant. After intubating the manikin with both techniques, each participant was asked to complete a Likert-style survey assessing ease of each technique. Results. Of the 35 participants, 27 were successful with both techniques and two failed with both techniques. The remaining six participants all failed at ETI but were able to intubate using BAI. There was significantly greater success in intubating the simulated difficult airway with BAI than with ETI (94%% vs. 77%%, p == 0.0313). The order of techniques attempted did not influence this conclusion. There was no difference in average time to successful intubation (20.4 seconds for BAI vs. 16.7 seconds for ETI, p == 0.102). Thirty-two (91.4%%) of the participants completed the survey regarding ease of performing each technique. Forty-one percent rated the ease of intubation as the same for the two methods, 50%% rated BAI as easier, and 9%% rated ETI as easier (p == 0.0006). Conclusion. In a simulated difficult airway, BAI has a higher success rate than traditional ETI without increasing the time to successful intubation. Intubators perceive BAI as being easier to perform than traditional ETI in this simulated difficult airway scenario.

Stanford Life Flight: A Silver Anniversary Perspective

In May 1984, Stanford Life Flight flew its first medical mission to airlift a 70-year-old woman critically injured in a motor vehicle crash in Santa Cruz to Stanford Hospital. That pioneering flight launched an air medical transport service that would change the healthcare landscape of Northern California. Initially, Stanford's flight program was staffed with a pilot/physician/nurse team flying in an Alouette III helicopter. Today, a Stanford flight crew consisting of a pilot and two flight nurses in an EC 145 aircraft complete approximately 700 transports each year.

Nurses with attitude: Characteristics of the role of a Flight Nurse

Nurses with attitude: Characteristics of the role of a Flight Nurse

Knowledge Assessment and Preparation for the Certified Pediatric Emergency Nurse Examination

January of 2009 marked the start of the Certified Pediatric Emergency Nurse (CPEN) examination. In support of this new certification, three times a year JEN will feature this new column supplying questions similar to those in the CPEN examination to assist in preparation for the examination. Questions, rationale for the correct answers, and references are provided here for your self-evaluation. January of 2009 marked the start of the Certified Pediatric Emergency Nurse (CPEN) examination. In support of this new certification, three times a year JEN will feature this new column supplying questions similar to those in the CPEN examination to assist in preparation for the examination. Questions, rationale for the correct answers, and references are provided here for your self-evaluation. Scott DeBoer is Flight Nurse, University of Chicago Hospitals, Chicago, IL, and Founder, Peds-R-Us Medical Education, Dyer, IN. Michael Seaver is Senior Healthcare Consultant, Vernon Hills, IL.

Flight nursing expertise: towards a middle-range theory.

This paper presents a middle-range Theory of Flight Nursing Expertise. Rotary-wing (helicopter) medical transport has grown rapidly in the USA since its introduction, particularly during the past 5 years. Patients once considered too sick to transport are now being transported more frequently and over longer distances. Many limitations are imposed by the air medical transport environment and these require nurses to alter their practice. A literature search was conducted using Pubmed, Medline, CINAHL, secondary referencing and an Internet search from 1960 to 2008 for studies related to the focal concepts in flight nursing. The middle-range Theory of Flight Nursing Expertise is composed of nine concepts (experience, training, transport environment of care, psychomotor skills, flight nursing knowledge, cue recognition, pattern recognition, decision-making and action) and their relationships. Five propositions describe the relationships between those concepts and how they apply to flight nursing expertise. After empirical testing, this theory may be a useful tool to assist novice flight nurses to attain the skills necessary to provide safe and competent care more efficiently, and may aid in designing curricula and programmes of research. Research is needed to determine the usefulness of this theory in both rotary and fixed-wing medical transport settings, and to examine the similarities and differences related to expertise needed for different flight nurse team compositions. Curriculum and training innovations can result from increased understanding of the concepts and relationships proposed in this theory.

Promoting the Use of Equestrian Helmets: Another Opportunity for Injury Prevention

There has been much attention paid to the use of bicycle helmets in reducing the rate of injury in children. Bicycle injury prevention programs exist in many communities, including “bicycle rodeos” and free bicycle helmet giveaways. Thirty-six states have some form of bicycle helmet laws, mostly for cyclists aged under 18 years. 1 Bicycle Helmet Safety Institute Helmet laws for bicycle riders. http://www.helmets.org/mandator.htm Google Scholar Another type of athletic activity that has received less attention and for which there is no legal mandate but where the promotion of helmet use can also have a significant beneficial effect in the prevention of head injuries is horseback riding. Gordon H. Worley, Member, California Chapter, is Flight Nurse, REACH Air Medical Services, Santa Rosa, CA.

Cardiovascular Emergencies

January of 2009 marked the start of the Certified Pediatric Emergency Nurse (CPEN) examination. In support of this new certification, three times a year JEN will feature this new column supplying questions similar to those in the CPEN examination to assist in preparation for the examination. This section appears in the January, May, and September issues of the Journal. Questions, rationale for the correct answers, and references are provided here for your self-evaluation. January of 2009 marked the start of the Certified Pediatric Emergency Nurse (CPEN) examination. In support of this new certification, three times a year JEN will feature this new column supplying questions similar to those in the CPEN examination to assist in preparation for the examination. This section appears in the January, May, and September issues of the Journal. Questions, rationale for the correct answers, and references are provided here for your self-evaluation. Scott DeBoer is Flight Nurse, University of Chicago Hospitals, Chicago, IL, and Founder, Peds-R-Us Medical Education, Dyer, IL. Michael Seaver is Senior Healthcare Consultant, Chicago, IL.

Knowledge Assessment and Preparation for the Certified Pediatric Emergency Nurse Examination

Knowledge Assessment and Preparation for the Certified Pediatric Emergency Nurse Examination

Certified Pediatric Emergency Nurse Review: Putting it All Together: DeBoer S. Chicago, IL: Peds-R-Us Medical Education, LLC. 419 pp, $39.95, www.Peds-R-Us.com

In 1980 the first CEN examination was administered by the Board of Certification of Emergency Nursing (BCEN). It was a paper and pencil test, and the test taker had to wait several weeks for the results. Since 1980, the BCEN has added several other tests for flight and transport nursing, and the test is now taken on a computer, which allows for immediate test results. This year, the BCEN added the Certified Pediatric Emergency Nurse (CPEN) examination. Reneé Semonin-Holleran is Editor-in-Chief of Journal of Emergency Nursing, Salt Lake City, UT.

Comparison of Nitrile Gloves and Nitrile over Nomex Gloves

Objectives Aeromedical flight crews must perform many tasks in flight requiring manual dexterity and fine precision. A common perception is that safety-enhancing fire-retardant gloves compromise patient care if worn during such tasks by providing added bulk and barrier to the hand. This study is a quantitative and qualitative analysis of this possible compromise to patient care. Methods Sixteen practicing flight nurses and respiratory therapists were asked to perform 10 different standard patient care tasks while wearing either nitrile gloves or a nitrile-Nomex glove pair. Tasks were timed, rated as completed successfully or not, and were subsequently judged subjectively by the participants. Results Whereas the time required to insert an intravenous catheter and to insert a central line while wearing only nitrile gloves was significantly faster than when wearing both gloves, the time to perform all other tasks was not significantly different. In subjective ratings, the nitrile glove alone was scored significantly better than the two-glove combination by the study participants. Conclusions Comfort, dexterity, tactile discrimination, and ease of use were all adversely affected by wearing a Nomex glove under a nitrile glove. Although the differences in times for most tasks may not be clinically significant, the difference in the subjective parameters may be great enough to cause helicopter emergency medical services (HEMS) practitioners to not wear Nomex gloves under nitrile gloves while performing procedures.

62: Comparison of the Airtraq® to Direct Laryngoscopy by Flight Nurses and Respiratory Therapists in the Simulated Airway

62: Comparison of the Airtraq® to Direct Laryngoscopy by Flight Nurses and Respiratory Therapists in the Simulated Airway

Rapid Sequence Intubation (RSI) and Rapid Sequence Airway: An Airway911 Guide. 2nd ed. By Darren Braude, MD, EMT-P: Albuquerque (NM): Airway911; 192 pp, $50, ISBN 978-0-578-00903-2

In his preface, the author says, “All I ask from you is not to let this book sit on the shelf; the airway is just too damn important.” As an emergency and flight nurse for more than 15 years, I loved this book. It is a great resource for those in emergency, critical care, or transport nursing. Even if you are not the person actually performing the intubation or placing the advanced alternate airway, this book is a wonderful review of the critical measures associated with emergency airway management. This book was written by a paramedic who later became an emergency and flight physician. His mix of real-life prehospital and ED experiences is especially evident when the author describes past airway management adventures. Eight chapters make up this very user-friendly guide: (1) Introduction; (2) Basic Principles; (3) Pharmacology; (4) The Difficult and Missed Airway; (5) Pediatric Considerations; (6) The 10 P’s of Rapid Sequence Intubation; (7) Rapid Sequence Airway; and (8) Legal Stuff and Quality Assurance. Most chapters also include the author’s practical “take home points.” The author uses real-life case scenarios throughout the book to summarize the previously presented information. In addition, the majority of paragraphs have one or more icons to the reader as to Evidence-based medicine (self explanatory); caution (highlighting potential pitfalls); or key (author’s most important points.) One of the most helpful features I found was the use of “blue boxes” throughout the book. The author describes the information in these boxes as “Advanced, Controversial, or Otherwise Supplementary Material.” The information in these boxes is written in a question and answer format, with such questions as: “Why does it seem like everyone eats and drinks right before their accident?,” “Is it possible to suffocate someone with a bag-valve-mask?,” and “I’ve heard that Fentanyl does not cause hypotension, but I swear I’ve seen it. Is that possible?” These boxes are a great way to summarize the medication, procedure, and equipment controversies in a very short and sweet manner. The author provides a non-biased review of traditional and new-to-the-market airway toys, medications, and placement confirmation devices. In addition, the concept of rapid sequence intubation versus rapid sequence airway is discussed at length. Rapid sequence airway is a vital addition to the current airway management armamentarium as more and more prehospital and emergency/critical care settings are now embracing this concept. The book, with more than 100 sharp, full-color pictures, is written in a style that is very easy to understand, and more importantly, very easy to remember. It is almost as if you were sitting down and talking about airway management with an experienced mentor. In summary, this book is an invaluable resource to emergency, critical care, and transport professionals, all of whom should remember the American Lung Association’s current motto, “If you can’t breathe…Nothing else matters!” Scott DeBoer is Flight Nurse, University of Chicago Hospitals; Transport Nurse, Superior Ambulance Service; and Founder, Peds-R-Us Medical Education, Chicago, IL.