UMEM Educational Pearls

Category: EMS

Title: Flip 'em and Fly 'em: Prone Positioning in Air Medical Transport

Posted: 1/7/2024 by Ben Lawner, DO
Click here to contact Ben Lawner, DO

BACKGROUND:
Critical care transport teams are tasked with extending specialized care to the bedside. Given the uptick in COVID and ARDS cases, there are increasing demands for the transport of patients proned for respiratory compromise. An air medical service in British Columbia (BC) published their experience with transporting intubated patients in the proned position. The BC service utilizes 2 trained flight paramedics and conducts transports via pressurized fixed wing and non pressurized rotor wing aircraft. The small, retrospective study of 10 patients demonstrated feasibility of this practice. No extubations were recorded in the study population. 6/10 patients experienced >6% increase in oxygen saturation and no medical lines were disconnected during transport.

BOTTOM LINE:

Proning patients for air medical transport is possible but incorporates significant logistical and educational challenges
Evidence base for proning in air medical transport is insufficient to inform comprehensive conclusions about risks and benefits

BALTIMORE, MD SPECIFIC PEARL:

Currently, one local helicopter service will accomplish missions involving proned patients. Therefore, attention to optimizing vent settings prior to transport is imperative

BONUS AVIATION ENTHUSIASTC SPECIFIC PEARL:

BC air medical services is the largest integrated provider of helicopter EMS in Canada. They operate four Sikorsky S-76 aircraft. The S-76 platform is a large twin engine helicopter capable of transporting 2 patients at a time.
http://www.bcehs.ca/our-services/programs-services/critical-care-program

References

Naples C, Micalos PS, Johnston T, Schlamp R, Besserer F, Vu E. Prone Positioning of Ventilated Patients During Air Medical Evacuation: A Case Series. Air Med J. 2024 Jan-Feb;43(1):55-59. doi: 10.1016/j.amj.2023.10.004. Epub 2023 Nov 8. PMID: 38154841.

Attachments

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