Changing patient care for the better

ECMO

For patients who are not able to be flown without support, ECMO (or ECLS) is the only option. ECMO in this indication of ‘bridge to high level standard of care unit’ is rare, but lifesaving for patients requiring lung or heart transplants, for example. This is probably the only way to safely move patients with very severe ARDS or heart failure – patients for whom we would have had no solution a few years ago.

Monitoring of the anticoagulation test is mandatory for the safe use of ECMO/ECLS

Communication GPS/WiFi onboard

This is not proper medical ‘equipment’, but having a channel to discuss a case, ask for help and receive advice from another doctor is a very important change in practice for medevac. Doctors are used to discussing severe or unusual cases with colleagues, to read medical guidelines, medical reviews or articles that might not be available onboard. In case of a difficult situation, or unusual symptoms, the coordinating medical officer can read the papers and guide the treating doctor for further investigation or treatment, meaning the physician in charge is no longer completely alone to handle complex situations.

European Air Ambulance – Didier Dandrifosse, Head of the Medical Department, tells us about the company’s important lifesaving equipment

European Air Ambulance (EAA) is committed to preserving human lives and safeguarding patient health through the provision of a worldwide 24/7 air ambulance service, adhering rigorously to the highest safety and quality standards. This commitment is realised through continuous investments not only in state-of-the-art medical equipment but also in comprehensive training for medical crews, ensuring their adept and efficient use of the medical equipment.

EAA, in conjunction with its non-profit parent company, Luxembourg Air Rescue, remains dedicated to continual advancements in medical equipment, dedicated to enhancing patient care standards. Every air ambulance mission presents a distinct set of requirements, necessitating special medical equipment tailored to the precise needs of each patient.

Selecting the top five medical equipment products proves challenging, considering the indispensable nature of each onboard tool in ensuring the safety of lives. The following list is non-exhaustive, as every equipment item aboard our aircraft serves a vital purpose. At EAA, our focus extends beyond acquiring the latest medical equipment; we prioritise cultivating adept medical crews capable of seamlessly handling these tools to perfection. Each piece of equipment contributes significantly to our mission of safeguarding lives in critical situations.

While not classified as medical equipment, the integration of our first Bombardier Challenger 605 into our fleet significantly influences the level of patient care our medical crew can provide. The abundance of space – both for the patient and the medical team – facilitates enhanced patient handling and unrestricted use of the onboard medical equipment. Additionally, the ample room allows for the seamless stowage of supplementary equipment, making the Challenger 605 a game changer not only for our crews but also for our patients in terms of comfort and comprehensive medical care.

Transport incubators

European Air Ambulance takes pride in its exceptional team of highly skilled doctors and nurses. Their expertise, coupled with state-of-the-art equipment, positions us as a global leader in the field of neonatal and paediatric air ambulance transportation.

Every air ambulance mission presents a distinct set of requirements, necessitating special medical equipment tailored to the precise needs of each patient

EAA currently operates three transport incubators which are constructed on a self-developed versatile platform adaptable for use on both air ambulance aircraft and helicopter stretchers. This flexibility holds significant importance for us, given that we operate not only four air ambulance aircraft but also air rescue helicopters. Furthermore, to ensure safe ground transportation, we developed a new platform which seamlessly accommodates common ground ambulance stretchers like Stryker, Ferno, and Stollenwerk. This adaptability across various transport mediums underscores our commitment to safe and efficient patient transfer regardless of the mode of transport used.

The incubator itself allows very easy clinical access to the patient and has a touchscreen user interface, 360-degree intelligent thermoregulation with integrated heated mattress along with NASA-approved antivibration mattress. It can host three different sizes of certified baby transport cocoons (Traveller, NxtGen). A total autonomy of four  hours minimum can be achieved due to improved batteries. It is possible to connect it to 12V, 28V and 230V power sources with automated power distribution along with a backup unit onboard. LED observation lights and phototherapy are also part of this new incubator.

The incubator transport platform includes a fully integrated transport NICU Hamilton-T1 ventilator with invasive and non-invasive ventilation modes (NCPAP and high-flow oxygen therapy) with humidification, integrated O2, along with fully integrated Philips X3 neonatal cardiac monitoring with SpO2, ECG, temperature, NIBP, IBP. It also features an integrated neonatal suction unit (10 – 150mmHg) and integrated Braun Perfusor compact pro syringe pumps for medication and enteral feeding.

Video laryngoscope

A video laryngoscope is a medical device used in difficult airway management during intubation. Unlike traditional laryngoscopes, it has a camera at the tip, offering a clear view of the airway on a screen. This technology helps our medical crews in navigating challenging intubation scenarios, enhancing visualisation, and reducing complications. Their user-friendly interface and improved visibility contribute to safer and more efficient airway management, benefiting patient care. EAA invested in an airway trainer equipped with a video laryngoscope, permanently housed within our medical training academy. This resource ensures comprehensive training for our medical crews, allowing them to adeptly utilise this equipment.

corpuls cpr (cardiopulmonary resuscitation)

Air ambulance transfer flights are typically conducted under controlled circumstances. However, given that patients often require intensive care, unforeseen complications can arise, even among non-intensive care cases, particularly linked to cardiac issues. Hence the corpuls cpr, a thoracic compression device, is a fundamental component of the standard medical equipment aboard each air ambulance operated by EAA, ensuring optimal readiness for unforeseen cardiac complications. The corpuls cpr is equipped with multiple features to enhance cardiopulmonary resuscitation, including real-time feedback on chest compression depth and rate, ventilation assistance, and continuous monitoring of vital signs. European Air Ambulance’s specialised nurses and physicians are deployed not only in ambulance aircraft but also in emergency air rescue helicopters. As a result, the utilisation of the corpuls cpr is a familiar practice for them.

EpiShuttle

The EpiShuttle serves as a mobile biocontainment unit created specifically for the secure transportation of patients affected by highly contagious diseases. It provides a secure environment for patients while minimising the risk of transmission to the medical and flight crews during transportation. The unit resembles a high-tech isolation pod, equipped with its own ventilation and filtration systems to prevent the escape of airborne pathogens. The EpiShuttle’s design includes features such as multiple layers of protection, gloves for medical interventions, and access points for medical equipment while maintaining a sealed environment.

Every air ambulance mission presents a distinct set of requirements, necessitating special medical equipment tailored to the precise needs of each patient

Its mobility makes it useful in various situations, allowing rapid and safe transportation of infected individuals while containing the spread of the disease. EAA’s EpiShuttle is used in its air ambulance aircraft and air rescue helicopters. While the EpiShuttle has notably simplified the transportation of infected patients, it still possesses limitations. These include constraints related to patient measurements, managing claustrophobia, and handling heat-related concerns.

EAA is presently in the process of developing a new infectious disease module for its Bombardier Challenger 605 aircraft, aimed at eliminating existing limitations of the EpiShuttle and enhancing the secure transportation of infected patients to a greater extent. With its expertise gained during the Ebola outbreak and the Covid-19 crisis, EAA further increases its capabilities in infectious diseases and hence looking to increase better care for the patients.

corpuls3

The corpuls3 is part of the standard equipment of each EAA air ambulance mission. The corpuls3 is a compact and versatile monitor/defibrillator which integrates vital functions like ECG, defibrillation, pacing, and monitoring, enabling real-time patient assessment. Its exceptional portability, weighing around 2.5 kilograms, makes it lightweight and easily transportable, which is essential since the available space within the air ambulance aircraft is limited.

Its compact design allows our medical crews to swiftly move around and provide critical care in diverse environments, from the hospital to the ground ambulances and onwards to our aircraft. The device’s robustness and durable construction ensure its resilience in demanding conditions without compromising its functionality.

The user-friendly interface makes it ideal for patient care in critical situations. The corpuls3 offers comprehensive data recording, allowing for precise analysis. With its advanced technology and reliability, the corpuls3 plays a pivotal role in ensuring prompt and effective medical care for each patient on every EAA flight.

Redstar Aviation – Dr Neslihan Kömek Erdal, Deputy Medical Director, considers the crucial medical equipment for their needs

At Redstar Aviation, the health, safety and the best care of our patients are our number one priority, in compliance with our international quality standards. In order to ensure uninterrupted patient care, we aim to perform flawless air ambulance operations around the world, with highly skilled medical teams and extensive state-of-the-art medical equipment. Consequently, we closely follow the latest developments in the field of medical equipment.

In my opinion, we could observe the most significant change for better patient care in the development of the newest generation mechanical ventilators.

Maybe due to the recent pandemics, modern ventilators can provide more specific, intelligent and differentiated modes, which were not commonly used a few years ago. Most ventilators nowadays are equipped with high-flow oxygen mode, which allows us to therapy target the patient’s condition and significantly improves the long-term outcome.

In order to ensure uninterrupted patient care, we aim to perform flawless air ambulance operations around the world, with highly skilled medical teams and extensive state-of-the-art medical equipment

In acute care settings such as in our business, it is very important to observe a patient via objective numbers. For intubated and mechanically ventilated patients, it is absolutely necessary to receive critical information about the patient’s condition quickly.

Here, blood gas testing devices have shown a huge improvement in accuracy, speed and handling for the user. As standard, we are equipped with portable blood gas analysers; this enables us to rapidly assess the patient with blood test results and adjust the therapy as needed.

Monitors and defibrillation units have definitely improved with additional features such as data management, data transferring online, and analysis, which, for example, allows a whole new dimension of telemedicine.

With the recent pandemics, isolation units have shown a positive development regarding patient comfort, handling and safety.

Ultrasonography devices have developed tremendously. With sharp detection and analysis of the different tissues, they allow detailed diagnostics of organ (mal-) functions and, consequently, intervention. With this development, portable ultrasound systems are nowadays commonly used in both ground and air ambulance business. The newest generation of the portable devices are nearly pocket-size, yet deliver the highest quality pictures – an enormous benefit for both the medical team and the patient.

Capital Air Ambulance – Dr Rowan Hardy, Medical Director, talks us through the medical equipment that is improving patient care

The video laryngoscope

This is a device to aid endotracheal intubation, improving the grade of intubation view and therefore ease of intubation, compared with a conventional laryngoscope. In cases of difficult intubation, a video laryngoscope can be hugely beneficial, with great benefits to patient safety. In the UK the availability of this device is becoming mandatory and a few hospitals are now using them for all intubations. Portable devices mean that this improvement in patient safety can also be realised during a patient transfer, including by air ambulance. At Capital we use the C-MAC PM (Pocket Monitor) on all ventilated cases.

Portable ultrasound machine

In hospital, ultrasound machines are increasingly used to allow doctors to perform nerve blocks to manage pain, including in the trauma and elective surgical settings. Small, portable devices are great for the transfer setting and we take ours (a Butterfly ultrasound machine) on missions for cases such as hip fractures, where improving analgesia for transfer is extremely important.

In cases of difficult intubation, a video laryngoscope can be hugely beneficial, with great benefits to patient safety

Transfer ventilators

Modern transport ventilators (such as the Hamilton-T1) are increasingly sophisticated and capable. These robust little ventilators can provide a variety of modes of ventilation, to match the performance of larger devices found on ICU. This means that they can reliably be used to transport patients (adults and children) with significant lung injury, with a reduced risk of deterioration en route. They are extremely robust and well designed for the challenges of travel by road and air. Although complex, they are easy to use and popular amongst our medical teams, especially as they are increasingly familiar in local NHS [UK National Health Service] hospitals as well.

We asked LifeFlight about tailoring equipment, retaining staff, and the best new flight tech

Every air ambulance mission requires a different set of skills and equipment. How do you tailor the equipment on each mission to each patient? 

LifeFlight is home to some of the most advanced and specialised medical equipment in the world. Our Challenger 604 aircraft and fleet of rotary wing assets are outfitted with comprehensive medical equipment that closely mirrors the capabilities of a tertiary hospital intensive care unit (ICU). This enables the delivery of superior medical care and support in-flight. Having operated in the aeromedical field for 45 years, our crews know what’s critical for mission success and flexibly adapt the aircraft configuration and equipment to suit each patient, according to the severity and complexity of their condition.

While the prime mission is high acuity medical evacuation services, our highly flexible platforms are readily adapted for other uses. LifeFlight provides multiple configurations for different medical scenarios, including extracorporeal membrane oxygenation (ECMO), bariatric, isolation units, NICU/neonatal, PICU/paediatric, and organ transplant transportation services.

Striking the right balance between aviation and medical requirements for each mission means our Challenger 604 aircraft can be configured accordingly and airborne within 90 minutes of receiving the call. 

Equipment is now lighter, smaller and smarter. How much has this helped with saving the lives of patients in such dangerous situations?

Advancements in medical equipment enable LifeFlight to carry specialised equipment onboard without increasing the current medical space’s footprint or impacting the aircraft’s fuel consumption and weight limits. Combined with LifeFlight’s team of specialist physicians, the reduction in equipment size and increase in capability ensures crews are fully self-sufficient on most missions. Over the years, LifeFlight has witnessed significant changes in aircraft configurations. This is particularly important when tasked to regions where there are no major hospitals.

With the ever-changing landscape of aeromedicine, we are always looking at ways to improve patient outcomes. Most recently, we focused on maximising the space in the cabin, giving clinical crews an optimised space to access the patient and to accommodate equipment. In turn, our specialist physicians are able to perform tertiary level care in a pre-hospital setting.

The industry is struggling to retain qualified and skilled staff. How is LifeFlight coping with this and what are you doing to stall or reverse the situation?

As a world-leader in aeromedical care and a globally-recognised Training Academy, we are committed to providing the very best training to our staff and up-skilling our greatest asset – our people. We are fortunate to train more than 1,500 aviation and medical professionals annually.

Employing more than 180 medical professionals, LifeFlight is the largest employer of pre-hospital retrieval medicine (PHRM) specialists, registrars, flight nurses and flight paramedics in Australia.

We are committed to promoting continuous learning by offering training and development opportunities to expand the skills across LifeFlight’s advanced fleet of fixed wing and helicopter emergency medical services – what we learn in the field one week, we teach the next.

LifeFlight employs some of the most experienced pre-hospital and retrieval medicine physicians, and twice a year we welcome 31 new registrars from around the globe to partake in our six- to 12-month specialist medical training. They learn from the best and the weather in Australia and Singapore is also a drawcard.

What are your top five vital pieces of equipment? 

Hamilton ventilator: A transport ventilator that can be used on a range of patients from neonates to large adults for invasive ventilation, BIPAP and high flow nasal oxygen.

Zoll monitor/defibrillator: Enables accurate monitoring of pulse, blood pressure, ECG and saturations.

Phillips Lumify Ultrasound: Allows point of care, high quality ultrasound images as well as allowing the doctors to accurately place invasive lines.

Spectrum dual stretcher in each aircraft: An extremely versatile stretcher, specifically made for fixed and rotary wing aeromedical evacuation. It can be configured to carry adults, children and infant transport decks.

Patient loading system: Reduces the need for paramedics and crew to do the manual lifting. This innovative technology, designed and manufactured by LifeFlight, is capable of loading and unloading patients of up to 220kgs and has proved invaluable in reducing mission times and improving crew safety.