Interhospital Transfers

Above Photo: A flight team member manages a labile cardiac patient with an Intra-Aortic Balloon Pump catheter in place. Med FLIGHT utilizes a Datascope System 98 portable IABP unit for these types of interhospital transports.

Albany Med FLIGHT is available for interfacility transports of critically ill patients. The aircraft is equipped with advanced medical monitoring equipment, an extensive pharmacy of medications, and a staff well trained in providing interfacility critical care.

Medical Equipment Includes:
*ECG monitors   *External Cardiac Pacer   *Cardiac Defibrillator   *Pulse Oximeter   *Non-Invasive Blood Pressure Monitor   *Invasive Pressure Transducing Monitor   *End Tidal   CO2 Monitor   *Doppler   *Volume Ventilator   *Infant Transport Isolette with Pressure   Ventilator   *Portable Intra-Aortic Balloon Pump   *IV Fluid Warmer  

On-Board Pharmacy Includes:
Adenosine, Albuterol, Aminophylline, Amiodarone, Anectine, Aspirin, Ativan, Atropine, Calcium Chloride and Gluconate, Cefazolin, Ceftriaxone, Cetacaine, Dextrose 25%, Dextrose 50%, Dilantin, Diphenhydramine, Dobutamine, Dopamine, Epinephrine, Esmolol, Etomidate, Fentanyl, Furosemide, Glucagon, Heparin, Insulin, Labetalol, Lidocaine, Magnesium Sulfate, Mannitol, Methylprednisolone, Metoprolol, Morphine, Naloxone, Nifedipine, Nitroglycerin SL, Nitroglycerin IV, Nitroprusside, Norepinephrine, Oxytocin, Phenobarbital, Potassium Chloride, Procainamide, Promethazine, Racemic Epinephrine, Sodium Bicarbonate, Terbutaline, Tetracaine, Thiamine, Vecuronium, Verapamil, Versed, Xylocaine

Advanced Flight Team Medical Skills
The Albany Med FLIGHT Medical Team is experienced in performing the following advanced skills as well as any skills in regular practice on ground ALS ambulances.
*Rapid Sequence Induction Facilitated Intubation
*Femoral Venous Catheter Insertion
*Pericardiocentesis
*Needle Thoracotomy
*Escharotomy
*Surgical Cricothyroidotomy
*Gastric Tube Insertion
*Blood Product Administration

Guidelines for Use of Air Medical Transport

(As defined by the National Association of EMS Physicians, the Association of Air Medical Services, and the American Academy of Pediatrics)

General Trauma

• Systolic BP less than 90mmHg or requiring aggressive fluid support to maintain above 100mmHg
• Severe hemorrhage
• Sustained tachycardia
• Penetrating trauma to head, neck, or torso
• Age <12 or >55 with multiple trauma
• Burns >20% of body surface area, electrical in origin, or with respiratory involvement

Neurotrauma  

• Glasgow Coma Scale <12
• Lateralizing neurologic findings
• Penetrating or depressed skull fracture
• CT showing subdural or epidural hematoma
• Spinal cord injury or unstable spine fractures

Airway and Thoracic Trauma  

• Airway compromise
• Need for mechanical ventilation
• Substantial chest wall injury
• Evidence of aortic or great vessel injury

Abdominal and Pelvic Trauma  

• Evidence of intra-abdominal trauma such as rigidity, bruising, or a positive diagnostic study
• Grossly bloody urine, stool, or emesis
• Pelvic fracture

Orthopedic  

• Limb amputation
• Contaminated, open long-bone fractures

Medical - Surgical  

• Continuous intravenous vasoactive medications
• Mechanical ventilation
• Unstable airway or potential need for mechanical ventilation enroute
• Acute ischemic event (extremities or intestinal) requiring urgent diagnostic and therapeutic treatment
• Aortic aneurysm, dissection, or rupture
• Significant gastrointestinal hemorrhage
• Unstable poisonings requiring critical care stabilization
• Uncontrolled seizure activity
• Decompression illness requiring hyperbarics
• Time-dependent issues surrounding organ transplant
• Severe hypothermia (<82^oF)

Cardiac  

• Cardiogenic shock
• MI patients with thrombolytic contraindications or who have failed thrombolytics or otherwise determined to be a primary angioplasty candidate
• Patients requiring acute intervention not available at referring institution

Pediatric*

• Patients experiencing or at high-risk for respiratory failure
• Need for invasive airway procedures
• The following unstable vital signs:
  • Respiration rate <10 or >60
  • Systolic blood pressure
    • <60 in neonate
    • <65 between 3 months and 2 years
    • <75 between 2 and 5 years
    • <80 between 6 and 12 years
• Near drowning with signs of hypoxia or altered mental status
• Status epilepticus
• Acute bacterial meningitis
• Unstable toxicological syndrome
• Hypothermia
• Multiple trauma

High-risk Obstetrics  

• Anticipated need for NICU services beyond the capacity of referring institution
• Premature labor or rupture of membranes less than 34 weeks or estimated fetal weight less than 2000g
• Severe pre-eclampsia or eclampsia
• Abruptio placenta or placenta previa
• Fetal hydrops

Neonatal*  

• Respiratory distress/airway obstruction
• Respiratory failure with actual or potential need for mechanical ventilation or CPAP
• Shock/significant acidosis
• Status epilepticus
• Multiple organ system failure
• Need for specialty referrals/evaluations requiring immediate interventions due to life-threatening conditions

*The Albany Med FLIGHT team provides transport of neonates and pediatric medical patients in conjunction with the transport teams of the neonatal and pediatric intensive care units of the Children's Hospital at Albany Medical Center. A Med FLIGHT medical team member assists a neonatal nurse and a respiratory therapist during NICU transport missions. Pediatric medical pateints are serviced by a Med FLIGHT team member working in conjunction with a PICU nurse and a pediatric residency physician.

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