Case Studies

Stories from the Street: Keeping our Patients Safe
Lee Varner, MSEMS, CPPS, EMT-P, Center for Patient Safety

In the past few years great strides have been made in EMS with innovative delivery systems, new treatment modalities and a focus on data.  But at the same time clinical mistakes continue to reach patients either directly or indirectly from the care that’s being provided.  The Center for Patient Safety is non profit organization and a federally listed Patient Safety Organization which collects data around adverse events, near misses and unsafe conditions.  This session will present 4 EMS cases where harm reached a patient and will ask the following questions: What happened? Why did it happen? What can we do to prevent it in the future? Each case will be a retrospective review with key findings from the root cause analysis with an additional goal of understanding if the event outcome was a process failure or behavioral choice of the provider.  Resources and basic strategies to prevent future events will be shared during the presentation.

An Industrial Auger, Traumatic Amputations, Tourniquets and Chaos – A Patient’s Perspective When the Unthinkable Happens
Janie Kofford-Ford, RN, CFRN, MS, MSN, AGACNP-CB; Randy Scott, BS, FP-C, University of Utah AirMed

The notion that we had “been there, done that and seen it all”  was challenged when we responded to the scene of a meat rendering plant where a 32 year old patient slipped and fell into an auger literally ripping both his legs off above his knees.  After miraculously overcoming the sucking force of the industrial auger, he lifted his upper body out and miraculously had the  strength to straddle supporting beams preventing his entire body from being pulled into the auger.  This was just the beginning of his struggle to survive.  With unbelievable presence of mind, he  placed his belt above one of the stumps and maneuvered over a large pipe.  His continual cries for help were eventually heard by a  co-worker who placed a second belt over the other stump.  This complex call will be reviewed including the integral role that dispatch, rural EMS, the flight crew and receiving hospital all played in these life saving efforts. Options for pain management in the hypotensive trauma patient as well as the latest literature on tourniquets and pre-hospital care of traumatic amputations will be reviewed.  Both the immediate and long term effects of traumatic amputation will be discussed from the patient’s perspective as well as supporting evidence of the long term sequela on victims.  Participants will benefit from lessons learned by listening to the patient’s candid and raw description and the impact of these life altering events on him and his family.  What you hear and see will prove both thought provoking and  inspirational.

Hurricane Michael: Remote Coordination of a Disaster Response
Michael Wargo, RN, BSN, MBA, PHRN, CMTE, HCA Mission Health; Joseph Hill, RN, BSN, CFRN, CMTE; Marty Delaney, EMT-P, MBA; Brandon Thomas, EMT-P, CPA, Air Methods Corporation

Hurricane Michael was the third most intense Atlantic hurricane to make landfall in the United States.  It arrived at Mexico Beach, Florida as a Category 4 on October 10th and continued a destructive path while enroute to the coast of Georgia.  Gulf Coast Regional Medical Center was near the direct impact zone of the hurricane and required both pre-emptive and post land fall evacuation of patients from the facility as well as ongoing planning to address the health needs of the area.

When the Patient Took too Many “Blue” Pills: Toxicology Emergencies
Christian Grant, BS, NRP, C-NPT; Jennifer Vieira, CEN, CCRN, CFRN, CNRN, EMT-B, Boston MedFlight

This lecture is to discuss four different toxicology emergencies in a case study format.  Speakers will present four cases and review immediate interventions required as well as assessment skills to rapidly move forward with being able to reverse or eliminate agent in order to stabilize.  Speakers will review imaging, lab values, interventions to eliminate the suspected toxin, airway management, medication administration, as well as EKG and hemodynamic stabilization.  Speakers will also discuss use of consults such as toxicology, cardiology, and the use Poison Control Center. Speakers will discuss briefly on each topic as follows Serotonin Syndrome, OD using Beta-Blockers/Calcium Channel Blockers, Anticholinergic Syndrome, ASA, amphetamines, TCDs, and cocaine. The talk is given with the intent to give listeners better skills and awareness in recognizing a possible OD to prescription and non-prescription medications.

Blood In The Head From The Other Side Of The Bed: A Story About The Worst Headache Of My Life
Zachary Roper, RN, CCRN, NR-P, FP-C, St. Luke’s University Health Network

This session begins with a review of neurological anatomy and physiology, transitions into the pathophysiology of arteriovenous malformations and intracranial hemorrhage, and finishes with a case study about a Flight Paramedic turned Neurological ICU Nurse who became a patient in the ICU that he worked in secondary to an AVM rupture. CT scans, MRI’s, Angiograms , and applicable practice pearls will be included in the session.

Stories from Florence: Are You Personally Ready to Work a Major Disaster?
Sara Thomas, CEN, EMT, RN; Bethany Hart, EMT-P, CCEMTP, NHRMC AirLink/VitaLink Critical Care Transport

Hurricane Florence made landfall September 13, 2018 at Wrightsville beach only 8 miles from our major medical center.  Causing over 18 billion dollars of damage to our region and cutting off the greater Wilmington area from the rest of the state for days with flood waters.  How would knowing that you were reporting for a life changing storm affect you as a provider?  Stories from the storm looks from the view point of providers from NHRMC’s AirLink/ VitaLink program as they experienced “The storm of a lifetime.”  Are you prepared to provide care with few resources and intense emotional stress?

Air Medical Transport in Recent Natural Disasters
Justin Fairless, DO, NRP, FACEP, University of Texas Southwestern Medical Center

Review of Air Medical Transport (rotor wing and fixed wing) during recent United States Natural Disasters.  Concepts of integration of private air ambulance services, local and state governmental agencies, and federal agencies will be discussed.  Examples of response to recent disasters, including Hurricane Harvey (2017) and Hurricane Michael (2018) as well as the Camp Fire (2018) will be discussed.  Future expansion to include a more organized approach to disaster preparedness and response will be included in the discussion.  National Guard, State Guard, FEMA / DHS, NDMS HHS, as well as Local and State Fire/EMS/Law Enforcement integration with public and private air medical transport agencies will require a coordinated effort to improve patient movement before, during, and after widespread national disasters in the United States.

Impella in Flight: Postpartum Case Study
Cathleen Vandenbraak, BSN, MBA/MHA, CEN, CCRN, CFRN; Alex Shehu,AAS, NRP, CCEMTP, FP-C, JeffSTAT

Impella transports are a recent addition to the critical care transport field in our region. In the last several years JeffSTAT has transported many patients with an Impella device in place. One recent case was a postpartum patient home just a few days with her newborn. This case study will review the initial care at the referring facility and follow through the care in flight. In hospital and transition out of hospital care will conclude the presentation.

Over-Triage of Critical Care Transport Helicopters: A Failure Mode and Effects Analysis
Robert Grabwoski, DNP, APRN-CNP, AGACNP-BC, CPNP-AC, CEN, CFRN, CCRN, CMTE, EMT-P, Metro Life Flight

Over-triage is a problem many critical care transport programs must deal with. This Failure Mode and Effects Analysis, a quality improvement study, investigated the human-systems factors influencing inter-facility helicopter over-triage, and their downstream effects. During this session, we will discuss how this QI study was performed, what factors were found to be the leading influencers to over-triage, and what downstream institutional, administrative, and other effects were discovered.