Essential kit for medics

The charity’s three aircraft each carry a crew comprising pilot and two paramedics or flight doctors, plus full life-support medical equipment. Operating from strategically located regional airbases, 90 per cent of the region is within reach within eight minutes.

Ian Jones, Critical Care Paramedic 

“My favourite piece of kit is the aircraft itself. Without the helicopter, we wouldn’t be able to reach some of the most critically ill patients and offer advanced clinical intervention within minutes of the time of their incident.

“After that, my next favourite kit is the critical care drugs pack. This is a small bag of pharmaceuticals, which significantly changes pre-hospital care. Basically, it contains anaesthetics, which in small doses give pain relief, medium doses provide sedation and in large doses mean full anaesthesia. In addition, we carry sedatives, paralysing agents, inotropes to increase blood pressure by increasing cardiac output, and vasopressors to increase blood pressure by vascular constriction, magnesium and IV antibiotics.

“The presence of these drugs in pre-hospital care enables us to perform a number of procedures alongside a doctor. This includes treating acute pain, sedation of patients when we need to manipulate significantly displaced fractures, or those with agitated head injured patients. We can also sedate and paralyse patients who have suffered an out of hospital cardiac arrest, where we have achieved a return of spontaneous circulation, but with a hypoxic brain.

“These drugs are not used every day, but when they are, they are quite often the difference between life and death and can assist in patients’ overall outcomes.”

Luxembourg Air Rescue, which celebrated its 30th anniversary in 2018, currently has three EMS helicopters in service. While Air Rescue 1 and 2 are operating within the country, Air Rescue 3 is functioning as a cross-country EMS helicopter to provide the adjacent rural region of Rhineland-Palatinate and Saarland (Germany) with a physician staffed EMS-Helicopter.

Dr David Sinclair, Medical Supervisor 

Since Air Rescue 3’s inauguration in 2005 it underwent several changes in configuration. It is used for primary retrieval and secondary transfer missions. Therefore, it holds all necessary medical devices for these missions ready. Some devices, such as the ICU respirator, the monitoring system or the syringe pumps are attached by a quick release function to the cabin. This ensures safe operation in turbulent weather conditions, while at the same time they can be easily removed and taken to the scene on primary rescue missions.

LAR has recently replaced the BREAS LTV1200® ventilator with a Hamilton® T1. This brings great advantages because of the setup and the improved user-friendliness. Patients are monitored with a Corpuls® C3. This monitor also brings several advantages: the parameter box can be detached from the defibrillator/screen unit and carried separately, as the vital signs are transmitted via bluetooth to the unit. Especially when loading/unloading the patient, or extracting the patient from a difficult or constricted environment, it is helpful to have fewer cables. 

All other material we have stored in a modular configured set of backpacks. As German ambulances are DIN standardised, we know exactly what we can find onboard theses ground ambulances, so it seemed quite unnecessary to bring exactly the same items to the patient for missions where an ambulance is already on the scene.

In these cases or in ‘minor’ emergencies, we simply bring the ‘red bag’ (with or without the Corpuls® C3, depending on the presence of an ambulance) to the scene. It contains an IV set, gloves, disinfection and airway sets, including a C-Mac videolaryngoscope (Storz®), surgical and decompression set, intraosseous access kit (ez-io®), diagnostic pocket, stiffneck and AMBU® bag.

For ‘greater’ emergencies or when an ambulance is not on the scene, we take the additional ‘blue bag’ along. This contains a sterile surgical set (including chest tube), suction pump and ventilation kit, monitor and invasive BP set, antidotes and thrombolysis set (Metalyse®).

For paediatric patients, we have the paedia bag, which is configured according to the Broselow® tape. The principle of this is that the measuring tape gives an estimate of the child’s age, size and weight, which provides medical instructions including medication dosages, the size of the equipment that should be used, and the level of shock voltage when using a defibrillator. Each weight group is colour coded and the according devices can be found in a colour corresponding pocket. This immensely reduces stress-related mistakes. 

The final backpack is the trauma bag, which contains all necessary equipment needed to treat major trauma or bleeding, such as: amputation set, burn set, bleeding control kit (e.g. tranexamic acid, pelvic sling, CELOX® gauze, Israeli bandage, tourniquet) and a broad variety of sterile gauze and bandages.

LAR has recently invested in the medical equipment for their helicopters and fixed-wing aircraft. They are all now equipped with a high-end video laryngoscope to manage difficult airway situations, an ultrasound device (Lumify, Phillips®) for EFAST protocol examinations, and last but not least, the new Corpuls CPR® device, which allows non-stop chest compressions even in the constricted environment of a helicopter. This makes sense as we have co-operation agreements with Level One hospitals, which have established special eCPR procedure, to treat patients with cardiac arrest delivered with CPR devices (special and limited indication).
The Air Rescue 1 and 2 helicopters are configured slightly differently, as all physician staffed EMS vehicles must be arranged the same way in Luxembourg. The fixed-wing aircraft have a similar modular system, adapted to fixed-wing missions.

Pinpointing my favoured ‘kit’ is a tough question, as this obviously depends on the matter of the emergency. However I am extremely happy that due to the Corpuls CPR, we now have the possibility of transporting patients with persistent ventricular fibrillation to a cardiac centre under continuous CPR.
Furthermore, the videolaryngoscope makes intubation in the constricted environment of a Lear Jet or helicopter so much easier and safer for the patient.

HAA is a non-profit organisation dedicated to providing emergency helicopter services to the people of Haiti. It operates two Bell 407 medical helicopters leased from Air Methods Corporation.

Stacy Wolf, Current Board Member and former flight paramedic in Haiti

In Haiti, we carried a general medical equipment list similar to any other North American air medical aircraft to include all the necessary medications, 2 IV pumps, a full functioning monitor, and ventilator.  We carry a few items not commonly found on the majority of aircraft; due to the austere environment and scarcity of certain types of rescue or medical equipment on the ground in a developing nation such as Haiti.  For example, we carried a bone saw kit onboard due to the chance we may respond to an entrapped patient and there was no availability of Fire Department's hydraulic rescue tools like we might have in America. We carried other items like chest tubes as well, as sometimes we had to provide more definitive treatment out in the field prior to transporting the patient.
 

The two most important and very different items we carried were our survival kit and our start stick battery pack in order to jump start the aircraft if necessary. Our survival kit is made up of many extra items due to the remoteness of the countryside we were flying over. We carried extra water, food, and camping materials if possible. Our kit was at least twice as robust as most helicopter services in America. 

Based in Nuremburg, Germany, FAI operates a fleet of 10 dedicated intensive care air ambulance jets. Its group fleet of 26 jet aircraft and one turboprop includes seven Bombardier Global Express, five Bombardier Challenger 604s, one Challenger 850, 11 Learjet 60 series, plus one Premier 1A and one King Air 350.

Dr István Lunczer

Since our mission profile is so vastly different, which means we need very different kit for the individual cases, I can't really choose the ‘most essential’ piece of equipment that we carry in general. Instead, I would rather choose the one I consider to be the best of our stuff, which is undoubtedly our transport ventilator (Hamilton T1). The reason I’m saying this is because this ventilator has been designed from scratch to be used in transport – it is not simply a miniaturised hospital ventilator. The main features that are very useful for us (besides the broad spectrum of ventilation modes, including intelligent ventilation, of course), are the built-in turbine, and the long lasting, hot-swappable battery, which guarantee a long lasting, autonomous use.Furthermore, it features a low-pressure oxygen connector, which could potentially tackle all the compatibility issues of the different oxygen connections worldwide. All in all, in my opinion, this is the best piece of equipment that we carry.

Simon Schloth, Paramedic 

In my opinion the best and most valuable piece of equipment we carry is our ventilator, the Hamilton T1.
Very easy to use, operating with turbine so no external oxygen is necessary at room air. Also, it is worth noting its durability, long-lasting battery and convenient ventilation modes like ASV.But probably for me, the most essential piece of kit we carry is a high-performing monitor like our Zoll X, because even non-ventilated patients can be monitored neatly. It is mandatory to have an overview on the patient including all vital signs. Not just saturation and ECG, but invasive blood pressure and CO2 as well. Only by using these tools in this way are we able to intervene immediately in critical situations.

Michael Trautner, Flight Nurse

For me, the most essential piece of kit is the Hamilton T1 Ventilator. With it and the neonate software and the special ventilating tubes, we are able to ventilate all kind of patients, from adults to extremely small paediatric and neonatal patients. Furthermore, the battery capacity is big enough to last for several hours without any external power supply, so lengthy ground transports are not a problem.

However, for me, it is not just the ventilator – in fact, my favourite piece of kit is a very small, but essential, part of it: a low-pressure adapter. Normally to operate a ventilator, we have to use low-pressure oxygen from specific bottles, and all around the world, there are different adapters for these bottles that enable the flow of pressured oxygen to the ventilator. Carrying dozens of different adapters on the plane isn’t sensible, but with this specific piece of kit, the T1 is able to work without pressured oxygen. All we have to do is plug this low-pressure adapter into the T1, connect a regular oxygen line to it, press some buttons to switch it into low-pressure mode, and voila, the Hamilton is able to continue its work.

I carry one of these with me on all my missions – in fact, it’s attached to my crew ID so I can’t lose it!

Air Evac Lifeteam is the largest independently owned and operated membership-supported air ambulance service in the US.

Jon Fannin, flight paramedic/Base Clinical Lead at the company’s West Liberty, KY air medical base

It's difficult to say I have a ‘go-to’ piece of equipment I use in every situation, but if I had to pick a favourite piece of equipment it would be one of our newest tools – the IntuBrite. Even more than the tool, I like the teamwork it promotes because everyone involved in the patient's care at that point can visualise the intubation process.

As far as my favourite or most useful piece of equipment? Most flight crew members would say the most important piece of kit they carry are the snacks in their flight suit pockets for those times you are out all day without the ability to eat. I tend to agree, but if I’m looking at the overall picture, I would say that operationally the most important part of equipment would be the survival kit due to the reassurance it would provide me flying over the terrain and areas Haiti offered. Medically, I really relied on our monitors as sometimes we were helping patients that might've been sick for days but had never had a good look at vital signs or any other information the monitor would provide answers to. They gave me a great picture of what had been going on prior to our arrival and what to expect through the transport. Along with the monitor, and my EMT translator partner on board, I could learn what was going on both outside and inside in very short order!