Join Internal Medicine and Rheumatology Specialist Siobhan Deshauer, MD, as she follows a flight paramedic team.
(The following is a transcription. Note that errors are possible.)
Deshauer: Hi guys. I’m Siobhan, a specialist in internal medicine and rheumatology. Today, I join the paramedics who rescue and transport critically ill patients in helicopters.
Engineers: As for planes, November is the plane online, except it’s not online at the moment. It should be ready in about an hour or so.
Deshauer: This morning the helicopter was grounded for maintenance. Engineers tighten the rotor hub, which means they tighten the bolts to secure the blades. I’m not going to lie, loose bolts look terrifying. So I’m not surprised when paramedics tell me that they avoid disrupting or distracting engineers while they’re working.
While we wait, Mike and Evan prepare their medical equipment. Stock up on lifesaving medications as well as strictly regulated pain and sedation medications.
Mike: A bunch of fentanyl, smaller blisters, bigger fentanyl blisters too, and midaz [midazolam, Versed].
Deshauer: All their gear is organized in small portable bags so they can easily take it to the scene of an accident. This is their intubation equipment, which allows them to insert a breathing tube. Recently, they began to transport blood, in order to be able to transfuse trauma patients directly at the scene of an accident.
We just got a call so we’re leaving. Guys, I’ve never been on a helicopter before. I am both excited and very nervous. Oh my God. Notice how it looks like the helicopter blades are moving very slowly. It’s because the blades move so fast that my camera’s shutter speed can’t keep up. Cool, huh? OK. Here we are.
[PILOT OVER RADIO]
Deshauer: I thought I was going to feel pretty nervous, but honestly, I feel pretty comfortable, especially knowing all the layoffs in place. Unlike many helicopters, we have two pilots in case something happens to one of them. And this one has two fully functional motors. Even if one fails completely, everything will be fine. Plus, check out these views of Toronto. It is absolutely unreal.
While we were in the air, I had the opportunity to chat with Mike and Evan about what it’s like to be a paramedic. I learn that there are two main parts to the job. Okay, so you have to see a very wide variety of patients on each of these shifts.
Eva: Yeah. We are sent to care for many of the most seriously ill and injured patients in the province. Because of that kind of selection bias, we see in our huge catchment area a high volume of that kind of weird and wonderful stuff that if you were in a center you might not see very often in your career. It’s like the most exciting 30 minutes of each specialty, each day.
Deshauer: The second part is to keep the patient alive and comfortable.
Mike: My main job is transportation. It’s to get them where they need to be.
Eva: I think one of the challenges we have is just the limited resources we have. Compared to a large trauma team in a level 1 trauma center, we might come up with a stage call for a multi-system trauma patient who might be unresponsive to all kinds of injuries. They might need to have their chest needles done and their pelvis wrapped. They might need reduced fractures. They might need rapid sequence induction of anesthesia and putting them on a ventilator, and sedation analgesia for them. They might also be hypotensive and need blood products and tranexamic acid, calcium – like doing a massive transfusion basically, and that’s just me and Mike.
Deshauer: As we fly, we learn that we are heading towards the scene of a trauma. It looks like a car accident involving a motorcycle, and at this point we are still waiting to hear more about the patient’s condition.
Mike: Lindsay, 799 just to let you know we’re about 6 minutes away from your stage call. We have communication problems here. A patient update?
Dispatch: 799, wait. I’ll see if I can get the crew.
Eva: Let’s go. When we go out, what we’ll usually do is we’ll probably grab the bags to start with. So stick with us, keep your headphones on, stay close, and we’ll take a look. They’ll usually be in the back of a truck by the time we get there, so we’ll jump in the back of a truck.
Mike: Okay, 10-4. Copy, we are cancelled.
Eva: Well, it will happen. It happens all the time. We are cancelled. Sometimes they get there and it’s not as bad as they think. We’re canceled and now they’re asking us to go to another stage call. We’ll check the coordinates to see where he is. We’re gonna get the pilot to…
Dispatch: The coordinates are North 44 27 58.
Mike: Good at DT in a sec here. This call is always November 99.
Dispatch: November 99, go ahead.
Mike: Yeah, the pilot agreed. We will be there in a fortnight.
Dispatch: Well received. I’ll send you the details there.
Deshauer: We are now sent to urgently transfer a patient from a small center to a large hospital. The patient presented with agonizing chest pain and the emergency team found that one arm had blood pressure 100 points higher than the other arm. All in all, this is very concerning for an aortic dissection. The aorta is the largest and most important blood vessel in the body, which connects directly to the heart.
During a dissection, the inner part of the blood vessel wall tears and the force of the blood pumped out of the heart causes it to continue to tear. This can block arteries like the one that supplies blood to the arm and it can cause a big difference in blood pressure between the patient’s two arms. If this is happening, the patient needs emergency treatment. Unfortunately, he is currently in a small center without a CT scan to confirm the diagnosis. In this case, minutes count and transferring him by helicopter rather than driving by ambulance could mean the difference between life and death.
The patient arrives at the meeting place shortly after we land. Mike and Evan get a quick report from the nurse, quickly secure the patient, and within minutes we’re back in the air. They are watching him very closely, hooking him up to a heart monitor, checking his blood pressure and managing his chest pain with a drug called fentanyl.
Canada is a huge country, and a major challenge we face is providing equitable care to people living in rural and remote communities. Organizations like Ornge help bridge this gap by transporting patients to major cities where they can access services. Yet we still have a long way to go before we can really talk about equal health care for all.
Once we get to the bigger hospital, he is immediately transferred to the Cardiac Care Unit for further tests and treatment.
Mike: He said no pain since, but a difference of 100 points between left arm and right arm in blood pressure.
Deshauer: Our work is done here, and now it’s lunch time. As this is Canada, of course, the only restaurants available in the hospital are Tim Hortons. Spending time with the pilots and paramedics is great fun because, as you can imagine, they’ve seen some crazy things and have some amazing stories.
All right, we just took off. We are only a few minutes in the air. And we were heading for a car accident, but it was actually called off. I’m learning that a good number of these traumas are undone along the way, about a third of them, for various reasons.
Mike: Yeah. Seasonal.
Deshauer: Yeah, seasonal reasons. Fair enough.
I think what surprised me the most was the wide scope of practice of these paramedics. I mean, they do everything: intubation, trauma management, pregnancy complications, everything from children to adults. Really, any emergency that might arise, they see it and they carry it and take care of it. I learned that they maintain those skills using very high fidelity simulations, which is so exciting. Anyway, it’s so cool and I’m speechless. I’m so impressed.
The team has just been called to the scene of a trauma. Now unfortunately it’s about a 45 minute flight. And because it’s so hot outside, literally, my weight and that of my backpack are too heavy. They need to conserve as much fuel as possible, so I can’t opt for this one. But we can say goodbye to them, because it has been such an amazing experience.
That’s all for today. Many thanks to Ornge and of course Mike and Evan for taking me with them. I feel like I somehow checked off something on my to-do list that I didn’t even know was there. I learned so much and gained so much respect for the medicine they practice as paramedics. It is truly remarkable.
I hope you enjoyed this video. If you did, be sure to subscribe and that way I’ll see you in the next video. Goodbye.
Siobhan Deshauer, MD, is an internal medicine resident in Toronto. Before medicine, she was a violinist, which is why her YouTube channel is called Violin MD.
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