- Associated Press - Sunday, September 21, 2014

GREENVILLE, Miss. (AP) - A precise, essential choreography, performed in double time, regularly unfolds between Delta Regional Medical Center’s trauma team and the air ambulance crews that transport the hospital’s most critically injured patients when necessary.

Air Evac Lifeteam’s helicopter ambulance flies most of Delta Regional’s trauma patients in need of immediate care that is available only at the state’s lone Level I trauma center, which is at the University of Mississippi Medical Center in Jackson.

At that point, every second counts.

Given that Delta Regional boasts the region’s only Level III trauma center, the vast majority of people seriously injured in the Delta - be it by stroke, vehicle crash, gunshot, horrific accident or any other cause - are rushed to the Greenville hospital’s emergency room, where a team of trauma doctors, nurses and other critical-care personnel works in unison to stabilize the patient.

Most trauma patients can be fully cared for at Delta Regional. Others, however, particularly those with severe brain injuries, must be taken to UMC, as quickly as possible.

That, said Amy Walker, Delta Regional’s chief nursing officer, involves following “a very consistent procedure in stabilizing patients to the best of our capabilities for transfer. “We first make sure the patient’s airway is clear, and that may require intubation” - the insertion of a breathing tube - “and we make certain the patient is hemodynamically stable” - that the trauma victim’s cardiovascular system is functioning well enough to survive the 45-minute trip by helicopter to Jackson - “and that the vital signs are all within normal parameters.

“We may have to ship them on a portable ventilator. One and probably more IVs are inserted, saline and lactated Ringers, maybe vasopressors,” drugs that raise critically low blood pressure.

All of which must be accomplished with one eye on the clock.

“In our case here in the Delta, head traumas are almost always going to require transfer,” she said. “That’s why we’re so fortunate to have Air Evac available. If you’re bleeding in the brain, we can have you out of here in 30 minutes.”

O’Fallon, Missouri-based Air Evac Lifeteam, which was founded in 1985 in the south-central rural Missouri town of West Plains to provide emergency care for its isolated residents, today performs medical helicopter transfers from more than 110 bases in 15 states.

A map on the wall in Air Evac Lifeteam’s office here is augmented by a 150-mile-diameter circle, with Greenville at its center.

“That is our immediate response area,” said Lee Williams, Air Evac Lifeteam’s program director for the Greenville base, which is served by four three-member crews, each comprising a flight nurse, a paramedic and a pilot.

Air Evac Lifeteam’s Greenville base is near the Hodding Carter Memorial YMCA and includes a hangar, crew quarters and a fuel farm.

Recently, however, mold was discovered in the crew quarters, and they have since moved to the Lighthouse Lodge on the Delta Regional Medical Center campus.

The helicopter, for the most part, sits during the day on the hospital’s helipad. It is returned to the base at night, however, after a vandal threw a rock through its windshield, causing more than $1,000 damage and - worse - putting the aircraft out of service until repairs could be made the next day.

Negotiations are underway between Air Evac and Delta Regional about permanently basing the helicopter at the hospital, which would entail building a hangar to protect it.

“They’re a great partner,” said Delta Regional’s Chief Executive Officer Scott Christensen. “They need us, and we need them. It would be great to have them here at the hospital.”

Even with the helicopter at its base, which is little more than a mile south of the hospital on Martin Luther King Boulevard, “they’re at our facility in a matter of minutes when we need them,” said Delta Regional’s trauma program coordinator, Amy Holmes, who also is a registered nurse.

And, as soon as the helicopter arrives, “we meet them at the helipad with a gurney.”

The Air Evac crew, with a practiced synchronicity, removes its on-board stretcher, places it on the gurney and hustles into the emergency room where the trauma victim has been stabilized for flight.

A patient being transferred from Delta Regional’s ER to the Air Evac helicopter typically has been hooked up to IVs that move various medicines into their bloodstream. Many also are being mechanically assisted to breathe.

Once the stretcher is aboard the helicopter and locked down, “we may have to hook up a pump and/or a ventilator, and then, typically, we’re airborne in just a couple of minutes,” said Air Evac flight nurse Nathan Gladden, 33, who is both a certified emergency nurse and emergency medical technician.

The most frequent conditions requiring transfer, said Holmes, are neurological injury and pediatric and adult multi-system trauma, in that order.

The latter injuries, to children and adults alike, tend to spike in the summer.

“The worse months are June, July and August,” she said. “You have more people out on ATVs and more people riding motorcycles and more people are out of school.”

In an average month, 30 to 40 people arrive at Delta Regional’s emergency room who meet the specific definition of a trauma patient; the vast majority are successfully treated there. The others, typically, are flown to Jackson.

Vehicle crashes result in a significant number of trauma cases - and therein lies a frightening irony.

“You don’t want to be in a bad car wreck when it’s raining, and when do people tend most to have bad car wrecks?” Walker said. “When it’s raining.”

That, too, is when a medical-transport helicopter often is grounded.

The medical community has coined the term “Golden Hour,” during which the initiation of treatment can greatly enhance the odds of recovery from stroke, heart attacks and other traumas, including neurological injuries, which often accompany severe vehicle crashes.

Yet, it does neither patient nor flight crew any good to risk flying in adverse conditions.

Safety, Air Evac’s Williams said, “is what we live by.”


Information from: Delta Democrat-Times, https://www.ddtonline.com

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