View
213
Download
0
Category
Tags:
Preview:
Citation preview
I n t e g r i t y - S e r v i c e - E x c e l l e n c eThe Center for Sustainment of Trauma
and Readiness Skills Cincinnati
Division of Trauma and Critical Care
Department of Surgery
The University Hospital of Cincinnati
Cincinnati, Ohio
AE OVERVIEW
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Overview
Traditional AE aircraftNon-traditional AE aircraft
Capabilities Safety features and in-flight emergency
information
Ground operationsCrew Coordination
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
C-130
• Oxygen • No onboard therapeutic
oxygen for pt use• Portable Therapeutic
Liquid Oxygen (PTLOX)
• Communication system• Loud aircraft• Communicate through
MCD/loadmaster
• Electrical Systems• Seven 28VDC• Three 115 VAC@ 400Hz• Required use of
Frequency Converter and ECAS System
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
C-130
• How do you load the patient?• Cargo ramp (feet first)
• How many patients can I put onboard?• 70-74 litter patients• 92 ambulatory patients in evans seats• Maximum of 15 floor loaded patients
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
C-130C-130Emergency Exits Emergency Exits
Primary Ground Exits• Crew Entrance Door• Paratroop Doors
Secondary Exits• Pilot/Copilot Clear view
Windows• Side Escape Hatch – Avoid
Fish, Fan, Flame• Ramp - only if open and
unobstructed
Primary Ditching Exits• Fwrd Overhead Escape Hatch • Cntr Overhead Escape Hatch
Aft Overhead Escape Hatch
Chopping Locations• Have no hydraulics, electrical,
or oxygen lines in these areas• Chop in and inverted U
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
= Only if opened and unobstructed
=Ditching Evacuation
=Secondary Exits
=Secondary for Ground and Ditching
=Ground Evacuation
I n t e g r i t y - S e r v i c e - E x c e l l e n c e 7
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
C-17
• Stand-alone capabilities = 9 Litters (in 3 stanchions)• Patient Support Pallet (PSP) expands litter capabilities • Floor Load
• 48 Litters in cargo compartment • Additional 12 litters can be floor loaded on ramp
• 102 Seats for Ambulatory and AECMs• Loading/unloading
• Ambulatory: crew entrance door• Litters: cargo ramp (feet first)
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
C-17AIRCRAFT SYSTEMS
Oxygen• Two 75-liter LOX Converters on
board• Minimum 100 L before leaving
home stationo Therapeutic Oxygen
5 outlets all located on the right side
o Emergency Oxygen Dixie-cup diluter mask pull lanyard to start flow available at each potential
litter space on stanchions 60 masks on sidewall additional 48 for
centerline seats if/when installed
Electrical• frequency converter is NOT
required• twelve 115VAC 60hz outlets on 6
panels– 3 located on each side (forward, mid-
cabin, aft)
• twelve 28V DC plugs– No PMI application
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
C-17AIRCRAFT SYSTEMS
• Lighting• Controlled by
loadmaster (LM)• On/Off/Dim
• Communication• Controlled by LM• All briefings done by
LM
• Environmental• Heating/cooling
controlled by LM
• Comfort Items• Crew Lavatory
o Forward Left side of AC
• Galleyo Forward Sectiono Convection Oveno Refrigerator / Freezer
• May have Comfort Pallet
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
• Emergency Exits (12)• Flight Deck:
o Pilot/co-pilot sliding windowso Maintenance/ditching hatch
• Cargo Compartment:o Crew entrance dooro Forward emergency escape
dooro Four overhead ditching
hatches Flotation Equipment
Deployment System (FEDS)
o 2 troop doors (rt/lt aft aircraft)o Cargo dooro Chopping locations (4)
C-17EMERGENCY INFORMATION
I n t e g r i t y - S e r v i c e - E x c e l l e n c e 12
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
C-17
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
CCATT In-flight
Evaluate all patients when at altitude
Maintain situational awareness at all times
Utilize critical thinking skills
Utilize closed loop communication
Utilize crew resource management (CRM)
TEAMWORK-TEAMWORK-TEAMWORK!
14
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Non-Traditional AE Aircraft
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
C-21
• Oxygen Capabilities• Portable D-cylinder oxygen tanks• Spectrum Unit has self-contained oxygen 3,500L
• Electrical Capabilities• Equipment battery• Power required:
o 28V DC AC power
• Electrical Output:o #2 115VAC/60hz o total 15 Amps
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
C-21
• Communication Capabilities• Easy (real small aircraft!)
• Loading/unloading• Crew entrance door (only option)• If Spectrum unit is in place, use patient loader
o Aluminum folding ramp that allows you to “slide” patient in
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
EMERGENCY EXITS
• Crew entrance door• 2 over wing exits
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
KC-10
• Oxygen Capabilities• Bring PT LOX
• Electrical Capabilities• Use pigtail of electrical cable assembly system (ECAS)
o Power source: 115vac/400hz
• Frequency converter can be used for 60 Hz equipment o Modified Avionics Freq converter to receptacle #3 on the P22 auxiliary
panel/ galley outleto Total of 15 amps ( 1 amp to drive the unit, 14 amps remaining)
o Equipment On Battery
o PSP adds Litter Capabilities
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
KC-10
• Communication capability• Relatively easy to
communicate with one another• Use boom operator as a
runner/communication between aeromedical crew and flight crew
• Loading/unloading• K-loader• Lift truck• Patient loading system (PLS)
I n t e g r i t y - S e r v i c e - E x c e l l e n c e 21
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
KC-135
• Oxygen capabilities• Bring PT LOX
• PSP adds Litter Capabilities• Electrical capabilities
• Use pigtail of electrical cable assembly system (ECAS)o Power source: 115vac/400hz
• Frequency converter can be used for 60 Hz equipment o Modified Avionics Freq converter to receptacle #3 on the P22 auxiliary
panel/ galley outleto Total of 15 amps (1 amp to drive the unit, 14 amps remaining)
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
KC-135
• Communication capabilities
• Not that great, loud aircraft• Communication between
aeromedical crew and flight crew done through boom operator
• Loading/unloading• K-loader• Lift truck
I n t e g r i t y - S e r v i c e - E x c e l l e n c e 24
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
C-5
• Oxygen capabilities• Bring PT LOX
o Requires extra 300 feet of oxygen hosingo Load may require PT LOX be in cargo compartment and oxygen lines be
strung up to troop compartment• Therapeutic oxygen manifold system (TOMS) may be used from
recharger hose• Portable oxygen cylinders
• Electrical capabilities• Modified Avionic frequency converter for 60 Hz equipment• Secured in the cargo compartment with ECAS to troop or courier
compartment• Arrange with the loadmaster
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
C-5
• Communication Capabilities• Relatively easy to communicate with one another• Communication between flight crew and aeromedical crew
done through loadmaster
• Loading/unloading• K-loader• Lift Truck• Catering Truck • Cargo Ramp (If patient is placed in cargo compartment –
ABSOLUTE LAST RESORT!)
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
CIVIL RESERVE AIR FLEET (CRAF) Boeing -767
US DoD maintains several civilian/commercial airlines with B-767’s that are capable of rapid transformation into AE aircraft
Crew Complement:
• Flight attendants have primary responsibility for:• Egress• Patient briefings• Serve meals
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
CREW COMPLEMENT
• AECMs have responsibility for:• Patient care • Assist with egress/ other emergencies
• 2 AE crews• 2 FN’s/3 AET’s each crew• One forward crew • One aft crew
• CCATT • Augment critical care capabilities as mission
dictates
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
EXITS
• 6 Exits• 2 doors in front of
aircraft• 2 overwing exits• 2 doors in back of
aircraft
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
CRAF Capabilites
• Small-body B-767– Configured to transport 87 litters and
37 seats (includes 2 MCD seats)
• Large–body B-767– Configured to transport 111 liters and
37 seats
• Top litter is about mid-chest• 18 inches between each litter• Aisles are 25 inches wide
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
MEDICAL OXYGEN SUBSYSTEM
• Consists of six 75- liter LOX in forward cargo compartment
(total of 450 liters)
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
MEDICAL OXYGEN SUBSYSTEM
• Therapeutic oxygen outlets located at each potential litter space
Oxygen outlets
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
AIRCRAFT PASSENGER EMERGENCY OXYGEN SYSTEM
• Diluter-type masks from overhead consoles
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
ELECTRICAL POWER DISTRIBUTION SUBSYSTEM
• Subsystem consists of 6 electrical converters• Converts to 115 VAC 60 hz• Supplied to electrical outlets at
each stanchion• Outlets labeled #1, #2, and #3• Power strips not to exceed 20
amps
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
ELECTRICAL POWER DISTRIBUTION SUBSYSTEM
CAUTION
When switching from ground to aircraft power, power may be interrupted
momentarily in any aircraft
Closely monitor all critical equipment
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
LOADING/UNLOADING
High Deck Loading Platform System (HDLPS)• Holds 24 Patients• Patients placed 4-high• Raised/lowered to aircraft
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
High Deck Loading Platform System
37
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
High Deck Loading Platform System
38
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
LOADING/UNLOADING
Patient Loading System (PLS)• 50-foot length ramp • Can be assembled and rolled to
aircraft• Patients enplaned head
first/deplaned feet first• May have 2 units (one forward on
each side of aircraft)• Ground personnel enplane up ramp
and exit out aft stairs
I n t e g r i t y - S e r v i c e - E x c e l l e n c e 40
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
CCATT Onload
41
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
CCATT On-load
Ensure emergency litter is located under most critical patient
Set up airway/Advanced Cardiac Life Support bags
Ensure all medications/blood products are enplaned
Are patients adequately sedated-give boluses prior to take-off
Quickly re-evaluate all patients prior to take-off
42
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
CCATT On-load
Ensure emergency litter is located under most critical patient
Set up airway/Advanced Cardiac Life Support bags
Ensure all medications/blood products are enplaned
Are patients adequately sedated-give boluses prior to take-off
Quickly re-evaluate all patients prior to take-off
43
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Is all equipment secured?
44
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Hang Supplies for Easy Access
45
I n t e g r i t y - S e r v i c e - E x c e l l e n c e 46
I n t e g r i t y - S e r v i c e - E x c e l l e n c e 47
I n t e g r i t y - S e r v i c e - E x c e l l e n c e 48
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Stresses of Flight
G: G-Forces
H: Decreased Humidity
O: Decreased Partial Pressure of Oxygen
S: “Shakes”/Vibration
T: Thermal Changes
B: Barometric Pressure Changes
A: And
N: Noise
• All of the stresses of flight result in fatigue for both you and your patient
50
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
CCATT Preflight/Packaging
Preflight: CCAT team reviews Patient Movement Request, discusses pt needs and anticipates needs for flight-GAME PLAN!
Pre-Hospital: Have someone designated to do specific jobsDetermine patient load plan
Oxygen calculations/electrical requirement
Extra equipment/supplies neededVacuum Spine Board
Extra IV Pumps
Extra ventilator circuits and batteries
Sign out narcotics
51
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
CCATT In-flight
Evaluate all patients when at altitude
Maintain situational awareness at all times
Utilize critical thinking skills
Utilize closed loop communication
Utilize crew resource management (CRM)
TEAMWORK-TEAMWORK-TEAMWORK!
52
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
CCATT Post-Flight
Patient off-load is a critical phase of the missionCCATT crews are tired and have high risk factors for making a
mistake
Transportation from aircraft to the hospital is on a bus without electrical capability
Perform team huddle to discuss off-load game plan
Provide a thorough hand-off to accepting team
Perform a debrief with your team: strengths, weaknesses of mission and areas of improvement
53
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
SAFETY CONCERNS
• Secure loose bags/gear before take off
• No gloves when handling oxygen
• Avoid patient care activity during take off/landing• Alert AE if you need to stand during these times
• If pt is unstable, you can be secured to the pt litter while standing
• When 3 patients are transported per litter tower, each litter position is rated to hold 320 lbs• Considerations with OSL (Over-Size Litter)• OSL can be tier loaded but consider floor loading
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
SAFETY CONCERNS
• Airframe• Do not open crew entrance door on C-17 unless gauge
on door is in the “green”
• Patient• Do we have to remove all the rollers in the cargo
compartment?
• Crew/CCATT• What is our role during an aircraft emergency?
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Questions?
Recommended