Life Flight helicopter rescue team readies to expect the unexpected

Courtesy of SHC Life-Flight program

Life Flight does about 600 transports annually, with 60 percent transfers from local hospitals; the others are “scene calls,” responding to 911 calls from nine counties.

Kneeling on the ground in a red jumpsuit, Stanford Hospital nurse Susan Kimura, RN, pressed her fingertips firmly on the elderly patient’s throat. He was unresponsive after hitting his head in a fall, and Kimura’s partner, Geralyn Martinez, RN, was preparing to intubate him to help his breathing.

Kimura and Martinez had administered drugs to relax and sedate the patient, and Kimura continued to apply pressure to the throat, trying to ease the patient’s vocal cords into a position where Martinez could get a better view of his trachea. But it was impossible to get the endotracheal tube past the patient’s enlarged tongue.

So the two nurses switched to Plan B, digging into their airway bag for an alternative rescue airway. With one smooth, practiced movement, Martinez slipped a rubber device known as an intubating laryngeal mask airway into the patient’s throat. Suddenly, everyone—from the nurses on the simulated scene call, to the doctors at the control switches—began to breathe easier.

“When you swell the mannequin’s tongue, it’s really difficult to intubate,” Life Flight educator Kathleen Tompkins Bevin said, as she detached sensors from the “patient’s” plastic torso. “But our nurses are pros.”

Twice a year, the nurses who are part of the hospital’s Life Flight helicopter rescue team report to the Center for Immersive and Simulation-based Learning at the School of Medicine for a hands-on refresher in the advanced-skills lab. They work their way through five skills stations, where they practice doing procedures to open emergency airways on pig models, and get the feel of how to treat third-degree burns by making incisions on a block of latex tissue covered with brown suede.

“These are all high-risk skills,” said Bevin, who spent 12 years working on fixed-wing and rotor-wing medical transport planes. “Some of the skills, like the surgical cricothyrotomy (a procedure similar to a tracheotomy), are rarely used—in seven years, I did just one—but when you have to do one, you want to feel comfortable.”

The 14 nurses who crew the familiar red, white and blue Life Flight helicopter “have to have experience in critical care and emergency medicine,” according to chief flight nurse Sonya Ruiz. “They rotate through the adult, pediatric and neonatal ICUs, and also do two cadaver or ‘sim’ labs per year.”

When they’re not airborne, Life Flight nurses respond to trauma codes in the hospital’s Emergency Department and put their skills to use during busy times—say, by placing arterial lines in the intensive care units. Some 60 percent of the 600 transports Life Flight does each year are transfers of patients from local hospitals to Stanford Hospital & Clinics. The remaining 40 percent are “scene calls,” activated by 911 calls, which can come from nine Bay Area counties—involving automobile crashes, bicycle accidents, near drownings.

“By the time Life Flight gets to a scene call, basic initial care has usually been given by paramedics,” Bevin said. “Our nurses provide more advanced care.”

In the scenario that Life Flight nurses Kimura and Martinez recently worked at the simulation center, for example, they had to deal with multiple trauma injuries suffered by a 70-year-old male with diabetes who had taken a nasty fall. “The first priority is always airways,” Kimura said, referring to the “ABCD” (airways, breathing, circulation, deficit) shorthand nurses rely on. So first they intubated the patient.

But when his heart rate continued to increase at the same time that the amount of oxygen in his blood kept dropping, Kimura and Martinez reasoned that his heart was working harder, trying to pump more blood, because of a collapsed lung. “They figured out that they had to do a needle decompression of the chest,” Bevin said. “And that’s the kind of critical-thinking process we’re looking for: ‘We’ve done one intervention, gotten some improvement, but it’s going downhill again, we have no breath sounds in the left lung, so let’s place a needle in the chest to release trapped air.’”

The hand at the switches in the control room of the simulation center—ratcheting up the patient’s heart rate and providing the crackling chest sounds that indicated air was leaking out of his lungs—belonged to Gregg Gilbert, MD, medical director of Life Flight and a clinical assistant professor of emergency medicine. He and associate medical director Tim Angelotti, MD, PhD, associate professor of anesthesia, meet with the nurses every month and monitor changes in procedures and protocols.

For their part, Kimura and Martinez were eager to see a video of their nursing and decision-making skills on the huge plasma screens at the simulation center. The instant replay, Kimura said, is “the biggest bonus of the sim lab.” Martinez, a 19-year veteran of Life Flight, added: “It’s always interesting to see how we did, and what we could have done differently.”

Gilbert had high praise for the pair’s life-saving skills. “We wanted to make the intubation more difficult, so I blew up the patient’s tongue and tried to push you toward using ‘Roc’ (rocuronium, a paralytic drug),” he said. “And you made all the right calls.”

In the hallway outside the simulated landing zone, Bevin made like a helicopter, whirring her finger above her head as she hustled the next pair of nurses into a new scene call. “The scenarios are developing some interesting twists,” she warned. “Just do what you’ve been trained to do.”