I have been working on SOP for our airport and have met some resistence to change. Being somewhat new to ARFF (Aircraft Rescue / Firefighting) but 34 yrs in fire, I am still abit in the ozone on just how things should work here. I do feel strongly about the following issue and would like feedback. I recently witnessesed what I feel is sub standard patient care when a patient was made to walk down the stairs attached to a regional jet then put on a gurney. This was an in-flight EMS with a 94 yr old male who fell and sustained a head injury. Rather than have the jet connect to the jetway allowing EMS to access with the gurney at cabin floor level, the jet parked short of the jetway and the patient was assisted by EMS as he walked down the aircraft steps onto the concrete apron in 95 deg weather. In my opinion, the jetway should have been connected allowing easy and more direct transport of the pt to the gurney in an air conditioned atmosphere.
patient to gurney
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I'm missing the point of this post.
If the guy could walk and wanted to walk, why not let him walk? I can't imagine trying to maneuver a gurney inside an airplane, that'd be a tight squeeze.
If the guy could walk and wanted to walk, why not let him walk? I can't imagine trying to maneuver a gurney inside an airplane, that'd be a tight squeeze.
DrankTheKoolaid
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If full Spinal Precautions were ruled out, I can only guess they were and his legs are not broke then why would you do anything but walk him out?
Ideally using the ramp and a wheelchair would have been more appropriate, but in this case assisting the patient down the stairs seems appropriate
Ideally using the ramp and a wheelchair would have been more appropriate, but in this case assisting the patient down the stairs seems appropriate
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Let me make a simple comparison. If you had the same patient in a house, would it be considered good practice to require the patient to walk outside to the gurney or would it not be best to secure the pt inside the house (airport terminal jetway) then wheel the pt to the awaiting amb? By the way, a backboard fits in a regional jet aisle fairly easily.
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DrankTheKoolaid
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re
House, absolutely he would go out by gurney.
The best choice to this is without a doubt, park the plane where it connects to the terminal and take him out by stretcher.
But in the absence of that, assisting him if he is able to walk is also an acceptable substitute. What do you think is going to happen to him in the ED, especially if this is a well kept mobile elderly male. They are going to walk him to Xray, unless the ED is flooded with available tech's to wheelchair him there
House, absolutely he would go out by gurney.
The best choice to this is without a doubt, park the plane where it connects to the terminal and take him out by stretcher.
But in the absence of that, assisting him if he is able to walk is also an acceptable substitute. What do you think is going to happen to him in the ED, especially if this is a well kept mobile elderly male. They are going to walk him to Xray, unless the ED is flooded with available tech's to wheelchair him there
EpiEMS
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If he can't walk or is unwilling to walk:
House --> possibly to a board --> gurney --> ambulance.
Airplane --> board --> gurney.
At 94, I'd get him on a wheelchair or gurney if necessary. Perhaps a stair chair?
House --> possibly to a board --> gurney --> ambulance.
Airplane --> board --> gurney.
At 94, I'd get him on a wheelchair or gurney if necessary. Perhaps a stair chair?
nocoderob
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With the limited info given, I would not have walked him. I base this on the fact that he is being flown due to his head injury. That in of itself would lead me to believe it is of a fairly serious nature. That said, if you saw him walk with a steady gait, then there did not seem to be an issue with it.
Aidey
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It might fit in the isle, but it is a pain in the farking arse to get around the corner to get it out the forward door.
We likely would have used one of the small isle wheelchairs to remove him.
Often we are unable to get the gurney into a private residence, so depending on space constraints he probably would have walked from where ever he was sitting to the gurney outside.
Aidey
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The way I read it was that it was a commercial flight during which the patient fell and hit his head.
JPINFV
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As another alternative, is there any chance you can use a scissor lift like the Skychef vehicles to get the gurney to the plane?
nocoderob
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After reading your post, I re-read the OP and think you are correct. In that situation, no way am I walking him. Stair chair is just the ticket here.
Yes it was a commercial flight and he was injured while accessing the restroom. I will do more research on the availability of stair chair or narrow wheelchair. Possible the airline or airport may have these available or would be willing to provide. I don't agree with walking an elderly fall pt down several steps into a hostile environment then putting pt on gurney if there is a better option. If there were no acceptable alternative, then so be it. As I said in the original post, working in and around aircraft is new to me so I'm looking for feedback before meeting with airline and airport operations people. I do appreciate all opinions and for taking the time to reply.
Aidey
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I'm pretty sure all airlines are required to have them per the ADA.
It has also occurred to me that doing it the way described bypasses airport security. Believe it or not, if we go into the terminal the TSA will run our bags through the scanner. Plus it is faster than having to drag the gurney through the airport.
It has also occurred to me that doing it the way described bypasses airport security. Believe it or not, if we go into the terminal the TSA will run our bags through the scanner. Plus it is faster than having to drag the gurney through the airport.
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You guys must work in some really nice areas, it's pretty rare that we can get a gurney all the way to the patient's side in many of the houses/apartments here.
Like others posted a wheelchair is the best option, however I've met plenty of crotchety old people that fall and have "head injuries" and refuse to be carried out of their home. If he's A&O and wants to walk that's his choice. Does he have a lac/abrasion on his head or are we talking depressed skull fracture or a fall causing a +LOC? There's a wide range of injuries that people describe as head injuries. Technically when I stood up and knocked my head on the speaker on the tower of my friend's boat the other day I sustained a "head injury". What exactly was wrong with this guy? Is he on blood thinners? Showing CVA type symptoms? Altered? Dizzy/lightheaded? Raccoon eyes or Battle's sign? We can't monday morning quarterback the crew's decision without more information. Are we talking a 737 or a little prop driven puddle jumper?
I'm going to go out on a limb and say this isn't some frail old man if he's on a commercial flight. I'd be willing to bet that he takes pretty good care of himself and is pretty capable of deciding if he can walk or not.
Just my .02
Think of the down side. He falls down the stairs and sustains further injury. The airport just paid for all his great grandkids to attend college.
A neighboring service in my area a few years ago was walking a pt that was perfectly able to ambulate. The PTs driveway had some ice on it and she face planted into the steel bumper of the rig. Both EMTs fired, agency settled out of court for a huge payout. Bottom line is that once you take on someone as a pt you are responsible for their safety and well being until transferred to hospital staff. If your having an issue getting this past the airports ems system, ask the airports legal counsel if a PT injured walking down a set of stairs where there is standard ems equipment and procedures that could have moved him safely and if it could expose you to any litigation.
A neighboring service in my area a few years ago was walking a pt that was perfectly able to ambulate. The PTs driveway had some ice on it and she face planted into the steel bumper of the rig. Both EMTs fired, agency settled out of court for a huge payout. Bottom line is that once you take on someone as a pt you are responsible for their safety and well being until transferred to hospital staff. If your having an issue getting this past the airports ems system, ask the airports legal counsel if a PT injured walking down a set of stairs where there is standard ems equipment and procedures that could have moved him safely and if it could expose you to any litigation.
EpiEMS
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The airport and your service, too.
He's getting a stair chair. Either that, or a signed and witnessed form stating that he refused to be transported as advised.
A 94 y/o with a head injury and a bunch of lay people anxious to get to their destination signing a refusal would not probably not protect you.
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Where is BBG when you need him?!?
I don't think any aircraft can fit a stretcher. I'm not even sure every stair can fit, those tracked ones are questionable. Best bet is the airlines handicap wheelchair, I've seen EMS do that once, seemed to work ok. God carrying a board out would be a pain. So many busted knuckles.
I don't think any aircraft can fit a stretcher. I'm not even sure every stair can fit, those tracked ones are questionable. Best bet is the airlines handicap wheelchair, I've seen EMS do that once, seemed to work ok. God carrying a board out would be a pain. So many busted knuckles.