Ventilated Winching: A New Perspective
David Szyc / Tom Nicholls
CareFlight Northern Operations, Eaton, Australia
David Szyc RN/RM with CareFlight Top End for 8 years. Qualification include post Graduate Certificate in Emergency Nursing, and Graduate Diploma in Midwifery.
Dr Tom Nicholls BMBS, MRCEM is an Anesthetic Registrar. Originally from the UK, Tom has an interest in pre-hospital medicine and is currently working in the Top End for CareFlight.
CareFlight provides aeromedical retrieval and pre-hospital services to the Top-End of the Northern Territory. Both nurses and doctors undertake winch training for both land and over water operations, although currently there is no provision for attended stretcher winching. At this time there is no capability for winching patients who are intubated and mechanically ventilated.
A recent study has shown that, during helicopter winching, mechanical ventilation is superior to manual ventilation (1). CareFlight NT have developed a standard operating procedure (SOP) to facilitate the unattended winching of mechanically ventilated patients in the pre-hospital setting, with a goal to being the first retrieval service to provide this critical intervention to patients in Australia.
The SOP has incorporated not only guidelines for packaging the patient but also a training timeline that includes a purpose built competency appraisal along with equipment familiarisation and training. The introduction of this intervention has seen a complete redesign of the stretcher-bridge and placement of critical equipment.
There is a high potential for a serious adverse outcome due to unrecognised airway loss during the winch cycle. The winching and subsequent cabin protocol has also been modified to allow rapid airway recovery as soon as patient is winched into the cabin.
With the implementation of this intervention we are hoping to provide a safe and effective procedure for unattended stretcher winching mechanically ventilated patients. Although this scenario is not commonly encountered, simple structured guidance via the SOP, a rigorous training and familiarisation program and efficient teamwork will enable us to be the first service to incorporate this critical intervention into our skill base to ensure best patient outcomes.
1. Hollott J. Ventilatory choices for intubated patients during helicopter stretcher winching. Emerg Med Australas. 2017 Dec;29(6):692-696