Everyone dreams of a tropical vacation in Hawaii.

But for the passengers and crew of a recent Air Canada flight, an unexpected trip to Honolulu was not on the itinerary. Severe turbulence inflight caused multiple injuries that required the plane to be diverted to Hawaii.

With a significant number of mass casualties onboard the aircraft; federal, state and county agencies from the airport and surrounding areas responded.

Chief Dean Nakano of the Honolulu Emergency Medical Services explained the incident and how his organization was able to use an AmbuBus in its response effort.

“On July 11, 2019 we got a call that an Air Canada plane was on a non-stop flight to Australia when they hit some turbulence and that there were injuries on the plane. They were about one hour past Honolulu when the turbulence occurred. They turned the plane around and flew to Honolulu so the injured could be treated,” said Chief Nakano.

Initially, there were reports of critically injured people on the flight. It was estimated there were 20 individuals in need of medical attention from a total of 269 passengers and 15 crew members onboard the plane.

The Daniel K. Inouye International Airport falls outside the jurisdiction of Honolulu EMS. Incidents there are the primary the responsibility of Hawaii Crash and Rescue and American Medical Response (AMR). “Usually, if an incident occurs there, Honolulu EMS is asked to assist if needed before sending units. However, when we heard there were at least 20 injured and an unknown amount of critically injured people, we started deploying our resources,” Nakano said.

Honolulu EMS responded with a District Chief, three ambulances, along with the AmbuBus. The Chief of Operations also responded to assist with triage and treatment.

The AmbuBus deployed by Honolulu EMS was donated by the City and County of Honolulu Transportation Services, which operates the bus services for the county. “When we received it, the bus had 600,000 miles on it. They have great mechanics at the Transportation Services Department because the bus is still running four years later.”

Honolulu EMS purchased two AmbuBus kits to refurbish and equip one bus as a multi-patient transport vehicle. Now it’s capable of supporting 12 supine patients, or 24 seated patients.

“The AmbuBus is positioned about an hour away from the airport in rush hour traffic. Unfortunately, we have not been able to have a secure parking location for the AmbuBus closer to town,” said Nakano.

“The AmbuBus was rolling at about six o’clock (that) morning, which is peak rush hour traffic in the area. When it arrived at the airport, triage was set-up and we were able to assess the injured. Luckily, there were no critically injured patients, but we saw we had several walking wounded individuals,” said Nakano. In total there was close to three dozen patients.

There was one federal ambulance and four AMR ambulances at the scene, but their crews were tied up with triage, treatment, and transport duties, according to Nakano.

“Some of the patients were transported by the ambulances on the scene and we escorted seven patients onto the AmbuBus, treating and transporting them to the trauma center,” said the Chief of EMS.

“If the AmbuBus had not been available, transporting the patients would mean using 5 or 6 ambulances making multiple trips. That would tie up one third of the total pool of Oahu’s city ambulances. Taking that many ambulances off their regular duties would put a serious strain on our ability to respond to 911 calls,” Nakano added.

Unlike most EMS departments around the country, Honolulu Emergency Medical Services Division is not part of a Fire Department. The Honolulu Emergency Medical Services division is under the Honolulu Emergency Services Department which also includes the Ocean Safety division.

Honolulu EMS is responsible for providing services for the entire island of Oahu. Oahu county has close to 1 million residents and last year approximately 10 million people visited Hawaii.

The Division had approximately 150 paramedics, which includes unit supervisors, district chiefs, and about 80 emergency medical technicians and 25 emergency medical dispatchers. Honolulu EMS has 21 units (two of which are part-time) so when Air Canada experienced its incident last month, they had 19 units on-duty.

In 2018, Honolulu EMS responded to 95,995 911 calls by ambulance and transported more than 56,600 patients to local emergency rooms. Emergency medical dispatchers answered more than 120,000 911 calls.

Chief Nakano has been with Honolulu EMS since January 4, 1981. He started as an EMT before moving up to a paramedic. He was a unit supervisor for about 12 years and then a District Chief for ten years. He has served as EMS Chief for four years.

Chief Nakano said, “In the four years we have had the AmbuBus, we have used it primarily for training and as standby medical support for large events. For example, we have recently had it deployed during a Bruno Mars concert, the Honolulu Marathon, the Pearl Harbor 75th Commemoration, and the Fourth of July Fireworks show.

We are hoping to have a second bus donated so we will have additional multi-patient transport capacity if we have other large-scale events.”

But of course, they hope to have it but not have to use it.

 

Click here for more information on the AmbuBus. 

 

The Military Learns to Combat Deadly Heat Stress 

As temperatures rise, increasing numbers of soldiers are put at risk of enduring heat stress that can end their careers or even kill them. 

In a recent NBC News report by David Hasemyer of Inside Climate News, the U.S. Army is putting significant effort into understanding the causes of heat stress and treating soldiers that experience its effects. 

The video showcases how Fort Benning Georgia’s Emergency Room is developing new treatments for heat stress, as well as teaming with researchers to identify potential cases on an individual level before a serious health problem occurs. 

Research and treatment of heat stress is necessary, but an essential factor may be overlooked. 

Preventing heat stress is better than treating heat stress.

Recently, several Army bases, both in the United States and overseas are deploying a simple but highly effective heat stress prevention modality. Portable, durable basins of cold water such as the ICE System manufactured by First Line Technology are prepositioned along the route of march or at remote ranges where training occurs during hot weather. 

During training or operational cycles, soldiers immerse their forearms into the cold water and walk in place to circulate their blood. Their cooled blood flows throughout their bodies dropping their core temperature about 1.8F in 3 to 10 minutes. 

The ICE System can accommodate up to six individuals at a time. If a serious case of heat stress occurs, the ICE System can be used to fully immerse an individual up to six feet in height and the basin can hold up to 800 pounds. 

For more information on the ICE System, please visit https://www.firstlinetech.com/phasecore/#ice 

To see the original article visit, https://www.nbcnews.com/news/us-news/military-s-climate-change-problem-blistering-heat-killing-soldiers-during-n1032546 

The National Association of State Emergency Medical Services (EMS) Officials has just released the Pediatric Transport Products for Ground Ambulances, Version 2.

The document is a resource for EMS providers to determine existing options for securing infants and children who are transported by ambulance.

Over 1 million pediatric patients are transported by ambulances nationwide each year. There are an estimated 5,000 ambulance-involved crashes annually, with 10% involving infants or children. 

The Centers for Disease Control and Prevention (CDC) has noted that ambulances are 2.5 times more likely to be involved in a crash than an automobile. While ambulances are generally well equipped to secure adult patients, many are lacking proper devices to secure their youngest patients whose varying sizes make the challenge even greater.

A recent study found that of 200 ambulances observed carrying 206 pediatric patients, more than half of the patients were lying on the stretcher, and 11% were unrestrained. Additionally, 27% of observed pediatric patients were unrestrained on the bench seat, 10% were on the lap of a parent or EMS provider, and 13 different types of medical equipment were minimally secured or not secured at all. 

Why is there such a diversity of ways that infants are transported in ambulances? There are multiple factors, including:

Lack of Standards Increases Risk

There are no established guidelines for infant patient transport, only recommended best practices. This puts each EMS organization and ambulance provider in the position of deciding how they will handle infant patient transport.

Insufficient Funding

Up to now, the preferred method of infant patient transport required both a transport incubator and a dedicated ambulance that could accommodate it.

A transport incubator can cost between $50,000 and $80,000, while an ambulance to carry it could cost $300,000 or more. Many EMS organizations and ambulance providers cannot fund this level of investment.

Risk to the Infant Transport Crew

One factor that is widely overlooked is that a transport incubator during an ambulance accident can break free and injure or kill the infant transport crew. Some ambulance providers refuse to transport infant patients for fear of liability issues.

Separating the Child from the Mother

Many ambulances are designed to carry one patient. If the cot is being used to transport the infant, the mother may have to be transported in another ambulance. This not only ties up two ambulances- mothers sometimes refuse to leave the child during transport.

Infant Transport is Time Consuming

When infant patient transport using an incubator is required, the process disrupts the normal operations of both the ambulance provider and the involved hospital staff.

Typically, the ambulance crew must go to the location where the travel incubator is stored. They may have to remove seating and storage from the vehicle. They then must load and secure the incubator, which may weigh 250 pounds or more. They drive to the sending hospital, unload the incubator, and take it to the pediatric unit.

The hospital team prepares the infant for transport and loads the child in the incubator. The transport team then loads and secures the incubator and drives to the receiving hospital. The unload the incubator, take it to the pediatric unit, and the hospital team unloads the child.

The ambulance crew then must load the incubator, drive it to the storage facility, unload it, and reinstall the seats and storage.

The Baby Pod 20 – Born from Tragedy

After a series of deadly infant transport accidents, an engineer became obsessed with solving the problem.

While watching a Formula 1® race one day, he saw a car hit the barriers at over 200 miles per hour. Seeing the driver walk away from a crash that destroyed the car around him, he realized there was a better way;

Replace the heavy incubator with a smaller, lighter, infant transport device. Less weight equals less mass, less inertia, and less danger to the patient and ambulance crew. 

He approached one of the world’s leading manufacturers of Formula 1® racing cars. They quickly saw the need for a safer infant transport device and put their expertise, time, and talent to work.

Thus, the Baby Pod was born.

The Baby Pod 20 is safer, more affordable, and more efficient than travel incubators.

The Baby Pod 20 was designed to overcome all the disadvantages of a transport incubator.

SAFER

The Baby Pod 20 is designed and built with the same materials as a Formula 1® racing car. Altogether, there are four distinct layers of protection for the child:

1. The outer shell of Baby Pod 20 is constructed of carbon fiber, which is a strong, yet lightweight and durable material. It acts as a rigid cocoon to protect the infant from flying debris.
2. The Baby Pod 20’s internal shock absorbent foam is constructed of polyurethane foam with a PUNL® removeable cover, which remains breathable, yet is impervious to liquids and solutions. The foam interior surrounds the infant’s head, feet, and sides during transport and is designed to help protect the infant in the event of impact.
3. The vacuum mattress is manufactured from a soft foil and is filled with flame-retardant polystyrene beads. Removal of the air from the vacuum mattress via the attached valve allows secure positioning of the baby within the Baby Pod 20. It also reduces discomfort caused by road vibration as well as dampens traffic noise.
4. Maintaining the infant’s core body temperature during transport is critical. That is why up to now, transport incubators were necessary. The Baby Pod 20 incorporates the Transwarmer™ Infant Transport Mattress which is designed to provide radiant heat and additional shock absorption to the infant during transport. Unlike an incubator, the Transwarmer™ Infant Transport Mattress does not require electricity to maintain the infant’s core temperature.

In addition to these four layers of protection, the Baby Pod 20 incorporates additional state of the art safety innovations to protect the infant. With all these features the Baby Pod 20 can withstand 20Gs of force in four directions and up to 10Gs vertically or inverted making it the safest infant transport device available.

MORE AFFORDABLE

A typical transport incubator costs around $60,000 and requires a dedicated vehicle that can cost up to $360,000. You can buy seven Baby Pod 20 Infant Transport Devices for the cost of one incubator.

MORE EFFICIENT

Typical time to transport an infant using an incubator in a dedicated incubator ambulance is between 7 and 8 hours. Typical time to transport an infant using a Baby Pod 20 in any ambulance or aircraft is 3 to 4 hours.

With all these advantages over travel incubators, it is easy to see why EMS organizations, ambulance providers and hospitals are beginning to adopt the Baby Pod 20 as their primary infant patient transport device.

NASEMSO plans comprehensive crash testing

NASEMSO created the Pediatric Transport Products for Ground Ambulances resource to minimize the confusion by allowing the EMS industry to compare the products available.

Inclusion of a product in the Pediatric Transport Products for Ground Ambulances resource does not imply that it has been deemed “safe” or is endorsed by NASEMSO. Unfortunately, there are no minimum safety criteria to be included in the product list, because such criteria have not been developed.

Unlike child carseats used in automobiles, which must meet rigorous safety standards developed by the U.S. Department of Transportation, there are no such requirements for child transport devices used in ambulances. Further, industry experts agree the testing criteria for child seats designed for automobiles do not apply to the patient compartment of an ambulance.

NASEMSO hopes to fill this gap by organizing and leading a comprehensive crash testing project to determine pass/fail criteria for these pediatric transport products. The project will be a collaborative effort involving national EMS organizations, manufacturers of the equipment (who will donate their devices for the crash testing research), safety engineers, and pediatric experts. The crash testing research is expected to be a five-year effort before the criteria are developed and standards are published. In the interim, NASEMSO urges EMS providers to utilize devices specifically designed for child transport in ambulances.

View the Pediatric Transport Products for Ground Ambulances, V2.

2019 Could be a challenging year for emergency managers.

If current conditions continue, 2019 may be one of the worst years for natural disasters in America.  

From January through May, we have already seen 611 tornadoes that have caused at least 38 fatalities and left hundreds homeless. This figure includes a record 13 straight days with at least 8 tornadoes reported. 

For 2019, NOAA’s Climate Prediction Center is predicting a likely range of 9 to 15 named storms (winds of 39 mph or higher), of which 4 to 8 could become hurricanes (winds of 74 mph or higher), including 2 to 4 major hurricanes (category 3, 4, or 5; with winds of 111 mph or higher). 

Vast areas of the United States are at risk of flooding this spring, even as Nebraska and other Midwestern states are already reeling from record-breaking late-winter floods. Some 13 million people could be exposed to major flooding, making this a “potentially unprecedented” flood season, said Edward Clark, director of NOAA’s National Water Center. 

While much of the country should have fewer wildfires in 2019, the West Coast of the U.S. could see many significant wildfires according to the National Interagency Fire Center. 

Future events like those mentioned above may require the evacuation of patients in hospitals and nursing homes as well as home-bound, at-risk citizens.  

If your community suddenly must deal with a large-scale disaster, will you have enough multiple-patient transport capacity to manage both large numbers of casualties and patient evacuations? 

What emergency planners need is a scalable, affordable, and flexible approach to multi-patient transport. 

One option that is being used by many communities is to convert existing transportation assets on a permanent, or as needed basis to handle mass casualty situations. 

By leveraging surplus or end of service school or metro buses, using a conversion kit such as the AmbuBus from First Line Technology, a community can have a vehicle that can transport up to 18 non-critical patients for well under $50,000. 

The organization can often borrow the vehicles for temporary use or buy them for a nominal amount from the school or transportation district. They then purchase one or more AmbuBus conversion kits which cost between $25,000 to $50,000. Once assembled, which takes two people about two hours, the converted AmbuBus can carry up to 12 non-critical patients, two or more EMTs, and medical supplies. 

By having at least one AmbuBus kit permanently installed the community has a multi-patient transport vehicle (MPTV) that can handle mass casualty incidents that have no prior warning. 

They can then purchase additional kits that are unassembled and stored in wooden pallets. These can be stacked up in any available warehouse and used to temporarily convert additional buses for events such as hurricanes. 

Since the installation of the kits does not require any holes to be drilled, the structural integrity of the vehicle is preserved, and it can be returned to regular service after the event.                                                           

For more information, download the free white paper, “A Scalable Approach to Mass Casualty Transport” at https://www.firstlinetech.com/mci-transport-white-paper/ 

Why are communities still struggling to evacuate at-risk citizens during an emergency?  

In virtually every disaster, a disproportionate number of casualties are the elderly, disabled, or home-bound also referred to as socially vulnerable populations. 

For example, in the Camp Fire incident in California most of the 86 people who died in the fire were senior citizens. Of the 69 bodies that have been positively identified, 53 were over the age of 65. This age group accounted for 77 percent of the fatalities. 

In Hurricane Katrina 49 percent of the victims were 75 years old and older. 

In Superstorm Sandy, 49 of the 106 deaths were 65 or older. 

Ever since Hurricane Katrina, emergency managers, public health professionals, and emergency medical services directors have devoted significant attention to this problem, but many communities and regions still are not able to ensure the timely evacuation of all at-risk individuals. 

There are many reasons for the lack of progress in solving this problem, but the most obvious is that most communities simply do not have enough patient transport capacity. Their existing ambulance pool is quickly depleted trying to cover the surge in injured during an emergency as well as the evacuation of hospitals, nursing homes, and home-bound individuals in a major event. 

Typically, emergency managers have relied on mutual aid agreements with other jurisdictions or contracts with private ambulance providers to supplement their patient transport capacity. 

However, with massive events like Hurricane Katrina, Hurricane Matthew, and Superstorm Sandy, the ambulance assets they were counting on were overburdened trying to handle casualties in their own communities. 

One approach has been to buy an Advanced Life-Saving (ALS) equipped Medical Ambulance Bus (MAB). But an ALS level MAB costs between $500,000 and $1Million dollars. Most communities cannot secure enough grant funding to procure a MAB. 

A Better Approach 

What emergency planners need is a scalable, affordable, and flexible approach to multi-patient transport. 

One option that is being used by many communities is to convert existing transportation assets on a permanent, or as needed basis to handle mass casualty situations. 

By leveraging surplus or end of service school or metro buses, using a conversion kit such as the AmbuBus from First Line Technology, a community can have a vehicle that can transport up to 18 non-critical patients for well under $50,000. 

The organization can often borrow the vehicles for temporary use or buy them for a nominal amount from the school or transportation district. They then purchase one or more AmbuBus conversion kits which cost between $25,000 to $50,000. Once assembled, which takes two people about two hours, the converted AmbuBus can carry up to 18 non-critical patients, two or more EMTs, and medical supplies. 

By having at least one AmbuBus kit permanently installed the community has a multi-patient transport vehicle (MPTV) that can handle mass casualty incidents that have no prior warning. 

They can then purchase additional kits that are unassembled and stored in wooden pallets. These can be stacked up in any available warehouse and used to temporarily convert additional buses for events such as hurricanes. 

Since the installation of the kits does not require any holes to be drilled, the structural integrity of the vehicle is preserved, and it can be returned to regular service after the event.                                                           

Download the free white paper, “A Scalable Approach to Mass Casualty Transport“