Medevacs
Conditions: Temperature 28°F (20° with windchill). Clear. Population = 861
Yet, given that McMurdo has only 250-1000 inhabitants at a given time, it's remarkable how many serious illnesses we actually have occurred. Some things we've treated here (rapidly progressive cellulitis, perirectal abscess, pneumonia, fractured foot, dislocated shoulder) but others we've had to medevac to Christchurch. These include: metastatic cancer, ectopic pregnancy, broken neck (spinus processes C5-C7), fractured lumbar spine and/or severe lumbar radiculopathy (3 of those), COPD with poor response to outpatient therapy, ruptured appendix, painless hematuria and even a fractured penis. Today we had two people spooled up to medevac: a renal stone with acute kidney injury (Cr 2.8), probably from NSAIDs and a possible basilar skull fracture coming in from a field camp.
Medevacs are divided into three types: urgent, priority and routine.
- “Urgent medevac” means that transport is required as soon as possible with the highest support level to save life, limb, eyesight, or to prevent a permanent disability. A plane for an urgent medevac can be commandeered from another mission. The patient is typically transported on a litter and may require some acute care such as IV treatments, supplemental oxygen or a cardiac monitor. Usually two attendants--at least one of whom who knows how to configure an LC130 for medical use--accompany the patient. The neck fracture fell in this category.
- A "Priority medevac" indicates that movement is required within 24 hours, with intermediate support. A priority medevac may displace passengers or cargo but the plane is usually already scheduled to go. One medical attendant is required. Our ruptured appendix, who was on antibiotics and was hemodynamically stable, was a priority medevac. But it took 48 hours to get him out; there simply were no planes available sooner. He had a rough surgery, though, due to the delay.
- The term “Routine medevac” indicates that movement is required within 72 hours, with a low support level. The patient is walking and their medical condition is not expected to change in 72 hours. An attendant may or may not be needed. Our patient with the acute kidney injury falls in this category.
Regardless of the type of medevac, it's always a slog to integrate all the moving parts. Our boss at University of Texas Medical Branch has to approve the move. Then he contacts the NSF. They fund the flights--which can cost up to a million dollars for an urgent medivac from the South Pole to Christchurch--so they have to be on-board. To their credit, they are always supportive. The Air Force has to agree and needs to find both planes and rested crew; that process involves our flight surgeon, the NY Air National Guard that owns the LC130's and flies the planes, and the Pacific Air Force (PACAF) Aerospace Medicine Leadership in Honolulu. Then, the Antarctic Services Contract (ASC) people have to help with movement (shuttles, helicopters, etc) here in Antarctica. Finally, we have to find the right medical personnel and provide the equipment to support the patient on the way out. The LC130's have complicated connections for monitors and oxygen and for the litters if the patient needs to be lying flat. The configuration requires significant expertise.
With respect to the head injury, I initially heard about it at 1:00 PM (I'm the contact for field teams). The patient, who was working at a large field camp 30 minutes away by helicopter, had been whacked behind the ear with a 140 pound drill bit, throwing him to the ground and causing a big bump over his mastoid bone. He didn't lose consciousness. When the wilderness first responder ("woofer"), called, she told us the patient was doing well with no headache other than tenderness at the bruise, no neurologic symptoms and no nausea or vomiting. When I spoke to him, he was happily eating lunch. Although I wanted him to come in to be seen, we were told that helicopters had been cancelled due to weather. We decided to just have them watch him out there.
At the same time, the patient with the kidney injury was in the clinic, emotionally labile, anxious, clammy and vomiting--complications of the few vicodin he had taken for his stone. We gave him some IV fluid and compazine and decided to keep him overnight until his scheduled, routine medevac flight in the morning.
At 4:00 PM, the woofer called us back saying that the patient had an enlarging bruise behind his ear and now had a severe headache, despite 800 mg of ibuprofen, and was lying down with the lights off complaining of pain and photophobia. It sounded worrisome. I talked to Dean who agreed we needed to bring him in and then called our boss, an ER doc, in Texas. He said, not only does he need to come back to MCM but we need to get him urgently for an MRI given the location of the injury. "A retroauricular hematoma is a sign of a basilar skull fracture until proven otherwise". We called the ASC and NSF and arranged a helicopter to pick the patient up with our flight nurse and Ann, the Aerospace Medicine Resident (who is a board certified ER doc) on board. A search and rescue person also went because that's the NSF's (ridiculous) protocol. An ambulance was arranged to pick him up at the helicopter pad. A second helicopter was put on standby in case he had to then be flown out to the airfield for medevac.
We were scrambling to find out whether we could get a flight out that night. Our flight surgeon negotiated with the NY Air National Guard and PACAF and found yes, we could divert a plane going to the pole to go to Christchurch instead. All the passengers were notified that their flight might be cancelled and the flight crew was prepared. The kidney patient was also informed he might leave early so Shawn went to his room and packed up his things for early departure.
Then, the patient got here at 8:15. The ASC called me the instant the patient walked in the door saying, "You need to tell us within five minutes whether you need the plane. If the patient doesn't have to go tonight, we need the plane for the Pole and we have a 9:00 take off limit". No pressure there. Ann and Dean examined him--completely normal--no blood in the ear, no signs of increased intracranial pressure but just a "bump on the head" at the mastoid (probably a subperiosteal hematoma). He said he felt fine, his headache was gone after two tylenol, and he wanted to go back to the field. He looked healthier than the medical staff.
We released the flight. The patient went back to a dorm to be seen again tomorrow. I slept in the clinic because the acute kidney injury patient was here.
This morning, the kidney patient flew off with our flight nurse on a regularly scheduled plane--a routine medevac. Ann cleared the head injury to go back to the field camp. So, after frantic hours of shuffling pieces, planes and people, all's right with the world.
Anything happening up north?
With respect to the head injury, I initially heard about it at 1:00 PM (I'm the contact for field teams). The patient, who was working at a large field camp 30 minutes away by helicopter, had been whacked behind the ear with a 140 pound drill bit, throwing him to the ground and causing a big bump over his mastoid bone. He didn't lose consciousness. When the wilderness first responder ("woofer"), called, she told us the patient was doing well with no headache other than tenderness at the bruise, no neurologic symptoms and no nausea or vomiting. When I spoke to him, he was happily eating lunch. Although I wanted him to come in to be seen, we were told that helicopters had been cancelled due to weather. We decided to just have them watch him out there.
At the same time, the patient with the kidney injury was in the clinic, emotionally labile, anxious, clammy and vomiting--complications of the few vicodin he had taken for his stone. We gave him some IV fluid and compazine and decided to keep him overnight until his scheduled, routine medevac flight in the morning.
At 4:00 PM, the woofer called us back saying that the patient had an enlarging bruise behind his ear and now had a severe headache, despite 800 mg of ibuprofen, and was lying down with the lights off complaining of pain and photophobia. It sounded worrisome. I talked to Dean who agreed we needed to bring him in and then called our boss, an ER doc, in Texas. He said, not only does he need to come back to MCM but we need to get him urgently for an MRI given the location of the injury. "A retroauricular hematoma is a sign of a basilar skull fracture until proven otherwise". We called the ASC and NSF and arranged a helicopter to pick the patient up with our flight nurse and Ann, the Aerospace Medicine Resident (who is a board certified ER doc) on board. A search and rescue person also went because that's the NSF's (ridiculous) protocol. An ambulance was arranged to pick him up at the helicopter pad. A second helicopter was put on standby in case he had to then be flown out to the airfield for medevac.
We were scrambling to find out whether we could get a flight out that night. Our flight surgeon negotiated with the NY Air National Guard and PACAF and found yes, we could divert a plane going to the pole to go to Christchurch instead. All the passengers were notified that their flight might be cancelled and the flight crew was prepared. The kidney patient was also informed he might leave early so Shawn went to his room and packed up his things for early departure.
Then, the patient got here at 8:15. The ASC called me the instant the patient walked in the door saying, "You need to tell us within five minutes whether you need the plane. If the patient doesn't have to go tonight, we need the plane for the Pole and we have a 9:00 take off limit". No pressure there. Ann and Dean examined him--completely normal--no blood in the ear, no signs of increased intracranial pressure but just a "bump on the head" at the mastoid (probably a subperiosteal hematoma). He said he felt fine, his headache was gone after two tylenol, and he wanted to go back to the field. He looked healthier than the medical staff.
We released the flight. The patient went back to a dorm to be seen again tomorrow. I slept in the clinic because the acute kidney injury patient was here.
This morning, the kidney patient flew off with our flight nurse on a regularly scheduled plane--a routine medevac. Ann cleared the head injury to go back to the field camp. So, after frantic hours of shuffling pieces, planes and people, all's right with the world.
Anything happening up north?
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