Reducing Anxiety Key in Patient Comfort on HEMS

December 2019

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When a patient is being flown from the scene of a serious accident to life-saving medical care, comfort may seem to be of relatively little importance. But increased anxiety during a medivac flight can have negative effects on the patient’s overall well-being, resulting in higher blood pressure and heart rate as well as hyperventilation or shortness of breath. Increasing patient comfort can reduce anxiety and play a role in achieving a better outcome.

 “EMS (emergency medical services) providers typically find patients in an unusual circumstance and position of discomfort, embarrassment, and distress,” wrote Bob and Kirsten Elling in Principles of Patient Assessment in EMS. “One way to facilitate effective communication is to make the patient comfortable by providing emotional, psychological, and physical comfort whenever possible. Making a patient comfortable is often as simple as propping the patient up with a pillow and respectfully addressing the patient using a surname. Other situations call for a variety of skills and techniques.”

Air transportation often increases patient anxiety levels, especially in patients who have never flown in a small airplane or helicopter before. Patients leaving loved ones on the ground may be worrying more about the status of their families than their own health. Air and medical crews that can relay information to and from patients help ease anxiety for those patients and for their families.   

“We often forget in this profession how profoundly even the smallest of gestures can affect our patients and their families,” wrote EMT Kelly Grayson in a blog post on ems1.com. “For us, it was just another call, but for them, we were key players in a defining moment of their lives….What is important to my patients isn’t life-saving care, but something we have known in health care since Hippocrates: ‘Cure sometimes, treat often, comfort always.’”

While the crew plays a major role in patient comfort, the equipment is also important. Pressurized cabins can allow aircraft to fly above weather for a smoother ride. Specialized equipment ranging from supplemental oxygen to advanced medical devices enables flight paramedics to ease pain and treat many conditions on the way to the hospital. Communications equipment provides two-way interactions between the aircrew and operations staff, ground crew, or hospital.

Broadband internet systems such as Honeywell’s Aspire satellite communication solution provide in-flight connectivity for both fixed-wing aircrafts and helicopters. For helicopters, Aspire uses a High Data Rate (HDR) software package to mitigate the impact of the rotor blades utilizing Iridium® satellite constellation to send signal to and from the aircraft, which allows crew members access to high-speed, high-bandwidth data from pole-to-pole. For example, various air ambulance providers in the United Kingdom use an app called GoodSAM to stream live patient video to aircrew before they take off, monitor the patient, and send video and vital signs to medical staff at the hospital while en route.

“Being able to see the patient and the scene without them having to download a video-chat app, and getting a reading of their vital signs, dramatically improves remote assessment of illness,” said GoodSAM medical director Mark Wilson in a blog post on ems1.com. “This can be through visualizing the mechanisms of injury (e.g., number of vehicles involved) or how sick a patient appears.”

Accidents often occur in bad weather and flying with poor visibility and over unfamiliar or rising terrain can increase anxiety levels in patients and crew. Avionics systems such as an Enhanced Ground Proximity Warning System (EGPWS) coupled with on-board weather radar and synthetic vision can provide the situational awareness needed for the aircrew to feel more confident about their flight in such conditions. This confidence is often transmitted to patients subconsciously, and sometimes deliberately, to help ease their anxiety.

While HEMS pilots generally deliver their patients to medical facilities with cleared helipads, often they must pick up patients in improvised landing zones that may not be much larger than the helicopter itself or may contain obstacles, often at night and in poor visibility. Honeywell’s Mark XXI and Mark XXII EGPWS use robust databases that cover 100 percent of the world’s terrain—including more than 120,000 man-made obstacles—to present a real-time display and terrain alerts. These EGPWS solutions also include special modes for low-level operations and search and rescue over water.

Turbulence also contributes to patient anxiety, especially for those patients who are not used to traveling in small airplanes or helicopters. Advanced weather radar systems are now on the market that can detect turbulence up to 60 miles away, enabling the pilot to either avoid it or warn the patient and other aircrew members in advance.

The Honeywell IntuVue RDR-7000 is one such system; it scans up to 60 miles ahead of the aircraft to predict turbulence, lightning, or hail. The RDR-7000 automatically scans the sky in 17 segments to provide 3D views of thunderstorm cells from the ground up to 60,000 feet in altitude without pilot input or interaction.

“Weather is difficult to predict, and pilots continually run the risk of encountering unexpected weather like hail or thunderstorms, which can impact the safety and comfort of all onboard,” said Stevan Slijepcevic, president of Honeywell Aerospace Electronic Solutions. “The RDR-7000 reduces this risk by more than 50 percent using the new and improved automated mode, which helps pilots focus on upcoming weather hazards and reroute decisions instead of operating the radar.”

Honeywell also produces a compact system called Sky Connect Tracker that allows ground or operations crews to track and communicate with their aircraft worldwide, including through text and voice modes. Meeting the Flight Data Monitoring (FDM) rule recently issued by the FAA for large-fleet helicopter air ambulance operators, the Sky Connect Tracker collects data from various on-board systems and sends messages to ground operations using the Iridium satellite network. A Sky Connect FDM app allows ground maintenance and operations teams to easily download and view recorded flight data on their mobile devices.