Emergency Medical Transportation Guidelines for Nurses in Primary
Care
Chapter 6 - Equipment and Supplies
General Guidelines
Basic Interfacility Transport Equipment
Appendix 6-1: Ohio Transport Incubator
General Guidelines
In recognition of the differing needs of various regions and zones,
the following lists encompass suggested items and are generally
those basic supplies and equipment that will be required in any
situation. Individual lists may be developed and maintained at
the unit and zone level to meet the specific needs of each respective
area.
The responsibility for maintaining and monitoring equipment and
supplies for emergency use should be clearly stated and assigned.
This delegation includes maintaining sterility of those articles
requiring it. Emergency bags or kits used during medevacs should
be compact, waterproof, always ready for use and stored in a secure
location.
Basic Interfacility Transport Equipment
- Stretcher with appropriate linen and securement straps
- Spinal immobilization equipment:
- Spine board
- Cervical collars (all sizes)
- Straps
- Head immobilizer
- Cardiac arrest board
- Oxygen tanks, with regulator, wrench and adapters
- 100% bag-valve mask (BVM) devices with easy-seal masks for
adults and children
- Oral airways for neonates, children and adults (complete set
of sizes)
- Oxygen delivery devices for adults and children
- Portable suction device with extra drainage collection unit
- Suction accessories, including tonsil-tip catheters
- Backup portable suction device
- Stethoscope and sphygmomanometer (adult and pediatric)
- Thermometer
- IV supplies: IV catheters, intraosseous needles, IV tubing,
IV start equipment, IV solutions, tape, arm board
- Pulse oximeter
- Flashlight and penlight
- Spare batteries
- Hygiene supplies: disposable towels, wet wipes, sanitary napkins,
incontinence pads
- Sterile gloves, sick bags, garbage bags, tissues, towels, bedpan,
urinal, kidney basin (disposable, if possible)
- Scissors
- Tongue depressors
- Safety pins
- Syringes and needles in a variety of sizes
- Sharps container
- Glucose monitoring supplies
- Dressings
- 1 large pressure dressing (e.g., abdominal pad)
- 6 sterile gauze pads 10 × 10 cm (4 × 4 inch)
- 6 sterile gauze pads 7.5 × 7.5 cm (3 × 3 inch)
- 2 sterile eye pads
- 1 butterfly dressing
- assorted Band-Aids
- 1 roll of 2.5-cm (1-inch) tape
- Bandages
- two 5-cm (2-inch) tensor bandages
- 5-cm (2-inch) Kling stretcher gauze
- 1 triangular sling
- Basic medications kit:
- analgesic (e.g., meperidine, morphine)
- 6 analgesic tablets (acetaminophen)
- naloxone
- 2 ampules of epinephrine (1:1000)
- metered-dose inhaler (MDI) with bronchodilator (e.g., salbutamol)
- glucose 25% and 50% (for IV administration) in a preloaded
syringe or oral glycogel
- nitroglycerin tablets or spray
- antiemetic (dimenhydrinate)
- other drugs as needed or ordered
Refer to pharmacy standards and regional policy
for storage, handling, dispensing and recording of controlled substances.
Obstetric Supplies
- Incubator (if available)
- Reflective blankets
- Delivery instrument pack
- Fetal Doppler unit
- Neonatal bag-valve mask (BVM) resuscitator
- Neonatal suction or manual bulb aspirator
- Sterile gloves
Miscellaneous Supplies
- Additional client-specific equipment, supplies and medications
as needed
- Survival gear (e.g., life jackets and sleeping bags), if the
transport vehicle is not already equipped with such gear
- Reference materials (including policy and procedures manual)
and documentation supplies (including narrative notes, Glasgow
Coma Scale)
Other Frequently Used Medevac Equipment and Supplies
Oxygen Cylinders
Medical oxygen is purified and the moisture content removed; hence,
the oxygen requires humidification to promote client comfort and
to prevent drying of the mucous membranes.
Oxygen cylinders are never emptied to atmospheric pressure because
of the possibility that ambient air might leak back into the cylinder,
carrying moisture with it. Moisture will cause corrosion and may
freeze in the narrow orifices of the cylinder and block them.
Precautions to be observed when handling oxygen:
- Keep oil and grease away from the cylinder
- Keep oxygen away from fire (no smoking)
- Prevent cylinder from falling over; all oxygen cylinders must
be secured
- Handle cylinders and valves carefully
- Ensure that dust caps are replaced
- Inform air crew and all clients and other passengers when
oxygen is being used
- Do not use electrical equipment that is not certified for
aviation safety, because of the danger of spark
- Do not use woollen or nylon blankets because of the potential
for static electricity; use cotton ones instead
- Check oxygen gauges regularly
Bag-Valve Mask (BVM) Resuscitator
Purpose and Use
To provide positive pressure ventilation (PPV) and oxygen to clients
who are not ventilating adequately (e.g., spontaneous breathing
has stopped)
Operation
- Tilt client's head back and lift jaw forward (use jaw thrust
if cervical injury is suspected)
- Apply mask firmly to face, with narrow end on bridge of nose
- Hold mask firmly against face with thumb and index finger,
keeping chin and head back with other three fingers
- Inflate lungs by squeezing bag with other hand; watch chest
rise
- Release and let the client exhale; bag will refill for next
inflation
- Repeat every 3–5 seconds: 1 or 2 seconds for inhalation
and 2 seconds for exhalation
- Slow inspiration will help prevent gastric distension and
possible aspiration
General Information
- The maximum pressure from squeezing the BVM device is sufficient
to overcome obstruction in the airway without damaging the lungs
- Supplemental oxygen can be supplied through oxygen input nipple
located on the bottom of the bag
Cleaning Instructions
- Clean face mask with a cloth dampened with a chemical germicidal
solution that will not damage rubber
- Submerge non-rebreathing valve in chemical germicidal agent
that will not injure Lexan plastic; valve may be autoclaved,
if desired
- Do not disassemble valve
- After cleaning, dry the valve by installing in Ambu bag and
operating for a few minutes
Portable Suction Device
An example of a portable suction device is the Ambu foot bag suction
pump.
Purpose and Use
- To quickly clean the mouth and throat of blood, mucus, vomitus
and other liquids
- To clear the airway of an unconscious client, enabling proper
resuscitation or ventilation
Operation
- Hold catheter in client's mouth and pump bellows with foot
- Continue as long as suction is needed
General Information
- The mechanical Ambu foot bag may be used until electrical suction
can be instituted
- The foot bag is also used as an emergency backup for electrical
suction devices
- Pumping the bellows creates sufficient suction to remove obstructing
fluids
- If the trap jar overflows, it is not necessary to discontinue
use, because the aspirated liquid will enter the bellows and
will automatically be emptied from the bellows with the next
compression
- The extra ball valve on the rubber trap jar serves as a spare
in case the other one becomes clogged
Cleaning Instructions
- Dispose of the catheter and wash the "Y" tube, metal
tip and trap jar in a disinfecting solution
- Because all flow is away from the client, the rest of the pump
need not be sterile; however, clean water may be drawn through
the pump to wash it
- If aspirated fluid has been drawn through the bellows, keep
pumping until the clean water has thoroughly flushed out the
bellows
Intravenous Infusion Pump
The infusion pump can deliver a set volume per hour (from 1 to
9999 mL). The pump communicates operating conditions and alarm
situations to the operator by a liquid crystal display (LCD) panel;
there is also an audible alarm.
IV problems arising from changes in atmospheric pressure are eliminated
with use of an infusion pump. Where this equipment is available,
the medical escort must be thoroughly familiar with its operation.
Be aware that there are many types of infusion
pumps, each with its own alarm, LCD display and alarm volume range.
Cardiac Equipment
Cardiac monitors, defibrillators and other sophisticated cardiac
equipment are generally required for clients whose care is under
the supervision of a facility offering higher-level care than in
the community. They can be used where larger planes and appropriate
attendants are available.
Cardiac Monitor
The cardiac monitor displays electrical activity during the cardiac
cycle. The operation and components vary depending upon the client's
medical needs and the manufacturer. The user is responsible for
the safe and knowledgeable use and care of the equipment as an
adjunct to client care. The user should review and be familiar
with the manufacturer's operating instructions for the specific
monitor. Furthermore, in the aeromedical environment, the cardiac
monitor should be approved as safe for flight.
Defibrillator
The manual DC (direct current) defibrillator is a potentially
dangerous machine and should be used only under the direct supervision
of a physician.
Automatic external defibrillators (AEDs) are available in some
regions. Follow regional guidelines and the manufacturer's operating
instructions when using these devices.
Transport Incubator
There are various types of transport incubators. Nurses must be
cognizant of the requirements, operation and precautions of the
particular incubator available to them. See Appendix
6-1 for information about the Ohio transport incubator.
Appendix 6-1: Ohio Transport Incubator
The Ohio transport incubator is one brand of incubator that has
been adapted for use in the aeromedical transport of infants. Detailed
instructions for its use are set out in the operation and maintenance
manual.
The Ohio transport incubator has a portable oxygen supply and
a battery pack that supplies backup electrical power for transport.
The incubator is affected by ambient temperature; therefore, temperature
adjustments may be necessary during transport.
Loading Procedures - Unit on Board
Preparation
Thirty minutes before emplaning the infant:
- Remove adapter to connect to aircraft power
- Connect adapter to incubator power cord
- Connect to aircraft power source; some aircraft have 24-V
DC outlets into which the incubator may be plugged directly;
however, ensure that the proper adapter is available (either
in your transport supplies or in the aircraft)
- Turn voltage mode selector on incubator to 24-V DC
- Turn heating indicator to "START" position
- Secure oxygen analyzer in place, if applicable
- Connect oxygen flow meter to aircraft oxygen source
Consider administering oxygen by means of
an external oxygen delivery device rather than using the incubator
system. It is difficult to assess the concentration of oxygen in
the incubator environment.
Connect oxygen extension tubing from flow meter to desired oxygen
nipple on the incubator's right side:
- For ≤ 40%, connect to 40% nipple, red flag down
- For > 40%, connect to 100% nipple, red flag down
- For > 80%, connect to 100% nipple and raise red flag on
rear of unit to occlude ambient air
Place cap over nipple that is not being used.
It takes 5 minutes to reach 90% oxygen concentration with the
ambient air intake covered. Therefore, a few minutes before placing
the infant in the unit, turn oxygen on to desired flow. With the
oxygen connected to the 100% inlet and with the air valve open,
the following concentrations can be expected with various rates
of flow:
Oxygen Flow
(L/min) |
Approximate Oxygen
Concentration |
| 3 |
50% |
| 5 |
60% |
| 10 |
85% |
Check the sponge in the humidity drawer and add distilled water
as necessary. To obtain humidity above 60%, connect the oxygen
tubing for the Ohio incubator to a humidity bottle.
Loading the Incubator into the Aircraft
- Secure infant in incubator with two pairs of Velcro straps;
position feet toward cockpit
- An infant weighing more than 4.5 kg (10 lb) will not fit comfortably
in the incubator
- A pair of premature twins may both fit in a single incubator
- Uncover all air circulation inlets around bassinet
- Ensure that retaining clip is in place
- Close and secure plastic hood, ensuring that no tubes are
caught in the closure
- Secure IV line to aircraft, if applicable
Loading Procedures - Infant in Unit
- Follow initial set-up procedure and emplaning procedures as
outlined in "Loading Procedures-Unit on Board," above
- Convert oxygen flow from portable to aircraft oxygen source
- Turn portable oxygen liter flow off
- Turn portable oxygen tank off using wrench in utility drawer
- Bleed oxygen from gauge by turning T-bar to open or "down" position
- When gauge reads zero, turn T-bar to closed, "up" or
free-spin position
If oxygen lines are not bled when the tank
is turned off, the diaphragm in the regulator valve will be damaged.
In Transit
Regulate incubator temperature according to the infant's temperature
with reference to the temperature indicator inside the hood. To
increase the interior temperature, turn control knob to a higher
number; to decrease, turn control knob to a lower number.
The high-temperature warning light is activated
when the temperature exceeds 37.2°C (99°F) or when air
flow to or from the heating system is blocked. Check and correct
air flow blockage before decreasing incubator temperature (in this
situation, the temperature in the infant compartment may actually
be lower than required).
Regulate oxygen flow according to analyzer reading.
Check the sponge in the humidity drawer and add distilled water
as necessary, usually every 20 minutes. The humidity drawer will
supply 40% to 60% humidity. To achieve relative humidity above
60% add a humidity bottle to the aircraft's oxygen source.
Prevent blockage of the air circulation inlet at the infant's
head.
Special Considerations
Fully charged battery packs will last 2 to 2½ hours at
4.4°C (40°F) ambient temperature if the incubator is cold
and 4½ hours at 23.8°C (75°F) ambient temperature
if the incubator is prewarmed. However, use of the battery until
complete discharge can cause permanent damage and shorten battery
life. It is recommended that all Ohio incubators be prewarmed by
means of aircraft power.
The acid battery is not acceptable for use during aeromedical
evacuations. Place a 3 × 5 inch card on the battery pack
and record times when battery was used and when the unit was on
aircraft power.
If the incubator is not receiving power:
- Ensure that incubator power is turned on
- Verify that correct voltage mode has been selected
- Check circuit breakers and reset if necessary (reset
only once)
- Check electrical connections
- Check power source
If all of these check out, then the problem
is probably with the incubator power pack, and replacement is required.
In the absence of a functioning battery or power source (with
proper adapter) in the aircraft, it may be necessary to use hot
water bottles or "hot packs." Extreme care must be taken
not to overheat or burn the infant. Commercial "hot packs" contain
sodium thiosulfate and glycerine, which combine to produce heat
(in the range of 40°C) when the bag is squeezed.
Unloading Procedures - Unit Left on Board
After unloading the infant:
- Turn off and disconnect all oxygen
- Unplug incubator from aircraft power source
- Return adapter to utility drawer
- Secure incubator power cord at rear of unit
- Remove oxygen analyzer and remote sensor
- Clean unit with soap and water.
- Never use alcohol or acetone on
Plexiglas hood or doors
- Recharge battery using a 110- to 115-V alternating current
(AC) source; this may take 24–48 hours, depending on how
long the battery was used
It is recommended that once a month, the batteries
be allowed to run down until the warning light shows (but no further)
and then recharged.
Unloading Procedures-Infant in Unit
If the infant is to stay in the incubator during unloading, both
the unit and the battery power pack must be taken off the aircraft.
Convert electrical system to battery power pack:
- Disconnect incubator from aircraft power source, remove adapter,
and connect incubator to battery power pack
- Turn voltage mode selector to 12-V DC
- Return adapter to utility drawer
Convert oxygen system to portable tank:
- Turn on portable oxygen; ensure that T-bar is in closed or "up" position
If T-bar is in the open or "down" position,
the sudden surge of oxygen pressure from the portable oxygen tank
will throw off the calibration of the liter flow gauge and break
the flow meter.
- Turn portable oxygen liter flow gauge to desired rate
- Attach portable oxygen tubing to appropriate nipple
- Turn off aircraft oxygen source
- Secure portable IV pole to incubator (if applicable), and secure
bottle to pole
- Check humidity drawer and add distilled water as necessary
- Check security of infant, incubator and battery power pack
before deplaning
- Remove oxygen analyzer and remote sensor; if unit is to be
left on board, do not unload oxygen tables, oxygen analyzer,
remote sensor or flow-through adapter
If an infant with a contagious disease or contaminated organism
was carried in the incubator, special precautions must be taken
during cleaning.
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