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Nod to the work of our HEMS paramedics in REBOA cases. Quite a few recent cases where they have shown some extraordinary multitasking. Scene assessment and reading wreckage to determine injury load, (and point out what the doctors haven’t spotted yet), team leadership while 1/n
..the doc has their ‘eyes down’. Preparation, ‘scrub-in’ and hooking up of REBOA catheters to invasive arterial monitors with proximal and distal measurements. Regular (few minutes) flushing and line care. Blood transfusion, warming blood, ensuring accurate and proper 2/
conduct around large bore subclavian line access for transfusion. Oversight and leadership during prehospital anaesthesia (very very cautious, delicate anaesthesia as the patient is exsanguinating). Rule out or careful analysis of bleeding mimics. Careful ventilation and 3/
setting of ventilators, nuancing of ventilation care. Packaging, handling, and preservation of volume with proper splinting of fractures (careful packaging remains an essential component of haemorrhage control). Prevention of hypothermia when ambient temp is ~ 0C. Multiple 4/
people to communicate with including police and bystanders. Allowing relatives to hold the hand at the scene when the time is appropriate, watching the clock while not forgetting patients are humans. Decisions in the ambulance about partial reboa, balloon deflation, wire and 5/
lead control so handover is not a disaster. Watching lines like a hawk so they don’t fall out. More blood transfusion, checking and rechecking. TXA, calcium reminders. All done fast. This isn’t a retrieval, it’s all part of scoop and run. Run because REBOA isn’t the answer 6/
..it’s only a bridge to the next step, mostly, although sometimes it stops the bleeding below the balloon. Handover - prevention of chaos and ensure no delays. Organised and as professional as anyone ever, but usually silent. Restocking the kit, ready for the next call, there 7/
isn’t a break. Oh. Forgot to say. They usually drove the team to scene on blues as well. One of our paramedics drove 100miles in London on NYE. They’re a dream team and when you stop and think, it’s extraordinary what London HEMS paramedics do. Please weigh in and say 8/n
..it’s not just London HEMS. I know, there’s lots of great paramedics. But just wanted to say that these ones are brilliant. And @Ldn_Ambulance has another group to be exceptionally proud of. Some of them had covid really bad too...but that’s another thread for another time. Ta.
