Operation PRESENCE Mali - Major McLaren
Transcript - Major McLaren
Hey I'm Major Andrew McLaren. I'm one of the doctors on CMERT - the Canadian medical emergency resuscitation team. I want you guys to come in and have a look at my workspace. Come on in. This is our 'resus' room. We move the resus room to the patient. Adam here is going to help show the area and some of the issues working in a place like this, in a moving helicopter in.Come on in. The idea of CMERT is to bring this resuscitation room to the point of injury, to wherever that injured patient is out there. It has a lot of differences from the resus rooms at home.
One of those is the heat. At home, we're worried about cold, were worried about the patients cooling down; We warm up the resus rooms. In this helicopter, it's about 40 or 50 degrees at times. Sometimes there's air moving through, sometimes not. We're wearing about 50 pounds of stuff on us. So you can see that I have my camelback, so I can drink water while I'm resuscitating someone or getting to the scene. And we have to do things to cool ourselves down at times using ice packs in here, asking the pilots to fly in a way that gives us more air back here.
The other difference is that this is moving and shifting, sometimes very aggressively and so, unlike at home, I have to be tethered to my resus room. This is attached to my harness and I clip in to the aircraft so I don't go very far if there's a big movement.
Ever since I was a kid. I always knew I wanted to be a pilot. So I'm really excited to be here on my first deployment. However, it's kind of a moral dilemma because when I get to fly and do what I love, it means that it was a terrible day for someone else. The thing that kind of helps is that on the worst day of someone's life, my team and I get to bring them help.
The third big issue is communication. It's really hard to hear people when these rotors are running, it's deafening. I still need to talk to the resus team, I have my critical care nurse, I have a medic, and I have a medic and we still have to be able to communicate just like we would at home. Here we use these special ear pieces and the system called AWIS. That allows us to just speak and hear each other and not interfere with some of the flight stuff upfront.
There are a lot of similarities in this space as well. We still approach resuscitation with A B C, just like you learned at a first aid course. Just like the first aid course at home, we're going to address things that are going to kill you fast first. So when someone comes in here, we're looking for deadly bleeding. We're going to try to plug that hole or at the turnakey and then quickly, think about the airway.
The airways addressed here with a lot of options. We have simple stuff like the bag valve mask that we can oxygenate Adam with. We have some more advanced devices that we can put down through the vocal cords similar to what people have during an operation. In a dire situation where we can't easily see the airway, we can do surgery on the airway. We can make a hole right through the neck and put a tube in that to try to get air into the chest.
After we address A, we move on to B - breathing. Except no stethoscope here. All we would hear are the turbines up above. So I really want to use my hands here. All I hear is the rotor in the engine, the wind. I want to be able to use my eyes and my hands when I assess B, so I'm touching the patient a lot. I'm trying to feel for air under the skin, whether the chest is expanding, whether Adams looking at my face and I could ask him to do stuff like take a big breath. Sometimes people can't even hear that. After that I'm going to move on to an exam with my ultrasound. So I quickly, over about a minute, do a quick ultrasound. An ultrasounds would usually be used with a pregnant woman on a fetus. But here I'm just looking at the lung and I'm seeing if the lung is injured or popped on each side. I can even take a deeper look into the gut to see if there's blood around the intestines. And a quick look at the heart to see if the heart is beating normally.
After we've addressed the life threatening breathing problems, the lung is popped, we've put the tubes in, we put someone to sleep. We move on to C, just like you did at your first aid course and C is for circulation, it's adressing blood and blood product and preserve and clot. The biggest reason why we're here as a team, why does a physician, nurse, on the team is to deliver high quality blood product to the middle of Africa. That's hard to do. You can imagine, getting safe blood from a donor at home, through the blood chain, refrigerated and safe, and delivered safely out in the middle of the Sahara Desert. It is logistically difficult.
You can see in here, we have a little fridge called the credo cube. For every mission, we pull out a few of these little fridges and you can see blood there in the bottom - O negative blood. We keep it cold and we rigidly control the temperature for every mission we pull that out. We have six units of blood. We have some other blood product. And again, the clear stuff of blood, plasma which we deliver as a liquid back home. It's hard to move that liquid, it has to be frozen and then thawed at home and here we have freeze dried plasma. So you can see it's just like a solid, like a dust. We use a little bit of water, mix that up and then we can give it to a patient. We have some other product called cryo precipitate, same idea.
The purpose of CMERT, the whole idea of CMERT is to push resuscitative care straight to the point of injury, the middle of Africa in this case. We take a critical care nurse, a medic, a medic, and a physician to take all this technology that you'd find back at home in a resuscitation room, straight to the point of injury. In particular we move blood products safely, we deliver it to the right group of people. And we deliver care over that first hour and ultimately, get that trauma victim to a surgeon, and the surgeons what they need.
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