Inability to assess breath sounds during air medical transport by helicopter

Article Abstract:

Air transport of patients has become a common occurrence, with over 125,000 patients flown by medical helicopter in 1989. Because most of these patients are critically ill and require careful monitoring of vital signs, listening to the sounds of their breathing is extremely important. However, the noise of the helicopter engine and rotors interferes with detection of these sounds by stethoscope. A prerecorded tape of breath sounds was placed in the chest wall of a resuscitation manikin. Three flight control nurses accurately reported breath sounds in a quiet environment in 110 (92 percent) of the 120 trials. During the helicopter flight, the nurses used both their usual stethoscope and an amplified stethoscope, but were unable to hear any breath sounds, or the numerical cues identifying the segments. The internal noise for this type of medical helicopter ranges from almost 95 decibels to over 96 decibels; the noise in the helicopter used in this study was 100 decibels and higher. The breath sounds used in this study were those of an average adult, and very ill patients can be expected to have a lower intensity of breath sounds. A survey of flight nurses showed that they used the stethoscope, but they also said it was the least accurate method. If air medical transport is assumed to be a ''flying critical care unit,'' adjustment will have to be made for ambient noise and its effects on patient monitoring. New methods of breath sound assessment in flight are urgently needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Evaluation, Transportation, Critically ill, Critical care medicine, Helicopter ambulances

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Procedures for making medical decisions for incompetent adults

Article Abstract:

Decisions regarding medical care for incompetent adults may be made by a family member acting as a proxy (surrogate), by proxies (family members or the courts), by advance instructions left by the patient, or by following community and professional guidelines. The limitations of proxy decision making are that family members may not follow the wishes of the patient, or they may make decisions that do not benefit the patient. But the the outcome of most decisions made by family members are beneficial to the patient. The advance directive, or a document with set of instructions made in advance by the patient, is a new alternative for patients who have strong preferences or who do not have a proxy. But advance directives may be difficult to use. Community and professional guidelines may also be difficult to implement. A policy needs to be established for making decisions regarding medical treatment for incompetent adults.

Health aspects, Editorial, Planning, Medical care decision-making authority (Law), Medical care decision making authority (Law), Capacity and disability, Proxy

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