Saving Lives at Flight Nursing Camp
Christopher Manacci: So now I want to say before we do this, we want to make whatever errors - it's okay. Nobody's going to die.
In a converted sheep barn on a farm owned by Case Western Reserve University, about 25 nursing students and professionals practice emergency care on a roomful of artificial patients. At one table, Instructor Christopher Manacci is calmly showing students how to insert an IV into a femoral vein located in the upper inner thigh of a mannequin. He tells students this is the time to make mistakes. So when they encounter a real thigh in a real emergency, they'll be able to insert a central line without mishap.
Christopher Manacci: So, 45 degrees. Then advance the needle in...
Carolyn Nieman: Once you have it secured, and then they're bagging, again, continue to check breath sounds and then continue on...
Instructor Carolyn Nieman is showing students how to clear an airway.
Carolyn Nieman: Let's move down to the child.
Lisa Lorenz: Okay, then you put your Kellys in...
Instructor Lisa Lorenz is demonstrating proper insertion of a chest tube.
Lisa Lorenz: ...Have somebody on the other side of bed or stretcher to stabilize the patient for you, because sometimes it take a lot of force to get through a muscular person.
Nieman and Manacci are on the faculty of the School of Nursing at Case. Lorenz is a teaching assistant and a flight nurse specialist for Metro Life Flight. Their instruction in emergency care is part of a unique summer camp that trains nursing students and professionals to provide the best possible care under the worst possible circumstances.
Lisa Lorenz: We talk about our program as taking critical care from the bedside, like hospital, to the roadside, wherever the patient may be.
John Clochesy is research director of the National Flight Nursing Academy, a partnership between Case and the MetroHealth System. This camp is one piece of the Academy's work, and Clochesy says its purpose is to help prepare nurses to work in the air medical services or respond to natural and manmade disasters - anything from tornados or floods to nuclear accidents or terrorist attacks.
John Clochesy: We're here all day, every day for the week. Frequently, people will get this for an hour here or there or they'll get it for maximum 5 or 6 hours on Saturday and a few hours on Sunday.
Louis Binder: ...Diaphragm? yeah, the round thing is the diaphragm.
A student is lying shirtless on a couch, as Dr. Louis Binder shows a group how to check for internal bleeding using an ultrasound machine that's smaller than a laptop. Binder is a professor of emergency medicine at the Case School of Medicine.
Louis Binder: Here we go… This is a kidney. This is the liver...
Now, the portable ultrasound machine is cool. But today's most impressive example of modern technology is a simulated man who talks, demonstrates symptoms, and responds to students' efforts, according to John Clochesy.
John Clochesy: What will happen is, as a student assesses the simulator, the simulator may all of a suddent develop a life-threatening problem. If student does catch it, and does correct intervention, the mannequin gets better. if not, he gets significantly worse or dies.
Sim Man is the closest thing to real-life students can get without endangering anybody's health. Right now, he's complaining of chest pain.
Sim Man: Ah, my chest hurts...
They start by assessing the situation.
All right let's get some vitals, I call, sorry what's your name? Liza, Liza come in and get some vitals, is this what I see on the monitors.
And while they're assessing...
Pressure's tankin', pressure's in the 80s... Oh, he's in v-tac. Um, let's go ahead precardial thump anything happen? There no. Let's start baggin him. We'll go ahead and bag him.
They try CPR; they shock him; try to intubate to clear his airway. When the intubation fails, they use an oxygen mask. Nothing seems very effective for several minutes. But eventually they get a pulse and Sim Man's blood pressure stabilizes.
Harry Rees is a flight nurse specialist with MetroHealth's Metro Life Flight. He's been watching this team of students work on Sim Man, and says they did well.
Harry Rees: Even though - and you did the exact right thing - this is something you need to remember, absolutely intubation is the gold standard, but if you can't intubate, and sometimes that happens, you have to do effective ventilations, and that's why we stress being able to do effective ventilation because you still have to oxygenate your patient.
Camp wrapped up last Friday with a drill involving a car accident and a dirty bomb. It's a situation that has become more plausible in recent years, but John Clochesy says few health workers are really prepared to address it, and that is the point of the flight nursing academy and its week-long summer camp. In Cleveland, Cindi Deutschman-Ruiz, 90.3.