Transcription:

Dr Andrew Wilner: Welcome to Advance, the podcast that shares the science and stories of advancing health and personalizing care at Memorial Hermann Hospital. I'm your host, Dr. Andrew Wilner, Associate Professor of Neurology at the University of Tennessee Health Science Center, Memphis, Tennessee. Today, I'm interviewing John Talley, paramedic for Life Flight Operations. We're going to explore Life Flight's areas of expertise and what sets them apart from other air medical providers. John will tell us about Life flight's capabilities and some of the unique equipment aboard their aircrafts. Welcome, John.

John Talley: Hey, how are y'all doing? Thanks for having me.

Dr Andrew Wilner: To get started, John, would you like to tell us why you chose to work at Life Flight?

John Talley: Absolutely. You know, growing up in EMS, I've been in EMS for 10 years now. In the Houston area, Life Flight was a big part of a lot of our scene calls, getting to see how professional they were, how efficient, how quick they were on scene, getting to a level 1 trauma center that really made a big impact on me was a source for role models. When I was initially going through EMT basic, one of my instructors worked for and he still does now work for Life Flight. So getting to interact with him and learn about the program, it really left mark on me and set a goal for me.

Dr Andrew Wilner: So you'd already been an EMT, emergency medical technician, for awhile on ambulances and stuff like that?

John Talley: Yeah. Going on 10 years now.

Dr Andrew Wilner: So we have a Life Flight helicopter, I think, that lands on top of our hospital. And I'm interested in your daily routine. Could you give me a rough breakdown of the number and type of calls you get? You know, when does the helicopter take off? What triggers that?

John Talley: Sure. We have five bases that are surrounding the Houston area. And we have a centrally located base in the medical center. Shift changes at 5:00 to 5:30, depending on where you're at, 24/7 obviously. After we get our aircraft's checked off, make sure our bloods in date, brief with our pilot, we're on for the city and the surrounding areas. You know, it really depends on what day and what base you're at as far as a scene versus a transfer, hospital transfer or a scene call. But we have a pretty even mix. Now that it's warming up, people are starting to get out more, enjoy the weather. And we do quite a bit more scenes once it starts to get towards summer. We do a lot of wrecks, a lot of shootings and stabbings; transfer side, a lot of strokes, STEMI. Obviously, when COVID was going on, we did fly a lot of COVID patients. But honestly, our EMS providers and our hospitals, they really call for anything. So you really don't know what you're going to get, to be honest.

Dr Andrew Wilner: Now, how do they decide? I said, helicopter are there other types of aircraft as well?

John Talley: We do have a fixed-wing program as well. And that is interfacility transfer, so that's physician dependent, if they would want a fixed-wing provider do that transfer. But just your typical hospital-to-hospital around the Houston area, that's going to be physician-dependent. For our EMS providers, it's really based on their decision. Some providers have different protocols that say when to call, usually it's just the provider discretion whoever's in charge of the scene.

Dr Andrew Wilner: Right. So if there's a car wreck on the highway, how do they decide that an ambulance should come or a helicopter.

John Talley: So an ambulance will get dispatched every time once the crew makes patient contact, determines that that patient needs rapid transport to a level 1 trauma center. that's usually kind of the determining factor. But if the patient needs blood quickly, that would be another factor to call.

Dr Andrew Wilner: So, do you have blood on board? Do you have the ability to give transfusions en-route?

John Talley: We do. We hang a lot of blood at Life Flight, every day almost. We carry six units, two units of whole blood and we have our PRBCs and our plasma. So we do hang a lot of blood because we see a lot of trauma, especially with our scene calls.

Dr Andrew Wilner: And I'm not familiar with that term, a scene call. What does that mean?

John Talley: So a scene call would be when an EMS provider, so on the ambulance, whenever they request a Life Flight. So scene calls, typically, like I said, like your wrecks, maybe we're landing on the highway or landing on a neighborhood in a field. So that'd be a scene versus a hospital transfer and interfacility transfer.

Dr Andrew Wilner: So if the patient needs blood, I'm presuming they lost a lot of their own and might be hypotensive. So do you use vasopressors as well?

John Talley: We do we carry -- I have to count them -- seven vasopressors, and I might be lumping a few ionotropes in there, but we carry seven, norepinephrine being our first line for hemorrhagic shock. But the patient's always going to get blood first and foremost. As much blood as we can get in them, if that's not working and we have to move to a pressor, then sure. But blood is always going to be first-line in our hemorrhagic shock patients. Another common one, we give a lot of phenyl as a pre-RSI. We have to have some hemodynamic support there. But we do have the option for seven and that's not just trauma patients, but that's the complex medical patients that we also take care of.

Dr Andrew Wilner: Clarify a little bit, you said phenyl. Are there any other vasopressors that you use?

John Talley: Commonly, besides Levophed, epinephrine, phenylephrine, those really get used the most with us, just because the patients that we see. But we do have dopamine, we do have milrinone and we do have dobutamine and vasopressin. So we're able to pick and choose depending on what patient we have, what the pathology is and what's going on. So, we do have a lot of options for different patients.

Dr Andrew Wilner: Any diagnostic equipment on board? I guess x-rays probably too heavy. Are there any other gadgets that you could bring on board a helicopter and figure out what's going on with the patient?

John Talley: We're still waiting on x-ray. But until then, we do carry ultrasound and that gets used mostly for our trauma patients, but also our OB patients so if we have to check for fetal heart tones. Probably the most beneficial way for ultrasound, you know, in an aircraft you can't listen to lung sounds, if a patient is developing a tension pneumothorax, being able to do a quick scan and see if there's any kind of tension physiology, that's really beneficial because I can't put a stethoscope on the patient in the back of the aircraft, so that and the use on trauma patients to kind of identify any internal internal bleeding, it's really beneficial.

Dr Andrew Wilner: Well, that's a real advance. They didn't have portable ultrasound machines when I was in medical school. So that sounds like a good thing. What is Life Flight doing to benefit preventable or potentially preventable death rates in trauma patients?

John Talley: That's a great question. Being fortunate enough to work for a program that's at one of the nation's largest and busiest level one trauma centers. There's a lot of research that goes on and a lot of education, and given how much trauma that we do see at Life Flight, we're usually included in those studies. Our medical directors, one's an emergency physician and one is in trauma surgery. So they kind of go hand in hand to what's on the forefront for trauma care. So having access to what's new and upcoming and different treatment modalities directly to Life Flight. Not to mention having access to the blood that we carry, having an ultrasound and what's unique to Life Flight is that we have a helipad to OR process. So what that is is any patient that meets criteria to get taken from our helipads straight into the operating room, which is typically trauma patients, but we also do it for vascular and different cardiac patients. But that's a giant resource. If it's a 10-minute scene time and a five -minute flight, that's a quick time to get to the operating room for a trauma patient. So, I'm very proud that we're able to offer that to our patients.

Dr Andrew Wilner: As a Life Flight crew member, what does it mean to you to be a patient advocate?

John Talley: So given that most of our patients are intubated, it's a big responsibility to be able to, one, find out what their problem is, what pathology is going on and, two, treat that accordingly and take care of that promptly, but, three, relay that to the providers that are in the ED or the OR, so nothing is missed and there's no lapse in care. To me, that's a big responsibility, but I like that responsibility.

Most of these patients, it's the worst day of their life to get flown in a helicopter down to the med center. So being able to have the equipment and the resources to take care of them and advocate for whatever is going on with them that day, to me, that's a big responsibility, but I'm proud to be able to do that.

Dr Andrew Wilner: Well, that's terrific. To wrap up, is there anything else you'd like to add?

John Talley: I have to say working for Memorial Hermann Life Flight and the legacy that Dr. Duke set forth and all the history that we have here, it's an absolute honor. It's an absolute privilege to have the resources, the education, anything that we need to be 100% patient care-centered and focused. And I'm more than proud to work with this program.

Dr Andrew Wilner: Well, that's great, John. I want to thank you for your hard work and great explanation of Life Flight at Memorial Hermann Hospital.

John Talley: Thank you for having me.

Dr Andrew Wilner: And that wraps up this episode of Advance, the podcast that shares the science and stories of advancing health and personalizing care at Memorial Hermann Hospital. Now is the time to learn more about Memorial Hermann Life Flight and incorporate Life Flight into the community to improve patient care.

Visit us at www.memorialhermann.org/lifeflight or contact us at (713) 704-4000 to discuss how Life Flight can better partner with you as clinicians. I'm your host, Dr. Andrew Wilner. Thanks for listening.