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Objective: Activated charcoal (AC) has been proven useful in many toxic ingestions. Theoretically, administration of AC in the prehospital environment could save valuable time in the treatment of patients who have sustained potentially toxic oral ingestions. The purpose of this study was to determine the frequency of prehospital AC administration and to identify time savings that could potentially result from field AC administration., Methods: Adult patients with a chief complaint of toxic ingestion who had complete emergency medical services (EMS) and emergency department (ED) records and no medical treatment (gastric emptying, AC administration) prior to EMS arrival were eligible for inclusion. Data obtained from EMS and ED records included time of EMS departure from the scene, time of EMS arrival at the ED, and time of administration of AC in the ED. Since most EMS agencies in this system do not insert gastric tubes, patients requiring gastric tube placement for administration of AC were excluded., Results: Twenty-nine of 117 (24.8%) adult patients received oral AC with no other intervention. None of the 117 patients received AC in the prehospital setting. The EMS transport time for these patients ranged from 5 to 43 minutes (mean 16.2 +/- 9.7 minutes). The delay from ED arrival to AC administration ranged from 5 to 94 minutes (mean 48.8 +/- 24.1 minutes), and was more than 60 minutes for 14 (48.2%) of the patients. The total time interval from scene departure to ED AC administration ranged from 17 to 111 minutes (mean 65.0 +/- 25.9 minutes)., Conclusions: In a selected subset of patients who tolerate oral AC, prehospital administration of AC could result in earlier and potentially more efficacious AC therapy. Prospective study of the benefits and feasibility of prehospital AC administration is indicated.

Purpose: Previous research has confirmed the inability of flight nurses in an airborne BO-105 helicopter to hear breath sounds using normal or amplified transthoracic stethoscopy. The purpose of this study was to determine whether esophageal stethoscopy enabled effective auscultation of breath sounds in a simulated in-flight environment., Methods: The cabin-sound environment of an in-flight BO-105 was recorded and recreated in an audiology laboratory, where five flight nurses were evaluated listening to taped breath sounds via an esophageal stethoscope. This audiotape model, validated in a previously published study, used a tape consisting of 24 20-second segments. Each segment, the beginning of which was marked with a beep signal, consisted of 20 seconds of silence or breath sounds. The distal (esophageal) end of the esophageal stethoscope was attached to the tape recorder; the intensity level of breath sounds heard at the stethoscope earpiece was calibrated to equate the sound level of actual esophageal breath sounds recorded on a volunteer., Results: All nurses correctly identified the 24 taped segments as silent or including breath sounds 100% of the time., Conclusion: In the simulated environment tested, esophageal stethoscopy enabled 100% accuracy in identification of breath sounds, as compared with previously reported 0% efficacy for standard transthoracic auscultation. Study in the actual patient-care environment is indicated to confirm the usefulness of esophageal stethoscopy in the in-flight setting.

Introduction: Patients transported by helicopter often require advanced airway management. The purpose of this study was to determine whether or not the in-flight environment of air medical transport in a BO-105 helicopter impairs the ability of flight nurses to perform oral endotracheal intubation., Setting: The study was conducted in an MBB BO-105 helicopter., Methods: Flight nurses performed three manikin intubations in each of the two study environments: on an emergency department stretcher and in-flight in the BO-105 helicopter., Results: The mean time required for in-flight intubation (25.9 +/- 10.9 seconds) was significantly longer than the corresponding time (13.2 +/- 2.8 seconds) required for intubation in the control setting (ANOVA, F = 38.7, p < .001). All intubations performed in the control setting were placed correctly in the trachea; there were two (6.7%) esophageal intubations in the in-flight setting. The difference in appropriate endotracheal intubation between the two settings was not significant (chi 2 = 0.3; p > 0.05)., Conclusion: Oral endotracheal intubation in the in-flight setting of the BO-105 helicopter takes approximately twice as long as intubation in a ground setting. The results support pre-flight intubation of patients who appear likely to require urgent intubation during air medical transport in the BO-105 helicopter.