Implementation of the protocol of nursing care in trauma in aeromedical service

A cross-sectional quantitative study carried out in an aeromedical service, using a checklist with 106 care: 79 before flight, 25 during, and 2 after flight. 97 patients were included in the study.

Results:

Most care (n = 59; 55.7%) was implemented, totaling 4,435, 1,480 and 192 cares performed before, during and after the flight, respectively. They stood out as unrealized care: protect ears with ear muffler (n = 55) and avoid leaving the pulse oximeter exposed to the sun’s rays (n = 22). The main reason for the non-performance was lack of appeal (n = 94).

Conclusion:

Although most protocol care has been implemented, unrealized care compromises the quality of care, which requires the management of the service to provide more incentive to nurses and adequate resources for its implementation.

Descriptors:
Nursing Assessment; Advanced Trauma Life Support Care; Aerospace Medicine; Emergency Medical Services; Emergency Nursing

Characteristics of the Nurses	n	%	Average	SD
Age Bracket			31.8	1.9
16-30	2	33.3
31-45	4	66.7
46-60	-	-
≥ 61	-	-
Total	6	100.0
Gender
Male	1	16.7
Female	5	83.3
Total	6	100.0
Characteristics of patients	n	%	Average	SD
Age Bracket			37.6	16.1
16-30	46	47.4
31-45	23	23.7
46-60	18	18.6
≥ 61	10	10.3
Total	97	100.0
Gender
Male	78	80.4
Female	19	19.6
Total	97	100.0

Pre-flight care	Executed	Unexecuted	Not applicable
Pre-flight care	n (%)	n (%)	n (%)
Security guidelines for boarding and disembarking	588 (13.2)	8 (5.3)	181 (6.1)
Scene evaluation	347 (7.8)	3 (2.0)	38 (1.3)
Primary Evaluation
A) Airway and control of the cervical spine	181 (4.1)	1 (0.7)	303 (10.2)
B) Breathing	514 (11.5)	22 (14.8)	413 (13.9)
C) Circulation	713 (16.1)	17 (11.5)	521 (17.5)
D) Inability	269 (6.1)	2 (1.3)	117 (4.0)
E) Exposure and environment	262 (5.9)	-	223 (7.4)
Secondary evaluation
Principles and examination of parties	589 (13.3)	23 (15.4)	346 (11.6)
Other care procedures ^* Note: * Other care procedures: checking blood pressure; checking temperature; assessing the occurrence and intensity of pain with numeric scale; performing Sampla history (symptoms, allergies, medications, medical past, liquids, events); Re-evaluating neurological function; immobilizing fractures of limbs in the position in which they are found, including the joint above and below the injury site; recognizing the type of fracture: closed or exposed; use of traction splint in case of fracture of femur; padding the hard splints preventing interior movements; remotion of jewelry and objects before immobilization; evaluating neuromuscular function before and after applying any immobilization; attempt of immobilization of the patient in the most anatomical position possible: keeping the collar with side cushions on the side regions of the head, spider strap and in rigid board; performing analgesia, administering antiemetics; conducting survey oro/NG tube: in over 15-minute-long flight; performing vesical probe of delay if necessary when the volume replacement is large or when the flight has more than 15 minutes or reaches more than 1,870 feet altitude; reassuring the patient and family members if they are lucid at the crash site; strengthening compressive dressings; identifying orotracheal tube if the cuff is inflated with water; choosing equipment and materials to be placed in the cabin during the flight.	972 (22.0)	73 (49.0)	834 (28.0)
Total	4,435 (100.0)	149 (100.0)	2,976 (100.0)
In-flight care
In-Flight Security Guidelines	686 (46.4)	6 (4.8)	181 (22.2)
A) Airway and control of the cervical spine	88 (6.0)	-	9 (1.1)
B) Breathing	131 (8.8)	5 (4.0)	349 (42.7)
C) Circulation	93 (6.3)	26 (20.1)	74 (9.0)
D) Inability	128 (8.6)	24 (19.3)	138 (16.9)
E) Exposure and environment	354 (23.9)	63 (50.9)	67 (8.1)
Total	1,480 (100.0)	124 (100.0)	818 (100.0)
After-Flight Care
Passing of the shift to the nurse	95 (49.5)	2 (100.0)	-
Filling out of the entire information sheet	97 (50.5)	-	-
Total	192 (100.0)	2 (100.0)	-

Unexecuted pre-flight care	Reasons for non-execution
Unexecuted pre-flight care	NF	NK	NA	NR	NT	Total
Pilot assistance in landings and departures	-	5	-	-	-	5
Disembarkation with pilot authorization	2	-	-	-	-	2
Asking if the pilot will keep the driven rotors	1	-	2	-	-	3
Checking airway permeability and controlling cervical spine with collar	-	-	-	1	-	1
Administration of oxygen with mask or catheter	-	-	-	-	1	1
Filling the cuff with water, If patient is intubated	7	-	4	-	2	13
Double attachment of the orotracheal tube	2	-	1	-	4	7
Avoiding leaving the pulse oximeter exposed to sunlight	9	-	-	10	3	22
Using of capnograph	-	-	-	18	-	18
Execution of the Sampla history	1	-	-	1	5	7
Immobilization of fractures	-	-	1	-	-	1
Use of traction splint in case of femoral fracture	-	-	-	-	1	1
Padding hard splints inside	-	-	-	7	-	7
Remotion of jewelry and objects before immobilizing	1	-	-	-	-	1
Execution of analgesia	-	-	-	-	2	2
Performing antiemetics	2	-	-	-	2	4
Execution of of OGP or NGP, IN	1	-	-	-	2	3
Execution of DCR, IN	-	-	-	1	3	4
Checking of the carotid pulse	1	-	-	-	1	2
Observation of internal bleeding: assessing abdomen and pelvis	1	-	-	-	-	1
Obtention of access to two large caliber venous	-	-	-	1	1	2
Use of bandage on puncture dressing	2	-	-	-	2	4
Putting the syringe pump or pressurizer into the serum	3	-	8	3	4	18
Evaluating pupils	2	-	-	-	-	2
Seeing / hearing / feeling head	-	-	-	-	1	1
Seeing / hearing / feeling neck	-	-	-	-	1	1
Seeing / hearing / feeling chest	-	-	-	-	1	1
Seeing / hearing / feeling abdomen	1	-	-	-	2	3
Immobilization and tilt of rigid board (pregnant)	1	-	-	-	-	1
Reassuring patient and family	-	-	-	-	2	2
Strenghtening of compressive dressings	1	-	-	-	-	1
Identification of OTT, if cuff inflated with water	5	-	-	-	-	5
Choosing equipment and supplies to be placed in the flight deck	2	-	-	-	1	3
Total	45	5	16	42	41	149

Unexecuted in-flight care	Reasons for non-execution
Unexecuted in-flight care	NF	NK	NA	NR	NT	Total
Keeping materials in the aircraft fixed and well conditioned	-	-	-	1	-	1
Notifying the pilot or crew member if objects that may collide with the aircraft are observed	-	-	-	-	1	1
Knowing flight information to schedule assistance	1	-	-	-	-	1
Use of bacteriological filters for mechanical ventilation or manual resuscitation	3	-	-	-	-	3
Execution of oximetry monitoring and administer O2 in all patients	-	-	-	-	1	1
Observing signs of pneumothorax	1	-	-	-	-	1
Monitoring patient with multi-parameter monitor	3	-	1	-	17	21
Keeping serums in pressurizer and syringe pump medications	3	-	1	-	2	6
Placing sedation medications close	4	-	1	-	8	13
Watching out for seizures, wearing protective clothing / visors	7	-	-	3	2	12
Protecting ears with ear muffler	12	-	1	40	2	55
Keeping patient warm	-	-	-	1	-	1
Maintaining the separation between patient and aircraft structure	1	-	-	7	-	8
Total	35	-	4	52	33	124
Unexecuted after-flight care	NF	NK	NA	NR	NT	Total
Passing of the shift to the nurse informing about the cares executed	-	-	-	2	-	2
Total	-	-	-	2	-	2

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Gabriela Schweitzer. E-mail: gabyschw@hotmail.com