By Margaret Delaney
The Advocate
LAFAYETTE, La. 鈥� Zachary Dubroc thought he wanted to be a registered nurse. But, after pivoting to emergency medical technician school and working in emergency services, Dubroc found where he wanted to be 鈥� taking care of patients in the air.
Acadian Air Med, founded in 1981, operates a fleet of 13 medically configured helicopters and three fixed-wing aircraft from bases throughout Louisiana.
The aircraft can be used to transport patients with major trauma, post-cardiac arrest, severe illness, surgical emergencies and more.
Patients who require a high level of care during transport often take the helicopter and team to facilities in New Orleans, Houston or even as far as Tennessee.
Dubroc, who is both a registered nurse and paramedic, regularly commutes to air bases across the state for air med flights.
I worked in Lake Charles yesterday, Lafayette today and tomorrow I鈥檒l work in Houma and Hammond,鈥� Dubroc said. 鈥淚 kind of live in the middle of the state, so I just drive where I鈥檓 needed.鈥�
There are 86 people employed at Acadian Air Med including in-flight paramedics, in-flight registered nurses and staff members. Each flight has a pilot (a separate group provided by Metro Aviation ), a flight paramedic and a flight registered nurse.
When he鈥檚 not at an air base, or driving to an air base, Dubroc clocks in hours at an emergency room and ICU.
鈥淎 lot of the knowledge is the same,鈥� Dubroc said of his experience in both hospital and emergency settings. 鈥淥ut in the field, it鈥檚 very unorganized chaos, where the hospital is more organized chaos in the way they operate.鈥�
Joseph Sanchez, a paramedic with air med, compared arriving to an emergency situation in a helicopter to a duck treading water.
It鈥檚 important for the air med team to display a calm manner on the surface, according to Sanchez, even when they recognize the severity of the situation.
鈥淲hen we land in our helicopter, we are assuming control and command of the entire scene,鈥� Sanchez said. 鈥淓veryone鈥檚 going to look up to you, and your demeanor is going to be contagious to the rest of the scene.鈥�
Both the paramedic and registered nurse bring 鈥渦nique skills鈥� to the scene, according to Sanchez.
Paramedics with Acadian Air Med typically have previous experience with 911 calls or treating patients in moving ambulances as an EMT 鈥� skills that prepare them for new scenes and situations.
Nurses bring ICU experience, clinical knowledge and a better understanding of long-term care.
鈥淎 paramedic wants to make sure the patient stays stable enough to get to the hospital or facility,鈥� Sanchez said. 鈥淎 nurse is more likely to look at how the patient will react three or four hours later.鈥�
Keeping patients calm for the flight
According to Sanchez, part of the job is learning how to read people, especially regarding those who might be afraid of flying or have a fear of small spaces.
鈥淏efore we get to the aircraft, we鈥檒l talk with the patients and let them know the ceiling is gonna be six inches above their face,鈥� Dubroc said. 鈥淎nd we鈥檙e gonna be right there with them.鈥�
With children, air med has an extra seat in the front for a parent to accompany them to the hospital or secondary facility.
鈥淲e try everything we can to bring them,鈥� Sanchez said. 鈥淏ut some of what we do is weight-based as well, so we take all of that into account along with the pilot.鈥�
Outfitting the helicopter for emergencies
In each helicopter, the 鈥渢unnel鈥� (the back of the aircraft) is stocked with the latest emergency technology. However, with seats for two medical personnel and a patient in a gurney, space is limited. All of the equipment must be compact.
Bungee cords holding EKGs in place, nets fitting emergency equipment to the inside walls and efficiently packed med kits line the tunnel of the helicopter, with no space left untouched.
On board each flight, there are cardiac monitoring tools, ventilators that fit both adults and babies, med pumps that provide fluids to patients, a video laryngoscope, blood and blood warmers for transfusions and a mechanical CPR machine.
When in flight, a patient鈥檚 nose is typically six inches away from the ceiling of the helicopter. That leaves little space for the paramedic and nurse to provide CPR if necessary while in the air.
The CPR technology places a backboard below the patient and mechanically squeezes the patient鈥檚 chest.
鈥淪tudies show that in an ambulance going down the road, efficiency doing CPR drops by 60% or 40%,鈥� Dubroc said. 鈥淪o in the helicopter, where we have less room to do CPR, we can use the board that does CPR way more efficiently than we can.鈥�
Bringing in new technologies
Each quarter, the team gets together to look at new technologies 鈥� or different sized technologies 鈥� to add to the tunnel.
鈥淓very year, we try to update something,鈥� Sanchez said.
In 2018, the fleet added blood transfusion capabilities to its helicopters. Now, all operational air med aircraft are equipped with two units of blood at all times.
Sanchez treated a young adult after a crash on the way to work. The patient was trapped under the vehicle with a pelvic fracture and had lost a lot of blood.
鈥淲hen we got there, the patient was already in hemorrhagic shock,鈥� Sanchez said. 鈥淏eing able to have that blood and administer the units while he鈥檚 trapped inside of the vehicle, I believe, gave him the extra little bump he needed.
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