title: Administration of CroFab Antivenom by a Helicopter Emergency Medical Service Team.
abstract: The case presented here highlights an unconventional use of a helicopter emergency medical service (HEMS) to provide a specialized medication to a critically ill patient when definitive transport was delayed. A 39-year-old man presented to a rural hospital 1 hour after sustaining a copperhead envenomation. He developed severe symptoms and was intubated. Arrangements were made for transfer to a tertiary referral center by HEMS, but because of incoming weather conditions, the team would not be able to make the return flight safely. The decision was made for the HEMS team to fly antivenom to the patient, administer the medication, and then transport the patient by ground to the tertiary medical center. This plan was executed, and the patient was safely transported to the accepting facility. Antivenom is most effective when administered early because this will halt the progression of edema and may reverse the systemic effects of envenomation. In this case, HEMS transport of antivenom to the patient with severe toxicity prevented a delay to administration and likely improved the patient's outcome. Although the traditional role of HEMS is to provide rapid transport to critically ill patients, HEMS teams can also function to deliver specialized medications to remote settings.
authors.affiliation: Assistant Professor, Department of Emergency Medicine, University of Wisconsin, Madison and Flight Physician, UW Med Flight, UW Hospital and Clinics, Madison. Electronic address: mike.steuerwald@gmail.com.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Steuerwald
authors.affiliation: Flight Nurse, AirCare and Mobile Care, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Season R K
authors.initials: SR
authors.lastname: Gabbard
authors.affiliation: Fellow, Toxicology, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Beauchamp
authors.affiliation: Flight Physician, AirCare and Mobile Care, University of Cincinnati Medical Center and Resident Physician, Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Riddle
authors.affiliation: Professor, Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Otten
mesh_terms: D000328:Adult; D017836:Agkistrodon; D017732:Air Ambulances; D000402:Airway Obstruction / Q000209:etiology / Q000628:therapy; D000552:Ambulances; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use*; D004487:Edema / Q000209:etiology; D004632:Emergency Medical Services; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D007442:Intubation, Intratracheal; D008297:Male; D012121:Respiration, Artificial; D012909:Snake Bites / Q000150:complications / Q000188:drug therapy*; D014887:Weather
chemical_list: D000997:Antivenins; C431183:Crotalidae Polyvalent immune Fab; D007140:Immunoglobulin Fab Fragments