Critical Care in the Air

Emily Brant’s interest in prehospital medicine was sparked in the skies over Pittsburgh when she was a flight physician for STAT MedEvac during her Emergency Medicine residency. That interest matured during her T32 research fellowship and has led to a project to develop tools that help EMS clinicians identify and treat patients with suspected sepsis during prehospital care. Identifying sepsis patients earlier will help speed systems of care once patients reach the hospital.

Since STAT MedEvac patients are first cared for by prehospital providers, “This creates an obligation for us to have better care and tools for treatment in the pre-hospital setting,” said Emily Brant, MD, MS, who is an assistant professor of Critical Care and Emergency Medicine at the University of Pittsburgh School of Medicine. “The STAT team has an increased ability to effectively triage patients which translates into good prehospital care before the patient reaches the ICU.”

Growing up in a small town in a region with limited critical and emergency care facilities, Emily later realized that improved prehospital care could have played an important role in the of care her friends and neighbors. As a flight physician, she has seen firsthand the impact that STAT MedEvac has on connectivity and quality of care in the prehospital stage.

During the depths of the COVID-19 pandemic in 2020, STAT MedEvac set up remote connectivity points to staff individual ICUs with personnel from larger hospitals until local critical care staff were available. Emily spent time serving as the medical director at UPMC Williamsport, where the importance of good prehospital and interfacility care became even more apparent.

STAT MedEvac Program

The STAT MedEvac team is one of the most highly specialized and diversely trained medical teams with vast breadth of experience and versed in high-level safety and operational protocols. Yet constrained by helicopter-sized space, the onboard medical team functions with limited equipment and medication to provide critical care in the air.

Exposure to so many critically injured and largely undifferentiated patients and having to stabilize them without the diagnostic or imaging equipment normally found in an ICU, makes flight physicians extremely skilled at triaging patients and identifying the most critical parts of their illness or injury.

“Many of the therapies we would typically start in an ICU, such as certain vasopressors or antibiotics, they simply don’t have on the helicopter,” explained Emily.

Emily strongly encourages all residents or trainees to get prehospital experience so they understand where their patients are coming from and the care given to them before they reach the ICU, which will, in turn, make trainees better care providers.

As Emily did during her residency, Emergency Medicine residents at Pitt/UPMC work as STAT MedEvac flight physicians alongside critical care flight nurses and paramedics. The STAT MedEvac program is a service of the Center for Emergency Medicine of Western Pennsylvania. It has 17 rotor-wing base sites and performs 12,000-patient transports each year.

Career Path to Critical Care Medicine

“There were a ton of factors that guided my decision to pursue a critical care fellowship. As an ED doc, I simply wasn’t able to satisfy my desire to care for critically ill patients longitudinally,” said Emily. “I saw sick folks, tried to quickly establish a relationship with their family, and then sent them on their way to the ICU. I was always left wondering what happened once they were admitted and if their families were OK.

“Critical care medicine afforded me the opportunity to develop longer-term relationships with patients and their families. I also sincerely enjoy the opportunity to care for patients at the end of life—ensuring patients pass with the same dignity they’ve lived their life brings me incredible personal and professional fulfillment. I am thankful for the resuscitation skills I learned in the ED and on the helicopter, but I am very thankful for the opportunities in critical care. I love my job!”