T4 Arteriovenous Malformation
An arteriovenous malformation (AVM) is an abnormal tangle of blood vessels in the brain, spinal cord, or on the brain's surface. Normally, arteries carry oxygen-rich blood from the heart to the brain, while veins carry oxygen-depleted blood away from the brain back to the heart. An AVM causes a direct connection between one or more arteries and veins, disrupting the normal blood circulation process. AVMs may occur in any of the four major lobes of the brain, the cerebellum, the brainstem, or the ventricles.
AVMs usually are congenital, or present at birth. However, they often go undiagnosed if a patient doesn't show symptoms. Over time, thin-walled veins may not be able to handle the high-pressure blood flow from the arteries, and patients may begin to have symptoms, such as headaches, weakness, numbness, vision loss, or seizures. If not treated, AVMs may rupture and bleed into the brain, causing stroke and effects such as paralysis or difficulty communicating. A bleeding brain AVM is life-threatening and requires emergency medical attention. Medical professionals aren't sure what causes brain AVMs, although they do not appear to be hereditary. Brain AVMs occur in less than 1 percent of the general population and are more common in males than females.
UAB was the first hospital in Alabama to be certified as a Comprehensive Stroke Center by the American Heart Association/American Stroke Association and The Joint Commission, a nonprofit national health care accreditation agency. This elite designation recognizes hospitals that maintain the staff, training, and technology to treat patients with the most complex strokes, at any time of day or night. We handle more than 1,800 stroke cases annually, the most serious of them within our dedicated Neurointensive Care Unit and Stroke Unit. U.S. News & World Report consistently ranks UAB Neurology and Neurosurgery among the top programs of their kind in the nation.
Stroke care at UAB is delivered by a large team of expert stroke physicians who are on duty 24/7. UAB has more board-certified vascular neurologists, neurointensivists, endovascular neurosurgeons, and vascular neurosurgeons than any other hospital in Alabama, along with 350 nurses with stroke-specific training. Our 36-bed Neurosciences Intensive Care Unit is among the largest in the United States. Because UAB is a major center for stroke research, patients may be eligible to participate in clinical studies of promising new treatments for stroke, so they could receive therapies not available at most other medical centers.
When a stroke patient arrives at the UAB Hospital Emergency Department, a “Code Stroke” is activated, triggering a rapid response team that evaluates the patient to ensure that the most appropriate care is provided in the shortest time possible. Our range of advanced treatments includes acute therapies such as the clot-busting medication Alteplase (tPA), along with catheter-based procedures such as thrombectomy, aspiration, and stenting. The extensive resources and technologies of our neurovascular stroke service are not available at other hospitals in the area.
After admission and initial management, stroke patients are further evaluated in our dedicated Stroke Unit, which is staffed by nurses, physicians, and rehabilitation therapists who specialize in stroke. Every patient undergoes a thorough, individualized diagnostic workup with advanced imaging technologies to determine the underlying cause of the stroke.
When it’s time to begin the recovery process, UAB Spain Rehabilitation Center provides comprehensive rehabilitation programs that are customized to each patient. UAB created a Stroke Recovery Clinic (SRC) to help stroke survivors recover more effectively, with fewer long-term effects. One of only a few clinics of its type in the country, the SRC combines speech, occupational, and physical therapy with neuropsychology care and social work services.
UAB strives to provide the highest quality evidence-based stroke care to our community. The information listed in this report provides data on key performance measures that reflect our commitment to excellent care.
UAB is an active participant in research and clinical trials for the diagnosis and treatment of arteriovenous malformation. We encourage you to speak to your physician about research and clinical trial options and browse the link below for more information.View Clinical Trials
- Critical Care Transport Fun Facts
- Did its first transport in March 23, 1983 of quadruplets from UAB Hospital to Brookwood Medical Center.
- Has transported to 46 states and 38 countries
- Had the first civilian aircraft in the country with a liquid oxygen system; the oxygen canisters had serial numbers 1 and2.
- Has appeared on The Learning Channel, the National Geographic Channel, Discovery Channel, CNN, MSNBC and the film CCT team members starred in, “Johnny Flinton”, won an Oscar in 2003 for Best Short Films.
- Provided the medical team for President Bush's visit to Birmingham in 2001.
- Has performed up to 77 defibrillations on one transport. And the patient survived!
- Supplied one of the first 10 items writers for the Certified Flight Registered Nurse exam and served on the Exam Construction and Review Committee
- Has two brands of equipment that are still in use that have been used since the beginning of the program: the MVP-10 ventilator and Airborne isolette.
- Evacuated 21 patients during Hurricanes Katrina & Rita and provided staff, supplies, equipment and ambulances for NDMS (National Disaster Management System) twice in 2005
- Transported 8 babies simultaneously in the jet out of New Orleans during Hurricane Gustav in 2008
- Were the only civilian aircraft allowed back in the air on 9/11 returning a patient from Monroe, LA to UAB.
- Has the first Cessna Citation Bravo jet in the world to have a clam-shell type door installed
- Was the first U.S. aircraft to fly a new route over Cuban airspace to evacuate an earthquake victim following the earthquake in Haiti January 2010. This saved 30 critical minutes flight time, and the new medevac flight path was followed by many air ambulances afterward.
- “Ground transportation” on one international trip was a gondola in Venice.
- Supplied the ground content for ASTNA’s Transport Safety Position Paper in 2006 making it the first transport professional association to have all modes addressed in a safety position statement.
- Co-edited, authored and reviewed several chapters in ASTNA’s (Air and Surface Transport Nurses Association) Standards for Critical Care & Specialty Care Ground Transport, 2nd Edition” published in 2010. CCT also did the artwork for the book cover.
- Longest working full-time team member: Valorie Tucker, NNP, worked from 1999 – 2010, transported 1842 patients and traveled ~ 680,000 miles
- Most transports in one day – 23; Transport Coordinator Sheryl Pettis
- Most intra-aortic balloon pump transports in one day: 3 on multiple dates
- First nurse to transport 2,000 patients: John Doriety, RN, CCRN on 1-28-2016
- Critical Care Transport History
- Critical Care Transport's Jet Aircraft
- Research and Publications
- International Transports
- Frequently Asked Questions
- Recovery Apps and Helpful Links
- Frequently Asked Questions
- Incontinence Testing
- Preimplantation Genetic Diagnosis
Critical Care Transport Fun Facts
Critical Care Transport…
Standing CCT Records:
Critical Care Transport History
Critical Care Transport's Jet Aircraft
This Cessna Citation Bravo twin-engine jet flies at 480 miles per hour and has an un-refueled cruising range of 1700 miles. It can accommodate two adult or neonatal patients and has seating for up to five team members. The aircraft features custom design with installed medical air, dual suction system and dual inverter; liquid oxygen, air, and inverter; sectional/removable bench seat for intra-aortic balloon pump transports; installed Air Cell telephone; interior compartment storage for medical equipment and supplies; cabin area Flight Status Panel showing air speed, distance to next stop, outside altimeter and interior cabin altimeter. It is the first Bravo in the world with a cargo door, 36 inches wide, to facilitate loading for patients on stretchers. All pilots undergo annual simuflite training and have achieved their ATP (Air Transport Pilot).
The aircraft is operated by AirMed International, Air Carrier Certificate # MDGA382G.
Research and Publications
Demmons, L., “Vehicle Specifications and Fleet Maintenance”, Treadwell, D., Santiago, J., (2019) ASTNA Standards for Critical Care and Specialty Transport, 2nd Edition, Aurora, CO, p. 102-106.
Demmons, L., Minton, R., Taylor, G., “Transporting the Deceased: Partnering with the Organ Recovery Center to Improve Transplant Outcomes”, Air Medical Journal, Nov-December 2018, 37:6, p. 374-379.
Demmons, L., “Infectious and Communicable Diseases”; Clark, D., Treadwell, D., et al (2017), ASTNA Critical Care Transport Core Curriculum, Air and Surface Transport Nurses Association, Aurora, CO, p. 423-434.
Demmons, L., James, S., (2010) ASTNA Standards for Critical Care and Specialty Ground Transport, 2nd Edition, Air and Surface Transport Nurses Association, Centennial, CO, Cottrell Printing Company.
Demmons, L., "Twenty-five Years Later: Critical Care Transport", Air Medical Journal, Nov - Dec 2008, Vol. 27, No. 6, p. 276-280.
Air and Surface Transport Nurses Association: Demmons, L, Stevens, L, High, K, Lin, J., "Transport Nurse Safety in the Transport Environment, Position Paper", Sept 2006.
Demmons, L., "Chasing Ambulance Safety", Air Medical Journal, May-June, 2005.
Gruszecki, A., Kahler, D., Smith, D., Vines, J., Lancaster, L., et al, "Utilization, Reliability and Clinical Impact of Point-of-care Testing during Critical Care Transport: Six Years of Experience", Clinical Chemistry, Vol. 49, No. 6, 2003.
Commission on Accreditation of Medical Transport Systems Best Practices, Volume II, 2001; Volume III, 2004; most cited program in Volume IV, 2007; Volume V, 2012; Volume VI, 2017, Seventh Edition, 2020.
Randolph, V., Kahler, D., Howard, C., Hortin, G., "Laboratories on the Move: Blood Gas Analysis", Laboratory Medicine, Vol. 31, No. 1, 2000.
Brunson M., Lancaster L., "Transport of Critically Ill Patients: How to Avoid Pitfalls", Clinical Pulmonary Review, Vol. 6, No. 4, July 1999.
Demmons, L., Cook,E., "Anxiety in Adult Fixed-Wing Air Transport Patients", Air Medical Journal, July - September 1997.
Worldwide transport service is available through Critical Care Transport. International transports are equipped and staffed as domestic transports
Some advance notice is required for international transports due to overnight requirements. Due to the length of some of the transports, an overnight stay may be required. All arrangements for the overnight stay, as well as all other components of the trip, will be arranged by the transport service.
Because international transports are usually not covered by insurance, financial arrangements must be secured prior to US departure.
Frequently Asked Questions
Q: Will insurance companies pay for the services of Critical Care Transport?
A: Most major commercial insurance companies will cover 50 to 80 percent if "medical necessity" terms are met. However, persons should check with their insurance company to discuss individual coverage.
Q: What about Medicare Coverage?
A: For medicare to cover ground/air transport, a patient must be in a condition that would justify the need for transport. "Medical necessity" must be established. In addition, for maximum coverage, Medicare requires that the patient be transported to the "nearest appropriate facility."
Q: How does CCT determine to fly or drive a patient for transport?
A: Generally, patients within 100 to 150 miles radius of Birmingham will be driven from one facility to another. The patients outside of the 125 mile radius will usually be flown from the referring facility to the receiving facility.
Q: Will Critical Care Transport move a patient to a hospital other that UAB?
A: Yes. However, for patients to be transported to a facility other than UAB, payment must be secured prior to the transport. We can bill the insurance of most patients who have Medicare or Blue Cross. Certified check, VISA, Master Card, Discover, or American Express can be used. Persons should ask the transport coordinator if their hospital or company has an agreement with CCT, as many do. If this agreement exists, then the requirements for pre-payment will be waived. Some insurance companies, with prior arrangements, will allow CCT to bill the insurance company directly.
Q. Do you have a service available if you are traveling in the U.S. or abroad, become sick or injured and want to get back home?
A. Yes. Critical Care Transport works with AirMed Intl. to provide these repatriation services for an annual fee. You may call (205) 443-4840 or go to www.AirMed.com/UAB for more information and to obtain your membership instantly.
We understand that you may have additional questions. Please feel free to contact the Critical Care Transport Coordinator at 1-800-822-6478 to have these questions answered.
Recovery Apps and Helpful Links
12 steps AA companion
Comprehensive recovery tool includes Big Book Reader, sobriety calculator, search and more
AA Big Book and More
Ultimate Recovery Resource-The text of the Big Book and more
Narcotics Anonymous App
Basic Text of Narcotics Anonymous
One Day at a Time
Comprehensive Recovery Tool
Find A Meeting
Alcoholics Anonymous - www.aa.org
Narcotics Anonymous - www.na.org
Al -anon - www.alanon.org
Frequently Asked Questions
Does Addiction Recovery accept insurance for drug and alcohol treatment?
Yes. We are in-network for many major insurance companies. Additionally, the UAB Addiction Recovery Program is "insurance friendly," meaning that we both accept insurance and work hard with insurance companies on behalf of our clients in treatment to secure the best payment solutions for them. Our financial case managers have an expert understanding of using both in-network and out-of-network benefits, we will work closely with insurance companies to streamline the process and ensure that the patient receives the maximum benefit available. As a nonprofit organization, we also work to determine if patient aid and no- or low-interest loans are available that can be used in combination with insurance benefits for addiction treatment.
How much does drug and alcohol treatment cost?
It depends on your insurance coverage and the type of addiction treatment needed. Insurance may cover up to 90% of the costs. We offer a range of services, from less expensive outpatient rehab (for patients with less serious addiction issues) to residential programs where patients live with us for 4-6 weeks.
What kind of rehab programs do you offer?
The UAB Addiction Recovery Program offers a wide array of alcohol and drug treatment programs and services for adults and youth including specialized rehab programs for men, women, health care professionals, lawyers and pilots. Our mental health professionals are skilled at helping patients with co-occurring disorders (issues in addition to addiction, such as depression, anxiety, and eating disorders), which sets our Addiction Recovery Program apart from other alcohol and drug treatment centers. Family members play an important role in the addiction recovery process and are encouraged to attend our Family Program and Parent Program.
Do you treat conditions other than drug and alcohol addiction?
Many people who come to the UAB Addiction Recovery Program seeking treatment for their drug or alcohol addiction also may struggle with mental health issues such as depression, eating disorders, grief, anxiety, post-traumatic stress disorder, and sexual compulsivity. This combination of addiction along with a mental health issue is called "co-occurring disorders" and is quite common. The Addiction Recovery Program has medical staff, psychologists, psychiatrists, and counselors on site who are skilled at addressing the complexity of issues in co-occurring disorders alongside the addiction to drugs or alcohol.
There are many tests available to help determine the exact causes of incontinence.
These may include urinalysis (examination of the urine) and blood tests to check the cells and various blood components, hormones, and chemicals.
A thin tube is placed inside the urethra to view the inside of the urethra and bladder.
These tests are used to check the function of the lower urinary tract, which consists of the bladder, urethra, and the voluntary and involuntary sphincter muscles. Many of these tests can be done at the same time. Urodynamic tests include:
This test records the amount of urine, the time it takes to urinate, and the speed of the urinary stream. It also tests the ability to start and stop urination, and whether or not it is strong or forceful. The test is performed on a special urodynamic chair. After voiding, a catheter is inserted to see how well you empty your bladder.
Postvoid Residual Measurement
A catheter is inserted after voiding to see how much urine remains in your bladder.
For this test, a very small catheter is inserted to measure bladder pressure at various stages. Fluid is infused through the catheter to test how well the bladder muscle stretches during filling, how well it stores fluid, and how well you empty your bladder. A small tube is placed in the rectum, causing only minimal discomfort, in order to isolate the pressure of the bladder muscle itself.
Electromyography (EMG )
The EMG may be performed at the same time as the CMG. For this test, sensor patches are placed on the skin near the urethra and rectum to test the muscle activity of the external sphincter. Muscle activity is recorded on a machine. The patterns of the impulses will show whether the nerve messages are coordinated correctly.
Video imaging is used to take pictures of the bladder during filling and emptying. The imaging equipment may use x-rays or sound waves. If x-ray equipment is used, the liquid used to fill the bladder may be a contrast medium that will show up on the x ray. The pictures and videos show the size and shape of the urinary tract.
leak point pressure measurement - This test determines the lowest amount of pressure and amount of urine that causes leakage. It is performed as a part of the cystometry study.
Pressure Flow Study
This test follows the cystometry study and measures pressures required to urinate.
Anorectal physiology studies - These tests are used to help us characterize how well you sense a fullness of the rectum, your ability to contract and relax your pelvic muscles, and determine whether there is a tear in the anal sphincter muscle.
This checks the tightness of the anal sphincter and its ability to respond to signals, as well as the sensitivity and function of the rectum. A thin, flexible tube is inserted into the anus and rectum, then a small balloon at the tip of the tube is inflated. Pressure monitors inside the tube transmit the muscle impulses to a graph, similar to an electrocardiogram. The procedure is similar to a female pelvic examination and takes about 15 minutes to perform.
A small, balloon-tipped ultrasound probe is inserted into the rectum. The structure of the anal sphincter can be evaluated from the pictures of the as the probe is moved.
Small sensor patches are placed on the skin near the muscles around the anus to check for nerve damage to the sphincter. This is not painful.
Preimplantation Genetic Diagnosis
Some couples are at increased risk for transmitting genetic diseases to their children. The disorders include hemophilia, Tay-Sach's disease, Sickle Cell Anemia, Cystic Fibrosis, Down's syndrome, and others.
Women over the age of 38 or those with recurrent miscarriage may be at risk for chromosomal abnormalities called aneuploidies. Preimplantation Genetic Diagnosis (PGD) allows the embryologist to screen embryos for these and many other genetic abnormalities.
PGD patients undergo in vitro fertilization to create embryos that will be transferred to the uterus. Once the embryos mature, the embryologist makes a small hole in the embryo's outer membrane using a laser. A single cell is withdrawn for the PGD procedure(s) without damage to the embryo. Each cell contains the complete genetic makeup of the embryo.
The cell is examined for an abnormal number of chromosomes, using fluorescent in situ hybridization (FISH). FISH, enables the embryologist to count chromosomes and often identify other abnormalities.
The polymerase chain reaction (PCR) is used when damage, or disease, is suspected on a particular chromosome segment. The PCR duplicates and amplifies certain chromosome sections so that disorders can be seen.
Some diseases, such as hemophilia, are sex-linked meaning they are transmitted on the X chromosome. Because males have only 1 X chromosome but females have 2, these sex-linked diseases are more apparent in males. Hemophilia is an example of a sex-linked disease, meaning that males are the ones usually affected. FISH can be used to separate male and female embryos, and in this case, only female embryos would be transferred to the mother. The same applies if a chromosomal abnormality is seen using PCR in that only normal embryos would be transferred.
While no procedure is guaranteed to eliminate birth defects, there are many genetic diseases that can be identified using PGD and research continues to expand the list. Using PGD lowers the chances of genetic birth defects.
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