Guest guest Posted June 28, 2008 Report Share Posted June 28, 2008 I am really interested to hear how other providers determine when to transport a patient by air instead of ground. I've become more intrigued by this question lately as I've seen more and more helicopters being requested for cases which I feel don't really require them. I've heard through the grapevine that some services have basically a " protocol " on when to call for a bird, but most services leave it for the provider on scene to make a clinical judgement. Personally, I ask myself a few questions... 1) Would this patient benefit from being airlifted? If Yes/Maybe: 2) What is total difference in time between this patient going by ground and going by air (factoring in, how long it would take the ground crew to load the patient plus enroute time factoring in traffic depending on time of day and destination and then for air, launch time, enroute time, scene time, return time and offload time). If you sit down sometime and actually calculate it out, you might be surprised! 3) Would delaying treatment at the hospital by the amount of time that was figured in step 2 be detrimental to the patient's condition? Aeromedical evacuation, like most of EMS, is no black or white thing. So I'm just interested to hear how other providers are handling the decision making process... Until next time...... Ben Oakley, EMT Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 28, 2008 Report Share Posted June 28, 2008 This is primarily the way things work in my service(No officially classified trauma center within 45-60 min ground transport: Upon dispatch we instruct the dispatcher to contact the local facilities for availability of neuro, ortho, surgeon, etc. Then we instruct them to put whatever flight service that is available on stand-by. Our local flight service explained to us that that allows them to perform preflight checks, gather up refrigerated meds, and spin-up the engines (no lift-off), which reduces their response time by about 5min. After arriving on scene the providers do a RAPID assessment as far as extrication time, # of pts, severity of injuries, amd all of those other things we as providers use to determine treatment modalities. After that the final determination, as to fly or no fly, is relayed to dispatch and the bird either responds or spins-down. Of course we all know that each scene has its own challenges and that is where experience and lack of tunnel-vision comes in to play. Making those decisions is why we get paid the BIG BUCKS!!!(ROTFLMAO) Hope this helps. > > I am really interested to hear how other providers determine when to transport a patient by air instead of ground. I've become more intrigued by this question lately as I've seen more and more helicopters being requested for cases which I feel don't really require them. I've heard through the grapevine that some services have basically a " protocol " on when to call for a bird, but most services leave it for the provider on scene to make a clinical judgement. > > Personally, I ask myself a few questions... > 1) Would this patient benefit from being airlifted? > If Yes/Maybe: > 2) What is total difference in time between this patient going by ground and going by air (factoring in, how long it would take the ground crew to load the patient plus enroute time factoring in traffic depending on time of day and destination and then for air, launch time, enroute time, scene time, return time and offload time). If you sit down sometime and actually calculate it out, you might be surprised! > 3) Would delaying treatment at the hospital by the amount of time that was figured in step 2 be detrimental to the patient's condition? > > Aeromedical evacuation, like most of EMS, is no black or white thing. So I'm just interested to hear how other providers are handling the decision making process... > > Until next time...... > Ben Oakley, EMT > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 28, 2008 Report Share Posted June 28, 2008 Ben, A few things we have done (admittedly we are a suburban city of San , so we don't have the same issues of other agencies farther out): 1.? We have discussed the pros and cons of air medical transport.? We have talked about us only have 2 things the helicopter can do for us...advanced airway and speed...if the patient has a patent airway that's one reason gone...if the patient can be loaded without difficulty (extrication, etc) then we are well ahead of the curve.? 2.? We strive to get feedback on all patients that we transport as a trauma alert to our closest Level 1 and on all patients that we fly to the Level 1.? On patients that are not admitted, we do chart review and call critique with our transport crew. 3.? We have done some low volume time studies.? For example, a staff vehicle goes to the scene of air medical upgrades.? Once the patient is loaded into the ambulance and the vehicle could be driven away (i.e. we are essentially sitting waiting on the helicopter) the staff vehicle leaves the scene and heads to the Level 1 Trauma Center, non-emergency following all applicable traffic laws.? Since we are now only flying about 12 patients a year, we have only done this 5 times...but in all 5 times, the shortest time that?was spent waiting for the helicopter at the Level 1 Trauma Center was 4 minutes.? The longest was 13 minutes...the helicopter has never reached the Level 1 prior to the admin vehicle. 4.? We work tirelessly to educate our crews so that they are more confident in their assessment skills and their patient care skills.? There is very little that can be done by a flight crew for a trauma patient that we cannot do.? As close as we are, it really makes no sense to sit and wait on the scene for a helicopter, then once they land, wait another 5 to 15 minutes for them to assess and treat....5 minutes for them to get back to the helicopter...and 3 minutes to get airborne...coordinate air traffic (we do have an active air base in the middle of our district) and then get to the trauma center....add to that at the closest level 1, the aircraft lands 200 yards from the ED and has to unload from a helicopter, re-load into another ambulance, and travel 200 yards to the ED...where they unload again.... Man, just writing this out I am not sure why we fly 12 people... Anyway, these are some of the things we do...I hope you can glean something useful out of all these ramblings... Dudley Calling a Bird I am really interested to hear how other providers determine when to transport a patient by air instead of ground. I've become more intrigued by this question lately as I've seen more and more helicopters being requested for cases which I feel don't really require them. I've heard through the grapevine that some services have basically a " protocol " on when to call for a bird, but most services leave it for the provider on scene to make a clinical judgement. Personally, I ask myself a few questions... 1) Would this patient benefit from being airlifted? If Yes/Maybe: 2) What is total difference in time between this patient going by ground and going by air (factoring in, how long it would take the ground crew to load the patient plus enroute time factoring in traffic depending on time of day and destination and then for air, launch time, enroute time, scene time, return time and offload time). If you sit down sometime and actually calculate it out, you might be surprised! 3) Would delaying treatment at the hospital by the amount of time that was figured in step 2 be detrimental to the patient's condition? Aeromedical evacuation, like most of EMS, is no black or white thing. So I'm just interested to hear how other providers are handling the decision making process... Until next time...... Ben Oakley, EMT Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 29, 2008 Report Share Posted June 29, 2008 Dudley, It is so interesting that you bring up the time studies. One reason that I brought this up was the other day I was driving by a MVC where a chopper had been on scene for maybe 5 minutes. Anyways, I passed the scene in my POV, and I was already enroute to a location right by the trauma center. Anyways, the chopper flew over me when I was maybe 2 or 3 minutes out from the hospital. That's what really opened my eyes to how slow choppers are (when you factor in all the times that I mentioned and you mentioned, and not just flying time). The most nerve-wrecking time for me ever in EMS is sitting on the ground waiting for a helicopter. I can't help but time myself and think of how far I would be by the time the chopper lands, then takes off, etc. I think another thing people fail to keep in mind is the amount of stuff that aeromedical providers do preflight. Anything that needs to be done that isn't done before they get there, they seem to wait and do on the ground. So, in a true " scoop and run " , ground services have a fair advantage based on the amount of stuff we do enroute. Granted, we have a lot more working room than a helicopter, but it's still something to ponder....... Ben THEDUDMAN@... wrote: > > Ben, > > A few things we have done (admittedly we are a suburban city of San > , so we don't have the same issues of other agencies farther out): > > 1.? We have discussed the pros and cons of air medical transport.? We > have talked about us only have 2 things the helicopter can do for > us...advanced airway and speed...if the patient has a patent airway > that's one reason gone...if the patient can be loaded without > difficulty (extrication, etc) then we are well ahead of the curve.? > > 2.? We strive to get feedback on all patients that we transport as a > trauma alert to our closest Level 1 and on all patients that we fly to > the Level 1.? On patients that are not admitted, we do chart review > and call critique with our transport crew. > > 3.? We have done some low volume time studies.? For example, a staff > vehicle goes to the scene of air medical upgrades.? Once the patient > is loaded into the ambulance and the vehicle could be driven away > (i.e. we are essentially sitting waiting on the helicopter) the staff > vehicle leaves the scene and heads to the Level 1 Trauma Center, > non-emergency following all applicable traffic laws.? Since we are now > only flying about 12 patients a year, we have only done this 5 > times...but in all 5 times, the shortest time that?was spent waiting > for the helicopter at the Level 1 Trauma Center was 4 minutes.? The > longest was 13 minutes...the helicopter has never reached the Level 1 > prior to the admin vehicle. > > 4.? We work tirelessly to educate our crews so that they are more > confident in their assessment skills and their patient care skills.? > There is very little that can be done by a flight crew for a trauma > patient that we cannot do.? > > As close as we are, it really makes no sense to sit and wait on the > scene for a helicopter, then once they land, wait another 5 to 15 > minutes for them to assess and treat....5 minutes for them to get back > to the helicopter...and 3 minutes to get airborne...coordinate air > traffic (we do have an active air base in the middle of our district) > and then get to the trauma center....add to that at the closest level > 1, the aircraft lands 200 yards from the ED and has to unload from a > helicopter, re-load into another ambulance, and travel 200 yards to > the ED...where they unload again.... > > Man, just writing this out I am not sure why we fly 12 people... > > Anyway, these are some of the things we do...I hope you can glean > something useful out of all these ramblings... > > Dudley > > Calling a Bird > > I am really interested to hear how other providers determine when to > transport a patient by air instead of ground. I've become more > intrigued by this question lately as I've seen more and more > helicopters being requested for cases which I feel don't really > require them. I've heard through the grapevine that some services have > basically a " protocol " on when to call for a bird, but most services > leave it for the provider on scene to make a clinical judgement. > > Personally, I ask myself a few questions... > 1) Would this patient benefit from being airlifted? > If Yes/Maybe: > 2) What is total difference in time between this patient going by > ground and going by air (factoring in, how long it would take the > ground crew to load the patient plus enroute time factoring in traffic > depending on time of day and destination and then for air, launch > time, enroute time, scene time, return time and offload time). If you > sit down sometime and actually calculate it out, you might be surprised! > 3) Would delaying treatment at the hospital by the amount of time that > was figured in step 2 be detrimental to the patient's condition? > > Aeromedical evacuation, like most of EMS, is no black or white thing. > So I'm just interested to hear how other providers are handling the > decision making process... > > Until next time...... > Ben Oakley, EMT > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 29, 2008 Report Share Posted June 29, 2008 Ben, A lot of stuff done on the ground isn't because of space but because of the " normal " assessment tools and techniques that are no longer possible when you are sitting 4 feet below a REALLY big fan such as listening to breath sounds and carrying on a conversation.? There is actually conversations among some to take examples of air medical interiors into ground ambulances...where everything is tight and compact, within reach of a sitting, belted in care attendant.? Look at the Europe and Australia ambulances....they do a lot of this...you and your patient in a VERY close, intimate environment. Dudley Calling a Bird > > I am really interested to hear how other providers determine when to > transport a patient by air instead of ground. I've become more > intrigued by this question lately as I've seen more and more > helicopters being requested for cases which I feel don't really > require them. I've heard through the grapevine that some services have > basically a " protocol " on when to call for a bird, but most services > leave it for the provider on scene to make a clinical judgement. > > Personally, I ask myself a few questions... > 1) Would this patient benefit from being airlifted? > If Yes/Maybe: > 2) What is total difference in time between this patient going by > ground and going by air (factoring in, how long it would take the > ground crew to load the patient plus enroute time factoring in traffic > depending on time of day and destination and then for air, launch > time, enroute time, scene time, return time and offload time). If you > sit down sometime and actually calculate it out, you might be surprised! > 3) Would delaying treatment at the hospital by the amount of time that > was figured in step 2 be detrimental to the patient's condition? > > Aeromedical evacuation, like most of EMS, is no black or white thing. > So I'm just interested to hear how other providers are handling the > decision making process... > > Until next time...... > Ben Oakley, EMT > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 29, 2008 Report Share Posted June 29, 2008 Ben, I apologize for not answering this question sooner. I ended up getting sidetracked. Anyways, here's my unofficial criteria, which as always are subject to a lawyer's perogative to be changed. You should consider activating a helo for the following patients, if your transport time is longer that it takes to activate the helo, get them on scene, and for them to complete the transport: 1) Myocardial infarction where cath lab intervention is warranted 2) CVA/Stroke within your local stroke center's " window " 3) Trauma/medical conditions whose signs/symptoms warrant immediate surgical interventions. Hope this helps. -Wes Ogilvie Calling a Bird I am really interested to hear how other providers determine when to transport a patient by air instead of ground. I've become more intrigued by this question lately as I've seen more and more helicopters being requested for cases which I feel don't really require them. I've heard through the grapevine that some services have basically a " protocol " on when to call for a bird, but most services leave it for the provider on scene to make a clinical judgement. Personally, I ask myself a few questions... 1) Would this patient benefit from being airlifted? If Yes/Maybe: 2) What is total difference in time between this patient going by ground and going by air (factoring in, how long it would take the ground crew to load the patient plus enroute time factoring in traffic depending on time of day and destination and then for air, launch time, enroute time, scene time, return time and offload time). If you sit down sometime and actually calculate it out, you might be surprised! 3) Would delaying treatment at the hospital by the amount of time that was figured in step 2 be detrimental to the patient's condition? Aeromedical evacuation, like most of EMS, is no black or white thing. So I'm just interested to hear how other providers are handling the decision making process... Until next time...... Ben Oakley, EMT Quote Link to comment Share on other sites More sharing options...
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