Air-Medical in ND Michael Schultz Flight Paramedic Educator Sanford LifeFlight

Objectives  Define what Air-Medical is and what they offer.  What Auto-Launch is and how it works.  Understand the best use of the Air-Medical programs in ND.  Communication with the Air-Medical groups in ND.

What is Air-Medical?  It is a 24/7/365 ALS or critical care transport resource to the communities that we serve.  All have the same philosophy and goals for pre-hospital care.  Highest level of care for the shortest period of time to the most appropriate facility.

What is Air-Medical?  Emergency Transportation  High Acuity patient’s Trauma, Medical, Pediatric, OB, NICU  Local resources not available.  Patient is in a remote or difficult location to access by vehicle.  Transport to the most appropriate facility. Bypassing facilities.

What is Air Medical?  Each ND HEMS offers different care  RN and Paramedic RT and other specialty care  Patient needs a higher level of care.  Time is spent with 2 critical care attendants during the transport.

The Golden Hour  “Emphasizes the urgency necessary for successful management to maximize outcome of the injured patient” American College of Surgeons, Advanced Trauma Life Support  This is not just for trauma anymore! Strokes AMI’s

Pitfalls of EMS in ND  Few ALS services.  Call volumes of the BLS/ALS ambulance.  Response times/distances.  Time to a rural facility.  Often rely heavily on Volunteers  Level 4 and 5 trauma centers

Pitfalls of HEMS in ND  Helicopters are located at or near the receiving hospitals.  Most are hospital based  Few and far between  HEMS have a 10 min lift off goal.  Long distances to rural areas  ND Weather March and November…  Few fueling stations in ND Very Few with 24 hour coverage

ND Helicopter Response Times

How to combat pitfalls?  HEMS AutoLaunch  When the criteria is met send most appropriate level of care. BLS, ALS, and Helicopter  Remember the golden hour. To definitive care.  Do not wait until Responders are on the scene!  HEMS is an additional resource Still need standard EMS response per local protocol

Autolaunch  How would it work? Scenario – Rural Carrington ○ Severe Anhydrous Ammonia burns ○ Face, Chest, legs, and groin >18% 7 C-3 (>18%) or 7 C-4 (Facial Burns) ○ Difficulty Breathing 7 C-2  Where does he need to go? Fargo? Bismarck? Minneapolis?

Who can activate Air-Medical?

Autolaunch?  911 call for a Male trapped in a Grain Elevator  22 D-4

Autolaunch?  S.O. reports MVA rollover with entrapment in rural Jamestown area. What kind of entrapment? 29 D4

Why Autolaunch  Trauma center locations  The Golden Hour of Trauma  Highest level of care for the shortest period of time.  Time is always against the brain, heart, and trauma survival.

HEMS MYTHS  Only activate when someone is on scene.  If you cancel the helicopter, you will get a bill…  Can’t bill them.  Replaces the responding ground Ambulance.

 Too windy for a helicopter to fly. Partially true  “The weather is beautiful here.”  Helicopters can only land on the road.  “Too unstable to fly.”

When to utilize Autolaunch  Any medical or trauma pt requires emergent and/or critical care transport.  The most appropriate facility to handle patients acuity is in a major ND city.  Local resources not available.  Not on anyone's arrival.  Not after loaded and enroute to the hospital.

Autolaunch Trauma  High speed  Ejection  Rollovers  Extended extrication  Multiple patients  Death in vehicle  Trauma center >20 minutes away  Burns  Amputations  Changes in LOC  Falls >3 x pts height  MCC >20 MPH  Unstable or possibly unstable airway  Car vs Pedestrian

Autolaunch Medical  Cardiac or post arrest  STEMI  Stroke like symptoms  Unstable vital signs  Any trauma/medical patient needing quick access to specialized critical care and immediate transport.

Contacting Air-Medical  Fargo, Sanford LifeFlight  Minot, NorthStar CritiCare  Bismarck, Angel AirCare  Aberdeen, CareFlight HEMS does not count fixed wing transport.

What Air-Medical needs to know  Usual dispatch information  Nature of the call  Where is the scene? Closest town and intersecting roads GPS coordinates  The ground unit(s) responding Must have a ground ambulance respond also

Communication  Need communication with: Local Dispatch Center Deputy Responding Fire Department First Responders Responding Ambulance

Radio Communication  State Wide EMS  ND State Radio  MNSEF  ND Mutual Aid Channel 3  Regional Channels

Information for LZ  Flat and level  100’ X 100’  Relay obstacles  Wind direction  Wires

“Together we save lives”  Air-Medical can’t do their job, without you!  HEMS is an excellent additional resource  We need: Communication Early activation Teamwork ○ Local Dispatch Centers ○ Ambulance/FR/Fire/S.O.  We all have the same goal! What’s best for the patients.

Thank You!