1. Guidance Notes on US Coast Guard Medical Evacuations (MEDEVACS
Steve Williams, RN, CEN, CFRN
Institute of Cruise Ship Medicine

2. “Risk vs Benefit”
Hovering a helicopter over a cruise ship at sea is potentially one of the most dangerous activities in the cruise industry.
All requests for helicopter MEDEVAC at sea should be for life-threatening situations.
Some critical patients do not do well in a helicopter.
The risk of transport should not outweight the benefit.

3. March 2012 European Navy Keen to carry out MEDEVACS
Litter not properly secured
Patient nearly fell from litter

5. Air Ambulance Crash May 9th 2012 Transfer from St Maarten to Martinque
30 year old cruise ship guest, Panagiotis Vryonidis.
Dr Jean-Michel Dudoit
Gerard Omere RN
Capt Bruno Le Jeune
All died in air ambulance crash

6. USCG Helicopter Crashes
December 2004 off coast of Alaska
758 Freighter “Selendang Ayu”
Rescued 18 prior to crash
6 crew members died
USCG crew survived

7. Medico-Legal Responsibility
USCG Helicopters do not usually fly with a physician… Rescue swimmer provides care.
MD or Nurse should go with the patient.
Treating cruise ship physician legally responsible for patient until the patient gets to receiving hospital.

8. US Coast Guard Structure
USCG part of Department of Homeland Security.
Two areas: Pacific Area & Atlantic Area
Nine Districts:
Cruise Industry usually works mainly with the following districts:
7th District for South Florida and SE US & Caribbean
17th District in Alaska

10. US Coast Guard Helicopters
H 60 (Jayhawk, marine version of Blackhawk)
Weight: 22,000lbs
Crew of 4
Operational range: 700 nautical miles
H 65 (Dauphin helicopter)
Weight: 9,500lbs
Crew of 3
Operational range: 290 miles

11. USCG HH – 65’s at Miami, Opa Locka Air Station

12. Recovering trail line/cable

13. The hoist of the patient begins

14. This MEDEVAC is VERY challenging

17. Helicopter Evacuation Criteria
Sick enough to warrant evacuation
Well enough to withstand evacuation
Illness must be time-sensitive
Helicopter evacuation must be quickest form of transport
Risk of illness must outweigh risk of transport
Must be defined intervention at other end.

18. Appropriate Requests Acute arterial occlusion Vascular emergency
Unconscious patient - possible ICH
Unstable Fractures with NV Compromise
Acute MI not responding to Rx
Acute surgical emergency

19. Inappropriate Requests
Patient in cardiac or traumatic arrest
Cardiogenic shock or unstable rhythm
Acute respiratory failure
Potential airway compromise
Acute GI bleed not stabilized
Unconscious, not intubated
Active labor unless short flight to SCBU
Acute psychiatric or suicidal patient

20. CRUISE LINE MEDEVAC Policy
Call Corporate Clinical Support Resource
Review case and other possible options
Hard to justify at night !!!
No other option – “What is the gain?”
Does the benefit outweigh the risk ?
Discuss with Ship’s Captain, and then the Captain calls the local US Coast Guard District SAR Controller.

21. Key Points Requests for helicopter should be life or limb threatening.
Critical patients probably better off on ship.
Identify equipment being taken.
Anticipate all clinical needs.
Secure stretcher and prepare patient.
Brief receiving hospital.