1. Unit 54
Air Medical Transport

2. Overview Current state of air medicine in the United States
Scene and interfacility missions
Contraindications
Aircraft capabilities
Cost and reimbursement

3. Introduction
Emergency transport of critically ill and injured patients by air has become an expectation
Although some work is needed to improve integration of air medical services into existing transport system, progress has been made over the years

4. History Medical transport has origins in rescue efforts
First large-scale medical evacuation by helicopter in Korea
“Huey”: central to medical efforts in Vietnam
Helicopters: reduced morbidity and mortality in subsequent conflicts

5. Civilian Adaptation
Air transport integration into developing EMS systems important
1970: Maryland State Police Aviation begins first emergency air transport
Figure 54.3 The Maryland State
Police Aviation unit was the first
dedicated air medical agency
in the United States to provide
emergency air transport from the
scene of an accident

6. Ground EMS Development
Ground-based EMS developed as result of wartime
Multiple models of system operation developed to meet specific needs of communities
Private contractors, EMS based in fire departments, private for-profit services, and municipal third service systems

7. Integration of Ground and Air
Ground and air medical services developed in rather than in conjunction with one another
Although air medical and ground services coexisted, cooperation was
In recent years, efforts have been made to integrate ground and air EMS

8. Current State of Air Medicine in the United States
Last decade has seen incredibly rapid rise in numbers of air medical services
Increased need for distance transports of more critically ill patients
More specialized time-dependent treatments offered at larger centers
Improved reimbursement rates

9. Program Types Mission profile: expanded practice
Special operations: for search and rescue
Staffing configuration
Paramedic
Nurse
Respiratory therapist
Physician
Specialty team

10. Scene Missions Indications for air medical transport
Due to limited resources, helicopters must only be used when offering benefit
Two main advantages: speed and capability
Helicopters can fly up to 150 mph, avoiding obstacles (traffic)
Many helicopter services offer advanced level of care provided by flight team

11. Triage
Dispatch
Auto launch: simultaneous dispatch of helicopter and ground units based on dispatch information
First responder arrival: helicopter dispatchers accept flight requests from provider on scene

12. Specific Conditions Nontrauma considerations
Myocardial infarction, acute stroke, obstetric complications, neonatal emergencies, organ transplant
considerations
Patients in areas difficult to reach due to terrain; remote location far from EMS; other situations in which local services are threatened or overwhelmed

13. Interfacility Missions
Interfacility transport by air if:
Patient needs immediate treatment elsewhere and/or in unstable condition
EMTALA
States hospitals must make transport arrangements appropriate for patient’s needs
Indications for air medical transport
Patient benefits from speed or skill

14. Contraindications for Air Medical Transport
Air medical transport is and costly; not used when benefit is unlikely
Contraindications:
Terminally ill patient
Cardiac arrest patients without return of spontaneous circulation
Patients likely to die or decompensate en route who are in a facility
Patient in active labor

15. Operations EMT must understand Appropriate utilization
How to prepare the patient
How to select an appropriate landing zone for an incoming aircraft

16. Landing Zone Selection and Preparation
Landing zone (LZ): should be located close to scene, while being safe
Touchdown area: around 100 square feet, free of obstacles
Surrounding area: free of obstacles
Evaluate area for objects, wind conditions, and surface conditions

17. Figure 54.5 The LZ officer should choose a touchdown area that has a surrounding area and approach path free of obstacles

18. Landing Zone Selection and Preparation (cont’d.)
Approach
Approach path free of towers, poles, wires, trees, etc.
Mark touchdown area with cones, flares or headlights
Figure 54.7 Emergency vehicle headlights can be used to mark a landing zone

19. Landing Zone Safety Secure loose debris and objects
No one within ft of touchdown area
LZ hand signals:
Arms outstretched: approach is safe
Vigorously crossing arms: abort landing
Touchdown: do not approach running aircraft until given signal by pilot
Liftoff: stay 200 ft away from LZ

20. Figure 54.8 Ground personnel should be familiar with the danger
zones around a helicopter

21. Aircraft Capabilities
Choice of aircraft depends on local availability, types of service, geography, weather conditions, resources
Rotor : majority of aircraft dedicated to air medical transport
Flight rules: visual or instrumental
Weight and balance: max lift capacity
Speed: two to three times faster than ground

22. Fixed Wing Main Considered for transports greater than 100 miles
Fixed wing (airplane) operation needs to begin and end each transport at airport
Considered for transports greater than 100 miles
Advantages
More economical choice for long-distance flights; large cabin; fewer restrictions

23. Cost and Reimbursement
Cost to operate and associated personnel is significantly more than for ground ambulance
Air medical program charges standard rate for lift-off plus per mile fee
Many insurance companies set rate for air transport they believe to be acceptable

24. Safety Safety in air transport Regulation
Accidents in helicopter more catastrophic than accident in ground transport vehicle
Greater number of ground ambulance accidents than air ambulance accidents
Regulation
Equipment specifications, maintenance policies, training, risk assessment

25. Safety (cont’d.) Culture of
Air medical resource management: crew participates in risk reduction
Survival training: protective equipment is important
CAMTS: Commission for Accreditation of Medical Transport Services
Professional organizations: International Association of Flight Paramedics (IAFP)

26. Conclusion
When appropriately integrated into well-organized EMS system, air medical programs may offer benefit to critically ill and injured patients
EMTs should understand capabilities of air medical programs in their regions
Culture of safety is crucial with air medical operations