Efficacy of Air Transport

[helicopper 1,050]

Let me start out by saying that I am a staunch supporter of air ambulance operations and believe they play a vital role in the EMS system! However, they come at a significant cost at a time when the healthcare industry is under tremendous financial pressure and the operation of an aircraft is more risky than a ground vehicle - there was just another crash of a medevac ship on the left coast on Monday.

So, I ask the question - are we properly utilizing this important asset?

There was a recent MVA in a local community where ground BLS and ALS responded and a medevac aircraft was requested.

BLS left the scene with the victim (and ALS aboard if my info is correct) at 12:00 (times changed to protect everyone's privacy and avoid issues). At 12:17 the helicopter lifted off from the LZ and arrived at a trauma center at 12:25. Total transport time from scene to trauma center = 25 minutes.

Driving from the scene to the trauma center in question would take approximately 26 minutes without lights or siren - a distance of about 16 miles. Arguably it may take a little bit less with lights and siren.

How did the patient benefit from the one minute saved by air transport? (Weather was not a consideration at the time of this particular example and ground ALS was available so these are not factors)

Another question - it is possible that the helicopter was called prior to the paramedic's arrival. Does anyone have any thoughts about the paramedic reversing a decision made by a BLS provider prior to their arrival? Protocol dictates that the highest trained medical provider is supposed to be responsible for such decisions but would it be incorrect for a medic to call off the helicopter requested by the PD, FD or BLS in favor of ground transport?

Edited December 14, 2006 by Chris192

[IzzyEng4 427]

You know how many times Lifestar does routine transports from Norwich to Hartford hospital in CT? Oh I can tell you. Listen on the old MEDNET channel and listen for the Code 300.

[AFS1970 504]

Although this is slightly different, I remember working in dispatch during a call a few years ago, that the oposite decision was made.

The call was for some sort of trauma, suffered by a Child. ALS transported to the trauma center and the child was stabalized. When a Helocopter was called for to do the transfer to New Haven, their ETA was longer than it would take to drive. The EMS supervisor at the time had the ALS unit take the child from Stamford up to New Haven.

[STAT213 332]

So, I ask the question - are we properly utilizing this important asset?

There was a recent MVA in a local community where ground BLS and ALS responded and a medevac aircraft was requested.

MyResponse...No, we are not properly using this resource. Unless the patient needed something that the ground providers could not offer, there is little benefit. Some folks in the pretty suits may tell you that the patient is getting better care, and they may be right - for 7 minutes - but there is not any research tying outcomes of the trauma victim to being cared for by a nurse/medic team for 7 minutes.

BLS left the scene with the victim (and ALS aboard if my info is correct) at 12:00 (times changed to protect everyone's privacy and avoid issues). At 12:17 the helicopter lifted off from the LZ and arrived at a trauma center at 12:25. Total transport time from scene to trauma center = 25 minutes.

Driving from the scene to the trauma center in question would take approximately 26 minutes without lights or siren - a distance of about 16 miles. Arguably it may take a little bit less with lights and siren.

My Response Very true. People forget that calling a helicopter is not simple, nor is it quick. It generally adds about 20 minutes to the operation. Now, your points have to take into consideration that the ground providers would actually be enroute to the hospital in the same time frames if the helicopter was not involved i.e. would they stay and play to get that IV...

How did the patient benefit from the one minute saved by air transport? (Weather was not a consideration at the time of this particular example and ground ALS was available so these are not factors)

My Response..In this case, and many other in Westchester, the patient did not benefit. Heck, we can't PROVE that medics benefit patients. We THINK so, ASSUME so, but can't prove it. And, this is a flight medic talking...

Another question - it is possible that the helicopter was called prior to the paramedic's arrival. Does anyone have any thoughts about the paramedic reversing a decision made by a BLS provider prior to their arrival? Protocol dictates that the highest trained medical provider is supposed to be responsible for such decisions but would it be incorrect for a medic to call off the helicopter requested by the PD, FD or BLS in favor of ground transport?

←

My response..Sure, the medic can reverse the BLS decision. No decision is made in stone, or it shouldn't be. If the cop got on scene first and thought it was awful based on how the cars looked, but after eval you determined they were all sign offs, would you cancel the helicopter or have them land to help with the sign offs?

You also mentioned safety. I will fight this one tooth and nail. The ground ambulance is the most dangerous vehicle on the road, period. Air transport is WAY safer regardless of the highly publicized wrecks we have. There is an ambulance wreck EVERY DAY in the US. Take a look at emsnetwork.org for the stats.

So, are helicopters being used correctly? Nope. I did calls in towns within 10 miles from the medical center in my tenure wearing a red suit. The helicopter has been called to the Sprain at the medical center exit. Crazy, huh? The question is, as in most of EMS who will change things? How do you change things? To that, I have no good answer. Sorry.

[JustSomeGuy 0]

Chris, could this be another example? Let me start of by saying I no nothing of air ambulance operations, nor do I mean to offend anyone. But roughly a year ago at the trench collapse in greenville, which had massive amounts of M/A, they airlifted the victim from central ave, in greenville. Wouldn't it have been easier to drive straight down central to White Plains Trauma center? I was always curious, I worked that day I didnt understand, then again I know nothing of those operations so who am I to say anything, but I admire all the pilots, keep up the good work

[calhobs 110]

Wasn't there a big issue about this about 10 years ago here in Westchester about the abuse of air transports. I was living in the city at that time and remember seeing something on the news about that, how it took more time to get the bird up and to the scene then it took for many ambulances to ge to the ER.

[trauma74 111]

I remember the days of working at Empress and Stat Flight would be called to Yonkers. You could almost throw a rock at WCMC or Jacobi from anywhere in Yonkers. By the time the chopper lifted off, landed, unloaded their equipment, loaded the patient into the chopper and took off, we could have already had the patient at the trauma center. These Stat Flight runs could have been better utilized in the more rural areas.

[Guest]

Stat Flight is abused, plain and simple. Stat Flight is for multi-systems trauma victims and time sensitive cases (severe burn patients, decapitation with possibility of re implantation, etc.). And just to answer your questions - the patient probably would have had no difference in outcome given a 60 second difference in transport time. Its a great asset, but people have to remember its a very limited resource and serves a huge area!

[Guest alsfirefighter]

I rarely use stat flight. I was recently on a severe MVA with 2 patients (5 total) that had to go to WMC. One patient was flown (stat flight was launched prior to both our arrivals) and I ground transported my patient. The 1st arriving medic I was on scene with used stat flight and it was a legitimate decision. But I arrived as the helicopter was beginning to touch down. If not for waiting for a bus to arrive for me to use and a tight area that took time to arrived before hand. That is one of the reasons I do not often use it. As far as multi-system trauma, if you are extended response by ground, then multi-system nothing, if they fit the trauma center protocol away they should go.

As far as abuse years ago, there wasn't much ALS in the area to do some of the airway skills and so on, so stat flight was often the answer to many.

I've seen abuses left and right, some of us that know fellow medics personally that we rib about it.

Just some guy, the appropriate place for that victim is WMC, I cannot speak for anyone there, but it is a close ground transport.

It is a gut instinct often by the medic, I can't stand hearing traffic as an excuse. I've also heard the fact that for some its because they have RSI. If you delay beginning transport for RSI that's ridiculous. If you are that concerned about an airway and you can't get it without additional facilitation then what you have...that calls for immediate transport to the closest medical facility.

[SRS131EMTFF 471]

If the IC thinks there is a need for STAT flight and STAT flight is not busy then why not call for the helicopter to help get the patient to the approriate location and treatment

Now in very rural areas like northern westchester or some other areas of the state a bus ride to a trama center STAT flight like organizations are essential even if they are over used......care and response time can not be judged on the time it takes to get to the RIGHT hospiatal but the severity of the damage to the patient and the risk one takes to the patients life if they dont get the patient to the right hospital

Edited December 17, 2006 by bvfdjc316

[Guest]

ALS - just to clarify - i was talking in terms of using stat-flight as appose to going to by ground to WMC. I was on an MVA with pretty decent damage to the front end...patient met the criteria for a trauma center but did not merit an air transport. A few people o/s asked if we (the medic and i) wanted the chopper. What for? If a patient meets the criteria then off we go to WMC but just b/c you meet the trauma criteria doesn't mean you merit a medivac. I guess thats what my biggest pet peeve is, because the air assets in the state are so few they should be reserved for those patients who truly need them.

[Guest]

If the IC thinks there is a need for STAT flight and STAT flight is not busy then why not call for the helicopter to help get the patient to the approriate location and treatment

Now in very rural areas like northern westchester or some other areas of the state a bus ride to a trama center STAT flight like organizations are essential even if they are over used......A care can not be judged on the time it takes to get to the RIGHT hospiatal but the severity of the damage to the patient

←

With all respect, comments like that really rub me the wrong way. The IC should not be calling for stat flight until the medical authority requests it. I've been in situations where stat-flight was put on standby or launched for patients that have a dislocated shoulder or an equivalent injury. The only consistent feature in the cases I've been involved in is the fact that the patients were involved in MVAs. Like i said before, Stat-Flight is a limited resource and just cant be called "willy-nilly" for every MVA or every trauma patient - it simply just doesn't work that way. Heck, i work in Putnam and i have yet to call for a chopper for any of the trauma patients I've attended too. In fact the agency i work for has only flown out 1 person this year. Likewise, you have to understand that stat-flight is not an instantaneous service, its actually pretty time consuming - you figure the pilot has to figure out where hes going, the medics and nurses have to get prepared, they take off, then you have to establish an LZ, the bird lands, you drive to the lz, medic or nurse hops on to assist in packaging and get initial impression, you package the pt, move him to the bird, the bird takes off and flys to WMC. So in many instances your talking 1-5 minute differences in transport time. Stat-flight is great, i'm not trying to say it isnt, it just serves a narrow and very specialized purpose....it shouldn't be used as a johnson&johnsons band-aid.

[Guest alsfirefighter]

66alpha...I got what you were saying brother...I was just adding on. I'm with you, I am confident in my abilities as a provider and know that there isn't anything happening in that helicopter that I cannot do and unless its a pin job, I am off scene before they can even get in the air most times. Also yes...stat flight can be cancelled and I have done it, unfortunately I've had a few upset fire chiefs that didn't like being told they shouldn't unless an ems provider is on scene and certainly doing so as they pull up isn't very smart.

BVFD: I agree with 66alpha on this as well. "If they are not busy..." How do you know if they are busy? You call and ask and if your waiting for an answer that is wrong. Additionally it is the abused calls that takes it away for legitimate need. I know of a medic whom had an ejection with severe head trauma in norther westchester, called for stat flight air 1 was tied up (hold on for this one) and air 2 was on another call as well. Where was air 1 at? AT AN MVA ON THE TACONIC STATE PARKWAY IN NORTHERN BRIARCLIFF/MILLWOOD! Called by a medic. An incident commander, which unless there is multiple patients and multiple units, there isn't much need for EMS command. The other night, an EMT was EMS Command, there were 2 medics on the scene...he should call for stat flight? Only if me or the other medic wanted it, if it had not been called by an emt that arrived on scene first.

A care can not be judged on the time it takes to get to the RIGHT hospiatal but the severity of the damage to the patient

Perhaps you could clarify this statement, but it makes no sense to me. Part of the quality and continum of care is getting the patient to the right hospital in the best time frame possible in regard to the platinum 10 minutes, based on the severity of their injuries. On an ALS level and to a high degree BLS level it all goes hand in hand.

Edited December 17, 2006 by alsfirefighter

[mlfcemt093 0]

Works great in orange county

[SRS131EMTFF 471]

I am just saying that the IC calls for it.....i never said it was a good thing or bad thing

STAT flight is a great resource but how do we know if it is being abused.

Honestly we dont....to prove that it is being abused one would need to put together a list of all of the patients that died or had injuries or side effects that could have been prevented if a medivac service is avaible and compare that list to all of the incidents that a medivac was needed. I dont think that any one has done this. This is the only way to prove one way or another if the system is being abused or not.

Without that there is no true way to tell

[Guest]

I really don't mean to beat this to death...but dude....i know its being abused when im o/s of an MVA, the patient has a dislocated shoulder, i look up and i see Air 1 above me. I know its being abused when i have leadership calling for the chopper or putting it on s/b when they parent even O/S...then i or the medic have to get on the air and cancel it because its going to be a nice easy BLS or ALS transport to Saints. I'm just calling the shots as i see them, drawing from what i've learned in the field. Tabulating data is going to tell you one thing, that stat-flight works. We all know that it works. However, its how do you apply it...in other words how do you use the tool. The nature of the stat-flight system is most efficient (discussing 911, not inter facility transports) when your dealing with severely injured victims of multi system trauma, burn patients, and those with severed body parts who need immediate re-implantation, etc. its like a hot knife through butter. If we are talking "routine" trauma patients then the system becomes bulky, time consuming and just generally inefficient. There are only 2 choppers, with 1 being added for more distant areas (if my info serves me correct). The resources is so limited, i don't know how much more i can stress this, that it CAN ONLY be used properly for it to work properly. And lets not forget something, riding in the back of an ambulance with competent field medics and emts doesn't meant your getting half-assed treatment. Your likely getting just about the same as if you were in the back of the bird (with the exception of some cool tools like the adult IO drill ). Air transport is NOT the next big thing in EMS. I can assure you of that.

Edited December 17, 2006 by 66Alpha1

[STAT213 332]

...i know its being abused when im o/s of an MVA, the patient has a dislocated shoulder, i look up and i see Air 1 above me. I know its being abused when i have leadership calling for the chopper or putting it on s/b when they parent even O/S... Air transport is NOT the next big thing in EMS. I can assure you of that.

←

I can tell you from experience as well...STAT flight is mis-used. I wouldn't say abused. But, who is the guy calling me to the Sprain, or to Chappaqua? I can tell you that the flight crews are NOT in a position to change things. No way am I gonna show up on a scene call, declare something not worthy of my shiny helicopter and leave. Suicide.

So yes, Air transport is overused in certain areas. And, as with many of the issues on this forum, it ain't unique to Westchester. Bottom line, think before you act. Run through your mind why you are doing what you are doing. Does it benefit your patient to get to a trauma center 3 minutes sooner? Granted, they may be wrapped up in a shiny silver blanket, but that is about all the care they'll get in a hop from Chappaqua.

As long as they get to the trauma center in a timely manner, you have done well.

[SRS131EMTFF 471]

If you think that the medivac is being worn down by all of the non-esentail runs it is going on............it is not our place to say if it is too much and what calls to sent it on.....it is the countys and WMC's call to make

[STAT213 332]

If you think that the medivac is being worn down by all of the non-esentail runs it is going on............it is not our place to say if it is too much and what calls to sent it on.....it is the countys and WMC's call to make

←

Umm, FYI. The county and WMC have NOTHING to say about helicopter usage. It is not theirs. Now, they can bring it up in CQI or complain to the state but that really is their only avenue right now.

[Guest alsfirefighter]

STAT flight is a great resource but how do we know if it is being abused.

66alpha already hit this awesomely, however I'm gonna chime in still anyway. How do I know its abused? Pretty much the same reasons why 66alpha stated, in addition to being at the medical center often when these "traumas" come in. Medevacs were a concept to allow persons whom live in rural areas to get the trauma resources that urban and some sub-urban populations could get readily. It was part of the EMS white paper of the 1970's and was born out of the Viet Nam war with their efficiency of medevacs that saved 2-3 times the amount of Marines, soliders and sailors then previous conflicts. That number has even increased from then with Desert Storm and Iraqi Freedom. Here is the big newflash that many providers aren't getting or in some cases that I personally know are just down right lazy and/or perhaps have no confidence in themselves or their skills. Westchester is for the most part urban, the medical center can be reached from anywhere in a decent time frame that is no more then most flight times particulary if Air 1 is already tied up and they want to send you air 2. STAT also put in a great point...but in my opinion it is abused and mis-used. Abused by those whom just fly people to fly people as if its cool or they can't be bothered to do no more then what is in that helicopter and mis used by those whom do not understand that there are critieria and the severest cases of trauma should be flown. Simple LOC's with gut instinct and MOI isn't a fly case. Get your a$$ in the back of the bus and do your job. How else?

Utilizing a medevac from places like (some I've already mentioned)....Briarcliff on the sprain....load and your're there in 10 mins or less, its a straight shot down the parkway. White Plains, Croton, Ossining, Chappaqua. Why? You name it, "traffic," "The doc from xyz hospital said they'd be best suited at the med center" (didn't say to use up resources, some of these transports I don't think the bird barely gets to lift and they can have the cross wind blow them to the LZ).

I also disagree with your assessment of how to know if the system was abused or not. Your quantification has nothing to do with this argument.

to prove that it is being abused one would need to put together a list of all of the patients that died or had injuries or side effects that could have been prevented if a medivac service is avaible and compare that list to all of the incidents that a medivac was needed.

1. If a patient died...a "flight" Paramedic and "flight" nurse isn't going to put humpty dumpty back together again. This isn't a dig towards anyone on any medevac, however the only difference is the title "flight" in front of the Paramedic or nurse. Some seem to think it is "god." In the right scenario it makes a difference and I am friends and teach with a couple of flight medics from stat flight, so I am not digging them. I respect each of them professionally as well as they me. Patient mortality is not an indicator of the correct choice of transport. Believe it or not patients die in a helicopter just the same as an ambulance. There is no magic gas in a helicopter that because you flew injuries or side effects as you putted wouldn't be present because it is an air transport. Medevacs are supposed to save time in areas that are extended from a trauma center and on top of that, that is why we have level 2 trauma centers in areas. Where I live...flight is justfied for high priority life threatening trauma, ground transport to St. Francis which is about a 20 -25 minute ride...low priority manageable trauma justified. The majority of Westchester, even if they want to call it the "rural areas" of Westchester in many cases are not saving their patients any time, unless they are pinned which chews up the time the medevac is enroute to you. Too many people hear an ETA and forget...THAT IS ONLY ONE WAY! If they are not pinned, the only thing that needs to be accounted for is immobilization and that is getting a collar on, lay them on a board and get moving. Straps can go on while your moving, clothes come off, check for life threatening easily correctable injuries, and then head to toe, with vitals and other management as needed. WHILE YOU ARE MOVING! YOU WILL BEAT THE BIRD TO THE MED CENTER.

2. Abuse and mis use can be known if stats were kept of several data pieces:

a. Mileage from WMC for both ground unit and air

b. Patient injuries or other reasons why someone called

c. Actual injuries, condition upon arrival at trauma center

d. Who made the request, when and again why

I could go all day on how I prefer to manage trauma and I learned from some of the best, including my brothers and friends whom wear the red flight suit. The other answer has nothing to do with Stat Flight, nor WMC. It comes down to agency QA/QI and the region taking note of whom is calling what and when.

Edited December 18, 2006 by alsfirefighter

[Guest alsfirefighter]

I tried to add on something I missed and for whatever reason it didn't post when I edited. I should have looked at your info more closely. I know see why some of your information is incorrect. I don't know if you read your post prior to hitting the post button, however much of your statments are back and forth and are not factual or correct. Please utilize a little discretion based on what your affiliation/rank reads on your profile.

As stated, "the county," which I have no idea what part your talking about in regard to air transport and "wmc" do not own, operate, nor disptach stat flight.

We do have a say what calls it goes on, being they don't have ESP nor do they monitor dispatches and play paper, rocks, scissors for what call they want to go on. We request them and hospitals have criteria for what they call for an air transport for. And with many of the hospitals I deal with or the one I work for, that is being reduces with the amount of private companies looking for $$$$ (that doesn't filter to their employees pockets as much as it should) lining up for ALS transports and many more critical care medics out there.

[Oswegowind 17]

My opinion:

Air response is a very important asset to those departments that are either 30 minutes or more away from the area trauma center by ground or where an extrication of the victim needing such transport is equal to the amount of time it takes for the helicopter to launch, respond, and land at scene. Then it cuts down the transport time significantly! I don't believe it should ever be used by any department in Westchester County that is along any of the major highways and can rapidly transport a patient immediately from a scene. No one should ever delay said transport to wait for a helicopter. That is plain silly... If you are ready to go, re-assess the condition and travel time...if your in monticello you may want to change the lz and start moving and meet the helicopter at a more convenient location where they can land and get set up...then you pull in, turn em over and they are on their way. At least you are sitting on scene. God forbid the helicopter has a problem and has to cancel. Now you are stuck and have to drive and you just wasted whatever time by waiting and then put your patient in harm's way. Helicopters are cool! But do what is best for those you have vowed to assist!!!!

[Guest]

If you think that the medivac is being worn down by all of the non-esentail runs it is going on............it is not our place to say if it is too much and what calls to sent it on.....it is the countys and WMC's call to make

←

First of all, couldn't agree more with ALS or STAT. bvfd, i couldn't disagree more with your comments. I don't know what sort of experience you have or where your drawing your conclusions from but you seem to be operating on theoretics. We could sit here a debate theoretics all day and night, but thats not going to get us anything. Be assured, i'm not trying to sit here and lecture to you and say "look i have more time under my belt" because its not like i have 15 years under my belt. But i am in the field 36+ hours a week, i think the same applies for others who have commented (granted they have far more years on than me). This is about sheer facts. And the fact that SF, while an amazing resource, is simply over/misused or abused altogether - there simply is no debating it. Like ALS and STAT said, we (those in the field) make the treatment decisions and its that community who is responsible for the proper use of the assets we have avilable. Dispatch or a stat team isn't going to sit back and say "oh, well that doesn't sound 'serious' enough so no chopper for you!.'" If i had someone with a bruised knee and i called for a chopper i know i would get one and that pt would be taken by the STAT team. I'm confident of that. I've seen these guys work, they are a class act and know they wouldn't turn away any a patient even if they clearly didn't merit an air transport. But, to bring this thing full circle - i really think this topic more about becoming a better care provider and patient assessor and knowing how to better utilize those systems and tools we have available. So, yes...it is up to us (not the county, region or WMC), along with candid input from the STAT teams, to determine how stat-flight is being utilized in its emergency form, highlight the failures and success, and then come up with a comprehensive plan, protocol, or educational tool for proper utilization of the SF system!

Edited December 18, 2006 by 66Alpha1