AIR TRANSPORT

AIR TRANSPORT*

Policy:

A clear policy authorizing the use of air transport services is necessary to 1) promote appropriate use of limited air-to-scene resources and 2) assure scene safety. The following representatives or organizations are authorized to activate air transport services in Iredell County: ECOM Supervisors, ranking officers of local public safety agencies (EMS/rescue/fire/law enforcement), and all members/employees of local paid/volunteer public safety agencies (EMS/rescue/fire/law enforcement) credentialed at the Medical Responder level or higher by the North Carolina Office of Emergency Medical Services.

Purpose:

To provide rapid transport of critically injured patients from a scene, or rendezvous location, to definitive medical care at a regional trauma center. Such patients include: 1) any IMMEDIATE patient(s) with the potential for a transport time greater than 20 minutes to definitive care; 2) entrapped patients that may require 20 minutes or longer for successful extrication; 3) any multiple casualty incident involving IMMEDIATE and/or DELAYED patients; 4) any patient whose mechanism of injury reveals the potential for multi-system trauma; obvious spinal injury with neurological deficit; 5) any patient suffering from blunt or penetrating trauma in a situation where location, traffic conditions, etc. may cause a delay in transport time from the scene to definitive care; or 6) to rendezvous with a helicopter at a hospital helipad. In general, air transport will not be utilized for patients in cardiac arrest.

Procedure:

1. Activation Procedures:

ECOM will determine the flight status of available air medical services based upon the severity and nature of the incident. ECOM may automatically activate air medical services if warranted by the severity and/or nature of the incident in question.
First arriving personnel will triage all patients and make a determination based on the above listed “Criteria for Activation” as to the need for air medical services.
Notify ECOM immediately after determining air medical services are needed and request the closest available air medical service.
ECOM will inform field units of the availability, ETA, etc. of the air medical service.

2. Landing Zone Operations:

· Landing zone designation, preparation, and notification is the responsibility of the responding fire department with jurisdiction over the scene.

· In general, the landing zone should be on a solid, flat surface, clear of loose debris, and located approximately 200 yards from the scene. There should be no obstacles or obstructions within the zone, such as trees, utility lines or poles, vehicles, or unauthorized personnel.

· The actual landing area should be 100’ x 100’ at a minimum.

· If the patient’s condition is stable, and time permits, inspect the landing zone yourself. If the designated landing zone appears dangerous to ground personnel or the flight crew, express your concerns to the fire department incident commander. If resistance is met, immediately contact ECOM and request the flight crew abort the landing due to unsafe conditions.

· Never approach the aircraft unless given the “all clear” signal by the pilot or co-pilot and never approach without appropriate supervision.

3. Patient Preparation:

· The flight team will request patient information after landing zone information has been obtained. The flight team will be asked to contact EMS on County Fire 2 (153.890) for a patient update when approximately ten minutes out from the scene. County Fire 2 will be a shared frequency for on-scene helicopter operations between fire and EMS so keep information brief and to the point – just the facts.

· The patient must be properly immobilized on a tapered long-spine board with straps, C-collar, and head immobilization. Ideally, a minimum of one intravenous line will be in place prior to transferring patient care to the flight team.

· Upon arrival, the flight team will approach the scene and/or the ambulance if it is safe to do so.

4. Transfer of Patient Care:

· Provide a patient report to the flight team and work in conjunction with the team to provide any continued care while on the ground. Prehospital personnel may not exceed their level of certification nor perform outside Iredell County ALS Treatment Protocols while in the presence of the flight team.

· Avoid leaving EMS equipment with the patient unless it is absolutely necessary. Report any equipment left with the patient to the your immediate supervisor. The equipment should be retrieved from the receiving hospital as soon as possible.

· If the patient is prepared for transport, but the air medical service has not landed, the senior paramedic may choose to transport to the nearest hospital and do one of two things: 1) cancel the air medical service or 2) have the air medical service obtain the patient from the local receiving hospital.

· In general, do not wait on scene for an air medical service to arrive unless the patient’s airway is compromised to the point of requiring Rapid Sequence Intubation (RSI) and it cannot be managed effectively by conventional means. Even then, weigh the need for RSI against the amount of time you must wait for the flight team to arrive at the patient’s side. If you can arrive at the hospital in the same amount of time it will take for the flight team to arrive at the patient’s side, transport by ground unit immediately.

5. Rendezvous at Hospital Helipad:

EMS personnel have the discretion to utilize an LZ established on-scene or transport to a hospital helipad. The decision to land a helicopter on-scene or to rendezvous at a hospital helipad will shall be based on the anticipated ETA of the requested helicopter. Extrication time should be considered also when deciding where to meet the helicopter. In general, it is not advisable to sit on-scene with a trauma patient when the patient could be transported to a hospital in less time than it would take for a helicopter to arrive on-scene.
Always have ECOM notify hospital security of EMS intent to utilize their helipad. This will allow the facility in question to secure any potential hazards at their helipad.

EMS personnel should not sit outside an ED with a critical trauma patient, waiting for the helicopter to arrive if the helicopter an excessive delay occurs while waiting for the helicopter at a hospital helipad. In this situation, EMS personnel shall contact the ED physician at said hospital and seek immediate medical attention at said ED. The presence of the patient within 250 yards of the hospital and the action of contacting the ED by radio trigger federal laws that obligate EMS to transfer care to the ED and obligate the hospital to accept, assess, and attempt to stabilize the patient.