Requesting and pre-alerting Helicopters

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A little background first: Our service area is primarily rural. The closest portion of our area to a Level III center is a minimum 15 minutes, average distance is probably 25-30 minutes, and extremes being in excess of an 90. Also, we are fortunate enough to have 5 ALS staffed transports 24/7 with at least one placed on all medical calls.

Under approved procedures in MD, both dispatchers and LEOs are allowed to dispatch for a helicopter before a provider arrives on scene with specific patient information. Namely: - Trauma with an unconscious pt
- Trauma with ineffective breathing

I have done it once per a LEOs request, but overall we are cautious of doing it. A caller's information is usual not 100% let alone 80% of the actual picture of what is occurring at a scene. Generally I feel, and I'm sure others do, that it's a potential waste of a very valuable resource. In stead we generally will call aviation command (SYSCOM), and simply explain the nature of an incident, check on availability prior to EMS arrival. Which then leads to them going on standby and being ready the second we officially request them. About half the time, we'll do it under our own initiative, other half at the request of units en route.

We do have one call have in our system which we will do an automatic alert for. It is an LVAD patient who need to be flown to the facility that installed it. Depending on the SYSCOM operator, they hassle us about it since it is not one of the approved scenarios for their dispatch.

So here are my questions:
-As provider, would you prefer a dispatcher to start you aviation w/o your consultation?
- As a follow up, is it more beneficial for me to do that, or just pre-alert them?
-Does anybody else have a system in place for early helicopter dispatch, and what are the criteria they use?
-On a related note, does anyone have a good link for instructions on abdominal thrust CPR? I hope we never have to use it, but I'd rather keep a set around for that special caller, than be unable to do anything for them.
 
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PotatoMedic

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Well I am in an area at times where the closest hospital is 15' away and the level 1 trauma center is about 40-50' away. I have been on a few calls where enroute we have asked if HEMS was available and we would ask them to stand by. The reason we contact them early is because of a 20' required preflight. Also if we ask for the heli we also will have asked for medics (or they will already be dispatched). By pre-allerting the helicopter they can be in the air the second we decide they are going to be going by airlift. And by the time they get to the lz. hopefully the pt will be ready to go.

Now to answer your questions. Dispatch will never auto send a helicopter. (too few of them and its a risky way to go to the hospital (look at all the crashes)) And no I would not want dispatch to send me one without my consult. To set up an LZ I need to find the best spot for them to land and I need to set up a fire truck for suppression at the LZ. Even if it is an airport.

Honestly pre-alert is the best think you can do without asking for a helicopter. Again, it allows them to get set up and ready. (that 20' window before they even fly when I ask for them) and If I don't need them. no harm done besides a little lost sleep or missed a bit of a tv show. but if I do need them. I have saved 20 minutes of scene time.

Hopefully this makes sense.

We will ask the helicopter to get on standby. that way they are alerted they get ready. and when we request them they fly or when we say stand down they grumble and go back to sleep. But in the end it saves time. The criteria is really what does the Lt on the engine think. Usually they will speak with the medics and the medics usually make the final decision.
 
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Definitely makes sense to me. I've never specifically calculated what time we save by doing our pre-alert. Guessing, I'd put it around a minimum of 5 minutes. Speed is hands down their only use to us as the MD troopers are only EMT-P staffed. That just let me realize I forgot to mention we have staffed ALS units on all calls.
 

DesertMedic66

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Helicopters are never auto sent out by dispatch. The only people who are able to request a helicopter is the on scene fire personal.

It's not the best system. If we arrive on scene first we have to wait for fire to get on scene before the heli is requested. 90-110% of our burn patients get flown due to the burn center being 60-160 miles away.
 

NomadicMedic

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We have certain dispatch criteria for an automatic HEMS activation, like an MVC with ejection or entrapment.

Delaware State Police provide the aircraft, if the patient is intubated we fly with them.

However, we tend to cancel the helo often.
 
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It's not the best system. If we arrive on scene first we have to wait for fire to get on scene before the heli is requested. 90-110% of our burn patients get flown due to the burn center being 60-160 miles away.

Does fire run the helo? or is it just that they have the say on the LZ?

We're in a similar situation relating to a burn center. Probably the one time I'd specifically dispatch a helo would be for a severe burn case. Unfortunately, because of the statewide nature of the orders, we can't unless they meet the other criteria.

@n7lxi, it surprises me the number of ejections that we end up transporting by ground. People seem to be lucky enough to find freshly tilled farm fields to land in.

Maybe it's just because I get to look at the big picture, but it drives me nuts on the rare occasions that our enroute EMS requests a helo launch. One in particular always says "we can cancel them if we need too"... I understand having them ready to go, but it's not like we have 15 helos that run off a free energy source.
 
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rescue1

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I think Kent County MD has a similar dispatch protocol, or just started it. I don't ever remember it being used while I was there, though. If dispatch put a bird on standby for a call I certainly wouldn't mind, but I'd appreciate being told first. "Ambulance 8, we have Trooper 1 on standby" or something. Maybe auto-launching on big calls like a bus crash would be helpful, but I think launching on every serious MVC would be overkill. Maryland flies way too many patients as it is.

I think it's unlikely to be useful in areas with a reasonably short helicopter response time (<20 minutes for a good chunk of the Shore), especially since most multisystems trauma patients in rural areas are MVCs and will also require extrication.

Are you in Queen Anne's county, if you don't mind me asking?
 
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IAre you in Queen Anne's county, if you don't mind me asking?

Dorchester

As a follow up to n7lxi, if you read this:
What are DSP's capabilities, I know we can request your trooper if necessary. Are they just EMT-P or do they have RNs or RTs?
 
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TheLocalMedic

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My duty station is in a rural/wilderness area with a smallish town. For being so removed from "civilization" we generally stay busy and can generally expect at least 1 major traffic collision per shift. Although there is a small ED in town, it's classified at a "standby ED" with a handful of beds and is essentially a step up from a clinic. Our nearest trauma center is roughly 80 miles away on the winding highway, burn center or peds unit is 2.5 hours by ground, and the next closest ED (in the case of an MCI) is 25 minutes by ground. We are also the only ambulance in town, and calling for a second entails a 20-30 minute wait.

That being said, our dispatch center will automatically start a helicopter for any traffic collision or trauma, and also if the call is a medical rated as a 'Charlie', 'Delta' or 'Echo' and is greater than 10 miles outside of town. It's better to start them early and cancel them if they aren't needed than sit around waiting for them, especially when it already took 30 or more minutes just to get to scene.
 

NomadicMedic

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Dorchester

As a follow up to n7lxi, if you read this:
What are DSP's capabilities, I know we can request your trooper if necessary. Are they just EMT-P or do they have RNs or RTs?

They're just medics. No RTs or RNs.
 

DesertMedic66

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Does fire run the helo? or is it just that they have the say on the LZ?

We're in a similar situation relating to a burn center. Probably the one time I'd specifically dispatch a helo would be for a severe burn case. Unfortunately, because of the statewide nature of the orders, we can't unless they meet the other criteria.

@n7lxi, it surprises me the number of ejections that we end up transporting by ground. People seem to be lucky enough to find freshly tilled farm fields to land in.

Maybe it's just because I get to look at the big picture, but it drives me nuts on the rare occasions that our enroute EMS requests a helo launch. One in particular always says "we can cancel them if we need too"... I understand having them ready to go, but it's not like we have 15 helos that run off a free energy source.

The only Helo fire runs is the search and rescue/hoist.

All the medical helicopters are private companies with a Medic and an RN already on board.

We used to be able to call the helo but now the fire department has to.
 

Bullets

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If you think you need it, send it

We have an over-abundance of HEMS in NJ, and i have worked with Flight Medics who covered a "ground" shift. If you call them for stand-by, it is just that, a phone call, where they will pick up the phone get the info, hang up and tell they crew they might have a call, and then go back to watching Judge Judy until they actually get the "Go" call. Putting them on standby saves no time or get a chopper to you faster because they always run the same pre-flight check before they take off, even if they had just landed and arent even out of the bird. Pilots are creatures of habit and they will not deviate from their checks.
 

Tigger

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If you think you need it, send it

We have an over-abundance of HEMS in NJ, and i have worked with Flight Medics who covered a "ground" shift. If you call them for stand-by, it is just that, a phone call, where they will pick up the phone get the info, hang up and tell they crew they might have a call, and then go back to watching Judge Judy until they actually get the "Go" call. Putting them on standby saves no time or get a chopper to you faster because they always run the same pre-flight check before they take off, even if they had just landed and arent even out of the bird. Pilots are creatures of habit and they will not deviate from their checks.

I don't think this is the case for every operation. A lot of places appreciate the call, and while they might not have the aircraft ready to go when you call, they will have planned their route, retrieved the crew (who might be working in the ED or something), figure out an LZ, and looked at the weather.
 

cprted

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BC Ambulance has an Auto-Launch Program for our Critical Care helicopters.

http://www.bcas.ca/EN/main/services/214/autolaunch-program.html

Essentially, helicopter gets auto-launched for high-mechanism trauma that is greater than a 20 minutes ground transport time to a regional trauma centre. Head-on MVAs, rollovers, caller confirmed at least one fatality on scene, etc. Once the ground crew arrives, they will either cancel the helicopter or have them carry on to the scene. While the helicopter gets cancelled more often than not, when you do need them, it is nice to have them already on the way.
 

ffemt8978

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As rural as we are, we have a significant portion of our calls that get the helo placed on standby or actually launched before we actually arrive on scene. Time is the biggest reason we do it.

20 min for preflight and weather check, 15 minute flight, 10 on scene, 15 min flight back - Total time for helo to get patient to hospital is 1 hour.

Compare this to our ground transport times. 20 minute arrival time, 20 minute on scene, and one hour transport to hospital. Total time - 1 hour 40 minutes.

* The times listed are approximate averages.
 

Bullets

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I don't think this is the case for every operation. A lot of places appreciate the call, and while they might not have the aircraft ready to go when you call, they will have planned their route, retrieved the crew (who might be working in the ED or something), figure out an LZ, and looked at the weather.

We have no ER based HEMS. They are dedicated crews located with their choppers at an airport, even if they are affiliated with a hospital. Also the HEMS are required to check their unit every hour and log these checks. This log is subject to inspection at any time by the alphabet soup of government agencies. The LZ is determined by the ground units and usually are identified by the municipalities
 

TraprMike

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Helicopters are never auto sent out by dispatch. The only people who are able to request a helicopter is the on scene fire personal.

.

MAYO 1 bird is auto dispatched all the time depending on what the first caller says about the accident. and that's what Mayo wants. faster responce times. all ways can get called off.
 

Shishkabob

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Speaking as someone who's worked rural EMS with 1+ hour transports, and urban EMS...

-As provider, would you prefer a dispatcher to start you aviation w/o your consultation?
No. I know the area better than my dispatchers, I know my capabilities better than the dispatchers, I know the weather in my particular area better than the dispatchers, I know if it's feasible to call for a helo better than dispatchers, etc etc etc. Not including the facts that 911 callers suck at giving good information and I'm not a fan of risking people's lives for a hyped-up bystander.

- As a follow up, is it more beneficial for me to do that, or just pre-alert them?
If I want them pre-alerted, I'll let you know.

-Does anybody else have a system in place for early helicopter dispatch, and what are the criteria they use?
If I ask for them to be pre-alerted, they are. If anyone else asks, the ultimate decision is mine and only I can cancel them. (Per protocol, not my inflated self-ego, only the ambulance Paramedic can cancel)



I'm also just not a fan of using a helo outside of very certain circumstances, currently in my urban system typically being extended extrication, very far away from the hospital, during rush-hour. If those 3 aren't all met, I probably won't launch as there's very little difference between the helo and me, aside from them charging $20,000 more.
 
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DesertMedic66

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MAYO 1 bird is auto dispatched all the time depending on what the first caller says about the accident. and that's what Mayo wants. faster responce times. all ways can get called off.

MAYO 1? Who is that
 
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