Requesting and pre-alerting Helicopters

[Rialaigh]

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.

This is nuts. Horribly cost inefficient. I'd be pissed if I was paying the taxes to launch a chopper on every seizure, shortness of breath call, and everything else. And any traffic collision? I mean I understand rural medicine gets a higher rate of serious calls then urban medicine but I cannot imagine the costs accumulated by launching a chopper on everything....

I would like to see a study as well that shows improved survival rates to discharge. There are only a few reasons I see flying someone as a good option and most of them involve unstable burn patients. or witnessed cardiac arrests with resusc with hospitals that can handle those being over a one hour ground transport away.

Also...

California...

 

[Veneficus]

This is nuts. Horribly cost inefficient. I'd be pissed if I was paying the taxes to launch a chopper on every seizure, shortness of breath call, and everything else. And any traffic collision? I mean I understand rural medicine gets a higher rate of serious calls then urban medicine but I cannot imagine the costs accumulated by launching a chopper on everything....

I would like to see a study as well that shows improved survival rates to discharge. There are only a few reasons I see flying someone as a good option and most of them involve unstable burn patients. or witnessed cardiac arrests with resusc with hospitals that can handle those being over a one hour ground transport away.

Also...

California...

Considering that many reputable air services also run ground CCT in the event of inclimate weather, it may be more of a training and equipment issue than the actual mode of transportation.

I agree it would probably be much cheaper to add an extra ground unit than all of this helicopter launching. (We won't talk about the safety issues)

 

[Flight-LP]

Considering that many reputable air services also run ground CCT in the event of inclimate weather, it may be more of a training and equipment issue than the actual mode of transportation.

I agree it would probably be much cheaper to add an extra ground unit than all of this helicopter launching. (We won't talk about the safety issues)

It's ironic, I logged in to respond to your other statement that I questioned as being general. Once I did, I see this quote and it pretty well voices my response.

While I agree many private air providers are reaping some financial benefits with questionable practices, I have to ask about the reputable, mission specific specialty teams that provide a much needed service to the community and smaller hospitals. I believe that not only providers, but also their administration, places operational quality and patient care in front of the cost. Whether it be a hospital based or hybrid program, I know several that have the financial backing and budget support from sources other than direct flight revenue. This is where I was questioning the generalization.

My service uses all modes of transport, rotor if it's feasible, fixed wing for distance, and ground for weather or facility request. The determination of transport is based on our patient actual medical need. Time, distance, acuity, predicted clinical path, etc.

 

[Flight-LP]

Outside of state funded choppers like Maryland troopers and our NJ troopers, this is exactly the case. Recently we have calls for the helo that the state turned down but the privates jumped on. This is becoming more of a thing lately as more privates get involved in air med

What was the reason for turn down? Weather? Availability? Pt. acuity requiring something more than a minimally trained cop that sidelines as a medic?

Ok that last one was a cheap shot, my bad...........

But seriously, did any of the patients require a true specialized level of care that the state funded program could not provide?

 

[Rialaigh]

What was the reason for turn down? Weather? Availability? Pt. acuity requiring something more than a minimally trained cop that sidelines as a medic?

Ok that last one was a cheap shot, my bad...........

But seriously, did any of the patients require a true specialized level of care that the state funded program could not provide?

I think it is a matter of billing a lot of the time. Private agencies are better at billing for their services then state agencies are. They can make a profit on more transports then state agencies can.

I know here sometimes we have called for a chopper for interfacility transport of a trauma that is flat out not going to make it. We don't want the chopper for saving the patient. We want the chopper to get his donatable organs to a transplant hospital. I know we usually have to call 3-4 services before we will find one that will transport. And generally it is a service attached to a hospital that can then harvest the organs instead of an independent service. This is one of many reasons private transport will accept when state won't.

 

[usalsfyre]

I think it is a matter of billing a lot of the time. Private agencies are better at billing for their services then state agencies are. They can make a profit on more transports then state agencies can.

I know here sometimes we have called for a chopper for interfacility transport of a trauma that is flat out not going to make it. We don't want the chopper for saving the patient. We want the chopper to get his donatable organs to a transplant hospital. I know we usually have to call 3-4 services before we will find one that will transport. And generally it is a service attached to a hospital that can then harvest the organs instead of an independent service. This is one of many reasons private transport will accept when state won't.

No offense, but putting a three person flight crew at risk for a dead body is ludicrous. Good on the other services for turning you down.

 

[Rialaigh]

No offense, but putting a three person flight crew at risk for a dead body is ludicrous. Good on the other services for turning you down.

Launching a chopper for every Charlie delta and echo call and every MVA is just flat out dumb, talk about putting people at risk.


On the flip side they fly transplant teams all the time with organs on choppers to different hospitals. Flying those (fixed wing or chopper) is really the only way to get a transplant somewhere on time.

 

[jwk]

I think it is a matter of billing a lot of the time. Private agencies are better at billing for their services then state agencies are. They can make a profit on more transports then state agencies can.

I know here sometimes we have called for a chopper for interfacility transport of a trauma that is flat out not going to make it. We don't want the chopper for saving the patient. We want the chopper to get his donatable organs to a transplant hospital. I know we usually have to call 3-4 services before we will find one that will transport. And generally it is a service attached to a hospital that can then harvest the organs instead of an independent service. This is one of many reasons private transport will accept when state won't.

I think you need a better understanding of the mechanics of organ donation. Donor organs can be retrieved at just about ANY hospital that has an OR crew and anesthesia available. Flying the donor to a specific hospital as a matter of routine for an organ harvest is totally absurd.

 

[Rialaigh]

I think you need a better understanding of the mechanics of organ donation. Donor organs can be retrieved at just about ANY hospital that has an OR crew and anesthesia available. Flying the donor to a specific hospital as a matter of routine for an organ harvest is totally absurd.

I do clinicals in a hospital with a 9 bed ER. They don't have the ability to retrieve organs. We try not to waste donor organs, if we have someone who is a donor and is knocking on the door of death we will find out who wants him/her and get them flown out.

 

[CentralCalEMT]

This is nuts. Horribly cost inefficient. I'd be pissed if I was paying the taxes to launch a chopper on every seizure, shortness of breath call, and everything else. And any traffic collision? I mean I understand rural medicine gets a higher rate of serious calls then urban medicine but I cannot imagine the costs accumulated by launching a chopper on everything....

I would like to see a study as well that shows improved survival rates to discharge. There are only a few reasons I see flying someone as a good option and most of them involve unstable burn patients. or witnessed cardiac arrests with resusc with hospitals that can handle those being over a one hour ground transport away.

Also...

California...

If you lived in CA, trust me, helo launches would be the least of your worries when it comes to things the state spends your money on.

That being said, I also work in a highly rural area in California that has auto launch criteria. I think the wisdom of sending helicopters to certain calls automatically, varies by the characteristics of area served. High speed MVA, MVA with entrapment or over the side, off road rescue calls, significant medical calls at rural campsites, etc will get an auto launch. In addition to my agency (the only ALS for the area) the fire department, CHP, etc can also auto launch enroute or call for a helo prior to our arrival to the call if they feel its necessary based on updated information. It is expensive, but necessary. For example, at my part time job, we cover over 3,000 square miles with only 4 stations. We have a whopping 2 hospitals in our coverage area. We have no trauma, neuro, cardiac, GI, peds, etc as both of those hospitals are rural critical access hospital and one does not even have an ICU. We do not have any major highways and the vast majority of our roads are in areas with winding two lane narrow canyon roads that you can safely go 25 mph on a good day or, even worse, steep dirt roads that become muddy when it rains. We cover mountains, the desert, off road riding areas, national forest, you name it. Even with 4X4 type I ambulances, we have trouble even accessing areas that we cover. Sometimes our calls involve us hiking in. Part of the reason that the helo is auto launched out here is because there are times they will land on scene, treat the patient, and leave prior to our even arriving on scene. We have areas with ground response times of over an hour and ground transport times approaching 2 hours. If the roads are icy it can be as long as 3 hours. There are times that auto launching will save well over an hour in critical calls. Additionally, they can take the patient directly to a specialty center rather than just a rural hospital. I do agree that auto launch in a suburban area seems silly, but then again, helicopters are more useful in a rural system in my opinion when it comes to time savings.

 

[Bullets]

What was the reason for turn down? Weather? Availability? Pt. acuity requiring something more than a minimally trained cop that sidelines as a medic?

Ok that last one was a cheap shot, my bad...........

But seriously, did any of the patients require a true specialized level of care that the state funded program could not provide?

State said they couldn't fly due to weather.

Our troopers only pilot, they do not provide medical care. They carry a nurse and a medic for that

 

[exodus]

Check policy 5201

"In order to provide for a uniform system of dispatch of EMS aircraft, and to prevent potential problems with
the dispatch of more than one EMS aircraft, the Riverside County Fire Department is designated as the Coordinating Agency for the dispatch of EMS aircraft. Requests for an air ambulance or rescue aircraft will be made through the Emergency Command Center (ECC)"

My interpretation of that is it just means we can't call the chopper ourselfs. We have to contact county and have them contact the chopper. But we can request one through them before fire is on scene.

 

[Household6]

I do clinicals in a hospital with a 9 bed ER. They don't have the ability to retrieve organs. We try not to waste donor organs, if we have someone who is a donor and is knocking on the door of death we will find out who wants him/her and get them flown out.

Yea, I don't think my local hospitals are equipped either... At all... Medically or legally for that. You just can't hike up your gloves and go a-harvesting some organs without making sure legalities are squared away..

The place where I do my personal doctoring has one anesthesiologist on staff.

That's why there's AirCare. Fly them out, let Mayo or Hennepin do it..

 

[Bullets]

Timely article by Bledsoe. I love it
http://www.jems.com/article/vehicle-ops/reducing-inappropriate-helicop

 

[EpiEMS]

Timely article by Bledsoe. I love it
http://www.jems.com/article/vehicle-ops/reducing-inappropriate-helicop

I'd wager you're more likely to get sued for providing too little care rather than too much...
Can't be *too* cautious when n = 1, I guess. Not that the initial MD was correct, but was he/she cautious insofar as "overtreatment"? Yeah, I think so, despite the additional risk of crashing and all that...

 

[TraprMike]

Mayo 1 is based in S.E. Minn. Owned by the Mayo Clinic system in Rochester Minn..

http://www.mayoclinic.org/medical-transport/mayoone.html

3 birds, RochesterMN, Eue Clare, WI (sp), and Mankato MN. and one (?) jet for long range transport.
the birds are staffed by mostly RN's, but last few years they staff with paramedic's with all kinds of letters behind thier names.

considering the time it takes to get it off the ground. autolaunch is best. first on scene can always call them off (cancel).

 

[DesertMedic66]

My interpretation of that is it just means we can't call the chopper ourselfs. We have to contact county and have them contact the chopper. But we can request one through them before fire is on scene.

As long as it is done thru the communication office then it should be fine. I'm fairly sure the communication office is fire controlled so either way you are contacting the fire department who in turn sends out the HEMS unit. I don't think any of our unit cell phones have mercy or reach phone numbers.