MSP Medevac Helicopter Crash

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I saw that today. That sucks.

If they don't use the Medevac system what are other options for transporting critically injured patients to appropriate facilities? Are there any real viable options? I am guessing that this particular flight was probably on its way to Shock Trauma. Even if distance isn't an issue traffic would be in this situation. Closer to 95 than Hopkins but still quite a bit of surface street traffic when you get off of the interstate. Or here in the Land of Enchantment - huge portions of the state are at least 4 hours away from a Level 2 trauma center, never mind the only Level 1.

It seems like in many facets of life we have these situations. I ride horses. About 10 years ago there was a rash of deaths at the elite levels of my particular discipline. There was lots of talk and I'm not sure if anything was actually done. A similar situation has occurred over the last year or so, this time with more horse fatalities (so more media attention). There was a large safety summit, talk about changing the jump designs, but we are yet to see if any of this will make a change. Is it just a risk that you take with any inherently dangerous activity (flying a helicopter, riding a motorcycle , etc)? How many and what kind of changes will lower the chances of catastrophe without impairing the original function?
 
Air EMS needs to be re-thought.

I did a month on the chopper as a resident. It was fun, do doubt. It was a rush, it was sexy.

I'm not sure how many lives we saved though.

I remember thinking I was moments from death a few times. Landing a helo on the side of the road beneath power lines or between hundred foot trees is pretty risky business. It is one thing to be doing this in a war zone or when there is no other alternative. Quite another to be doing this when a ground unit is available and would only resut in an increased transport time of 20-30 minutes, if that. Especially considering that the large majority of the patients we transported really wouldn't benefit from the decreased transport time anyway.

The bottom line is that these services exist to make money for the parent company, be it the hospital, EMS system, or state.

The concept looks good on paper but really doesn't live up to it's expected benefit.

I don't know the specifics of the most recent incident, but it is hard for me to believe that these four deaths were worth the cost.
 
What about people living in the bush though? I live in AK and a lot of the villages are extremely far away from any real hospital. As well, ground transportation is often difficult, if not impossible, even in normal conditions.
 
How awful! Though I am still a fan of aeromedical rescue...
 
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HurricaneKatt said:
What about people living in the bush though? I live in AK and a lot of the villages are extremely far away from any real hospital. As well, ground transportation is often difficult, if not impossible, even in normal conditions.
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Clearly this thread is not about people living in "the bush".

It is about people living in suburban Maryland and any one of other similar areas around the U.S.
 
edinOH said:
Clearly this thread is not about people living in "the bush".

It is about people living in suburban Maryland and any one of other similar areas around the U.S.
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Well, this particular crash happened in Maryland, but air EMS exists all over the country in a variety of settings. I think HurricaneKatt was just pointing out that the usefulness and risk/benefit of helicopters changes depending on the setting. For more suburban locations, its seems true that the risks might outweigh the benefits (if transport time differences are minimal). When you start getting into more rural locations and areas without level I trauma or specialty hospitals, I think they are a necessity. Sometimes they are cutting transport times on the magnitude of hours instead of minutes.

At least around here the majority of transports by air are actually interfacility transfers and not field emergencies. Do people think this changes whether a helicopter should or should not be used?
 
EMmedic said:
Well, this particular crash happened in Maryland, but air EMS exists all over the country in a variety of settings. I think HurricaneKatt was just pointing out that the usefulness and risk/benefit of helicopters changes depending on the setting. For more suburban locations, its seems true that the risks might outweigh the benefits (if transport time differences are minimal). When you start getting into more rural locations and areas without level I trauma or specialty hospitals, I think they are a necessity. Sometimes they are cutting transport times on the magnitude of hours instead of minutes.

At least around here the majority of transports by air are actually interfacility transfers and not field emergencies. Do people think this changes whether a helicopter should or should not be used?
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If it's a real, no $hit emergency in the backcountry where helo is the only route out aside from donkey, then yeah, I guess I'd be pretty inclined to support it.

However, when they're doing inter-hospital transfers for the sake of convenience and $$$ for transporting an 80-something year old women who has a fraction of a % chance of improving (which was the case in the WI crash), then I think this should be stopped.

We're getting to the point, if we're not already there yet (just assuming here fwiw) that the functional healing capacity (lives lost x future years able to work) that have been lost may equal or exceed the number of years/lives saved by suburban/urban aeromedical transport.
 
Two things I think should be mandatory:

1. All programs with flight should take a long, hard look at the educational value. The appropriate question is this, "if you take away all the sexiness and all the fun of wearing a flight suit what did you learn on your flight month that you could not have learned in the ED/ICU?" Equally important, "what exactly do you feel that residents who opt out of flight are missing?"

2. All programs who adveritise flight on the interview trail should be obligated to present a good faith review of some of this literature questioning the value of flight for patients. Sound silly? Just consider that many students on the trail might be familiar with the literature.
 
AmoryBlaine said:
Two things I think should be mandatory:

1. All programs with flight should take a long, hard look at the educational value. The appropriate question is this, "if you take away all the sexiness and all the fun of wearing a flight suit what did you learn on your flight month that you could not have learned in the ED/ICU?" Equally important, "what exactly do you feel that residents who opt out of flight are missing?"

2. All programs who adveritise flight on the interview trail should be obligated to present a good faith review of some of this literature questioning the value of flight for patients. Sound silly? Just consider that many students on the trail might be familiar with the literature.
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I think it is the same concept as riding on an ambulance...done solely to increase understanding and appreciation of people you work with on a daily basis. As for medical educational value, there is none that couldn't be achieved beyond what you would learn in an ICU/ED, with the exception of gaining an insight into the differing "barometric" physiology seen in patients travelling by air.
 
As someone who has worked in both the ground EMS system of MD and flown with MSP while working for University of MD Med, I can assure that Aeromedical transport is a required and necessary tool in EMS's arsenal.

For those who have traveled through MD at least once, would realize that the amount of traffic during rush hours is insane. 295, 495, 695, even parts of 95 are routinely congested, to the point of causing major delays to responding and transporting EMS units. The use of HEMS allows us to shorten delays, and have an impact on the golden hour.

This accident occured in a county that is a decent distance away from the closest trauma center (PG). A transport time of at least 15-20 min would have occured by ground, and that is without adverse weather. So add on another 5 min. Extrication time was probably about 5-10 min, then you have to add response time, as well as initiation of the 9-1-1 system. So by ground transport you are looking at minimum of 35 minutes, and that is if everything runs flawlessly.

MD, as other states has set EMS protocols. Especially those that deal with how and where patients are transported. As Dr. Bass stated in the article, there was intrusion into the passenger compartment of more then 12" (Indication 1) as well as "complaints of chest, back, and spine pain" (Indication 2 and 3). They automatically met trauma criteria for the state of MD as well as many other states, and that is without vital signs being taken.

As for the overuse, I am on the fence on that issue. Working in the field of Flight medicince for the past 3 yrs, I have seen when HEMS has been used to overcome a time barrier only for a physicians comfort. But have also seen that barrier overcome many other times to improve a patients chance of survival. So it is a fine line that most be walked carefully, and my experience with MSP is that there is nobody who does a finer job.

MSP has been flying for over 40 yrs and has had only 3 crashes within that period, the last being in the 80's. They have some of the best trained and experience pilots and flight crew around, and they all have safety on their mind.

As for the education value. While I have yet to go to Med school. I can say that a better understanding of what occurs during both flight and ground transports would benefit many ED personnel. Its a different world when there are not multiple tools and hands at your disposal, or especially bright lights.
 
snulma1 said:
As someone who has worked in both the ground EMS system of MD and flown with MSP while working for University of MD Med, I can assure that Aeromedical transport is a required and necessary tool in EMS's arsenal.

For those who have traveled through MD at least once, would realize that the amount of traffic during rush hours is insane. 295, 495, 695, even parts of 95 are routinely congested, to the point of causing major delays to responding and transporting EMS units. The use of HEMS allows us to shorten delays, and have an impact on the golden hour.

This accident occured in a county that is a decent distance away from the closest trauma center (PG). A transport time of at least 15-20 min would have occured by ground, and that is without adverse weather. So add on another 5 min. Extrication time was probably about 5-10 min, then you have to add response time, as well as initiation of the 9-1-1 system. So by ground transport you are looking at minimum of 35 minutes, and that is if everything runs flawlessly.

MD, as other states has set EMS protocols. Especially those that deal with how and where patients are transported. As Dr. Bass stated in the article, there was intrusion into the passenger compartment of more then 12" (Indication 1) as well as "complaints of chest, back, and spine pain" (Indication 2 and 3). They automatically met trauma criteria for the state of MD as well as many other states, and that is without vital signs being taken.

As for the overuse, I am on the fence on that issue. Working in the field of Flight medicince for the past 3 yrs, I have seen when HEMS has been used to overcome a time barrier only for a physicians comfort. But have also seen that barrier overcome many other times to improve a patients chance of survival. So it is a fine line that most be walked carefully, and my experience with MSP is that there is nobody who does a finer job.

MSP has been flying for over 40 yrs and has had only 3 crashes within that period, the last being in the 80's. They have some of the best trained and experience pilots and flight crew around, and they all have safety on their mind.

As for the education value. While I have yet to go to Med school. I can say that a better understanding of what occurs during both flight and ground transports would benefit many ED personnel. Its a different world when there are not multiple tools and hands at your disposal, or especially bright lights.
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I am also "on the fence" with regard to HEMS, but there are serious flaws in your logic. First, of all level 1 or 2 trauma patients, only ~10% will go to surgery within the first 3 hours of presentation. Of those who do go to the OR, the overwhelming majority are ortho cases, followed next by neurosurg, and last by general surgery. In other words, the "golden hour" (as truly defined for penetrating trauma) applies in only a very small percentage of the patients. Second, 35 minutes (as you suggested) would be a great time for an EMS trauma transport - 25 minutes for an experience trauma team to stabilize a patient for the OR? Easy! Lastly, as you pointed out, the EMS guidelines for helicopter dispatch in this case were by mechanism of injury. MOI remains a very nebulous way to define trauma. In this case, it led to a helicopter flight being ordered for minimally injured persons.

The question has never been "is there any patient for whom HEMS would create a better chance of survival?". There certainly is. The question really is how do we reliably identify those individuals so as to bring the risk:benefit ratio into balance.
 
snulma1 said:
As someone who has worked in both the ground EMS system of MD and flown with MSP while working for University of MD Med, I can assure that Aeromedical transport is a required and necessary tool in EMS's arsenal.

For those who have traveled through MD at least once, would realize that the amount of traffic during rush hours is insane. 295, 495, 695, even parts of 95 are routinely congested, to the point of causing major delays to responding and transporting EMS units. The use of HEMS allows us to shorten delays, and have an impact on the golden hour.

This accident occured in a county that is a decent distance away from the closest trauma center (PG). A transport time of at least 15-20 min would have occured by ground, and that is without adverse weather. So add on another 5 min. Extrication time was probably about 5-10 min, then you have to add response time, as well as initiation of the 9-1-1 system. So by ground transport you are looking at minimum of 35 minutes, and that is if everything runs flawlessly.

MD, as other states has set EMS protocols. Especially those that deal with how and where patients are transported. As Dr. Bass stated in the article, there was intrusion into the passenger compartment of more then 12" (Indication 1) as well as "complaints of chest, back, and spine pain" (Indication 2 and 3). They automatically met trauma criteria for the state of MD as well as many other states, and that is without vital signs being taken.

As for the overuse, I am on the fence on that issue. Working in the field of Flight medicince for the past 3 yrs, I have seen when HEMS has been used to overcome a time barrier only for a physicians comfort. But have also seen that barrier overcome many other times to improve a patients chance of survival. So it is a fine line that most be walked carefully, and my experience with MSP is that there is nobody who does a finer job.

MSP has been flying for over 40 yrs and has had only 3 crashes within that period, the last being in the 80's. They have some of the best trained and experience pilots and flight crew around, and they all have safety on their mind.

As for the education value. While I have yet to go to Med school. I can say that a better understanding of what occurs during both flight and ground transports would benefit many ED personnel. Its a different world when there are not multiple tools and hands at your disposal, or especially bright lights.
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1. Re bolded statement #1: No, you can't. That's the point. The question at hand is not whether or not traffic is bad or if HEMS reduces transport time but rather if HEMS decreases morbity/mortality. Annecdotal evidence that HEMS is faster does not contribute to the discussion. If the issue were ever really well studied (and some of the EMS folk on here have discussed the studies before) then I strongly suspect there would be some pretty impressive data regarding the Number Needed to Treat (NNT). So I could see the data shaking out thusly, "HEMS saves lives, but you need to transport 200 blunt chest trauma patients by HEMS (at a cost of $15k apiece or whatever it would be) to save one life."

2. How exactly would "many ED personnel" benefit? I don't need to know how to function with few tools and dim lighting, I am training to be an emergency physician. This is a specialty which almost by definition is saturated with tools and resources (we have CT scanners in our departments, we have difficult airway boxes, almost every residency program has 24/7/365 specialty back-up). If you are saying that we would benefit by knowing what our EMS colleagues go through then I would say take a picture, or shoot a movie.
 
AmoryBlaine said:
2. How exactly would "many ED personnel" benefit? I don't need to know how to function with few tools and dim lighting, I am training to be an emergency physician. This is a specialty which almost by definition is saturated with tools and resources (we have CT scanners in our departments, we have difficult airway boxes, almost every residency program has 24/7/365 specialty back-up). If you are saying that we would benefit by knowing what our EMS colleagues go through then I would say take a picture, or shoot a movie.
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While it may not be crucial that everyone flys, I think that if EM docs are going to be doing online medical control and directing the actions of medics and nurses in the field, they should spend some time out there so that they have a good understanding what is and isn't reasonable to do on scene. It also helps avoid those "why the heck didn't you do XYZ, I don't care that he was under a subway train with bystanders throwing bottles at you."
 
snulma1 said:
The use of HEMS allows us to shorten delays, and have an impact on the golden hour.
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The golden hour: scientific fact or medical "urban legend"?

Lerner EB, Moscati RM.

The term "golden hour" is commonly used to characterize the urgent need for the care of trauma patients. This term implies that morbidity and mortality are affected if care is not instituted within the first hour after injury. This concept justifies much of our current trauma system. However, definitive references are generally not provided when this concept is discussed. It remains unclear whether objective data exist. This article discusses a detailed literature and historical record search for support of the "golden hour" concept. None is identified.
PMID: 11435197
 
AmoryBlaine said:
1. Re bolded statement #1: No, you can't. That's the point. The question at hand is not whether or not traffic is bad or if HEMS reduces transport time but rather if HEMS decreases morbity/mortality. Annecdotal evidence that HEMS is faster does not contribute to the discussion. If the issue were ever really well studied (and some of the EMS folk on here have discussed the studies before) then I strongly suspect there would be some pretty impressive data regarding the Number Needed to Treat (NNT). So I could see the data shaking out thusly, "HEMS saves lives, but you need to transport 200 blunt chest trauma patients by HEMS (at a cost of $15k apiece or whatever it would be) to save one life."

2. How exactly would "many ED personnel" benefit? I don't need to know how to function with few tools and dim lighting, I am training to be an emergency physician. This is a specialty which almost by definition is saturated with tools and resources (we have CT scanners in our departments, we have difficult airway boxes, almost every residency program has 24/7/365 specialty back-up). If you are saying that we would benefit by knowing what our EMS colleagues go through then I would say take a picture, or shoot a movie.
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1. Yes I can, EMS is not for treatment and surgical intervention, EMS is for rapid and emergent stabilization of life threatening injuries. Delays in transport times have major impacts on "Critical" patients. You state numbers of 1 in 200 to actually save a life, where as reports show numbers of 76% of patients benefit from HEMS transport. I will agree that sometimes they do get called for patients that only meet trauma criteria based on MOI (car deformity, passenger in a MVC with a fatality...etc) It is at the discretion of the responding ground personnel to activate and/or cancel a responding helicopter.

And as for cost... MSP's program is a no charge service. Their cost is subsidized by a small fee attached to your car's registration. So anyone in the state can utilize the service without charge. Insurance or no insurance.


2. I may have been of target in my statement about the benefit of ED personnel spending time with HEMS or EMS. While our environment does play into how much we can do with what we have, it is beneficial to have ED staff that understands this, so that when we bring in a patient that hasn't gotten the full standard treatment (due to extrication times, environmental issues...etc.) there isn't a pissing match in the ED. As well as better online medical control, as someone else had stated.

As an ED physician, you are responsible for developing and refining protocols as well as alerting medical directors of EMS programs for problems with patient care. Spending time in the field allows you to differentiate between piss poor care, and extenuating circumstances.

And to squad51,

While you state 10% go to surgery within the first 3 hrs at a level 1 or 2 trauma center, the questions is, what if they had been transported to a non-designated trauma center, or even worse, just a basic community hospital, some of which have no neurosurg capabilities? Then time comes into play again, and having a CC ground team drive to the community hospital to transport pushes this time crunch to the max.
 
Can you show me where you got numbers of 76%? Cuz I haven't seen them.



On the plus side, our helicopters are all shiny and clean since we haven't seen as many flights lately.
 
snulma1 said:
1. Yes I can, EMS is not for treatment and surgical intervention, EMS is for rapid and emergent stabilization of life threatening injuries. Delays in transport times have major impacts on "Critical" patients. You state numbers of 1 in 200 to actually save a life, where as reports show numbers of 76% of patients benefit from HEMS transport. I will agree that sometimes they do get called for patients that only meet trauma criteria based on MOI (car deformity, passenger in a MVC with a fatality...etc) It is at the discretion of the responding ground personnel to activate and/or cancel a responding helicopter.
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If you read the paper I posted above or the link Hard24Get posted you'll see that the evidence for HEMS benefiting patients is really not there. Most studies have shown little or no benefit in urban areas, although most people do believe it may help some people in rural areas.

Remember, just because it gets patients to the hospital faster doesn't mean it is improving their outcomes. Most patients are not that critically injured and can wait longer to get to the hospital. Many who are truly critically injured may die even with prompt intervention. For some, the decrease in transport time may help. Without doing research you don't know how many fall into each category.

snulma1 said:
And as for cost... MSP's program is a no charge service. Their cost is subsidized by a small fee attached to your car's registration. So anyone in the state can utilize the service without charge. Insurance or no insurance.
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Cost and billing aren't the same thing. Running a helicopter service is not free. It costs money to buy the helicopters and to pay for fuel and personnel. Whether the cost is borne by the taxpayers at large or insurance is irrelevant.

There is an additional cost to HEMS in the form of human lives lost due to crashes. It would not surprise me to find out that as many lives have been taken by HEMS as saved this year, if not more.

snulma1 said:
While you state 10% go to surgery within the first 3 hrs at a level 1 or 2 trauma center, the questions is, what if they had been transported to a non-designated trauma center, or even worse, just a basic community hospital, some of which have no neurosurg capabilities? Then time comes into play again, and having a CC ground team drive to the community hospital to transport pushes this time crunch to the max.
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Which? The 10% who went to surgery, or the 90% who didn't? If it's the 10%, no one knows, obviously. Clearly the 90% who didn't have surgery would have done fine at a lower level facility, or probably with longer transport time to a trauma center.
 
Pseudo addressed some of the major issues with you post such as no charge does not = no cost and where that "76% of patients benefit" figure is from.

snulma1 said:
It is at the discretion of the responding ground personnel to activate and/or cancel a responding helicopter.
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I would add that this is part of the problem. I see helo transports from scenes and outlying hospitals that just didn't need it. But, the transporting facility, doc, EMS, etc. were worried that they would be liable if the patient deteriorated enroute and they had not used the helo. Helos have become a measure of defensive medicine. If they're there the sending entities feel obligated to use it. They also like the rapid "Get this out of my ER or scene and fast!" even though it may not be necessary.
 
I'm also on the fence as to whether HEMS is really worth it.

I fly with our local service for moonlighting. I do it primarily to deal with sick people and their management, rather than working in my local urgent care, and because it's actually fun to fly, for the most part.

Going to work scares the shizzle out of my wife, but she understands how much I enjoy it.

I can't stand when we get a stupid flight from a hospital less than 10 minutes away by EMS for a kid with an appy because the surgeons at the hospital won't take them to the OR, or because the wait for the ground EMS is 2 hours. It's a total waste of my time, and the resources of the service.

However, it's extremely useful for, say, scene runs, as I've learned to find out. I had a guy a week ago who had a tractor roll on top of him. Nearest trauma center of ANY designation was 50 min by ground. 1:45 of extrication. I had to intubate him when we got there because he had 5k lbs of tractor on his back and couldn't breathe because of b/l hemo/pneumos and multiple flail segments. Ended up putting in b/l chest tubes before the flight. Had we not have gone to that, he wouldn't have made it. However, he's gonna live, from the last we heard.

I love the idea of HEMS.....it needs to be utilized properly.

The one comforting thing that I have in my system is that we're a 2 pilot system, which is the reason I do the job. Having 2 pilots means that if one pilot isn't comfortable flying in the weather or the situation, then we call off the flight. It's great in horrible weather....it also allows us to fly IFR instead of VFR, so we can fly higher in bad weather and fly more like an airplane, and have more guidance than in marginal VFR conditions like the MSP crash. It's really a great thing. If my program ever went to single pilot, I'll quit.

One of the other flight docs put it best (to preface, he's a navy seal): "I've jumped out of airplanes, moving submarines, been shot at and killed people. I've planted mines and done a lot of stupid things, and this job is one of the most dangerous ones I've ever done.....but I'd do it every day with 2 pilots. If they ever go to 1 pilot, I'd quit in a heartbeat."
 
snulma1 said:
1. Yes I can, EMS is not for treatment and surgical intervention, EMS is for rapid and emergent stabilization of life threatening injuries. Delays in transport times have major impacts on "Critical" patients. You state numbers of 1 in 200 to actually save a life, where as reports show numbers of 76% of patients benefit from HEMS transport. I will agree that sometimes they do get called for patients that only meet trauma criteria based on MOI (car deformity, passenger in a MVC with a fatality...etc) It is at the discretion of the responding ground personnel to activate and/or cancel a responding helicopter.

And as for cost... MSP's program is a no charge service. Their cost is subsidized by a small fee attached to your car's registration. So anyone in the state can utilize the service without charge. Insurance or no insurance.


2. I may have been of target in my statement about the benefit of ED personnel spending time with HEMS or EMS. While our environment does play into how much we can do with what we have, it is beneficial to have ED staff that understands this, so that when we bring in a patient that hasn't gotten the full standard treatment (due to extrication times, environmental issues...etc.) there isn't a pissing match in the ED. As well as better online medical control, as someone else had stated.

As an ED physician, you are responsible for developing and refining protocols as well as alerting medical directors of EMS programs for problems with patient care. Spending time in the field allows you to differentiate between piss poor care, and extenuating circumstances.

And to squad51,

While you state 10% go to surgery within the first 3 hrs at a level 1 or 2 trauma center, the questions is, what if they had been transported to a non-designated trauma center, or even worse, just a basic community hospital, some of which have no neurosurg capabilities? Then time comes into play again, and having a CC ground team drive to the community hospital to transport pushes this time crunch to the max.
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1. Transport time is NOT the issue. The issue is survival outcomes. You can prove that HEMS decreases transport times for X criteria critical patients by Y number of minutes. The question is a) what does that do accomplish exactly and b) how many people do you have to fly to save one person?

2. I made the 1/200# up as an example, I have no idea what it would actually be but think it's entirely possible that the NNT by HEMS to save a life would be large.

3. Am I misunderstanding you? Are you suggesting to us that helicopter flights don't cost money?
 
Actually the time savings is debatable. By the time the helicopter is pulled from the hanger, flies to the scene, spends 10 minutes on-scene, then flies back to the hospital, the ground crew can often be at the hospital. Most helicopter services can only be activated by EMS personnel. For the paramedics on-scene, it's just on-scene time plus transport time to hospital whereas for the helicopter, it's all the above.

Helicopters are cool, but they're dangerous, expensive, and probably have little effect on survival.
 
southerndoc said:
Actually the time savings is debatable. By the time the helicopter is pulled from the hanger, flies to the scene, spends 10 minutes on-scene, then flies back to the hospital, the ground crew can often be at the hospital. Most helicopter services can only be activated by EMS personnel. For the paramedics on-scene, it's just on-scene time plus transport time to hospital whereas for the helicopter, it's all the above.

Helicopters are cool, but they're dangerous, expensive, and probably have little effect on survival.
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For this reason I think it may only be appropriate for urban helicopters to be utilized with long extrication times. EMS shows up on scene, realizes its going to take an hour to get the patient out of the car, activates the helicopter - the helicopter shows up while the patient is still being extricated. In this instance, it saves time. If EMS is waiting on scene when they could be at the hospital with the patient -- yeah, totally inappropriate. That's the same issue as basic EMTs waiting on scene for medics to arrive.
 
EMmedic said:
For this reason I think it may only be appropriate for urban helicopters to be utilized with long extrication times. EMS shows up on scene, realizes its going to take an hour to get the patient out of the car, activates the helicopter - the helicopter shows up while the patient is still being extricated. In this instance, it saves time. If EMS is waiting on scene when they could be at the hospital with the patient -- yeah, totally inappropriate. That's the same issue as basic EMTs waiting on scene for medics to arrive.
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I failed to mention that at least at the two hospitals where I work, it is quicker to transport by helicopter. Seriously, EMS can take 20-30 minutes to show up at a hospital for an emergent transport! The helicopter is usually at the hospital in only 5 minutes after a request (they are close by).

However, my original post regarding helicopter transport times not being quicker was referring to scene transports.

The question for improving outcome by flying v. ground transport is another topic.
 
Do any HEMS programs require physician approval for scene to hospital transfers? I know that all of the interfacility transfers we make with Air Care go through the University Hosp attending to make sure they warrant a helo transfer, but I think scene flights are decided by EMS directly with dispatch and no MD. I definitely think there are patients in the field that benefit from HEMS (I have seen several of them first hand: patients who need and airway with RSI and prehospital providers don't have RSI where we are; very rural crews that are BLS have patients who need ALS--this may only be a 15 minute flight from a midwest city; truly ill trauma patients).....however, I also fly a lot of stuff that doesn't need to be flown and this is what needs to be weeded out (nail in the head via nail gun in an awake talking patient, trauma patient with GCS 15 and normal vitals---usually dispatched when they are unconscious, but then they regain consciousness and we never get canceled). It just seems that MD approval/oversight could help a little and I was wondering if this happens in most places for EMS scene calls? I still think one of the major issues is the business driven competitiveness of HEMS programs....if we turn down a flight because our MD doesn't think it is indicated, they just call the next program that may be private and looking at the money/business aspect of it. And next time the EMS squad or hospital will just call the other provider and not us and before you know it we'll be out of business. There should be some sort of governmental or non-bias medical agency that has to approve the need for a helo (interfacility or scene) and then dispatch the closest helo(we also have the problem of our competitor who may normally have a helo in some town accepting a call, saying they have a helo available and not telling them where it is coming from...and it ends up not being the closest helicopter available because they don't want to lose the call). All of which could be fixed with an oversight agency. HEMS sure needs some TLC over the next few years!
 
crewmaster1 said:
I definitely think there are patients in the field that benefit from HEMS (I have seen several of them first hand: patients who need and airway with RSI and prehospital providers don't have RSI where we are)
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Crew I agree with you about the oversight agency, but come on, are you really suggesting that HEMS needs to exist in order to provide pre-hospital RSI?
 
Squad51 said:
Crew I agree with you about the oversight agency, but come on, are you really suggesting that HEMS needs to exist in order to provide pre-hospital RSI?
Click to expand...

No not at all. There are plenty of ALS agencies that can RSI, but many cannot and in some cases it makes a difference. I just flew on a TBI with facial fractures. GCS was 6. EMS attempted non-RSI intubation and couldn't do it. NT contraindicated for facial instability. Patient needed an airway 20+ minutes from hospital. We RSI the guy, get a tube, and fly him. That is just one example of where I think HEMS can make the difference. A single oxygen sat below 90% can double the mortality of a TBI and this guy would have been hard to manage in the back of a squad for a 20-30 minute drive w/o getting low sats and increased risk of aspiration. There are a lot more reasons why HEMS is justified and useful in my opinion, I just feel that it is strongly over used and abused and nobody is willing to put a stop to it because it has become an unregulated business operation where money makes the rotor turn.
 
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