This begs the question:
Is there vigorous debate in the world of Emergency Care surrounding "aeromedical scene responses?" What do some of you more experienced folk have to say about it?
I wouldn't call it vigorous debate. I think most of the cynics like myself don't bother, since it wouldn't do any good to debate it. Money and changing or protecting referral patterns between hospitals is driving this. I'm told that at one time there were 5 different competing hospital services in Phoenix. Back when it was a much smaller town.
😕
As with most EMS topics, the lit on this is fairly poor. There is no evidence supporting the use of this for on scene response. There is some evidence that it is on average harmful. There is no question that on scene medical helicopter flights are among the most dangerous of all aviation tasks. That's because they fly in marginal conditions to unprepared sites. Think telephone wires in the dark. Think Crew, Patient and Doctor dying. Dropkick is right, it's happened a lot.
My experience started just after the Vietnam war as an Intern and then a flight surgeon in central Texas. Did a few flights with my patients on the Medevac from Del Rio to San Antone. then I received patients from the Maryland Police choppers as a resident. Then more Medevac when running a Air Force ED in NW Florida. Last 23 years in Far West Texas with long trips, at the edge of the fuel loads. First Medevac, now a private service based in Southern New Mexico. I've had little recent urban experience with this. Our in-city transport times are a few minutes.
Here's what I've concluded:
1. The chopper almost always takes longer. That's because it's usually called by the ambulance on the scene. It has to spin up, go out and back. Even if it's air speed is 2.5 times ground speed, they still get to me an hour later than an ambulance launched at the same time as the helicopter is called to the incident 90 miles away. I believe this is why there is some evidence that trauma does better with ground transport. I think some are just bleeding to death or herniating while waiting for a ride.
2. Choppers are not for medical care, transport only. Very little can be done in the air. In the old days, it was difficult to even to be sure that the patient had a pulse. You certainly couldn't monitor even the ECG. The equipment and personnel may be better today, but I doubt that the basic problem has changed.
3. Bringing better personnel to the scene sounds good, but it may make more sense just to bring the patient to the better personnel in their hospital with an OR and blood bank to back them up.
4. On scene helicopter transport can be justified in only four special situations:
a. Large urban settings with traffic gridlock
b. mountainous areas with windy roads and very slow ambulance ground speeds
c. wilderness rescues, far from roads
d. systems where the choppers are already out in the periphery so they don't have to go out and back. Examples: Maryland state police, Southwest Air in Arizona and New Mexico.
Nuff said. The proponents are free to post their objections, but I'm not going to debate it. As I say, I don't think it will make any difference because of the $$ incentive.
