[Scan-DC] Helicopter Transport

[Todd Sniffin]

I'm in the same boat as William-I'm not an expert and I respect the opinions
and experiences of everyone on here, but I would like to clear up a few
misconceptions.

The time of request for a helicopter to the helicopters arrival on scene
varies by jurisdiction as well as provider (MSP, USPP, Medstar, etc...).
For example, in Montgomery County the average time from request to arrival
is 15 minutes for a Trooper.  This time includes a mandatory checklist the
pilot must complete before takeoff and usually takes about 6 minutes.  The
remainder of the time is spent pushing the helicopter out of the hanger,
flight time, and coordinating a LZ with the ground unit.  The time from
opening the doors to arrival is interesting, but not as significant as the
time from request to time of arrival.

As William noted, the level of care between flight medics and ground medics
is actually not very different-*depending on the jurisdiction*.  In Maryland
they are both licensed at the state EMT-P level, but the flight medics are
allowed additional procedures-such as RSI.  Note-this is a jurisdiction
optional decision and is not related to the ability of the provider.  The
Maryland State EMS protocols are available online from www.miemss.org.
Everything in that book is skill that is available to all MD state EMTs
qualified at the appropriate level, however the jurisdiction may decide not
to allow their providers to practice certain skills for a variety of
reasons.  The only time the level of care may be higher between a ground and
flight medic is if the flight medic is also qualified in critical care
skills or if the flight medic is actually a flight nurse (or cross trained
as a nurse).  In general helicopters are overused in ubran/suburban
settings.  The most critical patients (such as a trauma code) usually do not
go by helicopter in Maryland because the patient must be reasonably
stable-and the two person crew and limited space/equipment are not
comparable to a large medic unit with multiple people and "unlimited"
supplies.  Maryland recently changed the trauma decision tree to help
providers determine when a helicopter should be requested.  As Michael
correctly noted, other factors include the availability of the nearest
trauma center, time of day, road conditions, primary injury (there are
speciality centers that can warrent a helicopter flight even if the patient
is not acutely critical-such as spinal injuries, eye trauma, hand trauma,
etc...)

Hope this helps.

Todd

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Michael Rumberg said:

I agree it appears ground transport would be faster at times and the FD is
very aware of when it is and isnt.

I dont know about the Aircare/Lifeflight helo procedures and timing, and
certainly not the incident you referred to and why it took so long for the
helo to be dispatched,  but for FCPD from opening the hangar doors and
pushing out to the pad to being on site anywhere in the county takes less
than five minutes.

but it isnt simply a matter of drive time.  there is quite a "calculus" to
determine if necessary or not.  I dont remember all the details but it
includes the nature of the injury, what ground units are available, what
medical center is available, what time of day/ground traffic is, etc.

Also remember that one of the most important, if not the most important
factor is the level of care the helo paramedic is trained, equipped and
authorized to provide which is vastly higher than ALS medics and units.
 These advanced procedures and medicines add tens of minutes to the critical
care time and just cannot be done on the ground.

The helo medical care is higher than the ground units because the medical
director has much more control over the helo medics and their training due
to numbers.  There are hundreds of ground medics/paramedics but only a
handful of helo medics (which are police officers BTW, not FD).  Because
there are so few the medical director can actually interact with each one of
them during their training and evaluations which he cannot do with the
hundreds of ground paramedics, resulting in the helo medics receiving the
authorization to do more and use different medicines.

so, the math becomes "watch my life slip away during the 15-20 minutes of
waiting for  medical care while driving to the hospital" or "get 30 minutes
added to your 'golden hour' by receiving the care I need immediately but
arrive at the hospital 10 minutes later."

they dont call them "meat wagons" for nothing.