Home | Special Operations and Major Events | Air Medical Transport
Effective: 08-24-20
Supersedes: CE 224, 06-22-20
Introduction
The use of air medical services has become the standard of care for many critically ill or injured patients who require transport to specialized medical facilities such as Trauma Centers. The purpose of these Guidelines is to establish a clinical framework for prehospital EMS personnel upon which to make decisions regarding when to access air medical support services. The following constitute the philosophical foundation for these Guidelines.
o EMS personnel should consider requesting ground advanced life support (ALS) and air medical support when operational conditions listed below exist and the following patient conditions are present;
o Patients with an uncontrolled or compromised airway should be brought to the nearest appropriate facility unless advanced life support (ALS) service (by ground or air) can intercept in a more timely fashion; and:
o Patients in cardiac arrest subsequent to blunt trauma should generally NOT be transported by air transport.
These guidelines have been established so that air medical support does not require prior Medical Control approval. However, Medical Control contact should be considered whenever appropriate for patient management issues.
Operational Conditions:
1. When a patient meets patient criteria defined below and scene arrival time to estimated arrival time at the nearest appropriate hospital, including extrication time, exceeds 20 minutes;
2. Patient location, weather or road conditions preclude the use of standard ground ambulance; or
3. Multiple casualties / patients are present which will exceed the capabilities of local hospital and agencies.
Patient Conditions:
1. Physiologic Criteria:
a. Unstable Vital Signs
2. Anatomic Injury
a. Evidence of Spinal Cord injury including paralysis or paresthesia.
b. Severe blunt trauma
· Head injury (Glasgow Coma Scale of twelve [12] or less)
· Severe chest or abdominal injury
· Severe pelvic injury excluding simply hip fractures.
c. Burns:
· Greater than 20% Body Surface Area (BSA) second or third degree burns;
· Evidence of airway or facial burns;
· Circumferential extremity burns; or
· Burns associated with trauma.
Penetrating injuries of head, neck, chest, abdomen or groin.
Amputation of extremities, excluding digits.
Special Conditions: The following should be considered in deciding whether to request air medical transport, but are not automatic or absolute criteria:
1. Mechanism of Injury
a. Motor Vehicle Crash:
i. Patient ejected from vehicle
ii. Death in same passenger compartment
b. Pedestrian struck by a vehicle and thrown more than 15 feet, or run over by a vehicle.
2. Significant Medical History
a. Age greater than 55
b. Significant coexistent illness (such as anticoagulation)
c. Pregnancy.
Advanced Notification / Cancellation
Aero-medical transport may be placed on an alert status when air medical transport may be necessary based upon initial reports of serious/critical injury, prolonged extrication time, or mass casualty incident. Arriving units should assess the situation and determine whether to have the aircraft launched or canceled.
Whenever pre-hospital personnel determine that there is no need for air transport, the appropriate Aero-medical communication center will be notified as soon as possible.
LANDING ZONES (LZ)
Preparations (usually the responsibility of fire department)
Confirm pre-designated LZ or new LZ
The public safety officer is dispatched to the LZ to secure and begin preparations for aircraft landing.
The landing zone shall be cleared of all unauthorized persons to a distance of at least 100 feet from the landing area.
Incident commander assigns a landing zone safety officer who is responsible for completely securing the landing zone.
Evaluate the landing zone for potential hazards such as wires, cables, backstops, light poles, or other obstructions that interfere with a safe, clear landing area. Remove any loose debris or secure such debris to avoid potential missiles during the landing and takeoff of the aircraft. Emergency vehicle may be positioned beneath wires/cables to enhance identification.
All unnecessary vehicles and equipment should be kept clear of the landing zone.
Emergency vehicles should activate their warning lights to enhance identification of the landing zone. The vehicle should be positioned as designated by the incident commander and all illumination lights directed towards the ground. Never direct any lighting upwards or at the aircraft. If the landing zone cannot be properly secured or cleared, then another landing zone should be selected, and the Aero-medical communications center notified.
Aircraft Arrival
Note: If the aircraft has not yet arrived when the ambulance arrives at the LZ the patient shall be kept in the ambulance until the aircraft is safely on the ground and the flight crew signals that they are ready to receive the patient. If the situation precludes keeping the patient in the ambulance until the arrival of the aircraft, then the patient shall be protected by a SECURED transfer sheet. In the case of transferring the flight team to a hospital and their scoop stretcher will be used to transport the patient back to the helicopter, remove the sheet prior to approaching the helicopter.
The aircraft will contact the referring agency and/or the incident commander 2-5 minutes prior to arrival. Information regarding the security of the landing zone, hazards, and topographical features of the landing zone may be communicated.
Do not approach the aircraft unless directed by the flight crew.
Once the aircraft is secure, the flight crew will disembark, discuss the situation with the incident commander, and receive a report from pre-hospital personnel.
Patient Loading
Follow the directions of the flight crew regarding the movement to and from the aircraft as well as procedures for loading the patient.
Approach/leave the aircraft from the direction indicated by the flight crew in a crouched position without any loose clothing.
Ground personnel shall maintain a safe distance of at least 50 feet during takeoff. Shield eyes and be aware of potential airborne debris.
Ground Transport for MedFlight
When transporting a patient with Boston Medflight to or from the helipad, it is essential that demographics including the Medical Record Number are included in the PCR for the patient-loaded leg. Keep in mind that although the patient is in the care of BMF, since we provided the transport we are required to document an assessment, vital signs, etc like every other transport. While the flight crew is assessing and transitioning the patient to their equipment, one of our EMTs should get a copy of the Face Sheet and note the vitals and relevant assessment findings.
Reference: MA STP 7.1
Boston MedFlight Helicopter Landing Zone Safety Training Video: https://bostonmedflight.org/news/boston-medflight-releases-helicopter-landing-zone-safety-training-video-series-for-first-responders/