Category Archives: Protocols and Procedures

Understanding Medical Flight Dispatch

Contrary to popular belief, hospitals are rarely involved in dispatch of a medical flight. The decision is almost entirely taken by the ground crew and treating doctor who determine whether the patient would benefit from an air ambulance service or not. Of course, there are some protocols that are followed. Although the process and protocols vary depending on the jurisdiction, there are certain common determinants that we discuss here.

Time Taken for Medical Flight Dispatch

It must be understood that not all hospitals have a medical flight on standby. It takes a reasonable amount of time to get the flight ready for takeoff. If this time and the time required to transport the patient is too much when compared to ground ambulance transport, the latter may be chosen. There is also a cost consideration when the difference in time advantage is too small.

Location and Distance of Transfer

This is another important criterion. Sometimes the location is too far away from the hospital and the patient’s health does not permit long travel times. Also, the location may be inaccessible through roads. In circumstances like these, the decision is usually made to opt for a medical flight to keep the patient safe.

The Condition of the Patient

This is of extreme importance. A delay by half an hour can mean the difference between life and death for the patient. In scenarios like these, a decision is taken quickly to call for an air ambulance and the patient is transported. Near-drowning, prior history or suspected stroke, and severe trauma could be some of the conditions that could influence the decision.

The Weather Conditions for the Medical Flight

If there are adverse weather conditions that prevent the choppers from flying, the patient may be transported through other means. As a matter of policy, the lives of crew members are not put to risk knowing very well that taking off in bad weather could be fatal.

It is important to understand that the above are just a few of the reasons that influence medical flight dispatch decisions. It is always the competent medical authority that takes the final decision.

Flag of Texas

Compliance Norms for Texas Air Ambulance Service Providers

Just because an aircraft is willing to transport a patient, it does not count as an air ambulance service, in any state of the US. Here, we discuss a few rules that have been laid down by Emergency Health Care Act. We discuss only such parts of the act that pertain to air ambulance service providers in the state of Texas. The rules may vary slightly for other states, but you would get the overall picture here.

Air Ambulance Service – What Constitutes Specialized Emergency Service

The vehicle must be specifically designed to carry the injured or sick by air. Also, all equipments necessary for transportation of the patient must be provided by the air ambulance service.

Any air ambulance service that claims to offer specialized transportation services must be licensed by the Department of State Health Services. This includes the aircraft as well as the staff involved. Even the air ambulance service providers flying into Texas from other states must be licensed by the Department of State Health Services and must be in compliance with the safety norms prescribed by it. Out of state providers must be accredited by Committee on Air Ambulance Medical Services. They would be considered to be in compliance with the Department’s norms if accredited.

The Location of the Air Ambulance Service

All advertisements of the air ambulance service provider must contain its physical address in the state. If the service operates from multiple locations, it is free to advertise them. If an out of state air ambulance service advertises within Texas, it must have at least one base in the state.

There is, however, one exclusion to state licensing. Any air transportation provider can offer voluntary service out of compassion without the expectation of remuneration and bear all the costs of transport. However, the company must be in compliance as a regular air transportation service provider.

Airambulance cabin filled with Medical Equipment

Structural Guidelines for Fixed Wing Airambulance Transport

All most all states in the United States have laid down certain minimum requirements that a fixed wing airambulance must satisfy. The guidelines given below have been issued by the state of Tennessee but the structural guidelines are, in general, similar in other states too.

Airambulance Doors

The doors of the airambulance must be wide enough that a stretcher can be passed through it without tilting it more than 30 degrees. This guideline ensures that the transit of the patient into the airambulance is safely done.

Vertical Height of the Airambulance

It is vital that there is enough headspace so that the medical personnel can function optimally and provide adequate care for the patient. For this reason, all airambulance vehicles must have a minimum vertical height of 30 inches.

The lighting of the Aircraft

The electrical capacity of the airambulance must be equipped to provide “sufficient” light inside, such that medical care is not hindered due to lack of it. The service providers are allowed to make use of portable lamps to achieve this.

Guidelines for Airambulance Equipments

To ensure stability of the patient while entering the aircraft and during the transport, the stretchers must be fitted with at least two restraining straps to keep the patient in place.

The suction devices must have a capacity to produce suction of at least 12 inches of mercury.

Oxygen bags or masks must be available within the airambulance. There must be enough stock so that 95% fraction inspired oxygen is available at all times. The equipment must be capable of adjusting flow between 2 to 5 liters of oxygen per minute.

Adequate sanitary supplies like trash disposal bags, emesis bags, urinal, bedpan, towels, etc, must be available.

Basic tools like stethoscope, blood pressure cuff, dressing materials, and flashlights must be kept handy.

As a patient and a customer availing airambulance services, it is your right to have these facilities and being aware of such basic things about air ambulances can help.

Patient on a stretcher with paramedics

Preparing the Patient for a Medical Flight

It is important that the medical flight taken by a patient is both safe and comfortable. Following certain guidelines ensures that the medical flight transport is carried out smoothly and quickly. Here, we discuss the vital considerations that must top your mind.

Proper Documentation for Medical Flight

Laws specify that transfer orders by the treating physician and acceptance documents by the receiving facility must be in order before the patient boards a medical flight. Also, the patient’s medical chart, discharge summary, lab results and other medical information must be carried. A photo ID is vital and must be kept handy. Consent for medical flight transport must be sent to the air ambulance operator beforehand.

Medications and Equipments during the Medical Flight

An IV access must be ready. If the patient does not need IV access on a continuing basis, it can be capped. All medications that are necessary and those that are meant for comfort must be administered. These meds must also be provided to the crew in case the need arises midair. This also includes IV medications.

Casts, Traction, and Diapers

If the patient is being treated with a circumferential cast, it must be bivalved beforehand. Hanging weights for traction are not suited for a medical flight. Appropriate traction device must be used instead. An unconscious patient must be diapered prior to transfer to the medical flight and any tube feeding must be discontinued about 7 to 8 hours in advance.

Accompanying the Patient in Medical Flight

The passenger accompanying the patient must have prior approval. If the condition of the patient demands that no one accompanies him or her during the medical flight, the passenger must comply. Most fixed wing aircrafts have limited space and one must understand that it is essential for the medical staff to have enough space to function efficiently. Even when accompanying the patient, the passenger must occupy minimum space possible.

Knowing these guidelines well in advance helps make the medical flight travel a comfortable one.

A neonate being transferred from ground ambulance to air ambulance

Fixed-Wing Air Medical Transport Precautions

When you accompany a patient to a fixed wing air medical transport vehicle, you would be accompanied by qualified professionals belonging to both ground ambulance and air ambulance. However, knowing certain protocols can always come handy, and ensure a safe and swift transfer of the patient to the air medical transport vehicle.

Getting to the Air Medical Transport Vehicle

First and foremost, the ground ambulance needs to wait for the aircraft to shut down its engines completely before approaching it. Even when the ambulance approaches the air medical transport vehicle, it has to stop at least 25 feet away. All flashing lights must be switched off and only the headlights must be used in case of poor visibility.

You must wait for the crew to arrive to the ground ambulance to take the patient away. Switch off the ground ambulance immediately after reaching the destination to avoid the exhaust fumes getting into the aircraft. Keep in mind that the aircraft might be pressurized to a certain degree and the exhaust fumes can be quite a disturbance.

Taking the Patient to the Air Medical Transport Vehicle

Walking in front of the wing of the airplane is a strict no. Also, refrain from opening the doors of the air ambulance. Assist in loading the patient only if help is requested. If the help is sought, do not stay inside the air medical transport vehicle unnecessarily after loading the patient, unless you are travelling along. Never hesitate to ask what you must and must not do once inside and when travelling with the patient.

Before Exiting the Airport

It is wise to leave the airport only after the air medical transport vehicle takes off. Inform the crew of any issues such as debris or animals in the vicinity that might hinder takeoff. Even when the ground ambulance moves away from the aircraft, the flashing lights must be switched off.

Finally, have all your questions relating to the medical travel answered before the transfer. Your questions at the last moment can unnecessarily waste valuable time.

What are Trauma Transport Protocols in Florida?

Trauma Transport Protocols (TTP) describe the procedures used by the emergency medical services prehospital provider for dispatch of vehicles, assessment of the extent and severity of injuries of trauma patients and determination of the destination (facility) to which trauma alert patients are transported. TTP’s are a legal document that should outline, as accurately as possible, the actual procedures followed by the emergency medical service provider, written within the context of section 395.4045, Florida Statutes and Chapter 64J-2, Florida Administrative Code.

 

When to Submit TTP’s:

  • Applying for initial licensure as an EMS provider.
  • A change in medical directors for the EMS provider.
  • A change in ownership of the EMS provider.
  • A change in hospital destination for the routine transport of trauma alert patients. Any change in EMS providers or health care facilities that will impact transportation requirements.
  • When the department requests a revision.

The approval period for TTPs is the same as the EMS provider’s two-year licensure period, unless revisions are made to department approved TTPs during that period.

Who Does Not Submit TTPs:

  • A service that provides only inter-facility services and does not respond to the scene of an injury to provide stabilization of injured patients in prehospital settings. The EMS provider needs to submit to the Bureau of EMS either a copy of the Certificate of Public Convenience and Need or a letter from the director or chief of the service stating that it is an inter-facility service only.

FAA Publishes New Air Ambulance Regulation

The agency said it reviewed about 4,000 accidents involving helicopters in the United States, of which 75 commercial helicopter accidents (88 deaths, 29 serious injuries, 42 minor injuries) and 127 helicopter air ambulance accidents (126 deaths, 50 serious injuries, 42 minor injuries) between 1994 and 2008 involved causal factors that are addressed in the proposal.

The Federal Aviation Administration published its 36-page proposed rule this past Tuesday intended to make helicopter air ambulance flights safer nationwide. The proposal will revise Part 91 visual flight rules weather minimums, require all commercial helicopters to be equipped with radio altimeters, require air ambulance flights with medical personnel aboard to be conducted under part 135 (including flight crew time limits and rest requirements), require Helicopter Terrain Awareness and Warning Systems (HTAWS), and require certificate holders with 10 or more helicopter air ambulances to establish operations control centers. Most of these changes fulfill NTSB recommendations made in recent years.

It says they would require training and testing on weather, navigation, flight-monitoring procedures, air traffic control procedures, aircraft systems, aircraft limitations and performance; and, more frequently, on topics specific to each certificate holder, such as aviation regulations and operations specifications, crew resource management, and the local flying area.

Along with requiring a load manifest for all part 135 operations, the proposal defines the role and training of operations control specialists for helicopter air ambulance operations. They will perform safety-sensitive functions “such as providing pre-flight weather assessment, assisting with fuel planning, alternate airport weather minima, and communicating with pilots regarding operational concerns during flight. These duties are similar to those of an aircraft dispatcher, and therefore,” the rule states, “operations control specialists would be subject to the restrictions on drug and alcohol use, and to a certificate holder’s drug and alcohol testing program as described in 14 CFR part 120.”

FAA estimated the proposal will cost the industry $225 million and yield benefits ranging from $83 million to $1.98 billion during a 10-year period.