Why are patients flown by fixed wing?

Patients are flown by fixed wing for many different reasons.  These can range from the stable patient involved in an accident, or with a long-term medical condition, wishing to relocate closer to family for rehabilitative care, to the critical heart failure patient requiring intensive care transfer to receive a transplant.  The fixed wing environment differs from the rotor wing environment primarily in that fixed wing travels farther, faster and higher. The fixed wing is primarily a facility-to-facility transport, typically long distance in nature.

Secondly, there are typically more choices of different types of aircraft, and selections that are less expensive per mile and/or per hour to operate.  With licensure and accreditation standards available and easily verifiable, the care provided in the fixed wing environment is the same as the helicopter.  The fixed wing is typically not in competition with the rotor wing in that the rotor wing service typically is for moving a patient from a scene to a primary care facility, or a tertiary care facility to a primary care facility.

Instrument Flight Rules (IFR)

“IFR” stands for “Instrument Flight Rules.” It refers to a set of rules governing the conduct of flight under weather conditions where navigation by Visual Flight Rules (VFR) is no longer reliable. The conditions for IFR flight and the flight rules themselves are contained in the FAA’s “Instrument Flying Handbook. (Advisory Circular 61-27C).”

What are the benefits of twin-engine vs. single engine?

The debate among users continues with this issue. Some pilots and passengers have always believed two is better than one. On certain levels this is still true today. Anyone flying 100 miles offshore, or over mountainous terrain at night feels better knowing that there are two engines working for him or her. However, with the advent of truly reliable turbine engines, the probability of and engine failure is greatly reduced making the single-engine helicopter a safe and economical choice. A great deal depends on the type of missions flown, and the space required to accomplish it. All medium and large capacity helicopters are multi-engine, needed for the power required to lift the payload.

Air Ambulance and Medical Flights – The Trauma System

The “Golden Hour” concept provides that along the route to the surgeon’s knife in that first hour, a patient should benefit from an organized EMS system which provides increasingly advanced care (e.g. BLS to ALS to the physician-level care provided by air medical crews). The complete EMS trauma subsystem must include: Rapid discovery of the injured patient and notification of EMS. Fast response of BLS EMS. Early activation by trained and authorized requesters. Timely availability of ALS resources. Rapid access to physician level intervention through HEMS response or the closest Emergency Department. Rapid transport to identified trauma centers. Inter-hospital transfer to needed specialty care by critical care ground ambulance helicopter or fixed wing air ambulance as needed. Excellent planning and coordination of EMS resources. Quality assessment of each component in the combined air and ground emergency response. A recent paper cites the Maryland system as having these components in place and organized well, and calls upon other systems to emulate it. It has been well demonstrated that organized trauma systems with trauma centers save lives.

In the early 1980’s, the first analytical attempts to determine the life-saving impact on mortality by HEMS response to injury scenes began to appear, largely demonstrating reductions in mortality compared with ground systems.18-20, 38 Since the ‘80’s, there have been many published medical studies which have attempted, through a variety of means, to assess HEMS’ impact on trauma mortality and morbidity for both scene and interfacility flights. Overall, these studies have demonstrated the power of HEMS to affect improvements in trauma-related mortality and morbidity.

As a part of an organized trauma system, HEMS cuts the injury-tooperating- room time significantly. Medical helicopters, dispatched simultaneously with ground EMS, can give over 54% of the US population access to a full-service trauma center within 60 minutes that they otherwise would not have.

Medical helicopters also discourage time-costly intermediate stops at small, non-trauma center hospitals. Such stops have been shown to be detrimental to trauma patients, even where HEMS is called from that hospital for the final leg of the trip.

In the future, improvements in cell phone technology and automatic crash notification (ACN) technology in cars may cut the time required to discover and report a crash injury to almost zero. Using “urgency” indicators generated by automatic crash notification data sent from crashed cars to dispatch centers, along with special medical protocols for assessing the probability of severe injury from the crash, will soon provide a rational and effective way for helicopters to be launched within minutes of an accident, no matter ho remote, thereby further improving the speed of EMS response to patients.

Examples of recent study findings demonstrate that: s Patients severely injured enough to require inter-facility transfer were four times more likely to die after the HEMS serving that area was discontinued. HEMS reduced injury mortality by 24% in a multi-center study with some 16,000 patients in Boston. Even injury patients in urban areas experienced a transport-time benefit by HEMS in 23% of the cases.

Traumatic brain injury (TBI) is frequently associated with events causing severe, multiple trauma in patients, and is the leading cause of death and disability in children and in adults in their most productive years. As with other major injury, treatment of traumatic brain injury is time-critical. Outside of urban areas, the reduced availability of the neurosurgical services required to treat traumatic brain injury has posed a challenge to EMS. Recent studies indicate that early advanced care by air medical crews and air transport to definitive care by a neurosurgeon can overcome this challenge, resulting in significant improvement to moderately and severely traumatic brain injured patients.

HEMS is generally effective in trauma care circumstances such as when: There is an extended period required to access or extricate a remote (e.g. injured hiker, snowmobiler, or boater) or trapped patient (e.g. in a crashed car) which depletes the time windo to get the patient to the trauma center by ground. Distance to the trauma center is greater than 20 to 25 miles. The patient needs medical care and stabilization at the ALS level, and there is no ALS-level ground ambulance service available within a reasonable time frame. Traffic conditions or hospital availability make it unlikely that the patient will get to a trauma center via ground ambulance within the ideal time frame for best clinical outcome. There are multiple patients who will overwhelm resources at the trauma center(s) reachable by ground within the time window. EMS systems require bringing a patient to the nearest hospital for initial evaluation and stabilization, rather than by-passing those facilities and going directly to a trauma center. This may add delay to definitive surgical care and necessitate HEMS transport to mitigate the impact of that delay. There is a mass casualty incident.

In rural and frontier areas, HEMS and fixed wing aircraft play a particularly important role.  Where the nearest ground ambulance is further, by traveltime, from the scene of injury than the nearest HEMS, the air medical service may be the primary ambulance for critically ill and injured patients in that area. Where the nearest ALS-capable medical facility is further, by travel-time, from the scene of the injury than is a HEMS or a fixed wing provider, the air medical service may be the primary ALS provider for critically ill or injured patients in that area. Where blood supplies or availability of other medical supplies or equipment are limited or non-existent, jeopardizing the care of the patient, the air medical service can bring these resources to the hospital with the patient.

The air medical service can transport specialized medical staff (surgical, emergency medicine, respiratory therapy, pediatric, neonatal, obstetric, and specialized nursing staff) to assist with a local mass casualty event or to augment the rural/frontier hospital’s staff in stabilizing patients needing special care before transport.

 

Air Ambulance – Cardiac Care and “Heart Attacks”

A heart attack occurs when an artery in the heart is blocked by a clot, and the heart muscle supplied by that artery is therefore deprived of oxygen. This causes chest pain, and the muscle is in jeopardy of dying. Untreated, these blockages can permanently damage the heart causing death or an otherwise reduced quality of life.

As with critical injuries, there is a window of time (generally thought to be two hours from symptom onset) in which the heart may be effectively treated before it, and the patient, die or are disabled. At any time in this window, the compromised heart may stop or otherwise require emergency treatment to keep the patient alive. Out of hospital, HEMS ALS has proven effective in dealing with these emergencies. Ultimately, these patients need either special medications or surgical procedures at specialist cardiac intervention hospitals to break up the blood clot, allowing blood and the oxygen it brings to return to the affected heart muscle. Done within those two hours, the heart may be undamaged or damage may be limited, allowing the patient not only to live, but to recover a normal life.

Similar to trauma centers, cardiac intervention centers have been developed to provide the more effective of these increasinglycommon surgical treatments. The scarcity of cardiac intervention centers, particularly outside of urban areas, suggest a role, supported by studies to date, for HEMS in quickly transporting patients, even patients whose hearts have stopped and been restarted, from remote hospitals to these centers.

Air Ambulance and Medical Flight Transport Services: Everything you need to know!