Like heart attacks, some strokes are caused by interruption of blood predominately from a blood clot, only this time in the brain. As in heart attacks, there is a window of time (optimally within 90 minutes but generally no more than three hours) in which clotbusting treatment can result in patients suffering little to no long term damage and disability from these events. Therefore, patients transported to specialty centers for the clot-busting treatment of strokes can benefit from a well-coordinated ground and air system to accomplish early transfer.
From 1972 through September, 2002, when HEMS safety research by Dr. Ira Blumen of the University of Chicago Aeromedical Network (UCAN) was completed, HEMS had flown approximately three million hours, transporting some two and three-quarter million patients. In that time, there were 166 crashes involving HEMS, with 183 fatalities. The UCAN study found that while the number of crashes each year has fluctuated, the number per 100,000 patients flown had dropped from 17.36 in 1980 to 5.5 in 2001.
The risk to patients, estimated over the years of the study, is reported as a fatality rate of 0.76/100,000 patients. Subsequent admission to a hospital carries with it a greater risk of death from complications or errors: various recent estimates range from 1.2/100,000 patents to 292/100,000 patients.
Nonetheless, any form of medical transport incurs inherent risk and in the past few years there have been increased numbers of accidents associated with the increased number of helicopters and transports. In an editorial comment in the UCAN study, a past president of the National EMS Pilot Association emphasizes that the causes of crashes haven’t changed over the years. The top three causes are “risk taking, pre-flight planning, and in-flight decisionmaking,” reflecting the unique pressure placed on crews by the condition of the patient and by the feelings of obligation to fly.
The air ambulance service community has taken significant steps, particularly in the area of aircrew resource management (a proven airline industry safety tool) to improve its safety for patients. Some HEMS prograir ambulance service are replacing aircraft, hiring pilots to fly under Instrument Flight Rules (IFR), and employing new technologies such as night vision goggles (NVG’s) and terrain avoidance warning systems (TAWS), especially important when weather conditions abruptly change mid-mission.80 Transport medicine is among the most complex arenas of medicine, and is characterized by the need to provide immediate access to time-sensitive care for critically ill and injured patients at the same time that operations are conducted in hostile environmental conditions with limited planning time. As Justice Oliver Wendell Holmes once noted: “to be safe does not mean to be risk free.” Recognizing that risk cannot be completely eliminated, it is essential both for the public served, and the pilots, nurses, paramedics, physicians, and other health care providers who deliver care, that the practice environment be as safe as possible.
To that end, the Association of Air Medical Services has already initiated Vision Zero (http://aamsvisionzero.org/) and has joined the International Helicopter Safety Team (IHST, www.ihst.org), led by the American Helicopter Society (AHS), the Helicopter Association International (HAI), the Federal Aviation Administration (FAA), and Transport Canada to reduce helicopter accidents by 80% in the next ten years.
These initiatives seek more effective methods and approaches to avoiding errors in complex systems premised on the model that providers must work collaboratively, on a voluntary basis, with regulators to identify and accelerate the implementation of best practice standards. These efforts focus on developing and implementing strategies using cost benefit analysis and evidence based best practices related to safety in order to prioritize investment and financial plans to result in a goal of zero serious injuries or fatalities.
We estimate that there are nearly 400,000 rotor wing transports annually, with an additional 150,000 patient flown by fixed wing aircraft each year. (US only)
In 1926, the United States Army Air Corps used a converted DeHaviland aircraft to transport patients from Nicaragua to France Army Base in Panama, one hundred and fifty miles away. The first civilian air medical transport was completed in 1928 when a DeHaviland Fox Moth aircraft in the service of Australia’s Royal Flying Doctor Service took off on its first mission. The Royal Flying Doctor Service holds the distinction of being the first civilian air medical transport program.
The Association of Air Medical Services (AAMS), established in 1980, is an international association which serves providers of air and surface medical transport systems. The association, a voluntary non-profit organization, encourages and supports its members in maintaining a standard of performance reflecting high quality patient care and safe and efficient operations.
Built on the idea that representation from a variety of medical transport services and businesses can be brought together to share information, collectively resolve problems, AAMS provides leadership in the medical transport community.
The core purpose of AAMS is to advance safety and quality in air medical and critical care transport.
Every patient in-need has access to safe, quality air medical and critical care ground transport.
AAMS Core Value Statements
Evidenced in behavior that:
Places patient care before self-interest
Celebrates common dedication to teamwork, compassion for patients, and a passion for safety and quality care
Evidenced in behavior that:
Demonstrates commitment to high professional standards
Promotes ethical behavior among all individuals involved in the work of the association
Evidenced in behavior that:
Honors the exchange of ideas
Embraces diverse viewpoints
Evidenced in behavior that:
Exemplifies transparent decision-making
Values honest communication and productive dialogue
The paper work requirements are listed on the application for AIR ambulance licensure, “Air Ambulance Service Provider Licensure Application”, DOH Form 1575. Click on the application and the application checklist to review most requirements. Other requirements will be found in Section 401, Florida Statutes, & Chapter 64J-1, Florida Administrative Code. The following is a partial list of the major requirement: Certificate of Public Convenience and Necessity (COPCN) from the county commission in the county you wish to operate your prehospital service, a medical director (licensed Florida physician) with a Department of Justice-Drug Enforcement Administration (DEA) registration (prehospital only), aircraft vehicle liability insurance, trauma transport protocols and an approved radio communication system. Approval of a radio communication system is completed by Department of Management Services-Information Technology Program. Contact DMS for more information on EMS radio communication systems.
Every person, firm, corporation, association or governmental entity owning or acting as an agent for the owner of any business or service which furnishes, orperates, conducts, maintains, advertises, engages in, proposes to engage in or professes to engage in the business or service of providing prehospital or interfacility advanced life support services or basic life support transportation service must be licensed as a basic or advanced life support ambulance service, before offering such service to the public.
Reference Section 401.25, Florida Statutes & Section 64J-1.002, & 64J-1.003, Florida Administrative Code.
An ambulance driver must meet the following requirements:
- Is at least 18 years of age;
- certifies under oath that he or she is not addicted to alcohol or any controlled substance, and is free from any physical or mental defect or disease that might impair their ability to drive an ambulance;
- Upon initial designation as a driver, has not within the past 3 years, been convicted of reckless driving or driving under the influence of alcohol or controlled substance and has not had a driver’s license suspended under the point system provided for in Chapter 322, Florida Statutes;
- successfully completed a 16 hour course of instruction on driving an authorized emergency vehicle, which includes, at a minimum, classroom and behind the wheel training. Section 64J-1.013, Florida Administrative Code for details on the 16 hour course content;
- possess a valid American Red Cross or National Safety Council first aid course or its equivalent; and
- possess a valid American Red Cross or American Heart Association cardiopulmonary resuscitation card.
There is no standard aircraft utilized in medEvac operations. Airplanes (fixed-wing aircraft) vary in size from single-engine turboprops such as the Pilatius PC-12 to twin-engine aircraft like the Cessna Citation, Beech B-200, and Lear 35. Most are either turboprop or jet aircraft which lends to faster, more versatile performance. In helicopter operations, again, no one make or model is the standard. Helicopters are chosen for a myriad of reasons such as payload capability, range, economy of operation, and geographic location. The most common helicopters found in medEvac use are the Bell 206/407, and Eurocopter AS-350 for single-engine aircraft. For multi-engine the medium sized Bell 222/230, Eurocopter BO-105, BK-117, and Agusta A-109 are widely used. The largest multi-engine helicopters in service with medEvac services across the nation are the Sikorsky S-76, Bell 412, and the Eurocopter AS-365. All aircraft used in medEvac operations have proven themselves with thousands of safe transports.
Chapter 401, Florida Statutes and Chapter 64J-1, Florida Administrative Code, are the law and rules, respectively, that governs Florida Emergency Medical Services.
Chapter 401, Florida Statutes
Section 64J-1, Florida Administrative Code