Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-2-2 - ALABAMA STATEWIDE TRAUMA SYSTEM › Appendix J - Guidelines For Helicopter Transport Of Trauma System Patients

Current through Register Vol. 42, No. 9, June 28, 2024
Purpose
Helicopter EMS services (HEMS) offer speed of transport and ALS
				personnel experienced in managing critical patients. The purpose of this Air
				Evacuation Protocol is to provide EMS personnel who are on scene, with
				guidelines for utilizing HEMS for transporting trauma system patients.
Process
Several factors must be considered before summoning HEMS for a
				trauma scene response. Stable patients who are accessible by ground vehicles
				and are within a reasonable distance from the designated trauma center are best
				transported by ground vehicles. Often, patients can be transported by ground
				ambulance and delivered to the appropriate trauma center before a helicopter
				can reach the scene. You must follow your Regional Aeromedical Plan when
				approved. If a question exists as to whether HEMS transport would be
				appropriate, Medical Direction should be consulted before summoning a
				helicopter for a scene response. HEMS are best used to transport critical
				trauma patients such as those entered into the trauma system because of
				physiologic or anatomic criteria. Those patients entered into the trauma system
				because of mechanism of injury or EMT discretion criteria are often more
				appropriately transported by ground ambulance.
The primary determinant should be to get the patient to
				the most appropriate facility in the shortest amount of time.
Emergency Medical Services personnel should request HEMS when
				transportation by air will SIGNIFICANTLY reduce actual transport time to the
				receiving facility and/or the patient needs potentially lifesaving prehospital
				interventions that cannot be provided by the responding EMS service. The
				following are some criteria when HEMS transport should be considered.
1. Transport time to the designated trauma center by ground
				ambulance is significantly greater than the response time and transport to the
				designated Trauma Center by air.
2. Ambulance access to the scene or away from the scene is
				significantly impeded by road conditions and/or traffic.
3. Prolonged patient extrication when a Level I facility is
				needed. Understand that some extricated patients are not injured and/or have
				sustained minor injuries and may not need HEMS.
4. Multi-system blunt or penetrating trauma with unstable vital
				signs.
5. Severe burns that require transport to a burn center (See
				Protocol 4.7).
6. Patients with severe respiratory distress or airway
				problems.
7. Multiple patient incidents that exceed ground ambulance
				service resources.
8. No ambulance available to transport the patient and/or no
				ALS service (if needed) within 30 minutes.
9. Discretion of Medical Direction or the on-scene EMS
				personnel.
When use of HEMS is not specifically defined by the protocol,
				the on-scene EMS personnel can establish communication with Medical Direction
				for advice.
Once the decision is made to use HEMS for a trauma patient, the
				service that can respond to the scene in the shortest time should be called.
				Because helicopters must go through a preflight protocol before lift-off, the
				shortest response time should be obtained by calling the HEMS first and then
				calling the TCC to decide on the proper destination hospital. When a decision
				is made on a destination hospital, the helicopter service should be immediately
				notified so they may develop their flight plan. If Early Activation was
				utilized, the responding HEMS service should be notified of the patient
				destination as soon as possible. If a HEMS service is unable to answer a call
				and a second service is requested, the requesting agency must notify the second
				service that the call has already been refused and why.
An EMS service should not wait on the scene or unduly delay
				transport waiting for HEMS to arrive. If the patient is packaged and ready for
				transport, the EMS service should reassign the landing zone to a mutually
				agreeable site that is closer to the hospital, and should initiate transport.
				The helicopter may intercept an ambulance at an agreed upon alternate landing
				site.
Cancellation
When EMS personnel arrive on scene, they should assess the
				situation. If HEMS has already been called and it is the professional judgment
				of the HIGHEST LEVEL LICENSED EMS PERSONNEL ON THE SCENE that the helicopter
				will not provide a significant benefit, it should be cancelled as soon as
				possible. A HEMS request by a BLS agency may be cancelled by the responding ALS
				agency
only
after an appropriate patient assessment
				has been conducted. A HEMS request by an ALS agency may be cancelled only by
				the agency making the initial request. If HEMS cancels a flight, they must
				inform the requesting agency ASAP.
If HEMS arrives on scene and determines that the patient does
				not meet criteria for helicopter transport or that patient, weather, or
				aircraft issues preclude use of the helicopter for transport, they may request
				ground transport of that patient. The request for ground transport does not
				preclude the HEMS crew from boarding the ground ambulance and continuing to
				provide advanced care as would be provided in flight. In situations where the
				HEMS crew determines that the patient does not have a medical need for HEMS
				transport, the transfer of this patient to a ground ambulance shall not
				constitute abandonment as defined by EMS regulations.
Quality Assurance/Improvement
As with all EMS responses in which HEMS is utilized, there
				should be QA/QI done in partnership with the responding helicopter service.
				Follow the Regional Aeromedical Plan when approved.
THIS IS A GUIDELINE AND IS NOT ALL INCLUSIVE. EMS
				PERSONNEL SHOULD USE GOOD CLINICAL JUDGMENT AT ALL TIMES. IF THERE ARE ANY
				QUESTIONS, OLMD SHOULD BE CONSULTED.
Authors:
John Campbell, M.D., and Choona
				  Lang
Statutory Authority:
Alabama Legislature, Act
				  299, Regular Session, 2007 Code of Ala. 1975, §
										22-11D-1, et. seq.