Pennsylvania Department of Health Operations 181 - BLS – Adult/Peds Effective 11/01/08 181-1 of 2
AIR MEDICAL TRANSPORT FOR NON-TRAUMA PATIENTS
STATEWIDE BLS PROTOCOL
Criteria:
A. Patient with ST-elevation myocardial infarction (STEMI) for whom air transport is considered.
B. Patient with acute stroke symptoms that started within the last 2 hours.
C. Patient with any medical emergency for which direct air medical transport from the scene is being considered.
Exclusion Criteria:
A. Patient requiring air medical transport for traumatic injury – See Trauma Patient Destination Protocol #180.
Possible Medical Command Orders:
A. Authorization of Air Ambulance transport for the patient
B. Transport by ground to appropriate facility (local hospital or more distant hospital for specialized care).
Policy:
A. Medical considerations when requesting air ambulance transport:
1. Extremely critical patients that are rapidly worsening:
a. Patients with the following conditions should be transported as rapidly as possible to the closest receiving hospital:
1) Patients without an adequate airway.
2) Patients that cannot be adequately ventilated
3) Other patients, as determined by a medical command physician, whose lives would be jeopardized by transportation to any but the closest receiving hospital.
b. Transport should generally not be delayed while awaiting the arrival of ALS service or air ambulance unless the ALS service or air ambulance has a confirmed ETA to the scene that is less than the ETA to the closest hospital.
c. STEMI patients:
1) A 12-lead ECG should be obtained before contact with medical command to request air transport for a patient with suspected STEMI. Also follow Suspected Acute Coronary Syndrome protocol #5001. For the best patient care, it is ideal that this ECG be transmitted to the medical command facility and (eventually) to the receiving facility once determined.
2) Transport the patient by ground if driving time to the specialty center (STEMI center) is less than 30-45 minutes.
d. Acute stroke patients:
1) Consider air medical transport if a patient has acute stroke symptoms
2) The time urgency for acute stroke patients applies to patients who are candidates for thrombolytic therapy. Patients with contraindications to thrombolytic therapy should not be transported by air solely for the purpose of reducing transport time to a stroke center.
3) Transport the patient by ground if driving time to the specialty center (stroke center) is less than 30-45 minutes.
e. Other patients requiring specialty care not available at closest hospital
1) Transport the patient by ground if driving time to the specialty center (STEMI center, stroke center, etc.) is less than 30-45 minutes.
Pennsylvania Department of Health Operations 181 - BLS – Adult/Peds Effective 11/01/08 181-2 of 2
B. Air medical transport considerations:
1. When considering transport by air, in addition to the actual transport time, which is clearly faster by air, EMS personnel should consider the amount of time required for arrival of an air ambulance, patient preparation by the air medical crew, and patient loading.
2. When air ambulance transport is indicated, EMS personnel must request an air ambulance through the local Public Safety Answering Point (PSAP) without requesting a specific air ambulance service. The PSAP should initially contact the air ambulance service that is based closest to the scene.
3. The air ambulance may bring equipment and personnel with resources that are not available on the ground ambulances. These may be useful in the following situations:
a. Patients with GCS
b. Air medical services may transport specialized medical teams for the treatment of unusual situations (for example, neonatal teams). Although gathering a specialized team may dramatically lengthen the time to arrival of the air medical service to the scene.
4. Prolonged delays at scene while awaiting air medical transport should be avoided.
C. Considerations related to contact with medical command:
1.
2. The EMS provider should contact a medical command facility accessible to the EMS provider using the following order of preference:
a. The closest specialty facility (based upon the patient’s medical condition) that is also a medical command facility. For example, the closest center capable of emergency PCI for patient with STEMI. Regional protocol may establish a list of emergency STEMI centers or stroke centers.
b. The closest medical command facility. In regions where the EMS practitioner is not aware of the location of the closest facility capable of handling the patient’s needs, the closest medical command facility should be contacted. If the closest medical command facility orders air transport to a further away specialty center, then the EMS practitioner should also contact the specialty receiving center, preferably via their medical command facility, as soon as possible to provide patient information.
3. If the patient will be transported by air ambulance, the air ambulance crew will determine the destination, and they will transport the patient to the closest facility that can provide the specialized care.
Performance Parameters:
A. 100% audit of all cases for appropriate use of air medical evacuation and appropriate use of other applicable protocols (e.g. Chest pain, CVA)
Pennsylvania Department of Health Operations 192 - BLS – Adult/Peds Effective 09/01/04 192-1 of 2
AIR AMBULANCE SAFETY CONSIDERATION
GUIDELINES
Criteria:
A. Landing zone operations associated with use of an air ambulance.
Exclusion Criteria:
A. These guidelines provide general information related to safety when interacting with air ambulances. This general information may augment information that is provided by local air ambulance services, but since specific recommendations may differ by aircraft type or other factors it is not meant to supercede such information.
Procedure:
A. Landing Zone (LZ) Recommendations:
1.
a. Global Positioning Satellite (GPS) systems may assist providing precise location of LZ.
2.
Size:a. Depends on size of aircraft, most use 100’ x 100’.
b. A larger LZ is recommended when higher surroundings and obstacles are present or multiple aircraft are responding.
3.
Slope:a. Must be relatively level.
4.
Ground cover:a. Dust can cause "brown out" where dust generated by rotor wash obscures pilot’s visualization.
b. Snow can cause "white out".
c. Both can be planned for and overcome by pilot—be prepared for lots of blowing debris.
d. Gravel—rotor wash throws gravel—broken windows, paint damage, eye injuries can occur.
e. Other—be aware of anything in and around LZ such as twigs, tents, charts, linen, mattresses, rope, scene tape, garbage cans, turnout gear, rescue and medical equipment.
f. Mud—aircraft can sink resulting in structural damage and difficulty taking off.
g. Brush--should not be more than 1-2 ft deep, may need to be cut or tramped down.
5.
Obstacles:a. Antennas, buildings, towers, wires, poles, hills, etc up to a mile from the LZ should be reported to the pilot. Do not assume that they see them.
b. Other obstacles in the immediate vicinity of the LZ must be identified and relayed to the aircraft by the LZ Officer--Wires, poles, signs, antennas, trees, fences, geography, ground depressions, livestock, bystanders, apparatus and other vehicles, buildings, grave markers, etc.
6.
Using roadways as LZ:a.
b.
NO pedestrian traffic.c. PSP and local police maintain authority in decision to close roadways and thoroughfares.
B. Marking the LZ:
1. Mark 4 corners of desired landing spot with a 5th marker on side wind is coming from, so that the pilot can determine wind direction for landing
2.
3. Flares
a. Good at night can be seen from a great distance.
b. Limited use during the day, hard to see from the air.
c. Be aware of fire potential caused by rotor wash.
d. Be sure to collect after use.
Pennsylvania Department of Health Operations 192 - BLS – Adult/Peds Effective 09/01/04 192-2 of 2
4. Traffic cones
a. Easy to see in daylight.
b. Blown over easily unless weighted.
c. Not useful at night unless internally illuminated by very bright light.
5. Strobes
6. Vehicles
are not recommended, as they become obstacles.7. Personnel
are not recommended as markers.8. Rotating red, yellow, or blue lights
a. Easy to see at night from miles away.
b. Pilot may ask for them to be turned off after LZ is identified depending on overall illumination
9. Miscellaneous:
a. Control bystanders to prevent their approach to aircraft and LZ.
b. Pilot always has the final say in LZ acceptance.
c. Many variables occur even if LZ has been used in the past.
C. Rotor craft safety:
1. All personnel should be outside LZ during landing and take off.
2. Never approach the aircraft unless requested or accompanied by air ambulance crewmember from the air ambulance.
3. Never open doors or operate aircraft mechanisms under routine conditions.
4. Never approach aircraft from front or back—only from the side and only when requested by a crewmember.
5. Tail rotor spins at high rate making it difficult to see and avoid, some are close to the ground (within striking distance to humans).
6. Main rotor systems vary widely—some types come within 4-5 ft of ground.
7. No running near aircraft.
8. No smoking within 100 ft (jet fuel and oxygen present).
9. No vehicles inside LZ.
10. Never approach or depart from an aircraft on a side where the ground is higher than the ground the aircraft is sitting on.
11. All loose objects must be secured before aircraft lands and departs.
12. Close all vehicle doors during landing and take off.
13. An engine company at LZ is not necessary unless required by local protocol.
14. Hot Loading:
a. Follow air ambulance crew direction carefully.
b. Wear turnout gear if available including eye, head, and ear protection.
c. Remove all baseball caps and hats and store safely.
d. Approach Aircraft only when accompanied by air ambulance crew.
e. After loading the patient, depart aircraft and LZ by the exact path used to enter.
f. Never carry anything that is higher than the level of your head (including IV bags.)