Helicopter Emergency Medical Service
Helicopter Emergency Medical Service Air medical transport has only been used for the past 70 years. The first true air ambulance flight was during the Great War.
A Serbian officer was transported from the battlefield to the hospital by plane. Air ambulance was being tested by different military organizations during the First World War. Schaefer Air services was the first United States air ambulance service, created in 1947. The Korean War was the big turning point for EMS helicopters. In 1950, the military was given authorization to use helicopters for medical purposes.These helicopters were used to evacuate injured patients from the battlefield during combat. The small helicopters were equipped with basket stretchers that were attached to the landing gear.
The patients were transported outside of the aircraft, which did not allow for medical during transport. From January 1951 to January 1953 more than 17,000 patients were removed from the battlefield and transported to the hospital by helicopter. The use of medical helicopter transport significantly decreased the causality/death rate among the people in combat.World War II death/causality rate was 4. 5 deaths per 100 casualties, whereas, the Korean War death/casualty rate was 2. 5 deaths per 100 casualties. The Vietnam War introduced to idea of patients receiving medical care during air transport.
The Bell UH-1 also known as the Huey was the frost helicopter that was large enough to carry the patient and medical staff inside the aircraft. The state of Maryland started the nation’s first combined emergency service helicopter program, in 1969. This program was put into place by the Maryland State Police and the University of Maryland.The program joined together the state police, rescue and HEMS (helicopter emergency medical service). In 1972, St. Anthony Central Hospital in Denver Colorado was the first hospital to have civilian hospital-based helicopter transport. This hospital-based helicopter transport system is still in use today and is now intergrated with Denver EMS.
The attributes of helicopter transport are speed, accessibility, specialized personnel and technology. Modern medical helicopters are capable of sustain speeds in excess of 150mph. This allows for patients to be transported to a specialized care center much faster than ground transport.Using a helicopter allows for emergency medical personnel to access patients in places ground crews cannot go. A helicopter can take off and land in a vertical motion. Emergency medical helicopters are staffed with highly trained and skilled staff. EMS helicopters are equipped with highly sophisticated medical technology and can reach people across a wide geographical area.
When considering the use of the EMS helicopter you should take all these attributes into consideration. If these attributes are not important, then the use of an expensive EMS helicopter should not be used.Air medical transport can pose its own stressors to patients, medical staff and medical equipment. These stressors are more predominant in fixed-wing operations rather than helicopter transport. Hypoxemia is the biggest threat to people who fly. However helicopters no dot exceed 1000 feet above sea level. Patients being transported by helicopter are at no significant risk of hypoxemia secondary to decreased ambient pressure.
Acceleration of the aircraft is another factor that can stress the patient. Helicopter acceleration force is not that much different than that of ground transport.Acceleration is more significant in fixed-wing aircraft. Noise is a major issue when it comes to helicopter transport. The noise inside the helicopter causes problems for the medical staff. The noise may hinder the medical staff from hearing lung sounds. The staff must use headphones and an intercom system to communicate.
Vibration of the aircraft is another problem for the patient and staff. The vibrations can cause fatigue and discomfort to the patient. Vibration can also cause monitoring errors and equipment malfunction. Air medical transport has a few cons but when life is on the line these issues seem minor.Each helicopter has its own transport team. The transport team may consist of a pilot, registered nurse or paramedic, and can include EMT’s and EMT-I’s. Some flight crews include a physician.
Physicians on fight crews have posed a lot of controversy as to whether a physician as a crew member improves the outcome of the patient. Each crew member must undergo many education courses as well as hands on training before being employed by HEMS. Safety is the most important aspect to HEMS. Emergency medical helicopters have an alarming history of crashes.The National Transportation Safety Board conducted a study to determine the major causes of helicopter crashes. Important areas of flight risk are the pilots, the mechanics of the aircraft, crew training, maintenance, weather conditions, time of day, and landing sites. The study showed that poor weather conditions posed the greatest risk for helicopter crashes.
Since, the study many improvements have been made to improve the crash rate. It has been said that the sole decision is set on the pilot as to whether it is safe enough to take the flight or not.The pilot must consider the weather conditions, aircraft maintainence, and crew readiness. Medical personnel cannot make the decision to take the call. Medical personnel should not tell the pilot the nature of the call, because this may deter the pilot’s judgment. Currently the Federal Aviation Administration is looking to make changes in the safety procedures of HEMS. Air medical transport is generally used in for two reasons, rescue and inter-hospital transfer.
Helicopter transport is very expensive and is potentially dangerous.Rescue helicopters are dispatched by emergency personnel at the scene. The helicopter reports to the scene of the accident or illness. When should a EMS helicopter be dispatched? EMS helicopter should only be called out when speed, accessibility, specialized equipment and personnel are all needed to save life or limb. Inter-hospital air medical transport is generally used to transfer critically ill patients to another hospital that suites the needs of the patient. There are two types of landing sites for EMS helicopters. One type is the controlled site.
The controlled site located at hospitals.These landing sites are constructed to safely accomindate the aircraft. The second type of landing site is the uncontrolled landing site. The uncontrolled landing site is landing at the scene of an accident. The landing site is selected by the ground EMS. The pilot looks at the site and determines if it is safe to land or not. Ground EMS are trained on how to chose, and mark a landing site.
Ground EMS personnel are also trained on how to behave around the aircraft. When a patient is going to be transported by air the ground EMS must prepare the patient for transport.The EMS ground crew should have the patient stabilized as much as possible before transport. Another way ground EMS can prepare the patient is to intubate a patient that has a high potential for loss of airway. Good communication is the biggest factor in a successful transport. Ground EMS typically has radio communication with the helicopter. The communication between the two should be maintained until after the helicopter takes off.
Maintaining good communication allows the flight crew to inform ground EMS of any major, unexpected patient complications or malfunctions of the aircraft.EMS helicopters must have well trained, diverse flight crews. These crew members must be able to perform their duties on the scene of an accident and while in flight. The crew members are trained to handle many different types of patients such as drowning, burns, spinal cord injuries, heart attacks, pediatric and neonatal patients. The flight nurse is responsible for the patient assessment, and interventions before loading the patient on the aircraft. The flight nurse must know how to use all the equipment and know all the safety guidelines pertaining to the aircraft.There are many different requirements to becoming a flight paramedic.
A person who wants to become a flight paramedic must be able to work in chaotic situations. Becoming a flight paramedic involves a lot of hard work and dedication. The person who wants to become a paramedic must have at least one year EMT experience and many different certifications such as: CPR, Basic Life Support (BLS), Basic Pediatric Life Support (BPLS), Basic Trauma Life Support (BTLS), Neo Natal Life Support (NALS), Advanced Cardiac Life Support (ACLS), and Pediatric Advanced Life Support (PALS).In order to become a flight paramedic this person would have to have at least 5 years critical care experience in a high volume progressive EMS system. Becoming a flight paramedic is no easy task.References Formm, Jr. Robert E.
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