Be honest, when you see an aero medical response unit hovering just over head, does your heart skip a beat? Are you stirred to grab your cell phone to take a picture? Do you fantasize about landing ‘The Bird’ before you’ve even gotten on scene? Well it sure seems that way if you work in EMS. I often wonder if most of the Medvac activation’s are partially because the people on the scene wanted to see them one more time.
I imagine that a scene like this is going on in every firefighter and EMT’s head as they think of bringing in the Mighty Joe Awesome of flying steel and glass that is an EMS helicopter. Well life is cooler with theme music. That being said, there is a right way and a wrong way to determine if a helicopter is needed. It’s actually quite simple. Will your patient benefit from care that only a flight medic and flight nurse can provide? Will it take less time from when the patient is extricated to fly them than to drive them? If the answer is yes to either or both, ‘get to da choppa!’ If not…well quit dawdling and drive, drive, drive. Of course there are minor variables but you need to have a better excuse to wait than “they are almost here.” Remember to treat the patient, not your ego.
I had an experience, well several but none more than this, that drove this point home. First let me say, I like the providers on this call, they did the best they could for the patient, but the very nature of reviewing is to learn and this is a great learning call. In a rural area of our neck of the woods, a patient drove their car into a non movable object, said object caused some broken bones and bruises with no obvious underlying injuries. Extrication was interesting due to terrain but was not as long as it could have been. County activated a Medvac soon after dispatching EMS. We were merely assiting the primary agency as there were initial reports of other patients that fell short of fruition. Being a good ditty, I prepared the truck on the roadway which had been shut down. We would simply remove the patient, load her and go, with 4 ALS providers on scene we could easily provide 3 in the back with one to drive. Plan molded and prepared.
Then reality set it. Chopper is 12 out, almost out of the car…chopper is 4 out, getting her on the back board…chopper is overhead, were just loading into the truck. “Let’s drive” was my assertion. My partner that day was a certified and licensed pilot, he had long ago explained the inner workings of how they cycle stuff and do things I’ll never remember or understand. Point being I knew it would take several minutes to get on the ground and take off, plus the time to load and evaluate then travel. We ended up staying and waiting for the flight crew as I was not medical command and was not in charge of the patient I had no say. We took great care of the patient, handed over the care to the flight crew and watched as they drifted away into the dark sky. We then loaded up our gear and drove non emergency, 65 miles an hour to the hospital they would be arriving at. What we found only confirmed what my partner and I had been saying.
The patient was in our ambulance ready to be transported by ground at 12:01, the helicopter landed at 12:04, it took off at 12:29 and arrived at the hospital minutes later. We were able to make it by ground, going the speed limit, without emergency lights in 12 minutes. Forgetting the natural tendency to drive *cough* 10 mph *cough* above the speed limit we will use the conservative 12 minute estimate. By my estimation it took 25 minutes from the time the helicopter arrived on scene to the time it took off, we will ignore the travel time and keep the 25 minute mark. That means if we had left at 12:01, the patient would have been at the trauma center at 12:13 a full 16 minutes before the helicopter would have even left the scene! This patient would have been evaluated by a doctor and probably seen by a trauma surgeon before the helicopter would have landed on the roof. That’s a conservative estimate, that’s not factoring in a faster driving speed, the travel time of the helicopter, the time to get her off the roof, through the hospital and to the ER mind you.
So with an extrication time of 30 minutes what could possibly motivate you to fly a patient that could get there faster by ground. Is it ego? Maybe it’s fear of having a bad patient die? This patient required no special care that wouldn’t have been available by the ground transport crew. You can’t point fingers at the providers on this call and say that it is an isolated incident because 75% of the Medivac contacts I have are like this. Unnecessarily expensive transportation. Bryan Bledsoe wrote a great article that gives studies and number that support this idea.
For the record I’m not saying that we should never call or get rid of medvacs in their entirety, just that we need to tighten up on when we call, only using the helicopter when it should be used and for heaven’s sake don’t be afraid to cancel them, even if they are circling overhead. Remember that they have to land, evaluate and package, prepare to take off, and then actually fly to the hospital, all while you could be driving there already. The bottom line is ignoring the fact that the golden hour has been debunked over and over, why are we sending patients out for injuries that do not require a helicopter. Is it really necessary to fly someone for a broken leg, at $87 a mile with a $9,000 dollar lift off fee, when driving would have been faster? We can’t be afraid to be the adults on scene and take charge of our patients.