Do You Have a Helicopter Fetish?

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.

This is a good summary of proper utilization.  Here is another great article on helicopter utilization by who other than Bryan Bledsoe.

 

 

 

Comments

  1. Bravo. Linked you.

  2. John A. Oscar says:

    Love it! The fire department I used to work for as well as several in the area have a helicopter fetish. I have been on scene where the EMS/Fire chief has called the copter prior to our arrival because of “mechainism of injury” even though there is no obvious injury to the patient. When asked why we are flying them, it’s because “they meet flight criteria” (which in our area is largely determined by the local HEMS provider).

    I’ve brough this up several times at meetings post incident- these people are having one of the worse days of their lives, they just lost their primary means of transportation, they are going to get a hospital bill that depending on insurance coverage, could be hundreds or thousands of dollars, and being the professional nice guys we are, let’s tack on 10k in addional bills because we want to tell everyone “I landed the bird!”

    You see it in their eyes- immediate check out…..facts aren’t cool…..

    • medic4ever says:

      i just heard of a certain fire agency that called a helicopter for a scene call .5 miles from there base at an er for a ‘possible hypothermic patient. the patient was then flown .5 miles to the hospital. i wonder how competent that makes them feel.

  3. Old Medic says:

    First off let me start by saying I have been in EMS 26 years , the last 20 as a Paramedic I have worked in a large metro EMS as well as rural EMS, I live in a community of aprox 15,000 people, we have a small hospital but the neaest trauma center is approx 75 miles away. What you have failed to mention or just are not aware of is that several of the air abulance agencies in my state are private owned companies, they make regular “pr” visits and constantly say over and over again how we need to call them even if were not sure if their needed and they will evaluate the patient and determine if they need to fly them, whats interesting when this happens every patient they fly out to evaulate goes with them. I do understand the need to use common sense but you simply stating all EMS providers simple call them to “land the bird” is not entirely true.

    As far as what the great Dr. Bledsoe has to say I really dont care, but that for another story and another time.

    • scaredyfish says:

      Old Medic, thanks for commenting, your bring up some good points. In our area the helicopters don’t make “PR” visits, they have “ground schools” which stress when not to call. Even still, people are often quick to call and slow to cancel. We have three hospitals that are less than five miles from each other, one being a level two trauma center. If the level two trauma center is not able to treat the injuries, the level one center is only 45 minutes away. The large majority of our calls are withing 20 minutes driving distance of either trauma center. At my other agency, in another region, most transports are 45 minutes to any hospital and helicopters are often very useful. I feel they have a legitimate role in EMS when used properly, I only hope that people can learn what that proper use is. The fact that the air ambulance agencies in your area are private owned companies only proves that their main motivation is profit, not patient care. We need to be the advocates for our patients and refuse to transport a patient by helicopter when it is not needed. In our area the highest level of care provider on scene from the primary agency can make the decisions for transport method, even if the medical command or fire command insists differently.

  4. Aww, shucks! I was looking for a real article with clear cut guidelines to share with the other members of my BLS squad, I am the only ALS provider for our service and I can’t respond to everything. They will often call for a helicopter for reasons that baffle even me, having served with many of them for years. Yes I’ve heard the “mechanism of injury” argument, and we’ve had LEO’s call for air before we’ve even been dispatched. I’ve also seen them panic, so having a clear cut list we all could agree on for 90% of their knee jerk impulse would be great.

    • scaredyfish says:

      Cindi, I posted a link at the bottom of my post to the State of NJ fly or drive criteria. Unfortunately it’s not as simple as just posting a definitive list of when or when not to fly. Often it depends on the local protocols in your area, I would encourage you to speak to the Medical Director for your agency to get them put in place for your particular situation. Remember as Old Medic pointed out that most of the information provided by air transport agencies needs to be taken with a grain of salt as they are for profit agencies that need transports to survive. Here is a link to a study that may help now and when developing your own guidelines. Thanks for commenting.

    • Having worked and lived in an area with no truma centers within a 1 hour drive(over two from some areas) and often prolonged response times, we would often have the helo in the air at the same time we were responding.In a truly rural setting or even one without appropriate trauma care like here air services truly do save lives.Often in the past we would get greif from others(fire etc) about choosing to fly a patient to Memphis or LR,but when you walk into a E.R. a few times with a bad patient and the Doc asks why you didn’t fly them(and then spends the next hour trying find a recieving hosp. and another hour finishing the tests the recieving hospital asked for) you tend to figure out they aren’t able to care for your patient.That 15 or even 30 minutes you waited on the bird doesn’t seem like such a bad deal anymore.

      • scaredyfish says:

        Very true James, some of the issue lies with the hospital that your driving to. That is one of the factors in the decision making process, it’s not a good idea to drive a patient to a hospital that isn’t capable of handling their injuries simply because they are closer. It all comes down to choosing the closest appropriate facility.

      • Where do you work at James? It sounds like your from my neck of the woods.

  5. So the accident in this story happened in a “rural” area, yet it would only have taken 12 minutes to drive the patient to the trauma center?

    Calling a helo in this case obviously was a dumb idea.

    Also, if it takes the flight crew 25 minutes to assess, load, and lift off with a non-critical patient, then I would have serious doubts about the capability of that particular crew….

    • scaredyfish says:

      Allan, I consider this a “rural” area. In our area, once you leave the city you are quickly surrounded by dairy farms and fields. It is not uncommon to find neighbors over a mile apart on the back roads in the county. Though the hospital is only 12 miles away, many areas do not have 24 hr ALS coverage. As for calling the helicopter, this was not the proper utilization. There are times when it is the best option for us, we respond to the bordering county on more than one occasion. On those calls we are nearly 40-60 miles from the hospital and a helicopter can be there in minutes to meet us as we are packaging.

      I also agree that it should not take a flight crew 25 minutes to do anything on scene. I do not know if the helicopter systems in your area still “Hot Load” with the rotors running or not but our system refuses. Each time they land the craft, shut it down, assess the patient themselves, provide any treatments they can ahead of time and load. Then there is a 4-5 minute warm up where they prepare for take off. It’s not new to me but some people are amazed at just how long it takes to get a patient out by helicopter.

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