Thread: Lifeflight requests
07-17-2000, 09:14 AM #1JimTFirehouse.com Guest
What are your SOP's regarding the request of a helicopter for patient transportation? Our area is 20 minutes away from a local hospital that is marginal at best, and they end up flying out all trauma patients. The nearest level 1 trauma center is 1 hour by road but has an 18 minute flight time. Our hospital is very hesitant to call the chopper on our judgement since we are not paramedics. Lifeflight courses have taught us that any unrestrained patients in headons, rollovers, and ejections should be automatic requests. (there is no charge for cancelling the bird in route.) After several close calls and the actual loss of one patient who died 3 minutes out from the hospital (it took EMS 35 minutes to package and transport!) I took it upon myself last night to call Lifeflight on my cell-phone after a rollover/ejection which has caused quit a stir with our local EMS. I did not break any SOP by doing this. The patient is currently in a coma with a swollen brain stem and a ruptured spleen. Our hospital is not prepared to handle this kind of trauma. We know it and they know it...they just want to run the patient through their ER before calling the bird. Anyone else in this type of situation?
07-17-2000, 09:26 AM #2fjbfourFirehouse.com Guest
All volunteers on my FD that are at least First Responder have the authority to call the bird. They can be over-ruled by a paramedic or the Chief, but I can't think of any time that has ever happened. We have similar transport times as you, but there are two birds available so there is usually not a concern about taking one when it might be needed elsewhere.
And, like you mentioned, there is no fee if there is no transport. We often call for standby as soon as we hear a call for MVA or major trauma, so they are near or in the helicopter already when we arrive. We then call up with the launch or stand-down order. They have expressly told us to get them on the way and turn them around if necessary instead of needing them and not having them come. Hospital does not question our judgement for even a second.
We don't really have an SOP as yet. It hasn't been needed. Probably couldn't hurt to have one, but we have other pressing issues.
Frank Billington, #11
Town of Superior Fire Online
[This message has been edited by fjbfour (edited July 17, 2000).]
07-17-2000, 10:52 AM #3JimTFirehouse.com Guest
And now...the rest of the story....
Our local hospital has contracted with a private med-flight service that has no affilliation with a major hospital or trauma unit. This contract DOES NOT include the independant Vol. F&R stations in the county. If the patient is transported and run through their ER, then they call the private bird, which carries NO BLOOD or "life-saving" drugs. This bird is not allowed sit down priviledges at the trauma center because of it's safety record and single engine. They land 10 minutes from Trauma unit and transport via ambulance to the center. I hear(vicious rumor) that the local ER recieves commission for patients transported. Anyway, about 5 minutes after the patient was flown last night, this private bird (who was launched by the hospital!!) was on the scene asking for an LZ!!! They were upset, to say the least, that the flew for 20 minutes one way and there was no patient to pick up! This is not good for our citizen's welfare and/or safety. It is a shame that this conflict of interest is occurring in our county. Please pray for us! GOD BLESS & STAY SAFE!!
07-17-2000, 01:29 PM #4bob1350Firehouse.com Guest
We've just had a few changes in Airlife's policy, but any EMT can call for airlife, whether it is as a standby or a go. Normally we let the responding medic units make the call when they go in route. Our designated trauma hospital is pretty close, so airlife is now probably only going to respond to calls in the mts.
07-17-2000, 05:06 PM #5WhipFirehouse.com Guest
I'll do my best to try to remember everything on this one. But here is the set up.
Level II Trauma Center w/"Lifestar" 15 min by ground, 5 by air.
Level I Trauma Center w/"Lifestar" 1 hour by ground, 20 by air.
Obvious head or chest trauma.
Obvious C-Spine compromise or loss of function in extremity
Serious MOI regardless of obvious injury
Systolic B/P less than 90
2 or more long bone fractures
Death of another passenger in same vehicle
These are the ones that I can remember off the top of my head. If anyone else from CT can add any that I forgot, I'd appriciate it. Thanks
Lt. Whip FSI/EMT
Ledyard CT FD
07-17-2000, 09:02 PM #6JMP17Firehouse.com Guest
Hey way to go Whip! You saved me some typing. The only one you forgot was 20 Minutes or longer from the closest trauma center.Miss ya at the emerald city brother.
Take care & stay safe!
JMP17 ( changed the name, not the Lt. anymore.)
07-17-2000, 11:13 PM #7Fireguy57Firehouse.com Guest
Pediatric head injuries
(2 persons in car scenario)
One passenger was killed, other should be flown.
Ejection from moving vehicle.
Ped hit by vehicle
07-17-2000, 11:51 PM #8LMRCap1Firehouse.com Guest
We are allowed to call for the bird here it is in the county SOP's- usually for extended extrication times. As first responders we make contact with the ambulance inform them then we must go through county dispatch-we cannot call the bird direct.
07-18-2000, 09:07 AM #9monteFirehouse.com Guest
Our district lies north of a "large" MT city, and we are dispatched through their 911 system. They at the center will often dispatch 2 als to our page, as protocol, lifeflight is one if available, and ground ambulance. It's up to us to cancel all, or just one. We can request als, but only the emts can cancel when als is enroute. It's a good deal when there are multiple patients, we don't have to worry about the call, they just show up. With hard to reach patients, backcountry county roads, they often travel the 20-25 miles, or fly in a pattern over the site and then we cancel them. So far the relationship has been very good.
07-19-2000, 08:53 PM #10pokeyfd12Firehouse.com Guest
Don't forget about burns in the protocol. I think it's 20-30 percent second degree and 10 percent third degree or something close to that.
Here in the lower Hudson Valley of New York, we have Stat-Flight which runs out of one of the only Level 1 trauma centers outside of New York City. It's based at Westchester County Medical center and a second air unit flies out of Orange County Airport or Stewart (former AFB). It's basically the EMS decision if the helicopter is needed. Fire dept. is sent for LZ set-up only, unless of course it was an extrication that the fire dept. was already dispatched for. The EMT's on scene actually make the decision for the helicopter and have never been questioned as to why. If ALS calls for the helicopter, they have to fill out paperwork explaining why they did not tx via ground to either one of the area hospitals that are within a 20 minute tx window. We have two level II trauma centers within 20 minutes of ground tx but the helicopter can be airborne and on scene in 12 minutes and flight time back to trauma center is 7 so the math doesn't add up sometimes. The chopper will be landing sometimes at the same time as the pt is being removed from the vehicle or was just packaged for tx.
I guess it stands with the old adage of "I'd rather have it coming and not need it, they can always go home, than to wait."
07-20-2000, 12:15 AM #11Haligan125Firehouse.com Guest
We are not allowed to call for lifeflight directly from the scene. We have to call medical Control, and they will call life flight. If we did call for it we could lose our jobs. This comes from the Regional Medical Director himself. we usually transport the pt to the samlll ER that we have in our town, stableize and then call the bird. we then go pick up the flight nurse and paramedic, and bring them from the LZ to the hospital. They then asses in the ER, and then we transport the crew and pt to the LZ, assist in getting the pt on board and then go home
07-20-2000, 09:50 AM #12J AlmonFirehouse.com Guest
I know the situation your are dealing with n Summertown since I'm from just up the road in Williamson County. Local protocols do not allow single engined helos to do a scene landing. Also, Vandy has two units in service. If Vandy can be there in less than 20 minutes and it takes 35 to get a triage at an ER by ground, why bother with the ground transport? Just 5 more minutes and the Pt can be in surgery in a Level One center.
07-20-2000, 12:12 PM #13JMP17Firehouse.com Guest
My God we need to do something here, not being able to call the bird is going to cost lives. If your not qaulified to pull up to a scene and survey the situation I.E.- MOI, fatalities,ejection and the such who is? An MD 10 miles away. This is crazy! When we arrive on scene we can put the bird on standby or even at dispatch depending on factors like multiple cars , head ons with entrapment or things like stated above. ONce the Triage is done on scene we start the bird for which ever Pt. needs it others may go by ground. And this going to multiple places , get them to the closest TRAUMA center, why waist time with a facility thats not able to do the job. You can stabilize them in a cut and scrape ED 3 times and they die there. Stabilize enroute to the L1, L2 TRAUMA center.
Sorry for venting a little.
Opinions expressed are mine and may not be those of my Dept.s
[This message has been edited by JMP17 (edited July 20, 2000).]
07-20-2000, 09:24 PM #14Scene25Firehouse.com Guest
Working for a Air Medical Helicopter/Fixed Wing Company, I have seen calls from just about everyone. I have seen police officers call for a helicopter, which is not a common practice, as well as Fire Chiefs, First Responders, EMT's, Medics, MD's, and 911 centers. We do not hesitate to get the person calling for the aircraft to the scene. Some places in this area meet the aircraft at the aircraft base site as to speed up the time getting the trauma, medical, burn patient to the respected facility.
My opinion is this:
If we are good enough to answer the call, and treat the injured, we should be good enough to understand if the patient meets guidelines for air transport. Air transport not only is faster 99% of the time, but the personnel on the aircraft have many more resources availabe "drugs - vents" etc to care for the injured.
"When In Doubt, Fly Em' Out" : )
Clairton F.D. (SouthWest PA)
Visit here for some great pictures of our fleet under STAT MedEvac.
Take care and Be Safe
07-20-2000, 09:53 PM #15Engine58Firehouse.com Guest
In our area only The Ems officer or Fire Dept Officer on scene most of hte time paramedics call for the Bird. We only call if the Mva is a head on (depending severity) that also goes for any other type of Mva...Basically any trauma that needs immediate ER attention.But basically any thing really bad that needs to be treated asap we call for hte bird because it takes agood 25-30 minutes (depending on traffic) to get to the nearest trauma center. And about 5-10 minutes by air..
South Amboy, New Jersey
Junior EMS Responder
"EMTS DON'T DIE THEY JUST STABILIZE"
07-21-2000, 01:33 AM #16FFCode3EMTFirehouse.com Guest
Anyone can request the helo, however it is usually the Incident Commander that places the helo on standby when the initial dispatch is received. In our area, we have 7 hospitals within a 20 minute drive including two Level 1 trauma centers that rotate as the trauma center on call. We also use the same criteria that was posted earlier to determine whether or not the helo is needed.
**The preceding comments in no way represent the views of my department, its members, or associations that it may belong to.**
07-21-2000, 01:54 AM #17fireman703Firehouse.com Guest
We have countywide protocols approved by a doctor who takes responcibility for them. they state a trauma or medical pt. w/ decreasing LOC, vitals etc. or medical personnels gut feeling that is located greater than 20 min ground transport to the appropriate medical center you may request the bird. (All the hospitals in are area are trauma centers). It takes almost that long for the bird to get on scene. The on scene personnel need to do their best to have the pt. packaged prior to the birds arrival. To me the pt. comes first, the heck with politics, or money issues. I think you did the right thing. I do what I think is best for the pt. regardless. The key is to remain professional and keep our priorities in the pts. best interest.
07-25-2000, 10:41 AM #18iwood51Firehouse.com Guest
Any EMT can call the helicopter. Most of the time PD has already called for it as they get there first. The helicopters are run by the police department and all police officers in Suffolk County since 1990 are EMTs. Never had a problem with calling and cancelling. I have called for it myself over a dozen times, and mad the suggestion countless other times.
07-25-2000, 10:46 AM #19iwood51Firehouse.com Guest
Perhaps the person that posted from Hudson Valley can clarify this, but I recall quite a few years ago there was an assisitant chief from a western Suffolk County department, I believe it was Dix Hills, that was told that no helicopter was available from either Suffolk or Nassau counties, and being faced with a long extrication, took it upon himself to call for a chopper from Westchester County Medical Center (some 75-100 miles away). He caught a lot of flak over this from the media as the helicopter service billed the patient, but the feeling amongst the fire departments was nothing but praise for his initiative.
07-25-2000, 03:38 PM #20JMP17Firehouse.com Guest
Who ever he was,WAY TO GO CHIEF!!!!
Pt care first at all cost, thats who we're here for.
They may have got a bill but they also got to LIVE!!
Sta safe & Keep up the good work!!
07-25-2000, 09:52 PM #21pokeyfd12Firehouse.com Guest
iwood51, I remember the incident although the details escape me. I think what you said is more or less the outcome of the incident.
I wouldn't care where the chopper comes from either. In Rockland County where my voly department is located (across the Tappan Zee Bridge from Westchester), we have a county fire dispatch. If they were to tell me that the two closest helo's are not available, I would ask them to see if there is one available from anywhere else. We have many resources around us and have used them more than once. The Stat-Flight medevac choppers were unavailable at times and we have requested services such as the Coast Guard, U.S. Military (there's West Point, Camp Smith and the former Stewart Air Force Base all within flight time) and even NYPD's elite aviation unit. We had a difficult rescue of an injured/missing hiker deep in a wooded area to our north. It would have been a 5-mile or better walk with this hiker in a stokes if not for the expertise of NYPD's air unit. Never underestimate the usefulness of your resources.
07-26-2000, 10:06 AM #22JMP17Firehouse.com Guest
There you go Brothers, thats what I'm screamin about! RESOURCES use'm if you got'm.
Stay safe & keep up the great job!!!
07-26-2000, 12:50 PM #23TommyBFirehouse.com Guest
We (volly fd)are in a rural area and have a similar situation as the original poster does wrt to capabilities of local hospital (only one in the county), and the nearest trauma ctr. Our local hospital is going to fly a trauma pt to the trauma ctr anyways, since they're not equipped to handle them. It is 1+ hr by ground to the trauma ctr (level I) and about 15 min flight time.
We allow any of our officers to ask for the helo if in their judgement it is needed. We do not have to get EMS authorization to dispatch Air Care, and a lot of times the first officer checking en route will request that they be placed on standby. The flight crews have told us on numerous occasions that they do not mind being cancelled while enroute.
The only time we have had any problems with requesting the helo is when we are running a call in our neighboring county (part of our district is in the other county). Their protocols state that it must be a paramedic level request. We have had a few occasions where one of our guys (at a minimum EMT-B) have requested the helo and their dispatcher has refused the request since their county EMS (paramedic staffed) is not yet on scene. Only problem with this protocol is that their EMS has (on a really good day) a 15-20 minute response time to this area.
A couple of times there have been some fairly heated dicsussions with their dispatcher, but in every case they have dispatched the helo, and in every case once EMS was on scene they agreed with our request for the helo.
As far as when we call the helo, some of the previous replies pretty much covered what cases we're going to call them for.
07-26-2000, 10:25 PM #24Big TFirehouse.com Guest
In our EMS area there are four chopper services.. They all have each others numbers if there birds are out they do not hesitate to send one from some where else... I feel sorry for the EMS services that can'request a chopper to the scene that is a gross waste of time and can cost lives... What about he Golden Hour?????
07-27-2000, 12:59 PM #25Dalmatian90Firehouse.com Guest
Lot's of variations...
I'm North of Whip and West of JMP...
Generally, we're looking at a 15 to 20 minute wait for a helicopter (although maybe as low as 10 minutes now that a closer Level II has a bird sitting there). We're looking at 15 to 20 minute transport times to our community hospital
Any EMT or MRT (1st responder) can call. I believe to cancel you need to consult med control (good practice even if not needed!)
What we usually do is call for a helicopter for "Modified Scene." The helicopter and ambulance converge at the community hospital, usually within a couple minutes of each other (just works out that way in our particular geography!). At the community hospital we can:
-- Wait in the parking lot for a minute or two for the bird to arrive...if they're late Med Control via radio can make a decision to wheel the patient on into the ER
-- Load and go into the bird if they're on the ground
-- The Flight Crew can evaluate in the ambulance and has on rare occassion brought the patient into the ER for stabilization prior to flight
-- The Flight Crew can pronounce in the ambulance and we wheel the patient to the hospital mourge....
-- If the bird has to turn around enroute due to weather, we simply roll into the ER.
-- Note, we try to avoid entering the ER since once the patient is in, the ER has to take a certain amount of time to evaluate before they can release them to the chopper for flight -- but again, on rare times I've seen the chopper crew do that to stabilize before transport.
Also, no free medevac here -- all the services charge (I think about $3,000) for the flight.
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