Saving Minutes Of The "Golden Hour"

Photo courtesy of E.C. "Easy" Wolfe/Bay City VFD The Bay City, TX, Volunteer Fire Department's Emergency Support Vehicle carries a Global Positioning System (GPS) unit inside the command module at the rear. Radio communications equipment, flares and landing zone cones also are onboard.

That scene is becoming a common occurrence throughout the country as we focus on reducing deaths due to trauma. Salvaging trauma patients often depends greatly on time. The objective is to get the patient into the right operating room within the golden hour the first 60 minutes from the occurrence of the traumatic injury. Some behind-the-scene planning and multi-agency cooperation can save precious minutes of the patient's golden hour.

The following is an account of how one rural community in Texas enhances the chances of a trauma patient being a survivor. Bay City, TX, is about 80 miles southwest of Houston, where the nearest Level I trauma centers are located. Ground transport requires 90 minutes to two hours, plus response and scene time. The local hospital provides the equivalent of a Level III trauma center.

Photo courtesy of E.C. "Easy" Wolfe/Bay City VFD A hand-held GPS device is used to locate the exact position of an emergency scene for helicopters. The unit is carried in the command post module of the Emergency Support Vehicle, which also is equipped with radios, mobile telephones, a fax machine and a computer.

Hermann Hospital in Houston flies a radius of about 120 miles with three helicopters. Their flight time to the Bay City area is about 25 minutes. Until as recently as three years ago, however, few requests were made for the helicopter. Those few requests probably put the aeromedical crews at more risk than they should have. Various responding agencies were uncertain about their responsibilities, and there was confusion or conflict regarding who would set the landing zone, and where. To further complicate and confuse matters, radio communications were not coordinated. There was sometimes competition regarding who would provide scene to helicopter communication. This confusion was compounded by the fact that Matagorda County has never had a key map with longitude and latitude coordinates. Therefore, flight crews had to search for scenes by looking for prominent landmarks while relying on estimates of distance and direction from responders on the ground. Precious minutes were lost in situations where seconds count. There had to be a better, more efficient way.

A meeting was arranged for all emergency response agencies in Matagorda County. In addition, representatives of Hermann Life Flight were invited to address how they could do a better, safer job and expedite the smooth transfer of trauma patients to the Houston trauma centers.

A Hermann Life Flight pilot addressed the problems from his perspective. He pointed out that due to time and fuel considerations, the pilots need clear and concise directions before leaving their helipad. While such is not always possible, it is appreciated and contributes to the overall effectiveness of the mission.

The pilot also indicated that his agency prefers to have landing zones set up by fire departments rather than by law enforcement personnel. Fire suppression and rescue are matters of concern which obviously can be better addressed by fire service personnel than by law enforcement. This system allows law enforcement to concentrate on traffic control and safety, and permits EMS personnel to focus on patient care. The rural fire departments generally have the greatest number of personnel at such a scene, and are the most likely to have sufficient resources to adequately manage a landing zone.

Photo courtesy of E.C. "Easy" Wolfe/Bay City VFD The command post module also serves as a "ready" area with four breakaway SCBA units for quick deployment of firefighters on arrival. Sensitive electronic equipment is protected by a plastic shroud.

With these thoughts in mind, the authors designed a system that has benefitted everyone involved, especially the patients. The heart of the new system from a technical standpoint, is a hand-held Global Positioning System (GPS) receiver. The GPS unit, about the size of a computer mouse, was purchased jointly by the Bay City EMS, a private company, and the Bay City Volunteer Fire Department.

Less than one minute from the time it is turned on, the GPS tells the users their exact location in longitude and latitude, accurate to within three feet. This device was used to pinpoint the coordinates of all major highway intersections, towns, industrial plant helipads and other important locations. These coordinates were collected, recorded and printed on heavy stock paper which was then laminated and distributed to all emergency agencies in the 1,100-square-mile county and to Life Flight's communications center.

When Bay City EMS personnel respond to a trauma scene, they are able to contact Life Flight via cellular telephone while enroute to the scene. They refer the communications center to the nearest known coordinates as they look at their identical charts. This lets the helicopter crew know, within a few miles, where they are going. If sufficient patient information is known, EMS may request that Life Flight respond immediately. As soon as the fire department arrives at the scene and confirms with EMS that Life Flight will be needed, fire personnel select a landing zone site.

The next step is for them to pinpoint the location by use of the GPS. At that point, scene communication with Life Flight diverts from EMS to the fire department on a designated frequency. The up-dated coordinates are relayed by the fire department to the helicopter.

The fire department has a flare pistol and smoke flares to aid a pilot in determining wind speed and direction. Fluorescent orange cones mark the corners and the upwind side of the landing zone, selected to avoid such hazards as power lines, radio towers, signs and trees.

This system of pre-planning and designating areas of responsibility has proven effective. The flight crew gets accurate location information from the start, and is directed to a safe landing zone. Police perform traffic and crowd control functions, fire department personnel effect entry into vehicles and secure the landing zone, and EMS has only to worry about the patient. Scenes run smoothly and clear more quickly. Most im-portant, patients reach a trauma center in the least amount of time. These procedures may buy the trauma patient the most important five to 10 minutes of his or her life.

Eddie Callender Jr., director of Bay City EMS, is a Texas-certified paramedic, coordinator, instructor and skills examiner. He has 19 years of career and volunteer EMS experience.