Vol.5-Ch.10 "Air Medical Operations"

Question 1

What are the 6 main uses of Air Medical Aircrafts?

Answer 1

• Scene Responses
• Interfacility Transport (w/in 150 - 200 miles)
• Specialty Care
• Organ Procurement
• Search and Rescue
• Disaster Assistance

Question 2

What are the 6 main uses of Air Medical Aircrafts?

Answer 2

• Scene Responses
• Interfacility Transport (w/in 150 - 200 miles)
• Specialty Care
• Organ Procurement
• Search and Rescue
• Disaster Assistance

Question 3

Aircraft as Medical Vehicle History on Pgs 277-278

Answer 3

Aircraft as Medical Vehicle History on Pgs 277-278

Question 4

What are the 2 types of aircraft used and what are the advantages to each? What is the choice of which to call based off of?

Answer 4

• Fixed Wing Aircraft (airplanes): offer comfort, speed, ad significant range.
• Rotor Wing Aircraft (helicopters): offer access to hard to reach places and provide faster transport.

The choice of which aircraft is based off of:

• distance
• medical needs
• patient condition
• availability

Question 5

What are the different types of fixed wing engines and propulsion systems? What are the disadvantages of fixed wing aircrafts?

Answer 5

There are turbine or piston engines. Turbine engines can be propelled by either a propeller (turboprop) or a jet engine. Most air ambulances are turbine powered and have at least 2 engines.

The limitations of fixed wing aircrafts is that they must take off and land at established airports which are not always close to the pt or hospital.

Question 6

Details on Rotor-wing aircrafts, what is the major limitation of rotator-wing aircraft?

Answer 6

Rotor-wing aircraft:

• Use rotating blades, a rotor, to provide lift and propulsion
• The tail rotor counteracts the natural torque produced by the rotor, without it the body would spin in the opposite direction of the blades.
• All are powered by a jet engine, most have 2.
• EMS uses small to medium sized helicopters.
• Most use a single pilot

The Major Limitation is Weather!

Question 7

What are the 2 types of flying rules for Rotor-Wing Aircraft?

Answer 7

• Visual Flight Rules (VFR): basically means that the pilot is able to see their orientation and position without instruments (clear weather). This is what most EMS pilots are trained in and aim for and only learn IFR for emergency situations where the weather was inadvertently encountered.
• Instrument Flight Rules (IFR): basically means that the pilot must use instruments to know their orientation/position.

Question 8

What major change led to a huge increase in air ambulance usage in the US?

Answer 8

In 2001 the Federal Government changed the reimbursement scheme for air medical transport making it much more affordable.

Question 9

What was the initial use of air medical used for and why?

Answer 9

It was originally mostly used for trauma. This was because of the “Golden Hour” concept and establishment of a network of helicopters in Maryland that state police would use to transport pts from the scene directly to the Shock Trauma Center in Baltimore. This was largely based off the work of Dr. R Adams Cowley.

Later the horizon expanded to include a lot of interfacility transports, due to the specialization of hospitals and the acuteness of pts with things such as strokes or STEMIs

Question 10

What are the major benefits of air craft transport?

Answer 10

• Speed
• Decreased out-of-hospital time
• Better quality of care (sometimes)

Question 11

Guidelines of Air Medical Dispatch on Pgs. 282-284

Answer 11

Guidelines of Air Medical Dispatch on Pgs. 282-284

Question 12

How much are air transports and what are some other limitations other than weather?

Answer 12

They often cost 30-40k, insurance may pick up some of the cost.

The internal size of the helicopter limits obese pts, extremely tall pts, or pts with traction splints.

Question 13

What does the common configuration of the crew look like?

Answer 13

Typically 1 pilot and 2 health care providers (this can be any combo of paramedic, nurse, doc, resp therapist, neonatal doc, ect)

Question 14

What is a major controversy of air medical aircrafts?

Answer 14

That there has been m a rising number of crashes and a rapidly increasing number of total helicopters being used in and out of EMS.

Question 15

If Air Medical Transport more or less regulated than Ground Medical Transport and why?

Answer 15

Air Medical Transport is LESS regulated, this is b/c they fall under the Airline Deregulation Act of 1978 which prohibits the overseeing of “quality, accessibility, availability, and acceptability” of air ambulance services. This is preventing local and state governments from developing rules and regulations for air ambulance usage.

Question 16

When should the decision to call air medical be made?

Answer 16

Early in the the scene operations. This is because it takes several minutes to do check offs, check weather, and travel to the scene. Also, if the decision that air is not needed it can always be cancelled with often no cost to anyone.

Question 17

What are some general concepts that apply to most systems when it comes to what EMS need to tell air support before calling?

Answer 17

• Location of scene: Closest Cross Streets or Roads, Closest City or Town, Actual Address of the location, and Well-known land marks
• Launch information: Agency identity, radio frequencies, call back cell phone number, local weather conditions, presence of hazardous material, and number of patients

Question 18

Who determines the landing zone of an incoming helicopter and what are their responsibilites?

Answer 18

A landing zone officer should be designated and should coordinate the landing zone with the incident commander.

Their responsibilities include:

• Selection of site
• Site preparation
• Site protection and control
• Air-to-ground communications with incoming aircraft
• Updating IC on ETA of aircraft

Question 19

What should be done while establishing and maintaining an LZ?

Answer 19

• Look for a 100x100ft (there is a note in a picture that says 75x75 is acceptable in the day time) area with little to no slope or debris
• If the area is dusty you can try wetting the area to prevent dust from flying up an reducing pilot visibility (Brownout)
• Approach to the LZ and landing should be done facing towards the wind
• Mark LZ with cones (in the day) or strobes (in the night), cones may be faced pointing towards the center of the LZ with a flashlight placed inside to light up the LZ. (DO NOT place lights going straight up)
• Keep in mind that green and blue lights are hard to see with night vision goggles (NVGs) but Red and White show up well.
• Clear the LZ of any debris, the pneumonic HOTSAW can help remind what counts as debris:
  a) Hazards
  b) Obstructions
  c) Terrain (Remember to look UP as well)
  d) Surface
  e) Animal
  f) Wind/Weather

Question 20

What should be done by the LZ officer during a night landing?

Answer 20

• Turn off flashing white lights
• Use spotlights to mark any possible obstacles
• Do not shine lights or lasers at the helicopter

At all times of landing the LZ officer should be in communication and ready to comply with requests from the pilot.

Question 21

When should you notify the aircraft as they are approaching?

Answer 21

Tell them when you can hear them and then when you can see them

Question 22

In what terms should you help direct a landing pilot?

What should you say if the LZ becomes unsafe as an aircraft is landing?

Answer 22

Use clock based directional terms using the nose of the aircraft as a 12 o’clock reference point.

Limit comms while landing to reduce safety concerns and distractions

If the landing zone becomes unsafe then tell them to “Abort Landing!”

Question 23

How should you approach a recently landed aircraft, and what are the danger zones?

Answer 23

• NEVER allow anyone to approach the aircraft until the crew has indicated that it is safe, it can take 30 sec to 2 minutes for engines to cool off before they can be shut down, also the rotors can droop as the engines are spooling down so they may be lower at rest.
• NEVER allow anyone to approach from the tail, even if it is a shrouded or ducted tail rotor.
• ONLY approach from the front and while in view of the crew, also ALWAYS approach from the the low ground when it is on unlevel ground (NEVER the high ground)
• ALWAYS leave the same way you approached

Question 24

How should the patient handoff be handled?

Answer 24

• DO NOT bring the patient immediately to the helicopter, the flight crew will typically go to the patient first in order to assess the pt and check viability of packaging of the pt
• The lead medic should give a short and concise report of the pts condition and any interventions preformed.

Question 25

If asked to assist the flight crew in loading the pt what should you keep in mind?

Answer 25

• Follow all the rules of approach
• Watch and obey any of the flight crew
• If an ambulance is driving toward the helicopter it should never get closer than 25 ft to the aircraft
• Some aircraft load from the side while others may load from the rear, but still never get close to the rear rotor

Question 26

What should you do while the aircraft is departing?

Answer 26

• Immediately leave the LZ and remain at a safe distance
• Assist the crew by being alert for open doors/compartments, any loose straps, or any new obstacles; if seen then notify the pilot immediately
• Remain in contact with the aircraft until it is well clear of the area