10 June 2008

Transporting Patients By Helicopter

It's a discussion that needs to be held.
What constitutes "sick enough" to warrant calling a helicopter to transport a patient to a tertiary care center? What matrix is used to determine if the time saved is worth the safety risk, not to mention the extra cost?

Too many lives have been lost. It's past time to have that discussion.


Anonymous said...

Money quote:

"What is missing from most medical air transport systems, said Slack, is triage, a process for determining proper medical response according to the condition of the patient."

Bob said...

I have a question as opposed to a comment...

In the last two medevac accidents in the US it appears that a cause of both was controlled flight into terrain at night. Of significant discussion has been the availability of night vision goggles for flight crews. See this from today, for example:


I am a fixed wing pilot and spend most of my time close to the ground near airports. I realize that in the case of your operations you need to be near the ground near hospitals, scene flights, and airports / heliports. Why is it, then, that I frequently witness medevac helicopters operating at very low levels in cruise? I frequently see life flight near me flying over my house at levels I would never consider in a fixed wing (I do not live near a hospital or airport and I'm certain we don't have daily scene flights near my house). Is there some aerodynamic or efficiency reason for low level flights in helicopters? If not, what is the purpose for flying so low (speed??).

Thanks for your response!!


Anonymous said...

Does the acuity of the patient actually matter? The risk of an "event" seems independent of patient condition. Reducing the number of missions by weeding out the "milk runs" will only serve to reduce the raw number of incidents not the number of incidents per hours of flight (rate).

Why not mandate the tools (equipment, dual-pilot, proper training) needed to do the job safely, prohibit high risk flights (night, marginal weather, inoperative instruments), and empower every member of the team to just say no without fear of retribution from their superiors.

I understand that originally a slightly different question was being asked, specifically, when is a patient “sick enough” to warrant the increased risk of mortality associated with air transport compared to ground or remaining at the requesting facility. However, the follow-on comment suggests that the larger issue is reducing the number of fatalities associated with air medical transport. Fixing this problem requires an overhaul of the industry and its culture, not attempts to argue that patients aren’t sick enough for aeromedical transport.

Greybeard said...

One of the reasons helicopters fly so low is to avoid airplanes. Helicopters can safely operate at a lower altitude than fixed wingers because we can do a forced landing onto a city street or into an empty football field, baseball diamond, or empty spot in a parking lot. There IS also the factor that most of our flights are very short... less than 30 minutes from A to B, and it doesn't make a lot of sense to waste airspeed climbing with a patient that needs the extra seconds when your stages are so short.
Do some operators fly lower than prudent? Probably.
I normally operate in the 1,000 AGL range during daylight hours, and at 1500-2000 feet at night for noise abatement. If there is a great tailwind I'll go higher.

The NVG issue is all the rage right now, but it's a red herring. There are programs that are made much safer with them... those programs working the mountainous areas where there is little or no ambient light. Most of those programs are procuring the googles as quickly as they can, competing against military needs. Our program operates in a relatively flat area where, for the most part, there are small towns every 50 miles or so. We are restricted to "more than 5 miles visibility" for our night cross country flights, so there normally are at least SOME lights out there to keep you oriented. I am not at all concerned about taking off on a flight without help from NVG's, and in fact know there are problems caused by the googles themselves. I really don't think the safety of our operation will be helped that much by the use of googles, but we WILL get them at some point in the future. (I'll be retired by then!)

We can stop virtually all these accidents by doing a couple simple things...
1. Educate pilots to turn down flights when weather is questionable.
2. Do more "inadvertent IMC" training so that those who are stupid enough to get themselves in trouble know how to keep the aircraft upright, then either find VFR conditions or shoot an instrument approach where possible.
NVG's at what, $10,000 per unit(?), are an expensive solution to a problem that could, for the most part, be remedied with common sense.

Your point is well taken. We will fly a patient that is seemingly unhurt if there is a fatality in the same accident, simply because the forces involved mean there are possible internal injuries worth checking.
But consider this:
I once flew a lady with back pain due to a urinary tract infection 150 miles to a State-supported medical facility, (she was uninsured!), because the Doctor didn't want her suffering the discomfort a 3 hour ambulance ride would have inflicted. State taxpayers picked up the tab on part of that flight... my company ate the rest!
(Wanta talk about how terribly the uninsured are treated in the U.S.? Don't get me started!)