One of the coolest parts in EMS in my opinion...

[azemt2007]

when I worked in the greater phoenix area, helos were way over-utilized. Even in rush hour traffic, I could usually beat a helo to the hospital running code 3. There is always the argument that running code 3 is more dangerous and potentially more expensive if causing an accident than just flying the patient. In the end, it's really based upon the severity of the patient. If that patient is going to expire if it takes just one more minute to go via ground, then the medic stating that as his reasons should buy a crystal ball. flights aren't cheap. in my area, they cost $17,000 to the patient or insurance just to transport...more if the flight medic/rn touches them. So we need to be more aware of what we are doing to our patients, during and after the call.

[Kiwiology]

1. Do you take a PT if they are still recieving CPR? They said something about it but i couldn't hear them.

For primary cardiac arrest no, for a secondary cardiac arrest where a clearly reversable cause is discovered very, very early in the resuscitation attempt then yes there may be a place for transporting a patient with CPR

2. They said something about pushing for transporting stroke PT's?

For ischaemic strokes there is a window where "clot busting" drugs can be given and it's about three hours from onset of symptoms

[Bernhard]

Here:

1. CPR will be continued (or stopped) on ground. However, CPR is possible in air, so if started there, it will be continued in air.
   
2. Fast transport over large distance is one of the main advantages of an helicopter. If that's needed for a stroke patient, it's a perfect solution if an helicopter would be available.
   

HEMS has it's pros and cons, just as everything in EMS, and one has to know them to use the "tool" appropriate. "Coolness" is not included in fact based decisions.

Medical conditions for fast transport are known: hemodynamic instable/suspected inner bleedings, perforating thorax/abdominal injuries, not controllable respiratory insufficiency, (increasing) inter-cranial pressure, severe hypothermia. In those cases one should consider HEMS. But don't underestimate the time-to-scene (especially if demanded later in the call), preparation of landing zone (night?) and time for handing over the patient - it may be that ground transport even beats this.

Some tactical indications would be:

• another unit for on-scene care and transport
  
• fast on-scene time, especially in remote or off-road settings
  
• fast transport of specialised staff/equipment (for example, we have the opportunity to get pediatric staff here quick by HEMS)
  
• ability to access a scene from birds view (not only getting information but may add another option: our next HEMS service includes mountain rescue by winch, this already helped recovering patients from deep in the woods)
  

Again, "coolness" is not included. Know your tools!

Edited November 1, 2011 by Bernhard