Flight Medics/RNs

[flight-lp]

Do they have a set of guidelines they follow, as far as criteria for what they will transport by air? What sort of injuries.

I notice with the two services we deal with there are some differences? As far as if the pt is stable/unstable, some will come for hand amputations, others it has to be above the elbow. Severe head injuries some want them trasported to the closest facility, and they will meet you there. Others will come right to the scene. Just seems a little vague. This is what recieve, but it seems its at the crews discresion.

Commonwealth of Massachusetts

Statewide Trauma Triage Guidelines for Air Medical Services

Operational Conditions

1. When a patient meets the patient criteria defined below and scene arrival time to established arrival time at the nearest appropriate hospital, including extrication time, exceeds 20 minutes.

2. Patient location, weather or road conditions preclude the use of standard ground ambulance or

3. Multiple casualties/patients are present which will exceed the capabilities of local hospital and agencies.

Patient Conditions

Physiological criteria:

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Unstable vital signs

- Blood pressure less than 90

- Respiratory Rate greater than 30 or less than 10

Anatomical criteria:

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Evidence of spinal cord injury including paralysis or Parasthesia.

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Severe Blunt trauma

- head injury (Glascow Coma Scale < 12 )

- severe chest or abdominal injury

- severe pelvic injuries excluding simple hip fractures

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Burns

- greater than 20 % body surface area (BSA) second and third degree burns

- evidence of airway or facial burns

- circumferential extremity burns

- burns associated with trauma

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Penetrating injuries of the head, neck, chest abdomen, or groin

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Amputations of extremities excluding digits

Special Conditions

The following should be considered in deciding whether to request air medical transport, but are not automatic or absolute criteria.

Mechanism of Injury:

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Motor Vehicle Crash

- High speed MVC

- Prolonged extrication > 20 minutes

- Fatality within the same vehicle

- Ejection from vehicle

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Pedestrian struck by vehicle and thrown more than 15 feet, or run

over by a vehicle.

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Significant medical history

- Age greater than 55 or less than 10

- Significant coexistent illness

- Pregnancy

What are the optimal flying conditions? (weather related)

Weather minimums for my service are:

Day local - 500ft. 2 miles

Night local - 600ft. 4 miles

Day x-country - 800ft. 4 miles

Night x-country - 1000ft. 6 miles

Decision for utilization of an aircraft should be the sole discretion of the EMS crew, not some beaurucratic type sitting in an office. I hate it when people try to define a presentation that must be present in your patient before you can call us. Your description given above is great and all, but it seems the state has clearly forgot an important aspect of rapid air transport; the MEDICAL patient. MI's, AAA's, CVA's, severe septic or cardiogenic shock, etc., etc. These patients need to be flown if your local ER does not have the capabilities to offer definitive care. Notice the term "definitive care" instead of "stabilization". All to often EMS agencies transport patients to the local ER to get "stabilized". In actuallity, all that is occuring is a delay in definitive care. Does your local ER have a cath lab? If not, ALL of your STEMI MI's should go to another facility, one that has the lab available. Same goes for strokes. No neurosurgery available? Then do not stop, keep going to a stroke center, pass go, and collect your $200. As said before, do no harm.......Get 'em where they need to go the first time around.........