When to fly?

[CaptBP]

What scenes have you all been on in which you have made the decision to fly that patient out?

[Timmy]

Well it really depends, every situation is different so I’d say it’s up to your gut feeling and training to kick in and make a decision. Saying that you’ve got the golden hour to take into consideration with trauma patients. Just do what you think best for the patient. If in doubt fly them out.

[strippel]

That is something that is specific to every patient, call, location, and system protocol.

At my full time, except for one area, we wouldn't consider a flight. Most of our district is in sight of, or less that 15 minutes by ground to a level II center. If the patient were a child, it is only a short helicopter ride to 3 pediatric trauma centers. The ride by ground is too long.

At my part time, we used to fly almost all "trauma" patients. Not anymore, we now have a level II center nearby. It takes much less time to drive them than to fly.

[SSG G-man]

Being in MD we have a great medevac system. Our state protocols list several categories of injuries which are to be used to start the process of should I fly the patient. To CYA, most will fly just about anyone who meets one of the categories. The nearest Trauma Center is close to an hour by ground, but we can get a patient to a local trauma center or Baltimore Shock Trauma in a relatively short period of time.

So I fly pts out when they meet the protocol category and I think they warrant it.

Sarge

[NREMT-Basic]

In Illinois, we also have protocols for which patients get to take to the skies. Some of them are full thickness/eschar burns over a certain percentage of the body, amputations, falls from greater that 20 feet and extrications which take longer than 20 minutes. Usually we will talk to the fire captain at about 12 minutes in (and yes I carry a stopwatch which starts at the first cut) and find out if hes almost got them out and if he says its going to be awhile yet, the bird goes aloft. Our mantra out here is "we can always turn them around." We have the availability of 3 dedicated med-evac bk-117s and the State Police helo if needed. So I agree..when in doubt.... Also we have sort of established an unwritten rule that if a patient has resps and pulse but is non-responsive and must be extricated, we get the helo in the air immediate and set up and LZ. We are fortuate that we have several great pilots that will really attempt to put that thing down just about any place the rotors will clear...high school and mall parking lots, cornfields and, when necessary, in the middle of the interstate. The other thing out my way is that we have three major hospitals within a few miles of each other and then nothing for quite a ways. So if the patient is 45 miles away from the city, hes gonna come in by helo. I think of the fellow that got drunk at the wake after a funeral and fell on the ice and whacked his head on the bumper of his car...in the middle of nowhere...so he got a nice ride...of course he panicked up there so he got paralyzed and tubed.

[Dustdevil]

The most consistent justification I find for flying my patients is that of safety.

It seems that, around here at least, there is a much lesser chance that a medevac bird will get shot down than that of me getting blown to smithereens by an IED on the way to the hospital by ground.

This illustrates, as Dr. Bledsoe so eloquently noted in another discussion, that engress and egress access issues are really the only consistently righteous justifications for helicopter transportation.

[Cookie]

Since we are at least 50 miles from the nearest Trauma Center, it will greatly depend on the situation. We fly severe trauma, weather cooperating.

Most recent I was involved in was a cowboy who had about 1500 lbs of pissed off bronc come down on his chest, head and shoulder. He was flown.

One that should have flown but helos were grounded due to weather was a kid who was ejected thru the sun roof of a vehicle. He was transported to the hospital then taken by Critical Care Unit to the trauma center with a Dr. and paramedics on board.

Depends on the situation and the medic on scene and the weather.

[Just Plain Ruff]

the two places I've mainly worked at, we have 40-50 minutes of fast driving time to a trauma center. If a call comes in that sounds remotely bad then we will launch the bird. You can always turn em around.

Trauma and peds got flown out a lot, most others we took to the er (local 106 bed hospital 12 bed ER) and stabilized and then either flew or transported.

when I first started, we never flew anyone out, the medical director said all patients come to the er and then flown. He was a old time doc who was one of the first ATLS physicians educator in missouri so he thought he could heal them all.

[Chief1C]

I fly someone if they need a specialty hospital or a trauma center.. two things we don't have unless it's okay to transport 90 or 120 minutes by ground. The Pedi Trauma Center is 2 hours away, and the Level 1 Trauma Center is over an hour and twenty minutes by ground.. If they have an extended ETA, I won't wait.. We often land chopped between us and the nearest hospital. I won't sit and wait longer than it would take to go to the closest ER.

[mrt2113]

In my service we don't fly much because our ER is five minutes or so away at any time. And we have two level 1 trauma centers about 20 mins away when I'm driving and a level 2 about 10 or so. We have had to fly peds out though because the ped center is a good 45 mins from here.