By Kory L. Sandoz
“625 to base. We have arrived. We have a rollover with ejection and multiple patients. Please start us a helicopter.”
Should an air ambulance be dispatched? That depends. Although not mutually exclusive, the decision to fly is not the same as the decision for medical care required.
Many regional and logistical flight factors come into play. A patient with major burns from a campfire may require helicopter or fixed-wing evacuation from a remote wilderness area, while ground transport may be the better option for a patient experiencing cardiac arrest near a level-one trauma center.
In this case—the traffic accident—on-scene trauma demands immediate care. The air medical dispatcher must determine the availability of the closest and most appropriate air medical unit necessary.
The unit selected is dispatched and the crew alerted. The aircraft is pulled out of the hangar and inspected, and a flight plan is filed for Visual Flight Rules (VFR) or Instrument Flight Rules (IFR).
Several factors influence the pilot’s decision.
The pilot must consider the safety of the trip along the entire route. Low visibility, thunderstorms, heavy rain, icing, heavy snow, fog, and extreme wind or temperatures can affect the safety of a flight.
Duty time must be noted. The Federal Aviation Administration (FAA) rules restrict the amount of time that a pilot can be on duty. Indications of mechanical problems can’t be ignored. A flashing warning light (the aircraft equivalent of a check engine light) grounds the unit until the issue is resolved. Also, temporary flight restrictions, issued by the FAA, require special permission to enter the area.
Systems are go
Once committing to the flight, the crew takes the helicopter to the scene to check surroundings and ground conditions.
As the unit gets closer to its destination, a first responder onboard describes the landing zone, including information about its shape, size, slope, and surface. Ideally, the area is firm and level, and at least 100 feet long and 100 feet wide. The approach and departure paths must be clear of wires, trees, antennas, poles, cranes, towers, and other obstructions. A night landing requires fixed lighting at the perimeter. The landing area should be at least 100 feet from the patient.
Mile markers, billboards, and other roadway signage are not helpful since visibility from the air is negligible. If ground markers are the only reference points available, the dispatcher will convert the location to GPS coordinates, preferably in degrees, minutes, and seconds rather than decimal degree coordinates. A hazardous situation developing in proximity of the landing area might force the pilot to abort the flight or go around the area until the situation is resolved.
Scene landing
The helicopter presents its own hazards. Access is restricted. First responders already on-scene stay back at least 100 feet until the aircraft lands, and bystanders are directed to keep a distance of at least 200 feet.
Approach is from the sides or front of the aircraft in full view of the pilot; no one approaches the aircraft without crew escort. A crewmember is assigned to prevent injury from the tail rotor, and medics carry equipment in a crouching position with nothing held overhead. Only the air medical crew can direct the loading and unloading of patients.
Patient delivery
Air ambulance medical crewmembers determine the facility best suited for treating the patient. The closest hospital would be bypassed if not staffed and equipped for a patient with severe trauma. The patient would be taken directly to the trauma center.
The helipad must be cleared of debris prior to landing, must be free of ice and snow, and lights should be aimed away from the helicopter.
The patient is delivered, the crew disembarks, and reports are filed. They wait for the next call to come in.
