When to call for a helicopter? [Archive] - Glock Talk

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bkflyer
03-07-2008, 14:40
When do you guys call for a helicopter? What makes you call a particular one? What could the air EMS do better for YOU?

RyanNREMTP
03-07-2008, 14:58
When calling for the nearest helicopter, I take into consideration of what they can provide that I cannot. Usually I only call for them: if they can get the patient to the hospital faster than I could, if they have better drugs than I do.

Faster transport means from the time I need to launch them to the time I can deliver a patient to the ER which is faster. I've seen crews launch a bird and just transport via ground with the helicopter crew riding in.

Luckily we don't use air transport much here since we can get a patient to the ER faster than waiting for the bird.

great, I just probably jinxed myself.

bkflyer
03-07-2008, 15:01
Thanks. Sometimes it seems like a war zone out here. You just wonder when you see the competition fly over going to a scene. You KNOW it took them at LEAST 15 min longer!

lthrbound
03-07-2008, 17:58
heavy traffic, extended extrication, and multipe critical patients. Those are the three big ones that I consider. Other than that its mine.

mtncat
03-07-2008, 19:38
Like already posted but we are in a remote are and handle calls in even more remote areas so you can toss in any back country rescue that is more then simple stuff, rock rescues, ATV wrecks. etc.
Had a compound fracture a year or so back WAY out in the sticks, in a rain/snow storm.
Took 4X4's and ATV's to get to the patient. Local "normal" bird refused to land in the postage stamp sized LZ.
Had to bring in a MAST chopper, they brought it in dark, using NVG's
Pretty impressive stuff.

swatmed4
03-07-2008, 20:09
heavy traffic, extended extrication, and multipe critical patients. Those are the three big ones that I consider. Other than that its mine.

I would also consider the distance to the nearest level I trauma unit. And our service we can do chest tubes in the field, so if you have a tension pneumo. we can fix that.

huskerbuttons
03-07-2008, 20:11
IF the extrication is 30 minutes or more. If our transport time is over 30 minutes to the nearappropriate medical facility. Or if we have newbie who freaks out when they arrive on a scene before an experienced person gets there.:supergrin:

volsbear
03-07-2008, 20:22
My brother is a pilot for one of these services. I'll have to ask him what his crew can do that typical EMS can't. I know most of his calls are to rural areas.

lthrbound
03-08-2008, 10:20
I would also consider the distance to the nearest level I trauma unit. And our service we can do chest tubes in the field, so if you have a tension pneumo. we can fix that.

In any part of my companies district we are never more than I'd say 20 to 25 mi. from 2 level I trauma centers, and thats from the farthest parts. Not to mention major highways funnel all sides of the districts right to them. The only time I have had an actual landing, PD called in a chopper before we were there. Which was way more of a headache than anything.

No chest tubes here, just needles.

backwoods113
03-08-2008, 12:16
I'm a new volunteer for a fairly rural paid/vol. county department just outside of a large metro area. Helicopter landings are relatively common for us (1-2 per week). There has been a recent memo sent out about when we can call for a helicopter or not. Used to, we would get a helicopter on standby just from hearing the mechanism of injury (ejection, motorcycle wreck, heavy entrapment, etc.). This was before any apparatus arrived on scene. I personally dont see any problem with this since patient care should be our #1 priority besides our own safety. But i guess you could say that some personnel got a little over anxious with putting helicopters on standby and to address the issue we were advised not to even think about a helicopter until an engine or ambulance went on scene. Makes sense I guess :dunno:

emtp2rn
03-08-2008, 22:22
From our local protocol: http://www.kcems.org/protocols.htm

These guidelines are offered as examples of patients who might benefit from helicopter transport. Additional considerations would include the physical exam, additional contributing factors such as age, mechanism of injury and the level of care available in the area.
A. Trauma Patients
1. Priority I patient
a. Long transport times
b. Poor road conditions
c. Entrapment with prolonged extrication
2. MCI
B. Medical Patients
1. Priority I- in rare circumstances if in the estimation of paramedic that the use of helicopter resources would be beneficial to patient outcome.

As to who can put them on standby:

Placement of Helicopter Resources on Standby Status
A. Standby Status
1. Public Safety Agencies may place the helicopter on Standby.
2. Place the helicopter resources on standby status as soon as the possibility that helicopter resources will be needed is determined.

Who can request service:

Request for Service
A. Request helicopter resources to be placed into service.
1. Non-ALS First Responder/Public Safety Agencies and/or responding ALS agencies may activate the helicopter service.


Who can cancel the request:

Cancellation
A. A helicopter resources request initiated by a BLS or Public Safety Agency can be canceled by the responding ALS agency only after an appropriate patient assessment has been conducted.
B. A helicopter request initiated by an ALS agency may be canceled only by the agency initiating the request.
C. If Aero Med cancels a flight, the pilot/flight team or Flight Com will contact the requesting ALS agency to notify of cancellation.
D. Aero Med Flight Physician may elect to send patient by ground.

lvfcfirefighter
03-08-2008, 23:10
From our local protocol: http://www.kcems.org/protocols.htm

These guidelines are offered as examples of patients who might benefit from helicopter transport. Additional considerations would include the physical exam, additional contributing factors such as age, mechanism of injury and the level of care available in the area.
A. Trauma Patients
1. Priority I patient
a. Long transport times
b. Poor road conditions
c. Entrapment with prolonged extrication
2. MCI
B. Medical Patients
1. Priority I- in rare circumstances if in the estimation of paramedic that the use of helicopter resources would be beneficial to patient outcome.

As to who can put them on standby:

Placement of Helicopter Resources on Standby Status
A. Standby Status
1. Public Safety Agencies may place the helicopter on Standby.
2. Place the helicopter resources on standby status as soon as the possibility that helicopter resources will be needed is determined.

Who can request service:

Request for Service
A. Request helicopter resources to be placed into service.
1. Non-ALS First Responder/Public Safety Agencies and/or responding ALS agencies may activate the helicopter service.


Who can cancel the request:

Cancellation
A. A helicopter resources request initiated by a BLS or Public Safety Agency can be canceled by the responding ALS agency only after an appropriate patient assessment has been conducted.
B. A helicopter request initiated by an ALS agency may be canceled only by the agency initiating the request.
C. If Aero Med cancels a flight, the pilot/flight team or Flight Com will contact the requesting ALS agency to notify of cancellation.
D. Aero Med Flight Physician may elect to send patient by ground.



I have been lurking around this thread for a little while. Because I work in the flight industry, I decided I would sit back and see what the responses would be. I would like to say that there have been some good responses and I wish more medics from my area would read this. One that makes me laugh though is the one I have highlighed in bold above. Believe me, if you cant drive on the roads, we cant fly! :rofl:

bkflyer
03-09-2008, 07:07
Why do you put an aircraft on stand-by? I know we would MUCH rather be launched and aborted than sit on stand-by for 10-15 min. I know some of your protocals may make you do this but can you change them? If we get aborted, nobody pays. We got to go fly and it's a good day:) As far as we can't fly if the roads are bad, yes and no. This last snowstorm is a perfect example. The snow stopped and we have 9" of snow...... For the most part though you are correct. If you EMS guys could run the flight program what would you change?

gruntmedik
03-09-2008, 11:11
Our protocol a for stand-by request is to launch, unless the scene is within 15 miles of the base, unless we are specifically requested to not launch.

Like bkflyer said, I would much rather be requested, then cancelled, than to wait and be requested once the on scene crew makes an assessment. You now have that much more time cutting into the Golden Hour.

4095fanatic
03-09-2008, 11:55
In a nutshell (and our shock trauma center is 20-40 minutes away by ground, depending on response area):

If transport will be expidited by more than 15 minutes, consider a helicopter.

All Class A trauma patients get flown.

Maryland State Police can have a helicopter anywhere in the state in 15 minutes, and transport time of another 5-10, so usually if you're more than 30 minutes drive time to the hospital, makes sense to call for the chopper. Get on scene, find a Priority 1, call for the chopper... patient will be mostly packaged and ready to go by the time the helo touches down.

Tvov
03-09-2008, 14:00
Believe me, if you cant drive on the roads, we cant fly! :rofl:

I was kind of thinking about the incident being out in the wilderness, or something similar. An hours rough dirt road driving may only be 15 minutes of smooth flying.

medic1213
03-09-2008, 17:27
Faster transport means from the time I need to launch them to the time I can deliver a patient to the ER which is faster. ....

Luckily we don't use air transport much here since we can get a patient to the ER faster than waiting for the bird.

But is the ED you're transporting to a Level 1 trauma center, or just a local bandaid station? Waiting a few extra minutes on a bird that can have the patient at a trauma center within the golden hour beats saving those 15 minutes and transporting locally to a facility that is not equipped to fully manage the patient's injuries. Now, if your local ED is a true trauma center, then yes, you should transport by ground if you can get them there quicker.

medic1213
03-09-2008, 17:30
Believe me, if you cant drive on the roads, we cant fly! :rofl:


Poor road conditions can last long after the storm has gone, and the skies are blue. Another poor road condition could be a logger injured a couple miles down a rough logging road.

medic1213
03-09-2008, 17:35
Why do you put an aircraft on stand-by? I know we would MUCH rather be launched and aborted than sit on stand-by for 10-15 min. I know some of your protocals may make you do this but can you change them? If we get aborted, nobody pays. We got to go fly and it's a good day:)

But unless you're government subsidized, somebody has to pay for all that fuel burned. Sure, it's a fun flight, but it's an expensive one too. Again, not a big deal if you're bills are paid by the government, but for a private helicopter EMS provider, those call us and cancel us runs can really hurt if they're frequent.

D25
03-09-2008, 19:59
Why do you put an aircraft on stand-by? I know we would MUCH rather be launched and aborted than sit on stand-by for 10-15 min. I know some of your protocals may make you do this but can you change them? If we get aborted, nobody pays. We got to go fly and it's a good day:) As far as we can't fly if the roads are bad, yes and no. This last snowstorm is a perfect example. The snow stopped and we have 9" of snow...... For the most part though you are correct. If you EMS guys could run the flight program what would you change?

If we have to use the FLIR equipped helo and cancle it, it is a $700 tab. No cost for our non-FLIR in-house stuff.

lvfcfirefighter
03-09-2008, 20:15
I was kind of thinking about the incident being out in the wilderness, or something similar. An hours rough dirt road driving may only be 15 minutes of smooth flying.

This is true, I wasnt thinking too much about that. We dont have too many instances of this in our area but it could happen. I can see in this situation how it could help to call an aircraft with a critical patient.

Poor road conditions can last long after the storm has gone, and the skies are blue. Another poor road condition could be a logger injured a couple miles down a rough logging road.

If the skies are blue, can I assume the sun is out? The snow is melting? The plow trucks are out? Where I live, the plow trucks are out well before the storm is done. Maybe its different where u live?

But unless you're government subsidized, somebody has to pay for all that fuel burned. Sure, it's a fun flight, but it's an expensive one too. Again, not a big deal if you're bills are paid by the government, but for a private helicopter EMS provider, those call us and cancel us runs can really hurt if they're frequent.

This is very true.



Now this is the reason I really didnt want to post in the first place. For some reason, medics get so offensive about this subject. Call the bird or not, I dont care. Your the one on the scene, not me. I dont know what was going through your head or what the conditions are. If your unsure of whether you need a bird or not, consult a doc. Just remember that patient care is #1 and I hope that if u call the bird that they really need it because its an additional $9,000 bill that you just gave them

medic1213
03-09-2008, 20:27
If the skies are blue, can I assume the sun is out? The snow is melting? The plow trucks are out? Where I live, the plow trucks are out well before the storm is done. Maybe its different where u live?

Just because the plows are out doesn't mean the road conditions are good yet. Besides, the "blue skies" part was not necessarily meant to be literal. I think we've all seen a winter storm dump a lot of ice and muck, and after it passes through, the visibility is well within VFR flight protocols. That's what I was implying.

Now this is the reason I really didnt want to post in the first place. For some reason, medics get so offensive about this subject.

Not sure what I, or anybody else has said that you could take as getting offensive about the subject. I merely stated that calling and cancelling the bird can get expensive. Many folks where I live have had the habit of calling the bird before ever arriving on scene, just because it 'sounded bad' over the radio. That is, the people calling 911 say it looks bad, this gets relayed to the responding units in one way or another, and somebody jumps the gun and calls for a bird, many times where it is not warranted. This is where it becomes a waste of resources. There will come a time where your service takes a close look at operating costs, and some bean counter in an office looks at ways to cut these costs. Trust me, when they start looking at ways to cut costs, patient care does not stand in their way. Ask me how I know.

backwoods113
03-09-2008, 23:16
Many folks where I live have had the habit of calling the bird before ever arriving on scene, just because it 'sounded bad' over the radio. That is, the people calling 911 say it looks bad, this gets relayed to the responding units in one way or another, and somebody jumps the gun and calls for a bird, many times where it is not warranted. This is where it becomes a waste of resources. There will come a time where your service takes a close look at operating costs, and some bean counter in an office looks at ways to cut these costs. Trust me, when they start looking at ways to cut costs, patient care does not stand in their way. Ask me how I know.

+1 this is EXACTLY what happened with our fire department and local ems air service. As I stated above, we cant even think about putting a helicopter on even standby until an apparatus arrives on scene.

lvfcfirefighter
03-10-2008, 11:54
[QUOTE=medic1213;10050148]Just because the plows are out doesn't mean the road conditions are good yet. Besides, the "blue skies" part was not necessarily meant to be literal. I think we've all seen a winter storm dump a lot of ice and muck, and after it passes through, the visibility is well within VFR flight protocols. That's what I was implying.[QUOTE]

I guess it could happen. Maybe I haven’t been in long enough to see this scenario.

Ive seen it happen IFR...... :dunno: The only problem with this is that the pilot must file with the FAA and that takes a while, then we must fly into an airport. Not allowed into a scene IFR.

lvfcfirefighter
03-10-2008, 12:05
When do you guys call for a helicopter? What makes you call a particular one? What could the air EMS do better for YOU?

I feel like we may be getting off topic. Like I said before, I don’t know what’s happening at the time of the incident. Only the medic on scene can make the decision! No point in arguing about weather. :rofl:

Now, lets get on topic and talk about when YOU would call an aircraft and why!

emtp2rn
03-10-2008, 12:13
Why do you put an aircraft on stand-by? I know we would MUCH rather be launched and aborted than sit on stand-by for 10-15 min. I know some of your protocals may make you do this but can you change them? If we get aborted, nobody pays. We got to go fly and it's a good day:) As far as we can't fly if the roads are bad, yes and no. This last snowstorm is a perfect example. The snow stopped and we have 9" of snow...... For the most part though you are correct. If you EMS guys could run the flight program what would you change?

I think in our area it is a two part issue on why we use standby versus an immediate launch.

First, our helicopters are hangered so this gives the ground crew enough time to open the hanger, and pull the bird out. In addition our service only does cold loading and unloading so that adds additional time to the startup and shut down procedure to get the crew on board before startup.

Also like someone else mentioned our bird is run by a private hospital and someone has to pay for the JP5.

RyanNREMTP
03-10-2008, 12:19
But is the ED you're transporting to a Level 1 trauma center, or just a local bandaid station? Waiting a few extra minutes on a bird that can have the patient at a trauma center within the golden hour beats saving those 15 minutes and transporting locally to a facility that is not equipped to fully manage the patient's injuries. Now, if your local ED is a true trauma center, then yes, you should transport by ground if you can get them there quicker.


Our local trauma center is Level 2 and the other hospital can take level 3 or level 4 trauma. The nearest level one is 45 minutes away and per protocol by our agency and by the state, patients first have to be flown to our local first and then if needed stabilized and taken to level ones in either Dallas or Temple. The level one that is 45 minutes away is in another RAC.

bkflyer
03-10-2008, 15:22
I am REALLY sorry the FLIR a/c charges 700 for a canceled flight. I guess that's the way stand alone programs do things. We are a hosp based program and we do not charge anyone if we don't transport. Just a question, how does this flir a/c get paid when they go on the scene and the person has no insurance? Another question, why do they use flir in ems?

medic1213
03-10-2008, 16:42
Another question, why do they use flir in ems?

That was my first thought as well. Are we talking search and rescues, or strict EMS calls? I can see it being used for search and rescue, but not routine EMS runs. I can also see a bill being sent out if it's called to a search and canceled.

DaleGribble
03-10-2008, 17:47
I can offer some perspective on the whole standby issue. Our protocols state we can put a bird on standby based on dispatch information but we can not call for a bird to fly until a first responder or EMT is on scene to verify the actual need for a bird. So if dispatch tells me a patient is entrapped and unconscious with four limbs amputated and a tree branch hanging out of the guys ass I can't call for a bird until I actually arrive on scene and see all four amputated limbs and a tree branch sticking out of the guys ass! :upeyes:

Besides that, we have some hard headed idiots that think they don't need a bird and get a pt to the hospital just as quickly as a helicopter can even though we have a minimum of a 30 minute ground transport time to the nearest Level 1 trauma center!

RyanNREMTP
03-10-2008, 18:28
I am REALLY sorry the FLIR a/c charges 700 for a canceled flight. I guess that's the way stand alone programs do things. We are a hosp based program and we do not charge anyone if we don't transport. Just a question, how does this flir a/c get paid when they go on the scene and the person has no insurance? Another question, why do they use flir in ems?

FLIR can come in handy when trying to locate a LZ in the dark before anyone has set up lights, flares or a LZ kit.

D25
03-10-2008, 19:33
Why do you put an aircraft on stand-by?

I am REALLY sorry the FLIR a/c charges 700 for a canceled flight.

I'm REALLY relieved that you're so sorry, but you asked the question to begin with.:upeyes:

D25
03-10-2008, 19:46
That was my first thought as well. Are we talking search and rescues, or strict EMS calls? I can see it being used for search and rescue, but not routine EMS runs. I can also see a bill being sent out if it's called to a search and canceled.

Here, in both EMS and SAR, we have criteria, both geographic and weather related, that dictate which of 3 helos we call for. I don't really understand the rationalle behind it.

jtull7
03-10-2008, 19:56
In the wilderness of Northern New Mexico, our SAR protocol is that only if the subject's life is in danger, do we call the helos. If it is, we have the NM State Police , the National Guard Blackhawks, the Air Force HH-53's, our commercial rescue helos, and the Border Patrol. We are quite lucky to have such substantial air support in our state.

HarleyArcher
03-27-2008, 18:17
You have to weigh your options and look at your geographical settings. Lots of good points already. 1. Can you get them safely by ground quicker as apose to air. 2. Most maybe not all helos carry more advanced drugs, porcedures and blood. You have to concider that also. I do agree with the no stand-by thing. Just launch them and disregard them if not needed. It is always a judement call, just make the call and stick to it. By the way I am a ground Paramedic for 15 yrs. and I have been a Flight Paramedic (full and part-time)for 3 yrs. Bryan