The Medevac Helicopter A Vital EMS Resource
“Air Rescue One, the patient is ready for transport.”
“Roger. Notify the hospital that our ETA is eight minutes.”
As providers of emergency medical service (EMS), we in the fire service are obligated, in the interest of patient care, to utilize all necessary resources at an incident scene. With over 150 dedicated EMS helicopters in service around the country, many fire departments and other public agencies now have access to an additional resource, the “air ambulance.”
Since the Korean War, the helicopter has provided safe, rapid transportation for the sick and injured. In recent years, the helicopter has evolved into a sophisticated airborne ambulance. Properly trained and equipped, helicopter crew members have the capability to administer definitive medical care both on the scene and en route to a treatment facility.
Medical studies indicate a significant improvement in survival rates of accident victims when patients arrive at an appropriate treatment center within one hour of incurring injury. This critical time is referred to as the golden hour, and it’s for this reason that those departments involved in trauma center programs are frequently required to provide patient transportation from the incident to the designated hospital in a specified period of time. By utilizing the EMS helicopter, this time criterion is satisfied, and the air ambulance provides the speed, range, and comfort that is unattainable by ground transportation.
When pre-planning any incident, we should mentally catalogue our available resources. An inquiry to area hospitals, public agencies, and military facilities will determine if any EMS helicopter services are available. Hospitals operate the majority of medevac helicopters; fire departments, law enforcement agencies, and the military comprise the balance of airborne EMS providers. Their services range from basic “scoop and run” to a fully equipped, paramedic level ambulance staffed by a physician and a nurse. The larger helicopters may have rescue teams and hoist or rappelling capabilities for high-rise, water, and remote area incidents.
Photos by Rick McClure
Once contacted, most EMS operators are delighted to demonstrate their capabilities and participate in a training and safety session. This session also allows department members to ask any questions and discuss any operational limitations of the helicopter.
Communications are a vital part of any incident. Most EMS helicopters have the ability to transmit and receive on a broad range of fire department frequencies. If direct two-way communication is not possible, then all communications must be relayed through the respective dispatch centers. While this method is functional, it may contribute to some confusion at the scene.
Consider the distance from the helicopter base to the incident. An average speed for the helicopter is about 125 miles per hour. Once the need for an air evacuation is established, the helicopter should immediately be dispatched. By doing this, transportation delays are kept to a minimum.
The landing site must be selected prior to the arrival of the helicopter. A level area, 75 feet X 75 feet, is sufficient for most aircraft. Ideally, it will be free of obstructions such as tall trees and power poles. Be observant for wires that cross the approach and departure path of the helicopter.
Helicopters typically draw a crowd. To avoid the possibility of people walking or driving into the helicopter, personnel should be strategically placed around the landing site. There was an instance of a press photographer who was tackled by a firefighter just a few steps away from the tail rotor of a running helicopter. This example demonstrates spectator preoccupation with the incident.
Safety personnel must be alert at all times to the hazards of an operating helicopter. If room permits, such as a street or freeway incident, apparatus may be placed at a safe distance on both sides of the landing area. Law enforcement personnel may also assist in securing the landing area perimeter. If sufficient manpower is a problem, use a lifeline to cordon off the landing area. Personnel should remain to one side of the approach and departure path during takeoff and landing. Remember that the pilot will usually land and take off into the wind.
Landing area precautions should include a charged hose line and a dry chemical or CO; extinguisher. The hose line (two or three sections of 1 1/2-inch hose with a variable pattern nozzle is fine) may be used to wet down a dirt or grassy landing area. This minimizes the dust and debris in the air, which could harm the patient or reduce the visibility of the pilot.
The pilot has the best vantage point for evaluating the landing area. Occasionally, he will select a landing site other than the one chosen. If so, be guided by his instructions, as he probably sees a hazard or a potential problem at the original site that is not readily apparent from the ground. By law, the pilot is responsible for the safe operation of the aircraft. Therefore, he will make the final decision regarding the landing site.
During night operations, do not shine any lights at the helicopter as this damages the pilot’s night vision. Flares may be used to outline the landing area. However, due to the helicopter downwash, flares will roll away during landing. Large beam flashlights are a better choice, if properly secured with the light beam pointed towards the ground.
There are a number of safety considerations when working around any helicopter:
- Helmets must be firmly secured by the chin strap.
- Goggles must be worn to protect the eyes from blowing dust, snow, small rocks, and other debris.
Photos by Rick McClure
- Always establish and maintain eye contact with the pilot when approaching the helicopter.
- Approach the aircraft from the front, bending slightly at the waist with your head down.
- Beware of the tail rotor. It turns much faster than the main rotor, and may appear to be invisible, particularly at night. For this reason, never approach a helicopter from the rear.
- Never run when working around a helicopter. Haste leads to preoccupation, which compromises the safety of the entire patient transfer process.
When preparing a patient for transport, explain to the patient that he is going to be transported to the hospital by helicopter. A brief statement will usually allay any apprehension or confusion. Be sure that all sheets and blankets are lashed or otherwise secured. The patient’s face should be covered to avoid additional injury due to dirt or flying debris.
Receiving and/or transferring patients
Personnel receiving call of patients coming in by helicopter should obtain pertinent information:
- Time of arrival.
- Number of patients.
- Extent of injury or illness.
- Condition of patient.
Notify security for helistop security and crowd control.
Personnel receiving and/or transferring patients at helistop:
- Be in proper uniform (pants suit, no cap or other headgear).
- No loose equipment on gurney (sheets, blankets, pillows, etc.).
- Check height of I.V. pole.
- Wait for escort. Crew member will direct personnel.
- Approach helicopter in slightly stooped over position and only from the front, in full view of the pilot.
- All cabin doors and other equipment shall be operated by crew members only.
- During landing and takeoff, rotor wash creates winds up to 40 mph. Beware of blowing dust, sand, and debris.
When planning a training exercise, use the following outline as both an organizational tool and a simplified lesson plan:
- Identify available resources:
- Hospital based EMS helicopters,
- Public agencies (police, fire, etc.),
- Contact appropriate entities for participation:
- Helicopter operator,
- Fire, law enforcement, and ambulance personnel,
- Hospital emergency/trauma departments.
- Schedule the training program:
- Select a convenient time for all participants;
- Select a location that willcomfortably accommodate the helicopter (parking lot, etc.).
Photos by Rick McClure
- Prepare the training agenda:
- Have the participants discuss their roles during an EMS incident;
- Discuss capabilities and limitations of each participant;
- Emphasize safety during all phases of the helicopter operations;
- Simulate an incident and have fire department members walk through a patient loading problem (helicopter not running);
- Resolve questions and address safety errors;
- Repeat the problem with the helicopter running.
- Critique and review.
The primary emphasis should be on safety. Familiarity with each other’s role and priorities will promote a smooth and trouble-free operation. When properly utilized, the medevac helicopter is a vital resource, a tool in providing optimum patient care at any EMS incident.