Virginia’s Air Transport Program Proves Its Worth
The trauma mortality rate throughout the Commonwealth of Virginia is astoundingly high. Approximately 2,200 trauma-related deaths occur there each year as a result of automobile and farm accidents, medical emergencies, fires, and other life-threatening injuries. Many of these injuries and emergencies are of such magnitude that immediate trained medical intervention is necessary to reduce this loss of life.
Intervention within the first 60 minutes after the injury occurs, referred to as the “golden hour,” is critical for trauma patient survival. To take full advantage of the “golden hour,” it is imperative that the victim have access to rapid transportation to an equipped operating room with a surgical trauma team immediately available on a 24-hour basis. Only then can the trauma mortality rate be reduced.
Experiences during the Korean and Vietnam conflicts indicated that the rapid transfer of trauma patients by helicopter substantially increased survival chances. This procedure was subsequently introduced into civilian life in many parts of the country, with equally successful results.
In 1981, the Virginia General Assembly approved legislation calling for a statewide air medical evacuation (medevac) system to be developed by the Department of Health in coordination with the Department of State Police and other appropriate state agencies. In September 1983, the State Board of Health adopted this bill and made it part of the State Emergency Medical Services Plan.
However, due to the limited availability of helicopters, the State Police were not able to provide complete coverage. If the statewide air medevac system was to become a reality, it had to be developed as a cooperative effort between state resources, the private sector, and other medevac services licensed to operate in Virginia.
Several locally based programs that provided various levels of emergency response services to their respective areas were established throughout the state. They included: the Nightingale Program in Tidewater, VA; the Life Guard Program in Roanoke, VA; and the Washington Hospital Center Program in the District of Columbia, which is supported by two police helicopters from Fairfax County. The University of Virginia Hospital in Charlottesville, VA, initiated its Pegasus Program, a private patient financed project, in August 1984.
While these programs were valuable within the areas they served, many other regions of the state, including Richmond and Central Virginia, were left unprotected. This was particularly significant because the mortality rate from trauma in these two areas was two-and-one-half times that of the national average.
The situation was alleviated when Med-Flight, a concept of rapid transport and trauma patient stabilization that provides a professional, immediate response system, became a reality in April 1984.
Photo courtesy of Richmond, VA, Newspapers, Inc.
The project’s initiation followed several months of close cooperation between the Virginia Department of Health, the Department of Virginia State Police, the Chesterfield, VA, Fire Department, and the Medical College of Virginia (MCV) in Richmond. Various individuals from these organizations worked together on the planning, the specific training, and the efforts to obtain specialized life support equipment for the program.
It was decided that Med-Flight would serve the Richmond, VA, metropolitan area in a 30-nautical mile radius of the MCV.
April 1, 1985, marked the completion of a one-year pilot test program that was developed to determine Med-Flight’s value and effectiveness in Central Virginia. The test program provided a public service to any citizen, hospital, rescue squad, fire, or police department in situations requiring immediate advanced medical intervention by trained specialists in a hospital environment. Trained fire department paramedics, flown to the scene by a State Police helicopter, provided the immediate medical life support necessary to stabilize the victims while transporting them to the Trauma Center at the MCV.
Direct administrative costs of the program were funded by the Virginia Department of Health through the Emergency Medical Services Division. This funding was obtained through the One For Life Bill passed by the Virginia General Assembly. It imposed a one-dollar surcharge to all motor vehicle registrations in Virginia, payable at the time of renewal. The legislation designated these receipts specifically for emergency medical services.
The Department of Virginia State Police supplied a primary helicopter (a Bell 206-B Jet Ranger), a back-up helicopter, and seven state trooper pilots to man the MedFlight Pilot Test Program on a 24hour basis. They also purchased specialized life-support equipment at a cost of $20,620.
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The Chesterfield Fire Department absorbed the cost of five state-certified paramedics who were also made available on a 24-hour basis, and provided the hangar and living accommodations.
The MCV provided training in advanced cardiac life support and advanced trauma life support to the paramedics at its hospital.
As the project gradually became a reality, its goals were set and its effectiveness was monitored by the following group of people, who donated their time and services:
The Division of Emergency Services of the State Department of Health, under the direction of Susan D. McHenry, coordinated the program; Alfred S. Gervin, M.D., director of the Trauma Center at the MCV Hospital, was the medical director; and Terry L. Wright of the Old Dominion Emergency Medical Services Alliance chaired the Central Virginia Air Medevac Pilot Project (CVAMPP) work group. These people, working with a team of physicians, reviewed the training process, the work of the paramedic personnel, and the appropriateness of the care rendered in-flight during each mission.
This work group also said that the purpose of the program was, by response priority, to provide:
- On-site air medevac for lifethreatening emergencies within the primary service area;
- Inter-hospital transfers of critical patients in the primary service area;
- Law enforcement missions in the primary service area;
- Air medevac for life-threatening emergencies outside of the primary service area;
- Law enforcement missions outside the primary service area;
- Inter-hospital transfers of critical patients outside the primary service area.
The primary area served by this pilot program included the Virginia counties of Amelia, Caroline, Charles City, Chesterfield, Dinwiddie, Goochland, Hanover, Henrico, King and Queen, King William, Louisa, New Kent, Powhatan, and Prince George, as well as the cities of Richmond, Petersburg, Hopewell, and Colonial Heights.
On April 1, 1984, the Med-Flight Pilot Program was actively launched at a dedication ceremony in Chester, VA, with the single-minded objective of saving lives. The slogan that appeared on the dedication ceremony program—”Together We Can Save A Life!”—best described the goal of many individuals and organizations involved.
The one-year pilot project represented a unique multi-disciplinary endeavor aimed at providing a much needed service in Central Virginia. One of the many missions involved a fire-engulfed accident during the morning rush hour on a controversial stretch of highway that had been narrowed for nearly one year due to construction. The driver of one vehicle was air lifted by a medical evacuation helicopter. The patient, a 45 year-old male, had secondand third-degree burns over his chest, back, and arms, as well as a compound fracture of the right lower leg.
A state trooper said traffic was backed up for several miles in both directions. It would have taken hours to get the victim to a hospital without the medevac helicopter.
Another situation involved the blazing collision of a tank truck with an automobile on Interstate-95 in Caroline County shortly after noon. The tank truck was carrying 8,300 gallons of gasoline from Richmond to Ladysmith. The collision ignited a smokey fire. The truck driver suffered secondand third-degree burns over one-third of his body. He was flown by Med-Flight to the MCV Hospital burn unit where he was stabilized. Interstate-95 traffic was backed up, and the highway remained closed for almost five hours. An ambulance probably could not have reached the scene. The helicopter landed beside the wreckage.
After this 12-month trial period, the program has proven to be a tremendous success. During the first 10 months, the medical transport team flew 195 missions. An additional 41 missions were requested, but 20 could not be flown because of adverse weather conditions. Medical control screened and disapproved the other 21 requests because they did not fulfill the need for emergency air evacuation.
Over 1,000 flying hours have been logged by the state police pilots and the fire department paramedics in the program. The team has presented 96 demonstrations and training sessions on the proper use of the service and loading of patients to hospitals, rescue squads, fire departments, and police departments in the primary area of responsibility.
The program’s Operational Medical Director Alfred S. Gervin, M.D., reported favorable statistics after the project had been in existence for 10 months. Of the patients transported to the MCV Hospital via Med-Flight, 15% definitely would have died otherwise. Another 17% probably would have died, and another 29% clearly benefited from the program.
Dr. Gervin’s six-month report (April-September 1984) indicated that the ages of patients transported ranged from seven months to 83 years. Trauma patients accounted for 83% of the transports, and medical patients comprised the remaining 17%. From both these groups, 91% were stable or improved during transport. Unfortunately, 9% died during transport due to the severity of the trauma.
Ten months into the test program, the agencies involved in MedFlight had already committed their services to continue the project. This decision, made even before the test program was completed and evaluated, indicates that the expectations of the agencies involved were fulfilled. The program has been a team effort; a commitment that “together we can save a life!”
Because so many people benefit from Med-Flight, it will continue as a regional cooperative effort in Central Virginia. This program will hopefully set a pattern for developing similar emergency services and life-saving efforts.