Air-Medical in ND

1. Air-Medical in ND Michael Schultz Flight Paramedic Educator Sanford LifeFlight

2. Objectives • Define what Air-Medical is and what they offer. • What Auto-Launch is and how it works. • Understand the best use of the Air-Medical programs in ND. • Communication with the Air-Medical groups in ND.

3. What is Air-Medical? • It is a 24/7/365 ALS or critical care transport resource to the communities that we serve. • All have the same philosophy and goals for pre-hospital care. • Highest level of care for the shortest period of time to the most appropriate facility.

4. What is Air-Medical? • Emergency Transportation • High Acuity patient’s • Trauma, Medical, Pediatric, OB, NICU • Local resources not available. • Patient is in a remote or difficult location to access by vehicle. • Transport to the most appropriate facility. • Bypassing facilities.

5. What is Air Medical? • Each ND HEMS offers different care • RN and Paramedic • RT and other specialty care • Patient needs a higher level of care. • Time is spent with 2 critical care attendants during the transport.

6. The Golden Hour • “Emphasizes the urgency necessary for successful management to maximize outcome of the injured patient” • American College of Surgeons, Advanced Trauma Life Support. 1997. • This is not just for trauma anymore! • Strokes • AMI’s

7. Pitfalls of EMS in ND • Few ALS services. • Call volumes of the BLS/ALS ambulance. • Response times/distances. • Time to a rural facility. • Often rely heavily on Volunteers • Level 4 and 5 trauma centers

8. Pitfalls of HEMS in ND • Helicopters are located at or near the receiving hospitals. • Most are hospital based • Few and far between • HEMS have a 10 min lift off goal. • Long distances to rural areas • ND Weather • March and November… • Few fueling stations in ND • Very Few with 24 hour coverage

9. ND Helicopter Response Times Minot 407 Bismarck 206 Fargo 222 Aberdeen 407

10. 15 minutes Minot 407 Bismarck 206 Fargo 222 Aberdeen 407

11. 15 minutes 30 minutes Minot 407 Bismarck 206 Fargo 222 Aberdeen 407

12. 15 minutes 30 minutes 45 minutes Minot 407 Bismarck 206 Fargo 222 Aberdeen 407

13. 15 minutes 30 minutes 45 minutes 60 minutes Minot 407 Bismarck 206 Fargo 222 Aberdeen 407

14. How to combat pitfalls? • HEMS AutoLaunch • When the criteria is met send most appropriate level of care. • BLS, ALS, and Helicopter • Remember the golden hour. • To definitive care. • Do not wait until Responders are on the scene! • HEMS is an additional resource • Still need standard EMS response per local protocol

15. Autolaunch • How would it work? • Scenario – Rural Carrington • Severe Anhydrous Ammonia burns • Face, Chest, legs, and groin >18% • 7 C-3 (>18%) or 7 C-4 (Facial Burns) • Difficulty Breathing • 7 C-2 • Where does he need to go? • Fargo? • Bismarck? • Minneapolis?

16. Who can activate Air-Medical?

17. Autolaunch? • 911 call for a Male trapped in a Grain Elevator • 22 D-4

18. Autolaunch? • S.O. reports MVA rollover with entrapment in rural Jamestown area. • What kind of entrapment? 29 D4

19. Why Autolaunch • Trauma center locations • The Golden Hour of Trauma • Highest level of care for the shortest period of time. • Time is always against the brain, heart, and trauma survival.

20. HEMS MYTHS • Only activate when someone is on scene. • If you cancel the helicopter, you will get a bill… • Can’t bill them. • Replaces the responding ground Ambulance.

21. Too windy for a helicopter to fly. • Partially true • “The weather is beautiful here.” • Helicopters can only land on the road. • “Too unstable to fly.”

22. When to utilize Autolaunch • Any medical or trauma pt requires emergent and/or critical care transport. • The most appropriate facility to handle patients acuity is in a major ND city. • Local resources not available. • Not on anyone's arrival. • Not after loaded and enroute to the hospital.

23. Autolaunch Trauma • High speed • Ejection • Rollovers • Extended extrication • Multiple patients • Death in vehicle • Trauma center >20 minutes away • Burns • Amputations • Changes in LOC • Falls >3 x pts height • MCC >20 MPH • Unstable or possibly unstable airway • Car vs Pedestrian

24. Autolaunch Medical • Cardiac or post arrest • STEMI • Stroke like symptoms • Unstable vital signs • Any trauma/medical patient needing quick access to specialized critical care and immediate transport.

25. Contacting Air-Medical • Fargo, Sanford LifeFlight 800-437-6886 • Minot, NorthStar CritiCare 701-852-2222 • Bismarck, Angel AirCare 855-254-5655 • Aberdeen, CareFlight 800-592-1889 • HEMS does not count fixed wing transport.

26. What Air-Medical needs to know • Usual dispatch information • Nature of the call • Where is the scene? • Closest town and intersecting roads • GPS coordinates • The ground unit(s) responding • Must have a ground ambulance respond also

27. Communication • Need communication with: • Local Dispatch Center • Deputy • Responding Fire Department • First Responders • Responding Ambulance

28. Radio Communication • State Wide EMS • ND State Radio • MNSEF • ND Mutual Aid Channel 3 • Regional Channels

29. Information for LZ • Flat and level • 100’ X 100’ • Relay obstacles • Wind direction • Wires

30. “Together we save lives” • Air-Medical can’t do their job, without you! • HEMS is an excellent additional resource • We need: • Communication • Early activation • Teamwork • Local Dispatch Centers • Ambulance/FR/Fire/S.O. • We all have the same goal! • What’s best for the patients.

31. Thank You!