Brought to you by Saint Alphonsus Life Flight, expert(s) at Air Ambulance.

Emergency medicine takes to the air

The use of Air Medical Services (AMS) has become an essential component of the health care system.

Appropriately used, air medical critical care transport saves lives and reduces the cost of health care by minimizing the time the critically injured and ill spend out of a hospital, by bringing more medical capabilities to the patient than are normally provided by ground emergency medical services, and by quickly getting the patient to the right specialty care.

Dedicated medical helicopters and fixed wing aircraft are mobile flying emergency intensive care units deployed at a momentŐs notice to patients whose lives depend on rapid care and transport. While Air Medical Services may appear to be expensive on a single-case basis compared with ground ambulance service, examining the benefits behind the cost on an individual and a system-wide basis shows that it is cost-effective.

Air Medical Services is a means to bridge geography and time. As technology provides new, time-sensitive care, the need for AMS will increase. As the costs of the health care system continue to rise, and the availability of even routine health care in rural communities is put at risk, Air Medical Services will play an increasingly important role in the delivery of health care.

Trauma care

The crews aboard air ambulances provide more than the Advanced Life Support (ALS) level medical skills and equipment found on ground ambulances. They bring the additional skills and equipment of a tertiary hospital, more advanced drugs, and more sophisticated critical care medical skills whenever they respond to a community hospital, to the scene of an injury or accident, or to a pre-planned rendezvous point with a ground ambulance.

Critical care for especially difficult breathing complications, blood and blood products, and more sophisticated patient monitoring tools make air ambulance helicopters more closely resemble a flying emergency department than simply an air-borne version of the typical Basic Life Support or Advanced Life Support-level ground ambulance. This higher level of care is especially important in rural areas which may have few Advanced Life Support ground ambulances to call upon, and even less critical care ground ambulance coverage.

The Air Medical Services team generally has physician level capabilities exceeding those of ground Advanced Life Support providers. The typical medical crew on-board Air Medical Services is usually made up of a specially trained critical care nurse and paramedic. Other specialist caregivers or physicians may be added to the team as needed.

This team effectively initiates tertiary hospital care directly at the patientŐs bedside, whether at the scene of an emergency or at a community hospital. Almost exclusively, the Air Medical Services team handles the most critically ill and injured patients, giving these caregivers more hands-on experience in dealing with the most severe cases than the ground EMS responders who see a large population of less emergently ill patients. The benefits of air transport have been demonstrated to outweigh any stressors that flying might add, even for the sickest trauma and, notably, heart attack patients.

Changing missions

While the public primarily pictures the helicopter landing at a car crash to help a victim with multiple injuries, in the last decade air medical services have increasingly taken on a variety of new missions. In fact, 54 percent of all air medical transports are hospital to hospital, 33 percent are scene responses, and 13 percent are other types, including organ procurement and specialty/neonatal/ pediatric team transport. The following are just some of the cases in which helicopters are being used to make a difference in patient care.

Cardiac care

In the case of heart attacks, as with other critical injuries, there is a window of time in which the heart may be effectively treated before it, and the patient, die or are disabled.

At any time in this window, the compromised heart may stop or otherwise require emergency treatment to keep the patient alive. Out of hospital, Advanced Life Support has proven effective in dealing with these emergencies.

Strokes

Like heart attacks, some strokes are caused by interruption of blood predominately from a blood clot, only this time in the brain. As in heart attacks, there is a window of time in which clot-busting treatment can result in patients suffering little to no long term damage and disability from these events. Therefore, patients transported to specialty centers for the clot-busting treatment of strokes can benefit from a well-coordinated ground and air system to accomplish early transfer.

Pregnancy complications

When a pregnant woman experiences complications, they can be life-threatening for both mother and child, and often require the specialized care found in larger hospitals. Timely Air Medical Services transfer to such facilities while the patient(s) receives care from obstetrical/neonatal specialists has been shown to be safe, cost-effective and beneficial.

Transfer via critical care ground ambulance is also successfully employed in these kinds of cases. However, when time is critical and a specialty team from the receiving hospital is sent to bring the patient(s) to the specialty center, air ambulance transport minimizes the out of hospital time for both the patient and the specialty care givers in a way that cannot be accomplished via ground.

Mass casualities

Helicopters and fixed wing aircraft play a vital role in emergency preparedness because of their ability to rapidly move patients to specialty care across a wide regional area.

Hospitals close to the mass casualty site will soon become overwhelmed with cases needing attention, whether the patients are injured or ill; incapacitated due to long-term electricity failures, lack of fresh water or dwindling supplies and medication; or may even be evacuated due to local conditions. While it is common practice to send less-injured patients by ground to distant hospitals to reduce pressure on local facilities, medical helicopters and fixed wing aircraft give those at the scene the option of moving severely ill or injured patients to more distant hospitals as well.

In cases of emergency, helicopters are also useful in evacuating hospitals in areas threatened by hurricane or other disaster, and are often utilized to bring medical staff, equipment and sorely-needed supplies (such as blood and blood products) to the scene when speed is important or roads are impassable. Fixed wing air ambulances can expand that capacity by meeting up with medical helicopters or critical care ground ambulance units to bring in supplies or transport patients even further distances.

When incorporated into a local, regional or national emergency response plan, air medical helicopters and fixed wing services provide much-needed and highly-experienced resources that can be deployed rapidly in times of disaster, either man-made or natural. Since most of the air ambulances in the U.S. today are civilian, they augment the nationŐs emergency response capacity without cost to the taxpayer.

The future

Maintaining access to care is an ever greater challenge for both healthcare providers and policy makers.

Natural and man made disasters have highlighted the need for an effective, available air medical system, as illustrated in events like Hurricane Katrina in which thousands of lives were saved during both scene response and the evacuation of critically ill patients from hospitals.

As communities continue to grow, air ambulance response will continue to play an increasing role in providing the most-advanced medical care available.

Information provided by The Foundation for Air-Medical Research and Education