Sunday, September 8, 2013

Proper and Judicious use of HEMS

                Tell me you haven’t had this discussion on the truck before.

911 Dispatcher “Small Town Ambulance Service Call, Middle of nowhere. Small Town Ambulance please respond to a 2 vehicle MVC head on, unknown injuries”
JG “County Dispatch Rescue 51 is enroute do we have any word on injuries”
911 “Unknown at this time 51”
JG “51 is clear.”
RD “JG Should we get F&U to send mutual aid”
JG “RD Why don’t we launch a bird, we know how bad it can be out there.”

       Herein lies the problem. Helicopter EMS is a growing and vital service in rural America. It is also overused, causing increased costs with no benefit to the patient. Helicopters save live, I truly believe that. There is very good evidence that they do in rural settings. The jury is definitely out in urban ones though. So in typical EMS fashion there are some of us that take it to a ridiculous extreme. I mean oxygen helps, so let’s put more people on more of it. Wait, there is evidence that Oxygen has negative effect on CVA patients increasing mortality.

      Helicopters are a finite resource that needs to be used judiciously. There needs to be sensible guidelines for HEMS usage. So in the interest trying to improve this, lets look at some sensible guidelines.

Lone Medic’s HEMS Guidelines

Helicopter should be considered in the following situations:

Pt. requires higher level of care than is available locally.
Helicopter can be at scene before EMS unit can have patient at a local hospital for stabilization
Pt. is suffering from immediate life threatening illness or injury.

Consider ground transport in the following situations:

You are able to arrive at an ER before the Helicopter is able to be on scene.
If you are able to transport a patient to an appropriate facility in less time than a Helicopter can.
If the Patient has non-life threatening illnesses or injuries.

        Now you notice that I stated that if you can have a patient to an appropriate facility before a Helicopter can. I know your ask, LM aren’t Helicopters always faster. Well let me take you through the process of activating a Helicopter in a STEMI situation. Something I think is appropriate, if time is saved.
Upon arrival you find a patient is having a Anterior Infarct after performing a 12 Lead ECG. You know there is a Reperfusion center 35 minutes away. Being a caring medic you contact the Helicopter. 3 minutes later they accept the flight and weather is clear. You give them the GPS coordinates and the backyard is clear enough to be a effective LZ. 10 Minutes later they lift off. They have a Flight Time of 15 minutes. After they land it takes the flight crew 10 minutes to prepare the patient to for lift off. They have another 10 minute flight to the Cath Lab. Diagnosis to balloon approximately 55 minutes depending on where the Lab is in the hospital. You could have had the patient there in less time, saving 13 minutes.

       This does not mean you shouldn't utilize HEMS, like I said they save lives. But use them judiciously. The other problem I have is using them when they are not needed. Mitchell Mightymedic gets called out to a man who fell off of a ladder and has a Tib-Fib fracture. Patient is hemodynamically stable with good pedal pulses. Mitch decides to fly this patient to a trauma center due to a  transport time of 24 minutes to the nearest facility.

       During this time, Gina Ditchdoc is called out to a ATV accident that requires a 25 minute ride on a Fire Department rescue UTV. Upon arrival Pt. is found to have systolic BP of 84 and an unstable pelvis. Gina contacts dispatch and there is only Helicopter available is 1 hour away due to Mitch’s patient being enroute to a nearby Trauma Center.

       Helicopters are also unable to fly during lightning, high winds, or other inclement weather. Do not delay transport to ask for a helicopter that is obviously unable to fly. If it is that time sensitive, they need to be in a Doctor’s care.

Your Feedback is always welcome.

Lone Medic.


  1. I remember getting guff for calling a bird for an ejected woman underneath an SUV. there was no wait time. Got her out and up as the helo landed very smooth and she got the care she needed. Another time in an urban setting a young man tumbled down a hill and they got a bird in the air. No assessment was done by medics or fire rescue crew. Flew pt. to trauma center even though an ambulance could have gotten him to a well equipped hospital within 10 min. After arriving to a trauma center was discharged with very minor bumps and bruises and light scratches. I do think mech. of injury, location, resources, weather, and time, should all be considered en route before calling in hems.

  2. Sorry folks, there was some formatting issues I had to correct. Carl, using MOI only is a mistake that is encouraged by some. If a patient is not actually injured and they are flown out, you are still tying up a critical resource. By the way, about that oxygen thing,