There are also logistical and operational factors to be considered. If the patient is not accessible because of location (e.g., off-road or wilderness), traffic, road conditions, or weather, a helicopter dispatch may be appropriate. However, helicopters are much more weather-sensitive than ground ambulances; if the weather is bad for ambulances, it is probably worse for helicopters.
Time and distance play key roles in electing to send a helicopter. A severe trauma or medical situation in an urban area close to a trauma center does not have the implications for the patient that the same situation would in a rural area 100 mi from a major medical center. If the time for transport to the trauma center is greater than 15 min by ground ambulance, if the transport time to the local hospital by ground is greater than the time required for the helicopter to reach the trauma center, or if patient extrication will take longer than 20 min, then dispatch of the helicopter should be considered. In general, scene responses occur within 25 mi of the helicopter base, although this varies with local conditions and protocols. It is likely that at distances greater than 25 mi the patient will be transported to the local hospital first for stabilization and then a helicopter will transfer the patient to the trauma center. Sometimes, if the patient is extricated faster than initially thought, the ground EMS personnel communicate to the helicopter to divert to the local hospital rather than go to the scene.
There is one group of trauma patients for whom air medical scene response has a very low rate of resuscitation and essentially zero survival: traumatic cardiac arrest.15 Some services have developed protocols that patients in traumatic cardiac arrest are not flown back to the trauma center, but instead the air medical crew assists the ground EMS service and transports the patient to the local hospital.
Scene responses for patients with medical conditions (as opposed to traumatic conditions) vary from program to program. —I7 Especially in rural areas, it is common for helicopters to intercept BLS ambulances that are transporting deteriorating or unstable patients. Basic life support technicians may call for a helicopter if the patient could be transported faster to the tertiary center by air than the ground ambulance could get the patient to the local hospital. Medical scene responses have not received as much attention in the literature as have trauma scene responses, although criteria for medical scene responses have been developed. 18 The small number of medical scene responses reported in the literature makes it difficult to judge the utility of this mode of response and transport. However, if a patient is in cardiac arrest and the ground ambulance crew has a defibrillator and has secured the airway, it is unlikely that the arrival of the helicopter crew will result in any more successful resuscitation.19 Such intercept situations must be dealt with on a local or regional level by guidelines and protocols, and they reinforce the importance of an integrated EMS system in which air and ground units work smoothly together under medical direction.
One important factor to be considered in initiating helicopter transport of a patient is whether ground transport of the patient by the local ambulance will deprive that community of vital EMS services. If the local ambulance is out of service for 5 to 6 h and emergency ambulance coverage in that area is compromised, then use of the helicopter should be strongly considered.
Another other important use for helicopters is in disaster situations. Rotor-wing craft can not only bring in sophisticated triage and treatment personnel for better medical care at the scene, but they can also give the incident commander a bird's-eye view of the events, which can assist in best distributing the available resources. These functions can be served in addition to the usual role of the helicopter in evacuating the most seriously ill and injured to the trauma center.
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