Air Medical Transport Overview
Helicopter EMS (HEMS) provides rapid transport and advanced care for critically ill or injured patients. Air medical crews typically include a flight nurse and flight paramedic (or a flight nurse and flight physician) who can provide interventions beyond ground paramedic scope, including blood product transfusion, surgical airways, and advanced pharmacology. However, helicopter transport carries inherent risks including weather-related crashes, and the decision to request air medical transport should be based on clear clinical criteria and a risk-benefit analysis.
The primary indications for helicopter transport fall into two categories: time-sensitive conditions where ground transport time significantly exceeds helicopter transport time, and patients requiring a level of care or interventions not available from ground EMS. Transport time is the key factor; if the ground transport time to an appropriate facility is comparable to helicopter response and transport time, ground transport may be more appropriate.
Air Medical Transport Criteria
While specific criteria vary by region, general indications for requesting helicopter transport include:
- Trauma: Mechanism suggesting severe injury (high-speed MVC, ejection, pedestrian struck at speed), GCS less than 10, penetrating trauma to head/neck/torso, amputation above the wrist or ankle, two or more proximal long bone fractures, pelvic fractures with hemodynamic instability, and burns greater than 20% BSA or burns with inhalation injury
- Medical: STEMI when PCI-capable hospital is more than 60 minutes by ground, acute stroke within the treatment window when a stroke center is distant, and cardiac arrest with ROSC when a cardiac arrest center is available
- Access: Patients in remote locations inaccessible to ground ambulances, prolonged extrication scenarios, and search and rescue operations
Landing Zone Setup and Safety
If you are establishing a landing zone (LZ), select an area that is at least 100 feet by 100 feet (some aircraft require larger zones), flat, and free of debris, wires, and obstacles. Mark the corners with emergency vehicles or cones. Identify the LZ with landmarks or GPS coordinates for the flight crew. Position a designated LZ officer to maintain communication with the aircraft. All personnel should wear eye protection and secure loose clothing and equipment. Never approach the helicopter unless directed by the flight crew, and always approach from the front where the pilot can see you, never from the rear where the tail rotor is located.
Safety Considerations
Helicopter accidents remain a concern in EMS, with weather being the leading contributing factor. Programs have implemented policies requiring instrument flight rules (IFR) capability and risk assessment tools. As a ground provider, you can contribute to flight safety by providing accurate weather observations at the scene, not pressuring the flight crew to fly in marginal conditions, and having a backup plan (ground transport) if the helicopter is unable to respond. Remember, the decision to accept or decline a flight always rests with the flight crew.