Medevac

[Guest WolfEMT]

Recently, I've read some threads on here that talk about a Medevac being put on standby, and then either launched or cancelled at a subsequent point. Aside from the standpoint regarding the cost of flight operations, why would one call for a bird to be put on standby rather than just call to have it launch and respond to the LZ?

My department has a Medevac procedure that states that if an MVA or trauma is bad enough for a bird, then it is to be called. If the circumstances change and the bird is no longer needed, it's cancelled; but if it is necessary, it can get to the LZ quicker than calling for it to be put on standby and then calling again to have it respond.

The reason for my question is because of an incident that I read in which a bird was put on standby and then called in to respond 6 minutes later, with a subsequent landing another 12 minutes later. Couldn't the process have been sped up by 6 minutes if there were guidelines that eliminated standby calls?

Also, I'm not trying to stir the pot; I'm just raising an issue.

[Guest]

This has been discussed before in the past, i think the threads are still available. Either way, ill give you my take on things.

It's my personal belief that air assets are abused in this area. I cant tell you how many times i hear on the radio to put stat flight on standby, which most often occurs without any units o/s. Now you've got a bird tied up on a job that may turn out to be nothing.

Not every pin job or serious MVA merits an air lift. Air assets are for victims of multi-systems trauma or time critical incidents which require a specialized facility (IE: re implantation center when an amputated body part has been directly exposed to extreme cold).

I've heard of and encountered incidents where a bird launched or put on standby for injuries from an MVA when those injuries were NOT multi-systems, NOT time sensitive, and NOT life threatening. Its really shameful.

You should know, within 10-15 seconds of being O/S if your going to need air assets and launch them accordingly.

I know it looks cool to have a chopper land - but we have area and regional trauma centers for a reason, so lets use them!

So, in essence, i don't see the point of putting them on standby - I've always waited until i arrived and assessed the situation before I've made the call for more resources, be it air, ALS, FD, etc (this is assuming its solely my call) .

Edited May 9, 2007 by 66Alpha1

[Guest]

you're not stirring the pot, this is very valid. i have only used STAT Flight once, but i was not the one to call for it. either way the bird was overhead when i arrived on scene, which made our lives easier. i can thank county PD for there quick thinking for that...which raises another topic...WHO SHOULD BE THE AGENCY TO CALL FOR THE BIRD??

i personally don't care, who calls for the bird. i know some people only want the MEDICS calling for the bird

[Guest]

I know it looks cool to have a chopper land

sad, but soo true

[paratrooper75 41]

I to beleive the helicopter is way over used. I've even heard of it being called to land on the sprain parkway. Even if the injuries are severe enough for a trauma center you still have that whole "30 minutes or less" window to think about. Extrication or wilderness rescue ok but as far as motorcycle accidents or incidents where you can be on the way to the trauma center in less than ten minutes transport by ground ALS, same thing. If you're outside that 30 minute ground time window than use discresion. My brother was transported by stat flight when he was involved in a motorcycle accident in somers. His only injury was a femur fracture which is severe but doesn't warrant a helicopter when he was twenty minutes away from the medical center and needed no extrication. People automaticly think trauma= helicopter. He didn't benefit at all from the helicopter and he got a $8000 bill for it. Dont get me wrong, you cant tell the extent of internal injuries on scene but my point here is the transport time. As far as the transport decision, that goes to the paramedic on scene unless its an obvious call. Thats all.

Edited May 10, 2007 by paratrooper75

[JetPhoto 626]

I agree also. I always hear Orange County units putting the bird on stand by just based on 1 call with no one on scene. I believe that the medevacs automatically went on stand by if the flight time was less than about 20 minutes, after that they auto launch.

When you call for a medevac, and you already got the victim out of the entrapment or remote location then you might as well drive to the ER.

5 minutes to check for availability

10 minutes or more minutes to get to the LZ

20 minutes for the flight crew to prepare the victim for transport

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.

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Hospital 25 minutes or less when driving.

The ER can stabilize them and call for a bird from there.

[Guest WCDES636]

Actually, calling for a medevac to be on stand by based on the initial call is a great thing. If the call is less than 25 miles the crew assembles at the aircraft and wait. If they do get launched it's only 3-4 minutes until they lift off. If they closest medevac is more than 25 miles, and a stand by is requested the aircraft is launched. If it's requested to the scene, great time has been saved. If it is cancelled they turn around and go back home.

BTW.... Anybody can call for the medevac. PD, FD, and EMS. In Westchester, 60 control may put the Aircraft on stand by based on info obtained from callers.

[Danger 160]

I'm wholly unfamiliar with Medevac. So there is a 24 hour crew who sits in a station waiting to be called?

[Guest]

Actually, calling for a medevac to be on stand by based on the initial call is a great thing. If the call is less than 25 miles  the crew assembles at the aircraft and wait. If they do get launched it's only 3-4 minutes until they lift off. If they closest medevac is more than 25 miles, and a stand by is requested the aircraft is launched. If it's requested to the scene, great time has been saved. If it is cancelled they turn around and go back home.

BTW.... Anybody can call for the medevac. PD, FD, and EMS. In Westchester, 60  control may put the Aircraft on stand by based on info obtained from callers.

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The amount of times they are put on standby v. the amount of times they actually launch from that standby is some data i wouldn't mind taking a look at. I would have to say about 90% of the standbys i hear called over the radio are canceled.

[Remember585 815]

The amount of times they are put on standby v. the amount of times they actually launch  from that standby is some data i wouldn't mind taking a look at. I would have to say about 90% of the standbys i hear called over the radio are canceled.

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No disrespect, but I have to argue that, at least in Westchester. The majority of the time in WESTCHESTER (can't speak outside of the county anymore) if it is on Standby it is launched.

636 Said it best, time is saved on the whole when you give the Medivac crew a heads-up - just like putting a Mutual Aid EMS or FD unit on standby.

It's a real shame that more agencies don't host or participate in a Stat-Flight outreach program once in the while. Not only would they be able to explain their capabilities, but they can enlighten all on what they prefer / hate. Would take some of the guessing out of what they can and can't do that so many people are guilty of.

As for incidents on the Sprain - never had any part of one other then behind the scenes, but I know how bad the traffic snarl becomes on any Westchester highway when there is an accident, specifically during rush hour. If Air 1 can go from WMC, plop down, make the pickup and land at WMC in less time then ambulances can fight the traffic - go for it!

[Guest]

No disrespect, but I have to argue that, at least in Westchester.  The majority of the time in WESTCHESTER (can't speak outside of the county anymore) if it is on Standby it is launched.

636 Said it best, time is saved on the whole when you give the Medivac crew a heads-up - just like putting a Mutual Aid EMS or FD unit on standby. 

It's a real shame that more agencies don't host or participate in a Stat-Flight outreach program once in the while.  Not only would they be able to explain their capabilities, but they can enlighten all on what they prefer / hate.  Would take some of the guessing out of what they can and can't do that so many people are guilty of.

As for incidents on the Sprain - never had any part of one other then behind the scenes, but I know how bad the traffic snarl becomes on any Westchester highway when there is an accident, specifically during rush hour.  If Air 1 can go from WMC, plop down, make the pickup and land at WMC in less time then ambulances can fight the traffic - go for it!

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Putting an air asset on standby is NOT like putting an ambulance or engine on standby. There are far more ambulances and engines than there are choppers. Your talking 2 choppers for Westchester, Putnam, Dutchess, Rockland (at least).

I just do not see the point or sense of putting a limited resource on standby when i can be on scene and determine if i actually need the air asset in less than 5 - 8 minutes.

[Guest WCDES636]

Actually, there are 4 Medevacs that cover the 7 Counties in the Hudson Valley. Backed up by 3 Medevacs in the Albany area. Not to mention 4 other Medevacs from out of state that can be called into the region for mutual aid.

If you can be on scene in 5 - 8 minutes you must work in an area less than 4 square miles. For other areas it takes a bit longer.

Are willing to give up 25% of the Golden Hour to get there and see if a Medevac is needed. Then additional time for the Air Crew to assemble???

I just dont see the logic. But that is just my opinion.

[Guest]

Actually, there are 4 Medevacs that cover the 7 Counties in the Hudson Valley. Backed up by 3 Medevacs in the Albany area. Not to mention 4 other Medevacs from out of state that can be called into the region for mutual aid.

If you can be on scene in 5 - 8 minutes you must work in an area less than 4 square miles. For other areas it takes a bit longer.

Are willing to give up 25% of the Golden Hour to get there and see if a Medevac is needed. Then additional time for the Air Crew to assemble???

I just dont see the logic. But that is just my opinion.

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I would say, i cover roughly 24 square miles, the total town is about 48.

The point i'm making, i think is a very valid one that is not unique to me alone. Why would i tie up an air asset without knowing the extent of the incident? It just makes no sense to me, even 4 choppers in 7 counties your talking about a very limited resource. I would go ground to Westchester or Saints before i would call a chopper from Albany who's ETAs are into the 20 minute range.

The 3-4 minutes is negligible. Why? Even if i call and and they launch upon my arrival i'm looking at a 10 - 20 minute ETA. Considering that this is an MVA, factor in the time for the FD to assemble, arrive, free and then EMS to package and move the patient to the ambulance then to the LZ the chopper would have landed or be above with or without a standby notification.

All I've seen it do is bring out more membership and get people far too excited.

P.S. - i'm not talking about a dispatcher here (if a dispatcher has his/her protocol and is afforded a piece of information that indicates the need then launch or put them on standby) i'm talking about EMS and Fire personnel who are not o/s but rather enroute calling for a chopper to be put on standby.

Edited May 10, 2007 by 66Alpha1

[Oswegowind 17]

I agree with 636...there are times when a dispatcher or the dispatched units feel it is necessary to put the chopper on stand by. This is not a problem. If they are needed somewhere else than take them. Otherwise why not have them ready to go if it is the "big one"? Sometimes the helicopter is useful, but I don't think anyone should ever wait for the helicopter once it is called. If you get there and are able to run and shoot to the ER than why waste it??? Otherwise you may get on scene and realize that you need it and they are ready to go! BTW they are getting paid whether they fly or not!!!! No need to worry about them...put em in the bird on standby, get their adrenaline flowing a little! Oh, and HQ to Air 2...jk

[Guest partyrock]

Put 'em on stand-by. Assembly and pre flight take time, and when you need stat-flight you don't want to waste a minute. But here's the catch...when you need stat flight. There is no way an accident on the sprain could f-traffic up so bad you couldn't beat the bird to the ER. Maybe a second accident between the ER and the MVA, but come on. I've seen a bus get from rt 100 by IBM to the Med Cntr in 18 minutes. With Jacobi 15 from the Med center how could you need a bird anywhere south of the Med cntr? Other than RSI what other interventions do they offer that cannot be provided by a medic?

[Remember585 815]

Why would i tie up an air asset without knowing the extent of the incident?

If you wait they can be sent to another incident, go out on a training mission, come out of service for routine maintenance or get sent on an inter-facility run. If you think you may need them, call for them.

The 3-4 minutes is negligible. Why? Even if i call and and they launch upon my arrival i'm looking at a 10 - 20 minute ETA. Considering that this is an MVA, factor in the time for the FD to assemble, arrive, free and then EMS to package and move the patient to the ambulance then to the LZ the chopper would have landed or be above with or without a standby notification.

I think you answered yourself. TIME TIME TIME. If called when needed (again, training on their resources will help) they can and HAVE MADE A DIFFERENCE.

All I've seen it do is bring out more membership and get people far too excited.

I see the same thing too, don't worry. But if these people would take just an hour and a half to sit in a STAT outreach then they may understand how they operate and how the hysteria can be left behind.

P.S. - i'm not talking about a dispatcher here (if a dispatcher has his/her protocol and is afforded a piece of information that indicates the need then launch or put them on standby) i'm talking about EMS and Fire personnel who are not o/s but rather enroute calling for a chopper to be put on standby.

If your dispatcher is getting sufficient and good information from the scene then they should relay it to responding units. A smart responder will start out resources as they feel fit based on dispatch info and knowledge of the area. For example if you get a call for a rollover on an Interstate, chances are the MOI is greater then a rollover in a parking lot. (Unless it's a Mall on the holidays....)

I remember the first time we called STAT - it was one of their first calls. I think 50 members showed up and a crowd from the public near 150. Now, if we call them (we haven't in a while) nobody really seems to care, it's almost routine. Our personnel don't get amped up simply because they have been trained by Statflight and understand how they function. (For the record we could of drove to the ER, but ALS wanted the chopper).

Abuse of Medivac does happen, some Medics can't do their jobs and call them, some Chiefs think because its a pin they're needed, but that's a different issue I ain't touching!

Edited May 10, 2007 by Remember585

[Guest partyrock]

Abuse of Medivac does happen, some Medics can't do their jobs and call them,

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Thank you for saying it. I've been informed it'd be in my best interest not to be such an antagonist.

[Remember585 815]

Thank you for saying it.  I've been informed it'd be in my best interest not to be such an antagonist.

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Most Medics are good and even great. Some....well....you know.

It doesn't apply to just Medics though. There's plenty of EMTs that suck. I always tell people I'm not a great EMT but I can write a damn good PCR.

Edited May 10, 2007 by Remember585

[Guest alsfirefighter]

I'm not one to use air transport either, very rare for me to do so.

However I think the point of a standby call is being missed to a point. I have put a medevac on standby, based on the dispatch and subsequent information. Size up begins at the time of dispatch and to that point even before then if you have a pre-plan. One of the things that a standby does is if it sounds like you have legimate trauma and you are going to utilize them that bird is waiting for you. I know at one time and my stat brothers or sisters will have to chime in, they were doing a program where if they were put on standby and it was outside a certain distance they were taking off to procede to cut down on flight time. So to me there is a time and place for everything.

The one thing I think any provider worth their salt can say is that it is often abused and misused.

On a further note...I often make some decisions based on the dispatch. Obviously there are some that need to be and then there are times where you add resources once you arrive. Prime example was a call I recently had at a department store where there was a chemical exposure. It was estimated that there were 17 employees in the store that needed to be evaluated. While enroute, I put an additional 2 ambulances on stand by. Some of the decisions that need to be made are based on your resource management and knowledge of your resources...their assemble time and such.

[JetPhoto 626]

Thanks for the clarification WCDES636

Some ground medics are trained to do RSI

[Guest]

I don't disagree with anyone who has said that your sizeup begins with dispatch and I'm not stingy with resources - if i know or anticipate ill need them i call for them.

But if i'm banged out for a priority 3 MVA Car v. Tree on Route 9 and dispatch hasn't relayed anything particularly telling I'm not going to tie up a resource when the chances are i'm not going to need it.

On the other hand, if i'm dispatched to a priority 2 job w/ possible ejection and the dispatcher asks what my pleasure for the bird is, ill check availability, and then determine if i need them when i'm on location.

I trust the dispatcher's judgment just as much as i trust my partner, so if they determine a need for the bird and put them on standby i am completely fine with that. What i have an issue with and refuse to be a part of is the flagrant abuse of putting the chopper on standby. We aren't talking about a VAC or a VFD which takes 10 - 15 minutes to sign on the air - in those cases i'm far more liberal with calling for a standby.

I've got Saint Francis 15 minutes to my North and Westchester 35 - 40 minutes to my South. I'm far more apt to check availability then putting the bird directly on standby. If the bird is out longer than 20-25 minutes and I'm not looking at an extensive extraction or removal time, then I'm going to Saints and have the chopper re-directed there.

As far as stat-flights capabilities, i know that they have authority to do a significant number of procedures that cannot be completed by a field paramedic. A medic can be trained in RSI but i don't know of any agency that is certified to preform it in the field - especially in the Hudson Valley region. I know they have an IO drill which is great for burn patients.

[helicopper 1,050]

There are some benefits to requesting stand-by or at the very least checking availability before you arrive on scene. First and foremost, it allows the pilots (the forgotten part of this equation) to check the weather, complete pre-flight procedures that need to be completed before anything else, and determine the course, flight plan, etc. Having all this done while you're still enroute saves time on both ends of the request! If it is not available for whatever reason, you're now armed with more information - and that's never a bad thing.

Once you arrive and determine that it is appropriate to use air transportation, the response is expedited because all the other groundwork is done. They should simply fire up and take off...

As for who calls for helicopter, the decision is a medical one and should be made by the highest trained medical provider on the scene who is providing care to the victim in question. Just because a cop or a fire chief is an EMT doesn't trump the responsibilities of the paramedic on scene or the EMT who is actually providing care to the victim. This may be a contentious opinion but the provider caring for the patient is the one responsible for their care and transport.

Regarding abuse of the service, there have been several threads on this subject in the past and I strongly believe that there are very few places or situations in Westchester County that benefit from helicopter transport. Certainly there are exceptions but for the most part I stand by the opinion that you can get there just as fast (or faster) by ground.

Just another two cents...