Aeromedics Essay, Research Paper

PC-I Spring 2000

Death from above . The is how the modern generation has the Helicopter

depicted to it by Hollywood. But reality hold a different truth. Most Ground

Pounders remember things a little different. To them it was Dusty that is

remembered from their war and they counted on. It was not a bird of prey, but a

dove of mercy that brought life to the wounded. This air medical helicopter was

the one that every wounded man listed and prayed for. And from this hope was

where the future lay.

The History behind Airmedical Evacuation began as many other things

did, as an experimental derived from a war time military. During World War II the

military s of the world took enormous casualties and suffered a high mortality rate

because there was no way to expeditiously evacuate the wounded. In 1951, at

the start of the Korean police action, Igor Sikorski s new invention, the Helicopter,

changed all that. Even tough crude it did allow for fast extrication of the worst of

the wounded and allowed Doctors to begin treatment faster. And yet something

was missing.

As world events changed the United States found itself involved in another

conflict. This time it was in a small country in South East Asia called Vietnam. It

was here in 1962 that the first of the Dustoffs were seen. At first there were no

medical personnel on these flights but reason soon prevailed and medics soon

went into the air. For several years these medics were the first line of care for

those troops. Then in 1967 a revised training program was begun and the

Paramedic was born.

This new breed of combat medic was trained to an advanced level of

medical care unheard of outside of a field hospital. With better equipment, more

knowledge, and faster transport time, care of wounded personnel significantly

improved and deaths from combat related injuries decreased.

As with any other good idea word spread like wild fire. The civilian

community saw the advantages of this new program and were impressed at the

success rate being achieved. Thought was given to incorporating this same idea

into the non-military sectors and allow for advanced treatment in a pre-hospital

environment. With the Emergency Medical Act of 1973 , a place for the first real

Emergency Medical Technicians was created. Throughout the United States,

Ambulance services began to adopt these new specialist and procedures. It is

well documented how many potential lives have been saved and disabilities

reduced since the appearance of this program and these personnel within the

Emergency Medical Services.

In the late 1970 s and early 1980 s a new form of pre-hospital

transportation was adopted for use in the field environment and this is were that

new invention from the Korea war came into use. The helicopter was now in an

advanced stage and was finally able to provide safe and rapid air movement.

Hospital personnel were first used in this service, but this composed

mostly of Physicians. Even thought the level of care was excellent, the numbers

of flight physicians were limited and the price was enormous. A new approach

was needed.

Shortly it was found that Registered Nurses fit the bill as a natural choice.

Even though they lacked the necessary pre-hospital experience, Registered

Nurses did have the skills with emergency and critical care that are needed to

properly function within their respective hospital rolls. With additional training they

soon became the predominant member of the flight team . These providers were

supplemented by other specialist such as Pediatric care nurses, Neonatal care

nurses, Respiratory care technicians, and Burn specialists.

In the early 1980 s the Paramedic was adopted by many programs, as a

permanent supplement to this flight team. At first, off duty Paramedics were used

from land based services. But over time, as many hospitals began to employ

them within their emergency departments, Paramedics became full time

members in these flight crews. This addition soon began to show the right stuff

and helped tremendously with the reclining number of available qualified nurses.

Registered nurses were needed badly within the hospital setting and in many

flight services the Paramedic became the sole flight care provider.

Today s flight paramedic, Aeromedics , are as far removed from their

counterparts in Korea as are the machines they fly on. The majority of

aeromedical service programs today fly with a paramedic either accompanied

with a registered nurse, a flight physician, with another paramedic, or solo. These

individuals are known for their professionalism and expertise in recognizing and

intervening in life threatening situations. Trained in scene management, hazmat,

and as health care providers with pre-hospital protocols, standing orders, and

voice to voice communications with a physician, they can perform the most

complex tasks within allowed levels.

Aeromedical Services reduce the time required for transport. This

statement may be true, and it might not. Under normal circumstances and

conditions, the price and time needed for a medical flight would not justify calling

upon their services. There is a time delay in getting a helicopter wound up, the

weather checked, and a position plotted. Unlike a land based Ambulance, Air

medical transport is very vulnerable to weather. Wind, fog, ice, snow, and low

ceilings of a cloud deck, all play a role to make a successful or unsuccessful

flight. There is no guarantee of Oklahoma weather staying as promised for very

long. Even temperature and humidity play a significant roll as does geography. If

temperature and humidity become too high, then the density altitude might over

come the helicopters ability to proved lift over weight. It is as if the air had

become too thin for the rotors to hold on to and lift becomes insufficient. The

higher the altitude on the ground, the more this will play.

Geography also has its say. Hills, valleys, mountains, or plains offer many

problems. Mostly man made ones. Trees, power polls, power lines, billboards,

cell phone towers, all these make hazards for a low flying helicopter and its crew.

Since all medical flights must operate into field landing zones under Visual Flight

Rules, or under extreme condition Special Visual Flight Rules may be granted,

see and avoid is entirely on the pilot with little help from outside agencies. All this

does severely limit the pilot and at no time can he ever lose sight of the ground or

fly into a cloud. We all know how hilltops and power poles like to hide in a

mornings mist. And other flying objects are also a concern, anything from another

helicopter or small Cessna to a bird. At 125 miles an hour even a sparrow will

make it mark.

When a pilot is dispatched to an incident site his primary concern is the

weather, fuel, and landing zone availability. Of these three, only fuel is

controllable by him. But even this can become a problem, too little and he won t

make it, too much and he will be overloaded and can t life the load needed.

Landing zones are the biggest if for a pilot. Sometimes luck will give

them an open pasture or field near by. More often he will find a packed interstate

loaded with rush hour traffic and officials who are hesitant about closing that

artery even for the few minutes needed. Landing in a grass medium is a risk at

best and is usually very dangerous to all concerned. Flying debris from the prop

wash can do damage to passing vehicles, near by personnel, or the helicopter

itself. A small amount of soft ground can become a trap allowing one skid the

sink enough to throw the balance off, or holding firm on life off and pulling the

craft over on its side.

Power lines are the second biggest cause of crash for low flying rotorcraft,

second to engine failure only. One power cable can lock up or sheer off a rotor

blade, slice into a cabin, tear off a skid, or just topple the balance. Any way you

go about it, there is an interesting landing ahead when one of these is

encountered.

The Aeromedic is in danger of all this and more. Flying debris is always

present when shut down is not an option. Hearing loss is high due to exposure to

engine noise as high as 120DB. Back injuries from constant bending under load,

both in and out of the flight cabin is lessening with education, but still not unheard

of. And the constant exposure to high heat and concentrated fumes takes its

respiratory toll. All this is on top of the normal risk such as contracting infectious

diseases.

On March 10th of this year Life Star, from Northwest Texas Health Care

System lost a BO 105 helicopter. A pilot, flight nurse, and paramedic were on

board. The official description of this event is as follows:

Amarillo Life Star Helicopter responded to a scene reportedly close to the

Texas / Oklahoma state line. Fog was reported forming while the aircraft was on

scene. The pilot and crew lifted with a pediatric patient on board at approximately

0605. No radio communication was established after lift off. Due to fog in the

area a ground search was initiated and the wreckage was found at approximately

1100 hours. There were no survivors. Name of the crew members have not yet

been released.

If you are thinking about a career within the flight crew community don t

look for a large raise in income. Don t expect a lot of time off or to have any less

work either. Competition is stiff for these jobs. There are 277 programs that

currently fly with a paramedic on board. For each flight paramedic opening, 250

applications are received. And there are only 1200 flight paramedics operating in

the United States as of Nov 1999. With an average turn over time of 3 to 5 years

per position, it might be easier if you have the right qualifications before applying.

As a whole most services are looking for personnel who are already in

possession of their Nation Registry Paramedics Certification, experience of 3 to 5

years in a high volume 911 system, emergency department or Intensive care unit

experience, Instructor qualifications in ACLS, BTLS, PHTLS, or PALS,

experienced in critical care inter-facility transport, bachelors degree or graduate

studies, and being up to date and well read on all current research and literature.

So how busy are these services? Tulsa Flight Life reported that since

1979 they have flow, with patients on board, 28, 363 sorties. That averages out

to 150 flights with patients per month.

What can you and your patient expect on board one of these standard

Flight Life Helicopters? Medical equipment will include ECG monitors, external

cardiac pacer, cardiac defibrillator, pulse oximeter, non-invasive blood pressure

monitor, invasive pressure transducing monitor, end tidal CO2 monitor, and a

doppler volume ventilator.

In addition to helicopter services, many companies also offer fixed wing

prop or turbine medical transport. These long range craft could be anything from

a beechcraft twin to a Learjet 25, that can cruise at 500 miles per hour and at

45,000 feet. All within 15 minutes of takeoff. These small but powerful aircraft

offer a flight crew of 2, medical crew of 2, room for 3 family members, and even

for the patient.

As you can see Air Medical evacuation has come a long way in a very

short span of time. From the early and primitive machines in Korea, to the big,

powerful twin turbine machines of now. Every day these machine and their crews

are saving lives in both Military and civilian world. They can reach unheard of

areas and provides services never dreamed of just a few years ago. Making

pickups on Interstate highway, small rural farm, or even mountain top, few

medical emergencies are out of their reach. If you want the challenge of a life

time, it awaits you here, in the Aeromedics!

Glossary

Internet resources:

National Flight Paramedics Association

http://www.ntpa.rotor.com.

The Dustoff Association

http://www.tbg.net/dustoff.htm

AeroCare Air Ambulance Inc

http://www.aerocare.com

Advanced Air Ambulance

http://flyambu.co