LZ prep and the like

VentMonkey

VentMonkey

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So I wanted to create this thread in order to better inform, and educate any providers unfamiliar with LZ preparation when awaiting the arrival of your local HEMS agency to arrive at the scene of a call. This is pretty well known to some of those more experienced with landing their local HEMS depending on their particular system (rural agencies typically), and the document can be uploaded for future reference.

Other things to consider in preparing for the flight crew is having the patient packaged in a way to expedite transport. This could include things such as ensuring nothing loose such as blankets, sheets, or pillows are left on the gurney with the patient so that they're not sucked into the rotor system with hot loads (most HEMS ops do hot loads for scene calls). Always follow the lead of the person walking you back to the helicopter, and make sure you are staying in the line of sight of the pilot. At my service we'll typically count off the number of providers (not including my partner and myself) that we brought underneath the rotor system to help load the patient. This helps the pilot keep a mental note of how many people to look for walking away from underneath the rotor system once the patient is loaded into the helicopter.

Each HEMS agency operates different helicopters with different loading configurations, so be familiar with your local HEMS op's aeromedical fleet. We operate a 407 which loads from the side, and at an angle. The feet load first. Oftentimes while hot loading patients from a scene call we are "shouting" at the other providers assisting us, and/ or using a lot of hand signals (communication is everything), and we don't have a gurney that rolls or folds out like some other helicopters may (e.g., EC-135/ 145's). The poster PDF makes mention of someone standing "tail guard" which is sometimes a role designated to a provider (typically a firefighter for us). Please do not stand directly in front of the tail rotor (yep, it's happened). For our helicopter, we ask no one goes beyond where to fuselage meets the tailboom; basically, where the frame, or "body" of the helicopter stops.

This may seem like common sense to some of you guys, but I figure it can help others unfamiliar with the procedures taken into account when landing a helicopter. Remember, safety is the most important factor. If it seems unsafe as the helicopter is approaching the scene from dust, debris, or the like kicking up the crew can always abort, and/ or rendezvous at another location, thanks all.
-VentMonkey

http://www.airmethods.com/docs/air-...ir-methods-safety-poster-05-2012.pdf?sfvrsn=2
 
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CALEMT

CALEMT

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And remember to wet the ground with water that way the flight medic has something to walk on ;)
 
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VentMonkey

VentMonkey

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CALEMT said:
And remember to wet the ground with water that way the flight medic has something to walk on ;)
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Yeah, a firm surface. Hey, I'll have you know I am every bit the ******* I was even before I started flying.

In all seriousness, this is a good point. Oftentimes the fire department will be asked to water down an LZ in preparation for our approach; they love doing this (firefighters and their "toys":rolleyes:). I'd like to hear from anyone else if they have anything to offer. While I doubt this thread will go very far, any, and all questions are welcomed. Perhaps we'll even get a veteran flight paramedic, or two to chime in also.

One more thing to add, which the PDF does sort of hit on is communication with the HEMS crew when approaching the scene. For us, as we're approaching the scene, and/ or on final approach we'll often switch over to a direct frequency with the fire company assigned as our LZ coordinator; we use CALCORD as our direct contact channel. This means we often shut all unnecessary noise out, and prep for the "sterile cockpit". When we land, and take off the "sterile cockpit" rule is in full effect, and oftentimes other providers may feel as if they're being ignored on the radio; this isn't the case. Again, safety, until we're safely at an acceptable/ cruising altitude.
 
CALEMT

CALEMT

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While I don't know all the particulars of HEMS and my first post was intended as a joke, I've regularly seen LZ's watered down. More typically if its going to be on the dirt vs a road. I don't know the exact reason for doing so, but I don't complain because it kicks up less debris that would otherwise be in my face/eyes.

Im pretty sure CALCORD is unanimous in CA. There's only a few direct line of sight channels that I know of. CALCORD, CESARS, and CDF A/G. The last two are primarily used with CAL FIRE (my own experience) while every department/ agency that I've seen has CALCORD programmed into their radios. CAL FIRE, AMR, CHP, and RSO all have CALCORD from my experiences. Not everyone will have CESARS and CDF A/G (CDF air-ground).
 
EpiEMS

EpiEMS

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@VentMonkey, thanks for the info! (Here's hoping I never have to call for HEMS backup...I'm usually <15 minutes away from a Level II, FWIW.)
 
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VentMonkey

VentMonkey

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CALEMT said:
While I don't know all the particulars of HEMS and my first post was intended as a joke, I've regularly seen LZ's watered down. More typically if its going to be on the dirt vs a road. I don't know the exact reason for doing so, but I don't complain because it kicks up less debris that would otherwise be in my face/eyes.
Yes, it's essentially designed to prevent a "brown out", or as you've described..."less debris that would otherwise be in your face."
Im pretty sure CALCORD is unanimous in CA. There's only a few direct line of sight channels that I know of. CALCORD, CESARS, and CDF A/G. The last two are primarily used with CAL FIRE (my own experience) while every department/ agency that I've seen has CALCORD programmed into their radios. CAL FIRE, AMR, CHP, and RSO all have CALCORD from my experiences. Not everyone will have CESARS and CDF A/G (CDF air-ground).
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Yep, it's our direct air-to-ground frequency for our county fire department and LZ prep. In the (rare) event the city fire department utilizes us, we can reach them on CALCORD 2.
http://users.snowcrest.net/marnells/calcord.htm
 
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VentMonkey

VentMonkey

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Sorry @EpiEMS, I haven't a clue as to why my last post is in blue and glitched.

@CALEMT to add to the watering down of an LZ, a firm solid (dirt) soil not only means less chances of "brown outs", but also prevents the skids from sinking into the ground. That. Would. Be. Bad.
 
CALEMT

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NomadicMedic

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Usually the services that we work with come and do an in-service once or twice a year. Bring the airship in, show everybody the capabilities and go over a safe hot load procedure. We all usually get T-shirts and other freebies, so that's pretty nice too. Air Evac always gives away shears and other marketing goodies.

As far as contact with the airship, they usually come up on the working EMS talk group on the radio system. The airship will auto launch on a simultaneous dispatch with ground medics on certain criteria, they'll get on the radio and start asking the EMS unit for a patient report before they're on scene. I can't tell you how many times I've had to say, "as soon as I get there I'll let you know."

All really good guys though, and flying a patient that's going to require stuff outside my capability or the capability of the community hospital is a far better bet than me ground pounding 50 or 60 minutes to the trauma center.

Although, it never fails… Whenever I really need an airship the weather keeps 'em grounded.
 
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VentMonkey

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@DEmedic, thank you for expanding on this threads topic. As it implies "...and the like."

We do offer in-services to our local fire departments usually right before the summer time every year, and cover the same topics that you've stated AirEvac will.

Our new hires are brought out and given the same/ similar briefing and then we go over our utilization criteria (hint: NOT just trauma).

As far as asking a for report from the on scene crews, if it's one of our ground units, I may ask, but typically we have a pretty good run down, so the only times it makes sense for us to ask is if we truly aren't sure what's going on, which doesn't happen all that often as our ground crews, and fire departments are pretty good about keeping us updated.

I don't want to make this the VentMonkey "show and tell" so, again, I'd love to hear from others as well. Thanks again for the replies thus far, everyone.
 
NysEms2117

NysEms2117

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Would your protocols for flights landing and whatever else is involved in hems be the same as state police? Or more restricted because your private(most likely) and police is municipal/state/federal?
 
VFlutter

VFlutter

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Don't forget to take off hats, lanyards, and other loose items before approaching the aircraft with the crew.

Don't get offended if we choose a different landing zone then you have set up, things look much different from the air and we may see something we don't like that you can not see. We will err on the side of safety even if it means we have to rendezvous with ground somewhere.

Almost any air medical company will have outreach and LZ classes that you can request. And most of us have awesome PR freebies. Personally I think air methods has way better shears the other guys :rolleyes:

On a side note although rapid transport is a big benefit of air medical transport it is not the only reason to utilize HEMS. I have heard some medics say they never call a helicopter because by the time we lift and get there they could be halfway to the hospital and we only save them "a few minutes' however bringing advanced treatments to the patient at the accident scene can be a huge benefit if you do not have RSI, Vents, etc.
 
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VentMonkey

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Chase said:
Don't forget to take off hats, lanyards, and other loose items before approaching the aircraft with the crew.

Don't get offended if we choose a different landing zone then you have set up, things look much different from the air and we may see something we don't like that you can not see. We will err on the side of safety even if it means we have to rendezvous with ground somewhere.

Almost any air medical company will have outreach and LZ classes that you can request. And most of us have awesome PR freebies. Personally I think air methods has way better shears the other guys :rolleyes:

On a side note although rapid transport is a big benefit of air medical transport it is not the only reason to utilize HEMS. I have heard some medics say they never call a helicopter because by the time we lift and get there they could be halfway to the hospital and we only save them "a few minutes' however bringing advanced treatments to the patient at the accident scene can be a huge benefit if you do not have RSI, Vents, etc.
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Great post and points, Chase. We get the same or similar from some of the ground crews as well, and I think it's unfortunate that in this day and age it's still viewed as such by some; not all, but some too many, IMO.

@NysEms2117 100' x 100' is the "standard" LZ perimeter, and the PDF is pretty interchangeable regardless of the agency providing the HEMS.
 
NysEms2117

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VentMonkey said:
@NysEms2117 100' x 100' is the "standard" LZ perimeter, and the PDF is pretty interchangeable regardless of the agency providing the HEMS.
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okay, i know the standard LZ perimeters and stuff like that was just looking for other HEMS "info" you may not have because your not the actual pilot.
 
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VentMonkey

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NysEms2117 said:
okay, i know the standard LZ perimeters and stuff like that was just looking for other HEMS "info" you may not have because your not the actual pilot.
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Such as?...
 
NomadicMedic

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As a medic in a very rural area, without RSI, I like having the helicopter at my disposal. And if they launch at the initial dispatch, I'm more likely to consider using that resource.

As for the timing, that's a tough one. If I call for the availability on a airship and get an ETA of 30 minutes, unless they need an emergent airway, I'm probably going to shove off and head down the road. Because we all know it's 30 minutes to the scene, 10 or 15 minutes on the ground and then however long to the ED. And yeah, I can actually be at the trauma center faster.

I think an airship should be utilized for the care they can bring to the patient, not just as a "faster ambulance" because that usually isn't the case.
 
VFlutter

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VentMonkey said:
Great post and points, Chase. We get the same or similar from some of the ground crews as well, and I think it's unfortunate that in this day and age it's still viewed as such by some; not all, but some too many, IMO..
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We have some great ground services around us that have a lot of what we do (RSI, Revels, similar protocols) however unfortunately it seems like that mentality is much more common among those who do not.

We also try to educate the hospitals that not all helicopters are the same and that just because one company may quote a 5 minute faster response time that it may not be the best for the patient but it is tough convincing them when they just want the patient out as quick as possible. There can be a huge different in training, equipment, and protocols between various flight companies.
 
Tigger

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This is going to be an disorganized post and I apologize. But we we fly a whole ton of people despite having pretty decent protocols (RSI, basic vent/CPAP).

75% of our flights are from pre designated LZs from our substation or fire stations. All of these are fenced off, have wind indicators, and clear approaches. The more often used one's have LZ lights and the flight services have GPS approaches for them. I think this significantly reduces risk and also negates the need to divert often needed fire apparatus from the scene for an LZ standby. The helicopters will stage at the station and wait for us to bring us the patient. We talk directly to them on federal simplex VHF channels (VFire).

We have an imaginary line through the district where we know the helicopter will save time if we call for them on an air standby when we get dispatched. If they make it to the area and want to save fuel, they can land at one of the station LZs. Knowing where the helicopter is appropriate is super important. The AStar that we usually get is not super conducive to patient care enroute, so if it's a time sensitive call (stroke, STEMI), the flight crew is more than happy to be the super speedy ambulance and we strive to have the patient ready for them. When the crew get's in back I like to have my monitor as disconnected as possible to avoid tangles with theirs. We'll stop using our vent and bag the patient to the helicopter as well, it's just one less to thing worry about.

The AStar we usually get does not to hot loads and I am fine with that. One of my partners likes to argue with crews about hot loads, I want to murder him when he does so. The helicopter crew is 100% responsible for the aircraft and arguing about what they do with it is just dumb. The AStar starts in like 2 minutes anyway. We do get a 407 occasionally which needs the hot load since the start up is longer.

We are at high altitude (much of the district that helicopter is needed in is over 9000 feet). In the summer the 407 sometimes cannot get off the ground, so we try not to use them in the summer (they are getting an AStar soon). Even the AStar struggles, they often need a several hundred foot long LZ to get a running start to take off. Bear that in mind when you want them at a TA in a canyon at high elevation.

We can and will use flight services to transport speciality patients to Denver, which could be a two hour ground transport. Might be worth considering even if you are relatively close to a real hospital but one that is not a burn or peds center.

One of our programs will use their helicopter for SAR things if needed, best to know this beforehand. Ours will actually fly SAR trained people close to the patient to help move them to an LZ. They'll also do spotter flights, I went up with them last spring with them and found some lost hikers and saved us many miles of hiking through deep snow in the wrong direction at night.
 
VFlutter

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At least for us, and I would assume most companies, we appreciate air stand bys. You can call us if you think there is potential and we will launch and head that direction then circle a few miles out so you will not hear or see us but if you decide we are needed we are right there. No issues or charges if you cancel us. It cuts down our response time and we like to get out and fly.
 
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