Just how dangerous are rotor-wing ambulances?

[Summit]

We all know there risks associated with rotor-wing air ambulances. But seriously, how great are those risks? Is working on an air ambulance more dangerous than on a ground ambulance? If so, how much so?

I'm curious because the topic came up in reference to a discussion regarding risk management and SAR use of rotor-wing transport.

 

[Airwaygoddess]

Weather problems, power lines, to name a few as far as high risk.

 

[Ridryder911]

All I know is when you have a flat in a rotor wing, there is no where to pull over!....

Seriously, rotors are extremely dangerous. Tower wires, heavies (other big aircraft), fence posts, geese, etc... It is a known fact, when you crash your lucky if you die.. if it is a short lift off or decent, you might get lucky with only a broken back and fractured ankles. Then as well, look at tail rotor incidences...

What is ironic, most assume you spend most of your time taking care of the patient in the helicopter... in reality, very little assessment and treatment is performed in the air. ( remember you can't hear, and probably only are able to reach & get to the chest area) One must be continuously looking for hazards, and other aircraft.... safety is the main goal, patient care is second...

R/r 911

 

[Flight-LP]

All I know is when you have a flat in a rotor wing, there is no where to pull over!....

Seriously, rotors are extremely dangerous. Tower wires, heavies (other big aircraft), fence posts, geese, etc... It is a known fact, when you crash your lucky if you die.. if it is a short lift off or decent, you might get lucky with only a broken back and fractured ankles. Then as well, look at tail rotor incidences...

What is ironic, most assume you spend most of your time taking care of the patient in the helicopter... in reality, very little assessment and treatment is performed in the air. ( remember you can't hear, and probably only are able to reach & get to the chest area) One must be continuously looking for hazards, and other aircraft.... safety is the main goal, patient care is second...

R/r 911

Not to mention always looking up front to make sure your 70ish year old pilot is still breathing!

Yea, its funny that most people think there is this high level of trauma care that occurs in the helicopter. To expand on what rid was mentioning, a typical flight will go something like this..................

1. Land (hopefully with minimal damage to the helo).
2. Immediately get out and stop some dumb volunteer firefighter from running into the rotors.
3. Drag said firefighter back to his truck and put him in time out.
4. Make contact with patient and ground EMS crew. Receive report, maintain airway as needed, insert chest tube and/or perform any invasive procedure as needed, establish our baseline vitals, get demographics, transfer pt. to our equipment, place hearing protection on pt.
5. Kick out the additional firefighters who insist on helping the already 4 people in the back of the ambulance just so they can be near the helicopter.
6. Drag said firefighters back to the truck to join their buddy in time out.
7. Either insert transport flat under pt. or transfer pt. to helicopter stretcher (depends on type of helo).
8. Move to helicopter with too many people including the aforementioned firefighters who are supposed to be in time out.
9. Stop same firefighter from again walking into the rotors, send him back to time out (3rd time, he's on his own. Damn thats going to be a painful lesson!)
10. Secure pt. in helicopter.
11. Get everyone other than the flight and medical crew away from the helicopter.
12. Perform final walkaround.
13. Put pt. on vent, pump, and additional monitoring as required.
14. Ignore pt. for a couple of minutes while we prepare to lift and depart the LZ.
15. Stop, get out and tell the firefighters that they do not need a charged hose line 3 feet from the helicopter as it is about to lift.
16. Get back in helicopter and depart LZ.
17. Glance at pt. to make sure they are still alive, take a pulse to confirm.
18. Continue to ignore pt. as we watch for VFR traffic in the area as we are flying too low to be picked up on radar by ATC.
19. Repeat 17 and 18 until arrival at destination.
20. Land (again hopefully with minimal damage)

Seriously though, yes rotor based EMS is significantly more dangerous than ground based EMS. The sad part is that most of the increased dangers are caused by EMS personnel not knowing when it is and is not appropriate to fly patients. Too many crews fly pts. based off of MOI, which has been proven to be an insufficient method of assessment. Your only benefit from a helicopter is time, not necessarily better care (unless your a BLS service in which case you should consider a better source of ALS care that reduces the increased mortality of the flight crews). This especially holds true for some for-profit based helicopter systems. There are a couple of companies that I wouldn't send my worst enemy's dog with..............

Another factor is the type of helicopter. I see so many Bell 206's flying in EMS. Yes it is the safest helicopter in the world, but it is a horrible EMS platform. Minimal load capabilities, minimal fuel capabilities, and slow. Plus if your trying to operate in the mountains, forget it. Higher altitudes = an increase in density altitude which the 206 cannot afford to compensate for.

Then you bring in the factor that most companies operate in visual conditions only. Bad weather, no helicopter. Provide IFR capabilities and you not only increase contingency operation possibilities, but you also can then file IFR, even its clear blue and a million, and be guaranteed ATC priority handling and radar coverage.

Honestly, the way to bring down the risk would be to increase education to the clients (i.e. ground EMS and hospitals), provide 2 pilots in a twin engine aircraft, have IFR capabilities, and provide NVG's for night operations. Then increase the required amount of crew resource management training for the flight and medical crews. The risk reduction would be quite significant!

 

[Guardian]

lol! I've been that firefighter put into time out on many occasions.

You flight nuts do ahellofa job.

 

[Anomalous]

20. Land (again hopefully with minimal damage)

I heard that if no one gets hurt it is a good landing.

If the can re-use the aircraft, it is a great landing.

:wacko:

 

[TheDoll]

lol! I've been that firefighter put into time out on many occasions.

You flight nuts do ahellofa job.

you just couldn't bring yourself to say "heli" could you?

 

[Guardian]

you just couldn't bring yourself to say "heli" could you?

lol.

Summit, go to any LODD website and look at what most of the paramedic deaths are from and I think that will answer your question.

I see medical flight systems being abused all the time. Example, poorly trained providers calling for a helicopter because they think they need ALS and don't have any ALS providers on scene or calling just for MOI without actual signs of injury. If we keep this up, there will be talk about doing away with helicopter transports, wait a minute, that's already happening!

I've always been jealous of flight medics because I can't be one. I'll too tall and heavy. But I do want to see the flight programs remain because they are a great recruiting tool. There is always hordes of flight paramedic wannabes running around that wouldn't be in the business otherwise

 

[babygirl2882]

I just wonder if helio transports being done away what will happen to all the transports that despritly need to go to a higher trama center but its 3hrs aways by land?

 

[Guardian]

http://nemsms.org/notices.htm

 

[Guardian]

I just wonder if helio transports being done away what will happen to all the transports that despritly need to go to a higher trama center but its 3hrs aways by land?

they're sol.

 

[babygirl2882]

so what could be done in place?

 

[Flight-LP]

so what could be done in place?

As previously mentioned in my earlier thread..........

A) Better education for ground providers pertaining to what is appropriate and inapropriate to fly.

B ) Twin engine, IFR certificated aircraft with dual pilots.

C) More emphasis on Crew Resource Management.

D) Stricter FAA and NTSB regulation on the industry.

E) Elimination of crap for profit services that use the "rural environment" need as their excuse to come in, collect membership fees, then relocate leaving their clients SOL.

F) Higher education and experience requirements for the medical crew. Stop sending Bubba Joe Bob with his 2 years experience as a medic out as part of a medical crew. The only reason he is there is because he also works for ABC EMS and can get flights from them. Sorry , but that is pure crap!

F) Federal inititives to bring in professional hospital based programs to the underserved rural areas, thus allowing them to actually have QUALITY services available to them instead of a half assed operation (see E and F above)(Yea, I am focusing on one particular service, but for good reason).

A lot needs to change or you will see this as a dying breed..............

 

[BossyCow]

Our small rural hospital doesn't have the staff, equipment or infrastructure to handle multi-system trauma, cardiac, head injuries and strokes, burns and many pediatric emergencies. We use air-lift regularly to transport these pt's to the regional trauma center.

We've been without due to fog, snow, wind .... insert inclement weather condition here........but we have mountains and several bodies of water between us and the trauma center, a 3 hour ride by ambulance or 40 minutes by air... do the math.

I can't imagine abusing this system.

 

[sandboxmedic]

What, you mean you cant do jumping jacks next to the Helo?? no kidding.....LOL.
FLIGHT-LP, that was a funny post......

Similar story, one of my teammates here in the sandbox had one just like it. Blackhawk landed, 4 iraqi's jumped out ran around like a bunch of "merecats" on redbull. One idiot ran under the rear rotor, full stride, and upright. Good thing he was a short guy he just missed the blades, or, i guess you could say he was almost made immediately shorter.

I have another quote to ADD to your list, one we use here quite often, usually related to some type of "Darwin Award" event.
" Screwing around an actively spun up helo is usually a "SELF-CORRECTING EVOLUTION" where stupidity is painful, and very immediate.

Cheers-