Air Medical Transport: No Place for the Cardiac-Arrest Patient!
Air medical transport is designed for patients in critical condition, but most air transport programs will not transport patients who are in cardiac arrest.
Air Medical Transport: No Place for the Cardiac-Arrest Patient!
Many EMS providers work in a region that has an aeromedical program utilizing helicopters as the means of transport of patients. Most of these programs provide a combination of services involving any or all of the following:
- Critical care transports from hospital to hospital
- Scene evacuation to the regional trauma center
- Neonatal or high-risk newborn transports
- Technical rescue missions (usually provided by public safety agencies)
The typical list of "when to consider calling for the helicopter" in each community may vary slightly based on the protocols and the configuration of the staff and ship. One thing that is often common is that most helicopter programs do not encourage transporting cardiac-arrest patients. There are a few exceptions, as in the case of a hypothermic patient needing the expertise of a regional center for dialysis and or possible heart/lung bypass. Another exception would be the situation where a critical patient "codes" in the helicopter en route to the receiving hospital.
The reasons for not routinely transporting cardiac-arrest patients are based upon a number of medical issues. These include the following:
- The chance of cardiac-arrest survival has been well studied. The patient's best chance for survival involves the immediate recognition, access, citizen CPR, and early defibrillation followed up by early definitive care. These are basics that should be in place in each community. If the community does not have ALS available at the scene, then the local hospital emergency department is the source of definitive care and an early transport decision needs to be made.
- Most helicopters do not have a lot of room to work, and they are especially tight at the head end of the patient. That is why many helicopter programs look to intubate the patient prior to placing them in the ship. It is difficult to do CPR and adequately manage a "code" in such a tight place.
- Most helicopter programs have a crew of two or three, including the pilot. Therefore, it would be difficult to manage a cardiac arrest with the limited number of personnel. Consider how many rescuers that are usually available on the scene or in the hospital emergency department to work a "code."
- Air missions are dangerous! All effort is made to control as many variables as possible to limit the dangers but they can never be completely eliminated. Basically, the risk to the flight personnel and the ship are not worth the benefit to a patient who is in cardiac arrest in most situations.
For more information about the protocols for your region, speak with your service's medical director and the regional helicopter program.
For additional information on helicopters used for medical evacuation, check out these internet websites:
http://www.camts.org
http://www.astna.org
http://www.nfpa.rotor.com
http://www.flightweb.com
http://www.aams.org
http://www.ampa.org
