BLS - Air Ambulance Utilization Standard

From Paramedipedia - Ontario Paramedic Standards

Jump to: navigation, search

Contents

A. Requesting On-Scene Response by Helicopter

1. During their scene and patient assessments, the paramedic will identify the presence of operational and clinical guidelines that could result in the request for an on-scene response by helicopter.


2. Upon identifying the on-scene call may meet the operational guidelines, the paramedic will determine if the patient meets the clinical guidelines before requesting an on-scene response by helicopter.
Note: If the patient cannot be easily reached by land ambulance (e.g. difficult land access to ravines/valleys, large parks/conservation areas, furrowed or heavily snow covered fields, flooded areas; sites without road access such as islands; geographically isolated places such as lumber and mining operations, wilderness camps), the paramedic will request an on-scene response by helicopter whether or not the clinical guidelines are met.


3. Upon identifying the patient meets the clinical guidelines, the paramedic will estimate the time to travel by land ambulance from the scene to the closest appropriate hospital*. If the travel time is greater than 30 minutes or there are multiple patients who meet the clinical criteria and the local land ambulance resources are overwhelmed, the paramedic will contact dispatch and request an on-scene response by helicopter.

*Closest appropriate hospital for on-scene call patients assessed as meeting the Field Trauma Triage Guidelines is the closest lead trauma hospital. On-scene call patients assessed as meeting the Field Trauma Triage Guidelines will bypass other hospitals to go to the closest lead trauma hospital if:
(a) the closest lead trauma hospital is less than 30 minutes away by land ambulance, or
(b) air ambulance helicopter is available to respond on-scene for direct patient evacuation to the lead trauma hospital.
If at any time the paramedic is uncomfortable with the safety of the patient during transport to the closest lead trauma hospital and bypassing other hospitals, the paramedic may divert to the closest hospital with an emergency department.


Note: Paramedics will divert to the closest hospital with an emergency department when, in their judgement, the patient could not survive transport to the nearest Lead Trauma Hospital (e.g. complete airway obstruction; no spontaneous respirations; no palpable carotid pulse). However, VSA patients with penetrating trauma to the chest or abdomen may be transported to a Lead Trauma Hospital.
Note: The 30 minutes is an approximation and includes extrication time, traffic and road/weather conditions, and those factors which affect response/transport time but cannot be predetermined.
Note: Specific geographic response zones may be used, rather than the 30 minutes time guideline.


4. The paramedic will provide the ambulance communications officer with the operational and clinical guidelines identified. Also, in order for the ambulance communications officer to determine if a helicopter response and transport will be quicker than land ambulance, the paramedic will provide the ambulance communications officer with the estimated time to prepare the patient for transport, identify separately any time required for patient extrication, the estimated land ambulance driving time to the closest appropriate hospital* and any additional information as required.


5. If in the judgement of the paramedic or ambulance communications officer an on-scene helicopter response is appropriate under the circumstances, even though the operational and/or clinical guidelines have not been met, a helicopter response should be requested.


6. Upon confirmation the helicopter is responding, the paramedic will designate a Landing Site Coordinator (see Section C - Landing Site Safety and Coordination).


7. The paramedic will provide patient care until responsibility has been transferred to another care provider of equal or higher level.


8. Land ambulance paramedics will not delay patient transport by waiting for the helicopter, unless the helicopter can be seen on its final approach to the scene. If the helicopter is enroute but not on final approach to the scene, and the land paramedics have the patient in their ambulance, then the land ambulance will proceed to the closest local hospital with an emergency department. The helicopter will proceed to that local hospital and, IF APPROPRIATE, assist hospital personnel prepare the patient for rapid evacuation to the most appropriate hospital/lead trauma hospital.


9. If the call’s circumstances and patient(s) fail to meet the guidelines and a helicopter is known to be responding based on the merits of the initial request for ambulance service, the paramedic will contact the CACC/ACS and advise that an on-scene response by helicopter is not required and why.


B. Determining Criteria for Helicopter Response

Requests for on-scene helicopter response should meet at least one of the bulleted Operational Guidelines plus one of the bulleted Clinical Guidelines. However, if in the judgement of the paramedic or ambulance communications officer an on-scene helicopter response is appropriate under the circumstances, even though the operational and/or clinical guidelines have not been met, a helicopter response should be requested.


1. Operational Guidelines

  • the land ambulance requires more than 30 minutes to reach the scene and the helicopter can reach the scene quicker;
  • the land ambulance requires more than 30 minutes to travel from the scene to the closest appropriate hospital* and the helicopter can reach the scene and transport the patient to the closest appropriate hospital* quicker than the land ambulance;
  • the estimated response for both land and air is greater than 30 minutes, but approximately equal, and the patient needs advanced paramedic level care which cannot be provided by the responding land ambulance;
  • there are multiple patients who meet the clinical guidelines and the local land ambulance resources are overwhelmed;
  • the patient cannot be easily reached by land ambulance, whether or not the clinical guidelines are met;
  • if in the judgement of the paramedic or ambulance communications officer an on-scene helicopter response is appropriate under the circumstances, even though the operational and/or clinical guidelines have not been met, a helicopter response should be requested.


2. Clinical Guidelines

Known Clinical Conditions
Patients meeting any one of the following conditions should be transported to the closest lead trauma hospital:
Field Trauma Triage Guidelines
  • spinal cord injury with paraplegia or quadriplegia;
  • penetrating injury to head, neck, trunk or groin;
  • amputation above wrist or ankle;
  • adult patients with a Glasgow Coma Scale less than or equal to 10;
  • If adult GCS is greater than 10, any two of the following:
(1) any alteration in level of consciousness;
(2) pulse rate less than 50 or greater than 120;
(3) blood pressure less than 80 systolic (or absent radial pulse);
(4) respiratory rate less than 10 or greater than 24.
  • Pediatric Trauma Score of less than or equal to 8;
  • paramedic’s judgement that the patient requires assessment and treatment at a lead trauma centre.


Patients meeting any one of the following conditions should be transported to the closest appropriate hospital:


Medical
  • acute abdomen (suspect obstruction or perforation);
  • acute headache (associated with decreased level of consciousness, altered mental status or neurological deficits);
  • acute respiratory failure or distress;
  • chest pain (suspect AMI or other serious underlying disorder) and/or potentially lethal dysrythmia;
  • overdose/poisoning (altered level of consciousness or quantity is potentially lethal and/or requires specialized treatment);
  • resuscitated from respiratory or cardiac arrest;
  • status epilepticus;
  • unstable airway or partial airway obstruction.


Environmental
  • decompression sickness needing hyperbaric oxygen therapy;
  • electrocution with signs of significant electrical injury;
  • hyperthermia (suspect core temperature of greater than 42°C and an altered level of consciousness with or without diaphoresis);
  • hypothermia (suspect core temperature of less than 32°C with or without shivering reflex);
  • major burns (2nd degree greater than 20%, 3rd degree greater than 10%);
  • near drowning.


Obstetrical
  • abnormal presentation (i.e. shoulder, breech or limb);
  • multiple birth;
  • pre-eclampsia/eclampsia;
  • premature labour (gestation less than 36 weeks);
  • premature rupture of membranes;
  • umbilical cord prolapsed;
  • vaginal bleeding (suspect abruptio placenta or placenta previa).


Unknown Clinical Conditions or Limited Clinical Detail (Injury Assumed)


Mechanism of Injury
Patients presenting with the following should be transported to the closest lead trauma hospital:
  • fall from a height greater than 5 metres;
  • pedestrian struck by vehicle where speed is greater than 15 km/hr;
  • person ejected from vehicle where speed greater than 30 km/hr;
  • vehicular collision where the combined speed is greater than 30 km/hr or death of co-occupant;
  • vehicle rollover with unbelted occupant(s) or death of co-occupant;
  • vehicle struck a fixed object (e.g. rock cut, tree, pole) or large animal (e.g. moose, deer, bear).


C. Landing Site Safety and Coordination

One rescuer (selected from either the police, fire, or ambulance personnel) should be chosen to assume the role of Landing Site Coordinator and take the following actions to coordinate the safe landing of the helicopter while maintaining the safety of the scene:


1. Wear Safety Apparel
a) don and secure a high visibility vest or coat;
b) don and secure a safety helmet with visor;
c) wear safety goggles or safety eyewear.


2. Landing Site Selection
The helicopter’s pilot-in-command is responsible for selecting the landing site and has the final decision on whether or not to land. Using the helicopter’s airborne vantage point, the pilot-in-command will select a site that best meets the following conditions:
a) a site that will not affect the rescue efforts underway;
b) a clear area of approximately 30 metres x 30 metres;
c) a safety area, extending approximately an additional 30 metres for the purpose of controlling vehicle and personnel access during landing and take-off;
d) the landing site should be away from overhead wires and utility poles;
e) the surface should be fat as possible;
f) no loose debris should be within the landing site or the safety area; check ditches;
g) gravel and sand sites should be avoided, if possible, due to the potential of injury from flying dust particles and reduced visibility.


3. Site Safety
a) no vehicles or personnel are allowed within the landing site and safety area during landing and take-off;
b) vehicle doors and access compartments should be closed;
c) stretchers should be left in the ambulance and all loose articles secured;
d) if requested by the fight crew, the Landing Site Coordinator will stand at the upwind edge of the safety area, back to the wind and facing the site, to maintain security during the landing and take-off;
e) firefghters should not lay out hoses; any lines that have been laid should be charged;
f) if site security is compromised, such as personnel or vehicles entering the safety area, the Landing Site Coordinator is to wave off the helicopter by crossing outstretched arms over their heads.


4. Safely Working Around A Helicopter
a) stay out of the safety area and landing site during landing and takeoff;
b) approach or depart only when directed by a member of the air crew;
c) do not approach the helicopter from the rear as the tail rotor is difficult to see;
d) if on uneven ground, approach or depart from the downhill side;
e) carry all equipment horizontally at or below waist level, never over shoulder;
f) ensure hats, scarves, gloves, glasses and any other loose articles are secure before entering the safety area.


D. Other Use of Helicopters

1. The helicopter will not be permitted to respond to night calls which require a landing at a site other than night licensed airports, helipads or night approved remote landing sites.


2.
a) A helicopter will not normally be diverted from a Code 4 response to an on-scene call unless authorized by the Ornge Communications Centre (OCC);
b) Helicopters assigned on lower priority calls may be diverted to on-scene calls if the request meets the guidelines for on-scene response (see Section B - Determining Criteria for Helicopter Response). If the air crew has already made contact with the lower priority patient the OCC must approve the diversion. If the lower priority patient is already on board the helicopter the fight paramedic’s base hospital physician must approve the diversion;
c) When a helicopter is diverted, as provided above, the ambulance communications officer responsible must ensure that all parties are advised.


3. Helicopters will not be permitted to conduct search and rescue calls. For purposes of this section, Search and Rescue is defined as:
  • Looking diligently for person(s) whose whereabouts are unclear and/or require removal from a location by specialized tools such as hoists.


4.
a) In those cases where land ambulance can reach the patient(s) and an on-scene response by helicopter is appropriate, the ambulance communications officer will assign a land ambulance as tiered response and continue the land response until the fight crew request the land ambulance be canceled.
b) In those cases where land ambulance is providing first or tiered response to air ambulance, the CACC/ACS with their vehicle first on-scene will inform the other communication centre as events occur.
c) The crew reaching the scene first is responsible for triage and scene management. The highest medically trained personnel on-scene will normally be the authority in patient/medical matters. If both air and land ALS crews are on-scene the crew transporting the patient(s) will have authority over patient/medical matters.



Table of Contents



Return to Paramedipedia-Ontario, Main Page
Return to BLS - Patient Care Standards
Return to BLS - Section 1 - General Standard of Care

Other headings in this section:

Personal tools