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
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