Lifesaving Aviation: The Role of Aircraft in Healthcare

Helicopters in Healthcare


A LifeLink III Helicopter Leaving a Hospital in Saint Paul, Minnesota

The Golden Hour
Now, this is an aviation forum, but to truly understand the importance of aviation in healthcare, you need to understand a little tiny bit about medical emergencies. For this topic, I talked to a friend of my Dad’s, a flight paramedic for LifeLink III, a helicopter ambulance service in the Midwest, based in Minneapolis.

The term “Golden Hour” is commonly used to characterize the urgent need for the care of trauma patients. This term implies that morbidity and mortality are affected if care is not instituted within the first hour after injury, according to the National Institute of Health. A major trauma could be anything from a gunshot wound to a boating accident to a burn. Patients who are involved in a major trauma are ideally brought to the most suitable hospital, Level 1 Trauma Centers. Not all cities and towns have Level 1 Trauma centers. To get this certification, a hospital must have on call trauma surgeons and specific plans and care abilities to help the most critical of patients. Hospitals can also be certified as Level 2 and 3 Trauma Centers, which have less standards.

If you are injured in a major city, then you’ll likely be picked up by an ambulance and brought to the hospital. But many patients are injured in small towns or rural areas, where the local medical facilities might not be enough to treat them. Most of the time, a ground based ambulance isn’t fast enough to need this “Golden Hour” rule. That’s where the helicopter comes in.


Air Ambulances
Helicopters are by far the most popular form of air medical transportation. Aircraft are sometimes used for extremly long distance travel (for example into the Australian Outback) or for mass casualty/ multiple patient incidents.

The most common types used in the United States are Bell 206, 407, and 429, Eurocopter AS350, BK117, EC130, EC135, EC145, and the Agusta Westland 109.

Helicopters are versatile and can be activated very quickly. According to my flight medic contact, his company, LifeLink III has a 15 minute target from receiving the call for help to being in the air. He told me that they can do it in as little as 8 minutes if need be. He ran me through a possible scenario, and it goes a little like this:

Someone calls 911, let’s say near Bemidji, Minnesota (NW part of the state). There has just been a terrible snowmobile accident. An ambulance is dispatched from the local hospital. Most times, the ambulance crew will inform the hospital that the patient is beyond what the local hospital can care for, and should be brought to a higher level of care.

The hospital dispatcher calls LifeLink III, who provide the majority of the Air Ambulance service for Minnesota, North Dakota, South Dakota, Iowa, and Wisconsin. They operate 24/7/365. LifeLink’s dispatcher will then scramble a crew, consisting of 2 flight paramedics (sometimes one paramedic and one doctor) and two pilots. The helicopters are kept in tip top shape and always fueled and stocked with supplies. They just have to start the engine and take off.

The flight would be about 45 minutes, and they’d land on the hospital helipad. The hospital doctors would have the patient (hopefully) stabilized somewhat and on a stretched just inside of the hospital doors. The second they touch down, the patient is rushed onto the copter. A turn could be as little as 4 minutes, and the engine is left running. The helicopter is chock full of medical supplies, and they can provide virtually any kind of care, including administering life saving medication, intubate a patient, or, in some cases, do imaging.

In Minneapolis, LifeLinkIII takes patients to either North Memorial Hospital or Hennepin Health. They will land on the hospital’s helipad where a team of doctors will be waiting. The patient can be rushed into surgery almost instantly.

While the Golden Hour might not be met, it’s still much quicker then trying to transport a patient by ground. The Flight Paramedic told me “we can’t always save them. It’s not always possible. That’s the way things are. But, they have a better chance by air then they would by land or staying at the IPC (Initial Point of Care).”


Air Medicine in the Outback
This really fascinates me. Most of the interior of Australia is the Great Australian Desert, known colloquially as the “Outback.” The vast majority of Australia’s people are concentrated along the coasts in big cities like Brisbane, Sydney, Perth, Melbourne and countless other smaller towns and communities. There are a few settlements in Central Australia, like Alice Springs, but they’re few and far between. Most of the land is uninhabited, or used for cattle ranching.

Because of this sparsity, there isn’t much in terms of medical care. Nevertheless, people still get sick and hurt. An ambulance on wheels would take hours, potentially days to reach someone in the remote Outback. While a helicopter is faster than a ground vehicle, it might not have the range to make it 800+ miles into the wilderness and back. So, planes are the only logical option.


New South Wales Air Ambulance Service

Patients are transported by airplane to hospitals from either a local airport or… a road. Yes. A road. Long stretches of straight road can be used to land planes, even small jets. A land based ambulance can drive a patient to one of these road airstrips, and hand them off to a waiting airplane to be transferred to a higher level of care.


Conclusion
Air ambulances have saved hundreds of thousands of lives, including that of my cousin. In 2018, my cousin suffered a severe spinal injury on Martha’s Vineyard, Massachusetts. The hospital on the island couldn’t treat the injury themselves, and he required a helicopter to transport him to Boston for a higher level of care. Without that helicopter, he could have been paralyzed or killed. Today, he’s a completely fine, 20 something year old grad school student.

Medical helicopters are only going to get better and faster as technology advances. With the introduction of electric aircraft in the semi -near future, they could be getting greener too.


Sources
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Is that another W post by Mort I see 👀👀

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Quite possibly 👀👀

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EMT (NREMT Only) here, allow me to preach the gospel of Trauma Centers. I like to call Level One Trauma centers Knife and Gun clubs because generally that’s where most GSW (gunshot wound) or penetrating trauma patients end up, they are the most well equipped to handle the associated things that come with that kind of trauma such as pneumothorax or compartment syndrome (usually that’s from broken bones but it arises in certain types of penetrating trauma).

Level 2 Trauma Centers are the second most well equipped and usually are geared towards other traumatic injuries such as crushing traumas, some types of traumatic amputation, and things like breakage or fractures in bones. They are equipped to handle most situations and Level 1 centers are usually reserved for the critical patients (all Level 1 centers are required to be at operational capacity 24/7 as are Level 2 Centers). Most trauma centers are Level 3 trauma centers save for those in large metropolitan areas which will usually have at least one Level 1 center and a multiple Level 2s.

Level 3 Trauma Centers usually are used in a front-line capacity so that we can package patients up for further care, not nearly as well equipped to handle severe traumatic incidents. Usually they serve as a choke/funnel point and provide the necessary interventions so that transfer of care to a Level 2 or Level 1 facility can occur without injury to the patient. Most centers are Level 3. At the minimum they have equipment for resuscitation, emergency surgery, and a cath-lab if it’s a particularly well funded facility.

There are also Level 4 and Level 5 centers, which are the most bare bones in the trauma care system. Primarily these two are there to serve as facilities to rapidly stabilize patients and package them for transport. To quote wikipedia, “It [Level 4 Trauma Center] may also provide surgery and critical-care services, as defined in the scope of services for trauma care. A trauma-trained nurse is immediately available, and physicians are available upon the patient’s arrival in the Emergency Department. Transfer agreements exist with other trauma centers of higher levels, for use when conditions warrant a transfer.”

If an MCI (Mass Casualty Incident) were to occur, generally the first line of facility would be Level 3-5 Trauma Centers so that less critical patients could be funneled through triage. If they are Triaged START Yellow or START Red, then they get shipped off to the Level 2 and Level 1 Centers (especially for START Red). However, with these situations ultimately getting the quickest care to them is priority so we generally use Level 3 centers as a way to assess and stabilize patients before sending them to more specialized care depending on what center is closer. It really varies, as my county has a Level 1 and a Level 2 center.


Now especially with Level 1-3 Centers, having a necessary landing pad for an air-ambulance is a must especially for rural or highly critical patients. Within my area (Pacific Northwest/Portland Oregon Metro Area) we utilize LifeFlight who handles these types of pick ups. It’s prevalent up near Mt. St Helens where ground-based rescue cannot always get to, so some of these air-ambulances actually can serve as dedicated SAR units depending on standing orders and scope of practice. Usually we have the Volcano Rescue Team up there within Clark and Cowlitz Counties to initiate a ground-based response for assessment and packaging so that the Aerial can pick them up and role them (usually to Southwest Medical which is our Level 2 Center).

Air ambulances can cover a lot of ground fast, which makes them perfect for these types of conditions. Now I want to note that I have very minimal first hand experience with handling these things and right now I am not apart of any ambulance service (just had an interview yesterday though so here’s hoping) so this isn’t exactly how it’s done in the field, but Aircraft have a big role to play in the US EMS system. Especially in Rural or hard to reach areas, or for extremely critical patients. Good write up @Mort, you did a good job.

TL;DR: My Vyvanse finally kicked in.

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Also worth noting that air transport can be useful for medical cases in addition to trauma cases. While they generally do go hand in hand trauma center category is independent of other care levels like being a comprehensive stroke center or having a cath lab. Children’s hospitals for pediatric cases also are a notable category that may require specialists not all hospitals would have, and burns while a trauma case do have specialized burn centers which may not be at all level 1 or 2 trauma centers.


Depending on the circumstances helicopters can also land at the point of injury and transport from there and provide a higher level of care on scene. In many cases taking the patient to a local hospital and then using the helicopter as an inter facility transport makes the most sense since even a small hospital can do more than a paramedic in the back of an ambulance. But for example in a major car accident with entrapments it can take some time to get victims out, if an air ambulance is half an hour away you could have them on scene to begin to provide a higher level of care and transport directly. Many air ambulances fly with a nurse or doctor who has a higher scope of practice than your average paramedic. One really important thing they can do is that a fair few of them fly with blood, not all, but whole blood on regular ambulances is very, very uncommon. It is becoming more of a thing, states are increasingly adding it to the paramedic scope of practice and some agencies are adopting it but it is a long way from becoming common. While pushing fluids and pressers can help stabilize blood pressure to a point, ultimately the patient does need a blood transfusion and starting that as soon as possible will help outcomes in major trauma patients in particular where blood loss is one of the leading causes of death.

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Tbh I just didn’t feel like writing up a whole medical section. Too much work.

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Yeah I mean that was just a general addition, I guess I did reply to your post but hopefully that didn’t come off as a correction

Loaded thoes birds up many times, great post !

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Im totally going to read this tomorrow. Looks like a great topic

Bookmarked :)

Damn, I forgot you were a firefighter. Good stuff.

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Great topic, a super interesting read. I enjoyed the main post along with other community members input as well. Super informative, and definitely plays a major role in saving people’s lives.

Thank you!

I really appreciate the added information from everyone, including @Mattheus and @DanyyRude.

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Nice, informative and interesting topic. I live near a hospital so I’ve seen a lot of these helicopters fly low over my house. It’s really cool to see.