Several Officials Question Dependence On Helicopters

In what could be a major step backwards for helicopter medevac operations, a panel of emergency medical officials met last week in Maryland to review the state of operations following the September 28 loss of a Eurocopter AS365 Dauphin II in poor weather conditions.

The Baltimore Sun reports a number of panelists expressed concern that local EMS operations may rely too much on helicopters to transport accident victims, adding several ambulance crews may now be reluctant to dispatch crews and patients onboard medevac helos.

"I'm concerned right now that there are some patients that should be flown to trauma centers that are not," said Dr. Douglas J. Floccare, director of aeromedical operations in Maryland. "There's some skittishness out there."

As ANN reported, three crewmembers and a patient were lost in the September accident, which occurred as the Dauphin was on approach to land at Andrews Air Force Base following a weather-related diversion. A second patient onboard the helicopter survived the crash.

At the core of helicopter medical evacuation policy in Maryland is the concept of the "golden hour" -- that accident victims stand a far better chance of surviving their injuries if transported to trauma centers within a hour of their injuries. The dictum -- coined by Shock Trauma founder R Adams Cowley -- was questioned by one trauma surgeon during the November 24 conference, who noted the oft-repeated phrase has never been scientifically proven.

"I know that time is easy to quantify... However, I think it is naive to think in 2008 that the value of helicopter transport is time-based," said Vanderbilt University trauma surgeon John A. Morris Jr. "The value of helicopter transport nationally is quality-of-care based."

Panelist Bryan Bledsoe, a Nevada physician, presented his published studies that cast doubts on whether helicopters are able to transport patients much faster than ground-based ambulances, and are able to save more lives.

Criticism was levied at both sides of the issue. A recording was played at the conference, of a dispatcher telling the September 28 accident pilot that ambulance drivers "never want to drive to the hospital." That comment has led to a national debate over how local medical services use their helicopters, the Sun reports.

Maryland EMS officials have already made a significant change to procedures since the September crash. Ambulance crews must now consult with a hospital before calling for a helicopter, if patients show no outward sign of injury. Before now, ambulance crews could call for a helicopter on their own, based on the likelihood of internal injuries.

Some question whether that step back has gone too far. EMS director Dr. Robert Bass told the panel 226 patients have been flown to the state's trauma hospitals since the accident, a pace of about 1,680 a year. That trend is less than half the over 4,100 patients flown by Maryland EMS in 2007.

FMI: www.mspaviation.org/frames.asp