EMERGENCY MEDICAL SERVICES

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1 POLICY NO: 403 DATE ISSUED: 06/1999 DATE REVIEWED/REVISED: 03/2008 DATE TO BE REVIEWED: 03/2011 EMERGENCY MEDICAL SERVICES AIR MEDICAL TRANSPORT PROVIDER Purpose: To establish criteria for Emergency Medical Services (EMS) aircraft operations, equipment and personnel. Authority: Health and Safety Code, Division 2.5, Sections , , and California Code of Regulations, Title 22, Division 9, Section Policy: I. EMS Classification/Definitions A. EMS Aircraft Any aircraft utilized for the purpose of pre-hospital emergency patient response and transportation. This includes Air Ambulances and all categories of Rescue Aircraft. B. Air Ambulance Any aircraft specifically constructed, modified, or equipped and used for the primary purposes of transporting critically ill or injured patients whose flight crew has at a minimum two (2) attendants accredited and/or licensed to provide Advanced Life Support. C. Rescue Aircraft Any aircraft whose function is not primarily a pre-hospital emergency patient transport may be utilized, in compliance with local EMS policy, for pre-hospital emergency patient transport when use of an air or ground ambulance is inappropriate or unavailable. Rescue aircraft included ALS rescue aircraft, BLS rescue aircraft, and Auxiliary Rescue Aircraft. 1. ALS Rescue Aircraft means a rescue aircraft whose medical crew has at least one (1) attendant accredited and licensed to provide Advanced Life Support care. APPROVED: Nancy A. Lapolla, EMS Director Angelo Salvucci, MD, EMS Medical Director

2 PAGE 2 OF 5 2. BLS Rescue Aircraft means a rescue aircraft whose medical flight crew has at least one (1) attendant certified as an EMT-I. 3. Auxiliary Rescue Aircraft means a rescue aircraft that does not have a medical flight crew. D. Air Rescue Service An air service using aircraft for medical emergencies, including rescue aircraft and air ambulances. E. First Responders Pre-hospital personnel trained to the Public Safety First Aid, EMT-I, EMT-D, and EMT-P level of care as approved by the EMS Agency. F. Incident Commander The designee of the public safety agency statutorily or contractually responsible for incident/scene management. II. EMS Aircraft Provider Authorization A. Any EMS aircraft operators seeking to provide service in Santa Barbara County, regardless of their base of flight operations, shall have an agreement on file with the local EMS Agency, which shall hold them accountable to all policies and procedures of Air Medical Transport and/or response. B. Any aircraft seeking authorization to provide Emergency Medical Services in Santa Barbara County shall comply with all applicable Santa Barbara County Ordinances and the EMS Agency policies applicable sections of Title 22 of the California Code of Regulations, and pertinent F.A.A. regulations. Exceptions to this authority are listed in Title 22, Division 9, Chapter 8, Article 2, Section (C). C. It is recommended that the EMS aircraft services (except for auxiliary rescue aircraft) accept and adhere to all current Commission Accreditation of Medical Transport System (CAMTS) minimum safety standards and other standards that are unique to this service area. III. EMS Aircraft Medical Control A. Treatment rendered by EMS helicopter flight personnel shall be accordance with Santa Barbara County EMS Policies and Procedures. B. Each helicopter provider shall have a Flight Program Medical Director who meets the following qualifications: 1. A licensed California Physician with significant experience in Emergency Medicine. 2. Knowledge of air medical operations and associated risks.

3 PAGE 3 OF 5 C. Each helicopter provider shall provide the Santa Barbara County EMS Agency with the following: 1. A Quality Assurance/Quality Improvement plan to be submitted upon application, and reviewed yearly. 2. Quarterly comprehensive Data/Statistics of Air Medical calls, which at minimum should include: a. Total number of calls for period b. Number of cancellations c. Number, type and destination of all transports d. All relevant response and transport times D. The medical flight crew shall: 1. Have training in aeromedical transportation. Training should be equivalent to the DOT Air Medical Crew National Standard Curriculum (Published by ASHBEAMS Pasadena, CA 1988 First Edition). 2. Participate in such continuing education requirement as required by their licensure or accreditation/certification. E. In situations where the medical flight crew is less medically qualified than the ground personnel from whom they receive patients the more qualified personnel will accompany patient to receiving facility. IV. Communications A. Each EMS helicopter or Rescue Aircraft shall at minimum have the following: 1. Inter-cabin headset communications 2. Communication with SBCO Dispatch 3. Communication with all EMS base hospitals (especially those with helipads) 4. Communication with ground units 5. One headset per attendant B. Base station contact shall be made at the earliest possible time, preferably prior to transport, to receive medical direction and transportation destination direction. Provider agencies which utilize medical flight crew members who have an expanded scope of practice (physicians/rns) beyond EMT-Paramedic scope of practice, may utilize specific treatments/procedures only upon prior written approval by the EMS Agency. In such cases, notification to the receiving facility shall be made and base hospital medical direction is not required. C. In the event that voice communication with the base hospital cannot be established or maintained, the flight crew will comply with the Communication Failure Policy (304). Through the same channels that EMS personnel on scene requested the dispatch of an EMS helicopter, EMS personnel will ensure that the receiving facility is alerted to the ETA of the transporting helicopter.

4 PAGE 4 OF 5 V. Safety A. Scene security and safety is of prime importance. The Incident Commander shall be responsible for the safety of all personnel, the patient, and the security of the incident. B. The pilot of the EMS helicopter will make the final decision regarding the safe operation of the aircraft and the suitability of the landing site. If in the pilot s judgment, patient transfer to or transport by the EMS helicopter would be unsafe, the patient shall immediately be transported by ALS ambulance. C. Helicopter Safety-Patient Loading/Unloading 1. Never approach the helicopter until signaled to do so by the flight crew. Eye contact should be made with the pilot. 2. Always approach the helicopter from the front. 3. Assume a crouching position when approaching the helicopter while the blades are turning. Only with extremely critical cases should this be necessary. 4. At no time is anyone permitted to work aft of the loading doors. The tail rotor is almost invisible and is the most dangerous area of the helicopter. 5. No IV poles on gurneys within 50 of the helicopter. 6. Never hold IVs or other materials with up-stretched arms when blades are turning. When around the helicopter, do not lift anything higher than your head. 7. No smoking within 50 of the helicopter. 8. No running within 50 of the helicopter. 9. Gurney should not have sheets, blankets, pans, nor any other loose articles present when brought near the helicopter while the blades are turning. 10. The flight crew, after signaling approval for approach to the helicopter, will be responsible for all loading and unloading of patients and equipment, and to see that all equipment is secured before each flight. 11. Never approach or disembark from a helicopter on ground higher than the landing gear. 12. Eyes should be protected from blowing dust as the helicopter lands or departs. 13. No light should be shined upward at approaching aircraft involved in night landing. Photographers should be instructed not to use flash attachments until

5 PAGE 5 OF 5 the helicopter has landed. D. Helicopter Safety During Transport 1. Seat belts and shoulder harnesses must be worn by all personnel. 2. Personnel must know the location and operation of all exits. 3. Loose articles must be securely stowed when not in use. Sharp articles, such as needles and IV catheters should be protected. 4. Medical personnel must always remain clear of flight controls, radios, and switches not specifically designated for medical personnel use. 5. Medical personnel should advise the pilot prior to use of distracting medical equipment, such as on board suction, lighting, etc. Patient needs, such as altitude or heating/air conditioning requirement, also should be discussed with the pilot. Non-essential conversation should be kept to a minimum during critical phases of flight. Communication with the pilot must be maintained at all times. 6. Lighting should be off or dimmed during night landing approaches. 7. Medical personnel should be familiar with fire equipment and know the location of the fuel valves. All oxygen tanks should be turned off when not in use. 8. Medical personnel should assist the pilot in monitoring air traffic, in order to avoid mid air collisions. Wake turbulence from other aircraft also can produce hazardous situations.

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