Royal Flying Doctor Service Essential Aspects of Aeromedical Retrieval

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Cody Brown
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1 Royal Flying Doctor Service Essential Aspects of Aeromedical Retrieval

2 Modes Of Transport

3 Session Objectives Consider the requirements for the ideal mode of transport Discuss the advantages and disadvantages of each mode of transport Introduce the evidence base for transport selection Introduce the relevant safety issues

disadvantages of each mode of transport Introduce the

4 The Gold Standard Easily available Safe Cost effective Spacious Easy to load / unload Access to the whole patient Fast Comfortable Quiet Door to door Easy to divert Not weather dependent No physiological consequences Adequate power supply Large centre of gravity Replicates your Resus bay DOES NOT EXIST

door Easy to divert Not weather dependent No physiological consequences

5 3 Principal Modalities Ground Ambulance ( Road ) Rotary Wing Fixed Wing

6 Choice of Transport Clinical scenario Diagnosis Stability Anticipated complications Urgency for definitive care Current level of care Patient numbers Availability Weather and traffic conditions Local geography Distance Terrain Accessibility Safety Cost

level of care Patient numbers Availability Weather and traffic

7 Ground Ambulance

8 Ground Ambulance Advantages Easily available Door to door Easy to load / unload Easy to divert Relatively roomy Familiarity Relatively low cost Well established infrastructure Few weather constraints

Relatively roomy Familiarity Relatively low cost

9 Ground Ambulance Disadvantages Lengthy transit times over long distances or difficult terrain Subject to traffic conditions Rough ride Firm suspension High centre of gravity Motion sickness

Subject to traffic conditions Rough ride Firm

10 Rotary Wing

11 Rotary Wing Advantages Rapid transport times over moderate distances Accessibility Maneuverability Versatility Pretty much go anywhere

12 Rotary Wing Disadvantages Requires adequate hospital based landing sites Loading problems Limited space and patient access issues Weather and fuel constraints eg high temps in QLD limit lifting capacity Non pressurised Noise and vibration Not always easy to maintain thermal integrity Incident light High staff training requirements Expensive

temps in QLD limit lifting capacity Non pressurised Noise and vibration Not always

13 Fixed Wing

14 Fixed Wing Advantages Rapid transport over long distances Pressurisation ( not always ) Higher operating ceiling Ability to fly around bad weather Relatively large cabin space ( usually ) Quieter than RW

15 Fixed Wing Disadvantages Need an airstrip to take off / land Multiple patient transfers Substantial take off / landing forces

16 Distance GA GA or RW RW RW or FW FW

17 ACEM Previously suggested that patients less than 30/60 by road are unlikely to benefit from helicopter transportation Australasian College for Emergency Medicine and Australian and New Zealand College of Anaesthetists. Policy on minimum standards for transport of the critically ill. Emerg Med. 1993;5:

Medicine and Australian and New Zealand College of Anaesthetists.

18 Thomas, Wisham et al FW vs RW at ranges of radial miles FW 509 vs RW 104 No significant difference in time to hospital No differences in ISS. Age, LOS, mortality, discharge disability score for trauma patient RW costs 400 x those of FW Thomas F, Wisham J, Clemmer TP, et al. Outcome, transport times, and costs of patients evacuated by helicopter versus fixed-wing aircraft. West J Med. 1990;153:40-43.

Age, LOS, mortality, discharge disability score for trauma patient RW costs 400 x those of FW Thomas

19 Diaz, Hendey et al Ground ambulance always faster at distances of less than 16 km At greater distances HEMS faster if simultaneously dispatched In the real world ground ambulance likely to be faster up to 70 km Diaz MA, Hendey GW, Bivins HG. When is the helicopter faster? A comparison of helicopter and ground ambulance transport times. J Trauma. 2005;58:148.

ambulance likely to be faster up to 70 km Diaz MA, Hendey GW, Bivins HG.

20 Trying to make sense of it all? GA < 16 km GA or RW km RW > 100 km RW or FW km FW > 240 km Guidelines at best!!

21 A sobering thought Fatal Crashes per million flight hours Airline Commuter Ground Ambulance All Helicopters Medical Helicopters A Safety Review and Risk assessment in Air Medical Transport AMPA 2002

22 But that was 2002!! Year Accidents Fatalities National Transport Safety Board Review on HEMS related Actvities

23 Australia Australian HEMS Data Year Flying Hours Accidents Totals Accidents: 4.38 / flying hrs Fatalities: 1.46 / flying hrs 14.6 / million flying hrs Holland J, Cooksley DG. Safety of helicopter aeromedical transport in Australia: a retrospective study. Med J Aust 2005; 182:

24 Twin vs Single RW Analogous to Crystalloid vs Colloid No definitive proven safety benefits Twins generally Perceived to be safer More powerful Cost more to buy initially Have ~ 30% more operating costs Increasingly regulated for AME work

25 Do you really understand your choices? Cheapest to buy may not be cheapest to run Fastest may not mean the best range Fastest does not mean safest Shortest flight time does not mean shortest time to definitive care Safety benefits may only apply if flown within strict weight limits and flight profiles VFR vs IFR? Turboprop vs jet? Single engine vs twin?

27 Summary Individualise the mode of transport to the patient s clinical need Consider Local knowledge especially geographical Actual or potential need for time critical interventions Availability of and impact on existing resources Risks vs benefits Safety Understand your transport choice, its limitations and its capabilities

28 FW vs RW No airplane will be good until it can go straight up and down Thomas Edison Helicopters can't fly; they're just so ugly the earth repels them Anon

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