AIR AMBULANCE POLICY

Virginia Beach Department of Emergency Medical Services CASS # 201.02.00 Index # Operations AIR AMBULANCE POLICY PURPOSE: The purpose of this policy is to establish a standard process for activation of Medevac Air Ambulances within the City of Virginia Beach. APPLICABILITY: This policy applies to all members of the Virginia Beach Emergency Response System. POLICY STATEMENT: It shall be the policy of the Department that the response of Air Ambulances to emergency medical scenes be closely coordinated to ensure effective resource utilization and operational safety. DEFINITIONS: Attendant-in-Charge: The EMS or Fire member in command of a response vehicle. EMS5: EMS Shift Commander. Supporting designee officers include, but are not limited to, EMS6, EMS7 and EMS10. Early Activation: A medevac provider is requested to respond to a scene prior to arrival of first responders, based on the high index of suspicion that specialty services will be necessary. Flight Medic: A medic with specialized air medical training certified to fly onboard an air ambulance. Flight Officer: A specially trained observer or 2 nd pilot assigned to staff the Virginia Beach helicopters. Launch: A medevac provider is requested to respond to the scene after the arrival and patient assessment by first responders, based on the ground medic s determination that specialty services are necessary. Nightingale: Privately operated air ambulance based at Sentara Norfolk General. 1

Standby: A state of heightened alertness and preparation for a medevac provider regarding a possible mission. Virginia Beach Air Medic: Air ambulance operated by the Virginia Beach Police Department based at the Virginia Beach Heliport. AIR AMBULANCE DECISION MAKING STANDBY EMS5 or his designee may order Standby of a medevac provider based on case comments. This will expedite response should arriving units confirm the need for air transport. Responding units are encouraged to recommend this action to EMS5 when appropriate. During Standby, at a minimum the medevac provider will: o Communicate if the aircraft is currently committed to another mission. o Evaluate the weather o Assemble the crew at the aircraft. o Crew will ready the aircraft for flight (i.e. remove from hangar, remove tie-downs, etc) aircraft will remain on the ground. o If already in flight, pilot-in-command will evaluate the need to refuel prior to accepting a medevac mission and act accordingly. o Await further information. While on Standby status, the aircraft will remain available to respond to another request for service. Once medical personnel arrive on scene, the Attendant-in-Charge or incident commander may direct a Launch or cancel the Standby. AIR AMBULANCE DECISION MAKING EARLY ACTIVATION Prior to arrival of ground units, EMS5 or his designee may launch a medevac provider based on case comments indicating a high likelihood that an air ambulance will be necessary. This will expedite response should arriving units confirm the need for air transport. EMS5 will notify responding ground crews that an air ambulance has been requested. Once medical personnel arrive on scene, the Attendant-in-Charge or incident commander has the option to cancel the aircraft if air transport is not 2

required. If medevac services are appropriate, the Incident Commander will initiate landing zone procedures. AIR AMBULANCE DECISION MAKING - LAUNCH Whenever an on-scene Attendant-in-Charge determines that medevac services are required and an aircraft has not yet been requested, he/she should issue a Launch order to the dispatcher. The landing zone should also be identified. An engine or ladder truck should be dispatched to establish the landing zone. If one is not yet assigned, a tactical channel should also be provided. MEDEVAC DISPATCH PROCESS EMS5 or his designee will facilitate Standby and Launch coordination. When either a Standby, Early Activation or Launch is indicated, EMS5 will facilitate determining which aircraft, Nightingale or Virginia Beach Air Medic, is the most appropriate to utilize.? Nightingale activation: EMS5 will direct the EMS dispatcher to alert Nightingale. Once commitment or non-availability of Nightingale is confirmed, the dispatcher will advise EMS5 and the incident commander accordingly. In the event of delays due to dispatcher overload, EMS5 may contact the Nightingale dispatcher directly via phone.? Virginia Beach Air Medic activation: EMS5 will direct the Virginia Beach EMS dispatcher to alert the Police Department Air Unit via the 1 st Precinct dispatcher. Once commitment or non-availability of Air Medic is confirmed, the dispatcher will notify EMS5 and the incident commander accordingly. Note: If the first helicopter agency contacted turns down the request due to weather, the second agency WILL NOT be contacted. It is acceptable to call an alternate agency if the call is turned down due to maintenance or prior commitment to another call. 3

Aircraft dispatchers will be advised the location of the incident, nature of the emergency, assigned tactical channel and the designated landing zone officer (if known at time of activation). Calls involving Air Medic may require the special dispatch of ground apparatus with a flight medic(s) onboard to act as part of the flight crew. LANDING ZONE OPERATIONS A secure landing zone will be established at the scene. Ideally, an engine company should accomplish this, but other public safety members may establish it. A charged hose line is not required. Landing zones should be large enough for the helicopter to land and take off safely. While minimum size is 60 ft x 60 ft (daytime) or 100 ft x 100 ft (night time), larger areas that allow longer take off runs are ideal. Consider the need for helicopters to land and take off into the wind whenever possible. Approach and departure paths should be free of obstructions (wires, poles, antennae, trees, etc). Mark the landing zone with lights, vehicle headlights or cones as feasible. Do not use flares. Spotlights and high beams should not be pointed toward the aircraft. Communications between the air ambulance and the Incident Commander/Landing Zone Coordinator will be conducted on an assigned 800 Mhz tactical channel. This can be the primary incident channel or a channel dedicated solely to air operations at the discretion of the Incident Commander (When more than one air ambulance is assigned, a dedicated air operations channel must be established). The Incident Commander or his designee will notify the EMS Dispatcher when the air ambulance has landed and when it has departed the scene. These times will be recorded in the case comments for data reporting purposes. No one should approach a helicopter unless escorted by an aircrew member. Air Medic is staffed with a Flight Officer who will assist with landing zone safety once the aircraft has been configured to receive the patient. This officer will deliver equipment (monitor, litter, PFDs, etc) to landing zone personnel to be given to the Flight Medics in advance of loading the patient. 4

Once the patient is packaged and ready to load, Flight Medics will select two or more ground personnel to assist loading. Ground personnel will remain with the stretcher under the direction of a Flight Medic at all times. Only flight crews may operate patient loading systems/stretcher mounts.? Loading Air Medic: Air Medic patients are loaded onto a swiveling litter from the side of the aircraft. Ground personnel should take care to ensure any stretcher sheets under the patient are secured as the patient is loaded. Once loading is complete, the Flight Officer will direct ground personnel and the stretcher away from the aircraft. All movement to and from the aircraft should remain forward of tail boom area.? Loading Nightingale: Nightingale patients are loaded from the rear utilizing a wheeled stretcher provided by the flight crew. This evolution takes place under the tail boom, but is well forward of the tail rotor. No personnel should step behind the bulbous antenna underneath the tail boom. Once loading is complete, a Nightingale crewmember will direct ground personnel away from the aircraft. Movement away should be toward the front of the aircraft. MULTIPLE AIRCRAFT RESPONSE When more than one helicopter is requested to the same scene (i.e. both Air Medic and Nightingale), the EMS dispatcher will advise the individual aircraft dispatchers about the multiple aircraft response, including the assisting aircraft name. Both dispatchers will relay the information to their associated pilots. A common 800 Mhz tactical channel will be utilized for aircraft-ground communications. The landing zone size should be increased to accommodate all aircraft simultaneously. Once the Landing Zone Coordinator makes first radio contact with an air ambulance, he/she will verify that the pilot is aware that multiple aircraft are responding to the incident. TRANSPORT The attendant-in-charge of the helicopter will determine the most appropriate receiving facility. This information will be relayed to the incident commander. Once airborne, the helicopter crew will shift from the tactical channel back to their primary communications frequencies. 5

Due to Air Medic s configuration, the Flight Officer and some aircraft components (i.e. the co-pilot s seat), will typically be left at the scene in order to make room for the patient. The Incident Commander will work with members at the scene from Police, Fire or EMS to arrange the most effective method for return of flight personnel and/or equipment to the Virginia Beach heliport or hospital. All Flight Officers are authorized to drive EMS zone cars. CANCELLATION The medic responsible for the care of patient on scene has the option of cancelling an air ambulance prior to the aircraft s arrival if he/she later determines that air transport is no longer required. The incident commander will ensure cancellation notification is made via the appropriate dispatcher. Flight Medics will evaluate every patient to determine their suitability for flight. Sometimes patient size or condition may prevent them from flying. When this occurs, the Flight Medic will advise the incident commander and pilot. Virginia Beach Flight Medics will assist with the ground transport when necessary. EMS5 will coordinate restoring equipment and personnel back to Air Medic after the call. GROUND CREW RESTOCK Ambulance crews will report to the closest appropriate hospital to restock supplies and obtain any required physician signatures. This may require a supervisor assist with obtaining replacement medications. Flight crews will assist as feasible. NOTIFICATION The Emergency Communications Center will activate the ESTAFF notification for every Air Ambulance scene flight in Virginia Beach. REFERENCES? Virginia EMS Medevac Best Practices 1.1, 2.1.1 and 2.1.2? Virginia Office of EMS Regulations 12VAC5-31 6

This policy shall become effective upon the approval of the Chief of Emergency Medical Services. APPROVED: Chief, Department of EMS 11/24/10 Date Originated Revised 1/1/2008 11/24/10 7