EMERGENCY MEDICAL SERVICES

POLICY NO: 402 B DATE ISSUED: 08/2000 DATE REVIEWED/REVISED: 06/2010 DATE TO BE REVIEWED: 06/2013 EMERGENCY MEDICAL SERVICES CRITERIA FOR AIR MEDICAL TRANSPORT Purpose: To define criteria for patient transport via EMS Aircraft in a medical emergency response. Authority: Health and Safety Code, Sections 1797.204, 1797.206, 1797.220 and 1798. California Code of Regulations, Title 22, Sections 100276, 100300, 100304. Policy: Patients shall be transported to the appropriate hospital via ground ambulance unless ground transport is 10 minutes longer than air transport AND this difference in time may negatively impact the patient s condition. Rescue Aircraft will transport patients only when the use of an air or ground ambulance is inappropriate or unavailable. Procedure: 1. EMS Aircraft transportation should be considered for cases that meet ALL of the following criteria: APPROVED: a. Patients meeting one or more of the following conditions: (1) Patients with potentially critical traumatic injuries (2) Hypotension/shock (3) Spinal cord injuries with neurological dysfunction (4) Vascular compromise in a limb or amputation (5) Snake bite with signs of significant envenomation (6) Unstable near drowning (7) Status epilepticus refractory to medications (8) Cardiovascular instability (STEMI, dysrhythmias or postresuscitation) (9) Critical burns (10) Critical respiratory compromise (11) Severe barotraumas (12) Uncontrolled hemorrhage (13) Other conditions subject to the approval of the Base Hospital physician Nancy A. Lapolla, EMS Director Angelo Salvucci, MD, EMS Medical Director

OF 5 AND b. A minimum of 15 minutes ground travel time to the appropriate hospital, AND c. EMS Aircraft transport will be a minimum of 10 minutes faster than immediate ground transport, based on when the patient is ready for transport. This decision should be based on the following formula: X minutes ETA of EMS Aircraft to scene (if not already on scene) + X minutes air transport time to landing zone (LZ) + X minutes loading/unloading/transport * = ETA to appropriate hospital for the air transport unit *Loading/unloading/transport time for patients going to SBCH is 15 minutes *Loading/unloading/transport time for patients going to MMC is 5 minutes Alternate sites (La Cumbre Junior High or Elings Park) may be utilized as a transfer landing zone ONLY if the patient is in extremis (e.g. profound hypotension, unmanageable airway). The use of an alternate site (besides airport) as a transfer landing zone is considered an unusual occurrence and will require an incident report to be submitted to the EMS Agency within 72 hours.

OF 5 Remote Area Transport Times By Helicopter County Location From Scene to SB Airport From Scene to Marian Medical Center Jalama Beach 17 14 Santa Ynez / Solvang 10* 15 New Cuyama 16* 17 Lake Cachuma 6-7* 16 Oil Platforms Gaviota area 5-6* Vandenberg area 15-20 15-20 Ventucopa Area 16 26 Gaviota Beach 10* 15 Gibraltar Reservoir 6-7 23 Paradise Road Area 5-6* 20 Oceano/Nipomo 28 9 2. Helicopter transport should NOT be utilized in the following situations: a. Asystole, not responding to appropriate therapy. Exceptions: cold water drowning, lightning or some types of overdoses. b. Patients contaminated with hazardous material. c. When ground transport time is equal to or shorter than air transport time. d. Stable patients (except in inaccessible back country areas 3. Relative Contraindication to air transport a. Transport from heavily populated areas. b. Other safety conditions as determined by pilot and/or crew c. Potentially violent patients or those with behavioral emergencies d. Barotrauma patients should be flown at as low an altitude as possible in order to minimize pressure changes.

OF 5 4. Patient destination decisions shall be determined by the highest medical authority, with the following considerations: a. Condition of patient(s) and facility resources. b. Transport time to the receiving facility (see chart attached). c. The desires of the patient if appropriate. d. STEMI destination criteria e. Trauma Criteria f. It is the responsibility of the air medical crewmembers to determine the status of each receiving hospital regarding availability of specialty physician coverage, such as neurosurgery, for the purposes of determining patient destinations. g. It is the responsibility of each receiving hospital to utilize Reddinet to communicate diversion status, for the purposes of determining patient destinations. Hospitals with state permitted heliports should be given first consideration. If using one of these heliports is not in the best interest of the patient, a backup destination should be an EMS landing site that has been designated by a public safety agency in accordance with State Public Utilities Code Section 21662.1 and the California Code of Regulations (CCR), Title 21, Subchapter 2, Airports and Heliports. The objective is to assure critically ill or injured patients be taken to the facility most appropriate to their medical needs, regardless of their ability to pay. This decision applies to hospitals both in and out of Santa Barbara County. 5. There may be incidents in which a Rescue Aircraft is dispatched due to its hoist capability. The hoist may be used to gain access to the patient, get medical personnel and supplies to the patient and/or to extract the patient from a remote, inaccessible location. Use of a hoist does not necessarily imply that the Rescue Aircraft should be used to transport the patient to an appropriate hospital UNLESS it meets the criteria outlined by this policy. In general, a stable patient that was hoisted from a remote area should be transported via ground, while an unstable patient may be better served by transport from an Air Ambulance which provides a higher level of care.