EMERGENCY MEDICAL SERVICES

POLICY NO: 402 DATE ISSUED: 08/2000 DATE REVIEWED/REVISED: 03/2008 DATE TO BE REVIEWED: 03/2011 CRITERIA FOR AIR MEDICAL TRANSPORT AND DISPATCH EMERGENCY MEDICAL SERVICES Purpose: To define criteria for patient transport via air unit and dispatch procedures for helicopter services in a medical emergency response. Authority: Health and Safety Code, Division 2.5, Sections 1797.204, 1797.206, 1797.220 and 1798. California Code of Regulations, Title 22, Division 9, Section 100276. Policy: Patients shall be transported to 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. EMS helicopters function in three different types of settings based on location and population density. These areas are classified as urban, remote, and interface area. Dispatch of the helicopter will depend on the location, severity, and accessibility of the patient. Procedure: 1. Medically equipped and staffed air unit dispatch and transportation of patients shall be considered for cases that meet ALL the following criteria. The incident commander or highest medical authority on scene makes this decision. The person requesting a helicopter shall NOT request a specific provider, unless a hoist is needed to extricate a patient. Helicopters will be dispatched in the following order: In the northern half of the county, the order of dispatch is CALSTAR, Santa Barbara County Fire 308/309, CHP. In the southern half of the county, the order is CALSTAR, Santa Barbara County Fire 308/309, Ventura S.O. Dispatch will request an ETA from the responding helicopter. If the ETA is more than 30 minutes, Dispatch will contact the next provider in line for their ETA. If this ETA is less, that provider will be assigned to the call and the first helicopter cancelled by Dispatch. 2. In urban settings, a helicopter should be dispatched to multi-casualty incidents where other resources are unable to respond in a timely manner or when requested by the incident commander. APPROVED: Nancy A. Lapolla, EMS Director Angelo Salvucci, MD, EMS Medical Director

OF 6 3. Remote: The helicopter should be dispatched to the same type of incident to which an ambulance would be dispatched. It should also be used where transport by ground personnel would be excessively long, might negatively affect the injury or be exceedingly painful for the patient. 4. Helicopter transportation should be considered for cases that meet ALL of the following criteria: a. A minimum of 15 minutes ground travel time to the appropriate hospital, AND b. Helicopter transport will be significantly more rapid (generally 10 minutes faster) than immediate ground transport. The air unit can deliver the patient to the hospital in a shorter time than the ground unit, based on when the patient is ready for transport. This decision should be based on the following formula: X minute ETA to scene + X minutes air transport time to hospital + 5 minutes loading/unloading transfer to ED = ETA to hospital for the air transport unit c. 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 (chest pain with dysrhythmias or post-resuscitation) (9) Critical thermal burns (10) Critical respiratory compromise (11) Severe barotrauma* (12) Uncontrolled hemorrhage (13) Any other injuries or medical problems in areas inaccessible to, or with prolonged ETA times, for ground units (14) Other conditions subject to the approval of the Base Hospital physician or the highest medical authority on scene (15) barotrauma patients should be flown at as low an altitude as possible in order to minimize pressure changes 5. Helicopter transport should not be utilized in the following situations: a. Asystole, not responding to appropriate therapy. Exceptions: cold water drowning, lightning or electrocution victim, some types of overdoses. b. Patients contaminated with hazardous material.

OF 6 6. 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. Stable patients (except in inaccessible back country areas). e. When ground transport time is equal to or shorter than air transport time. 7. Simultaneous helicopter dispatch shall be utilized in the following conditions: a. Remote area (Jalama Beach area, Cuyama area, Lake Cachuma area, Ventucopa area, Gibraltar Reservoir area, and Figueroa Mountain area). b. Multiple Casualty Incident with report of serious injuries in rural and semirural areas. 8. The designated EMS Helicopter Dispatch Center will be the Santa Barbara County Public Safety Dispatch Center (Dispatch). a. All requests for and cancellations of EMS helicopter will be through this center. No EMS air transport services shall respond to an incident without the formal request of a Public Agency or a Santa Barbara County approved EMS Provider. In a non-autolaunch area, the authority for requesting EMS helicopter services shall be vested with the Incident Commander, or responding EMS unit(s) (Note: if, in the judgment of the incident commander or responding medical units the incident has a high probability of requiring the use of air ambulance, the request for helicopter dispatch may be made while enroute to the scene.) The following information will be provided to the Dispatch Center: (1) Identification of the requesting agency and ground contact (2) Location and number of patients (3) Type and extent of injuries, if known (4) Any of the following if possible; general location of nearest landing site, map coordinates, significant landmarks, latitude/longitude coordinates if available (5) Any local adverse weather conditions (6) Contact frequency at scene (7) Additional information, such as the need for a hoist b. Upon completion of dispatch, the Santa Barbara County Public Safety Dispatch Center shall immediately furnish the Incident Commander or requesting agency with the following information: (1) The name of the responding helicopter (2) Contact frequency (3) The responding EMS helicopter shall immediately provide Dispatch their approximate ETA. Dispatch shall relay this and pertinent information to the Incident Commander or responding personnel.

OF 6 9. Cancellation of Helicopter a. Cancellation by Helicopter Crew: the pilot and/or crew may cancel the flight: 1. For safety considerations, eg. weather, fuel status, landing zone safety 2. If no patient is found at the scene 3. If the patient is not appropriate for air transport 4. If the patient is turned over to a ground unit b. Cancellation by At-Scene Personnel Helicopter request may be cancelled through the Incident commander, by public safety agencies, EMS provider agencies, or other approved requesting parties who are involved with or at the scene of the incident. If cancellation is requested by an agency other than the original requesting agency, the EMS dispatcher will notify the original requesting agency prior to canceling the helicopter response. 10. Patient destination decisions shall be determined by the flight nurse, with the following considerations: a. Condition of patient(s) and facility resources. b. Transport time to the receiving facility (see chart attached). If the patient requires transportation by ambulance from Santa Barbara Airport or Goleta Valley Cottage Hospital to Cottage Hospital, should be factored in. c. The desires of the patient if appropriate. d. 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. It is the responsibility of each receiving hospital to inform County dispatch of 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. Remote Area Transport Times By Helicopter

OF 6 County Location From Scene to Goleta Valley Cottage Hospital 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 If GVCH will be used only as a rendezvous for the helicopter and the ambulance for a final destination to Cottage Hospital, the added transport time of 15 minutes must be considered and may warrant transport directly to MMC, rather than Santa Barbara Cottage Hospital. 11. Dispatch: a. As soon as possible, the flight nurse will notify Dispatch by radio of the hospital destination and ETA. b. As soon as Dispatch is notified of destination and ETA, they will telephone the receiving hospital to alert them to the fact that they will be receiving a trauma patient. Only the most minimal information will be given by Dispatch and will include age, sex, chief complaint, mechanism of injury and ETA. c. If the helicopter will be landing at Goleta Valley Cottage Hospital, Dispatch will notify S.O. and AMR ASAP to secure the helipad and transport the patient to Santa Barbara Cottage Hospital respectively. Goleta Valley

OF 6 Cottage Hospital ED will also be notified that a helicopter will be landing so that they can notify hospital security to secure the helipad. d. If the flight nurse is unable to contact Dispatch by radio, he/she will contact the receiving hospital directly. If the helicopter will be landing at Goleta Valley Cottage Hospital, the flight nurse will request that Goleta Valley Cottage Hospital contact the Sheriff s Office and AMR to arrange for securing the helipad and transporting the patient, respectively. e. As soon as practical, the flight nurse will give a complete report to the receiving hospital. 12: A helicopter is considered unavailable for dispatch when one or more of the following conditions exist: a. When a helicopter is more than 30 minutes from the county line. b. When assigned to a patient transport. (Note: if the call did not originate from Santa Barbara County Dispatch, the flight nurse shall notify Santa Barbara County Dispatch that they are unavailable until further notice.) c. The helicopter is grounded for mechanical reasons. d. Unavailable staffing. HELICOPTER COMMUNICATION ALGORITHM HELICOPTER IS AUTOLAUNCHED INCIDENT COMMANDER REQUESTS A HELICOPTER Dispatch selects a helicopter with an ETA of less than 30 minutes. As soon as patient destination and ETA to hospital is known, flight nurse calls Dispatch. Dispatch calls hospital where helicopter is landing, gives ETA and short heads-up ONLY. Also dispatches AMR and SO if landing at GVCH. If unable to contact Dispatch, flight nurse calls hospital asap and requests them to call AMR and SO (for GVCH). Flight nurse calls report to receiving hospital.