MEDEVAC112 www.greypencils.com IRELAND S FIRST EMERGENCY AEROMEDICAL SERVICE On June 4th of this year the National Ambulance Service (NAS) saw a huge leap forward in their rapid response capabilities with the launch of the new Emergency Aeromedical Service (EAS). The new service, a joint project between the HSE and the Defence Forces, means that NAS paramedics now have the assistance of a dedicated military helicopter for the rapid transfer of critical patients to the most suitable hospital. The aim of this new 12 month test project is to assess the level and type of dedicated Helicopter Emergency Medical Service (HEMS) needed in Ireland. The joint helicopter crew includes a NAS Advanced Paramedic, who leads the clinical care and is assisted by a military paramedic. The EAS is a new venture for the Defence Forces that builds on the inter hospital air ambulance service it has offered the State since the 1960s. To date the Air Corps has carried out over 3000 inter hospital air ambulance missions utilising its aircraft. The interhospital service is still available from Casement Aerodrome, Baldonnell.
The EAS got off to a great start with its first successful callout on the first day of the service, followed by 11 aeromedical missions in the first two weeks of its launch. However, on the 19th of June the service suffered a temporary setback when a helicopter had a heavy landing after striking a wire during a callout. Since then the service has recommenced using another helicopter type. The Defence Forces has invested heavily in recent years in the equipment it uses to complete air ambulance missions and now utilises the state of the art Lifeport system shown in the picture below. This ambulance equipment is shown fitted to the Agusta Westland 139 (AW139) type helicopter. The AW139 is a next generation medium, twin engine, multi role helicopter, having a five bladed main rotor, a four bladed tail rotor and retractable tri cycle undercarriage. It is generally flown with two pilots and a crewman in the cabin. When configured for Emergency Medical Services (EMS) operations, it can accommodate an array of medical equipment, including oxygen, suction and defibrillator, several attending medics and a patient. It is the fastest helicopter in its class, capable of travelling at 315 kilometres per hour. The EAS can be anywhere in the country and deliver patients to an appropriate hospital in minutes.
The EAS is based out of the Army Barracks in Athlone, where the helicopter remains on immediate call to the NAS seven days a week, 365 days a year. The helicopter is known by its callsign MEDEVAC112 reflecting its military and medical nature with 112 highlighting the standard european emergency contact number. The EAS is an element of the Health Service Executive (HSE) which, in conjunction with the National Ambulance Service (NAS) manages the air transport of patients within the State and abroad. Command and control is in the National Aero medical Coordination Centre (NACC); the NACC provides a dedicated desk to screen calls, requests for air support and assign air assets as appropriate. It is co located with ambulance control at Tullamore regional contro l centre. MEDEVAC112, has had numerous examples where the outcome of patients has been positively altered by its contribution. During one emergency, Damien Gaumont, a NAS Advanced Paramedic on the crew, provided rapid transport to an adult victim of a road traffic accident outside Portlaoise. The patient sustained a head injury. MEDEVAC112 was called to the scene by HSE Paramedics who contacted their Regional Control Centre very early during their assessment. Their quick decision allowed MEDEVAC112 to be standing ready a couple of hundred feet away from the scene just as the Fire Brigade freed the patient from the wreckage. The patient was taken directly to Beaumont Hospital after a flight time of 20 minutes which permitted rapid access to vital surgery. This patient has since recovered. Damien Gaumont has worked for the HSE NAS since 2000; he qualified as an Advanced Paramedic in 2006 and was working on the Rapid Response Vehicle in Limerick and North Tipperary before becoming part of the MEDEVAC112 crew. How does the service work? Any paramedic who believes that time critical treatment or transport is required for their patient and this is unachievable by ground transport may request the support of MEDEVAC112. The guideline is that the time it might take from leaving the scene to being at hospital should be greater than 45 minutes. In such an example, the paramedic simply requests MEDEVAC112 from Regional Control. They in turn pass the request to the NACC who assess the situation and then task the helicopter. The crew is ready to launch in moments and will quickly make their way to a suitable Helicopter Landing Site (HLS) to collect the patient. Do I need permission from anyone to request the aircraft? No, the service is available to any Paramedic who feels his patient could benefit from the use of the service. Detailed activation criteria are provided in the Table below
When is it available? MEDEVAC112 is available from 0800hrs to 1800hrs but it has the ability to continue a mission after 1800hrs should it be requested. In all cases, the service is in daytime hours. What does the helicopter bring to patient? MEDEVAC112 brings an AP with a full range of NAS equipment in addition to the LIFEPORT system. The photo below shows the medical crew and equipment. It includes, inter alia, Paramedic bag, Drugs Bag, Entonox, Resuscitation Bag, Defibrillator (Zoll type), Spinal Board, Paediatric Bag, Vacuum Splints, Spare Medical Equipment Bag, Suction Unit, Medical Cabinet and contents. How will the MEDEVAC112 know where I am? The NACC should be able to locate your position using the AVL system in the ambulance or the address of the call and pass it on to MEDEVAC112. You can also pass this information to the crew by radio as the aircraft approaches. The aircraft can be contacted, when in range, using a designated channel on the ambulance radio. This channel will be dictated by the NACC. Where can the helicopter land?
Helicopters can land almost anywhere but currently the service makes use of any location that meets military planning guidance for a Helicopter Landing Site (HLS). Potential sites are constantly being planned and developed with the NACC. Any site that is clear of wires, loose objects (such as rubbish) and is relatively clear of obstacles can make a good HLS. It should have good road access to link up with the local ambulance. A good example of a HLS is any local football field. Can I get a briefing on the service? NAS ambulance stations or Regional Control may request a visit from MEDEVAC112 at any time and a briefing can be arranged. Please contact our Operations Room on +0906 421294 or send an email to medevac112@defenceforces.ie at any time. Why should I call for it? Any Paramedic who believes that their patient s condition requires a rapid move from the incident scene to hospital should ask for MEDEVAC112. In one example MEDEVAC112 was tasked by the NACC to assist in a response to a cardiac arrest in a sport facility in the South area of Donegal. The local HSE Paramedics, AP and Fire Service achieved ROSC with LBBB presumed new, after eight shocks. MEDEVAC112 was able to bring the patient to University Hospital Galway in 30 minutes where the patient under went emergency angiography and insertion of a stent. Prompt medical care of local paramedics complimented with the rapid transfer of the patient to hospital by helicopter is why MEDEVAC112 should be called. Other examples of activations by paramedics that have occurred were for medical causes (CVAs, cardiac events, unexplained collapsed) and traumatic injuries (suspected internal bleeding, suspected pelvic fracture, multisystem trauma). These missions came from farms, off road or traffic incidents.
Helicopter Landing Sites : Scene Safety While an EAS helicopter offers great advantages in terms of speed and response, they are complex machines and like any complex machine, care must be taken when working around them. Hazards include; noise, main and tail rotors, downdraught and engine exhaust. It is easy to stay safe when operating around helicopters so long as all of the above are kept in mind. In order to ensure the most effective use of the EAS helicopter, and achieve the best result for your patient, consider the following : 1. Never approach the aircraft unless you are under escort from an EAS crewmember 2. Stay Visible If you remain by the ambulance or AP car you are visible to the crew, once you move away from there you become less predictable to them. Remember: the aircraft may not land in the direction it approached from and it may have to move to find solid ground to land on. 3. Secure any loose articles (or extra people/onlookers) that may become a hazard in the landing site prior to the aircrafts arrival this also counts for the patient, especially in a rotors running situation.
ACTIVATION CRITERIA IN ORDER TO TASK MEDEVAC112 JOINT MILITARY- NAS HELICOPTER A. Expected Leaving Scene to At Hospital time > 45 minutes AND Advanced Paramedic or Paramedic on scene, AND one of the following apply: 1. Patient meets criteria for Trauma Appropriate Hospital Access (NAS Procedure - NASCG009). 2. Stroke FAST Positive and transport to centre providing Stroke Thrombolysis within 4 hours of symptom onset by land not possible, but possible by EAS. 3. ST Elevation Myocardial Infarction (STEMI) and transport to Primary PCI Centre by land within 90 minutes not possible, but possible by EAS. 4. Adult Cardiac Arrest with return of spontaneous circulation (ROSC). 5. Paediatric Cardiac Arrest. B. Expected Leaving Scene to At Hospital time > 45 minutes AND Paramedic on scene with NO Advanced Paramedic availability AND one of the following apply: 1. Two or more seizures 2. Hypoglycaemia not responsive to treatment with Glucagon and diminished level of consciousness 3. Severe or life threatening asthma Adult or Paediatric (as defined by CPG 5/6.3.2 and CPG 5/6.7.5) 4. Severe Cardiac Failure or Chronic Obstructive Pulmonary Disease (COPD) 5. Symptomatic Bradycardia 6. Septic Shock - Adult or Paediatric (CPG 5/6.4.21 and CPG 5/6.7.12) 7. Prolapsed Cord (CPG 5/6.5.5) 8. Shock from Blood Loss - Adult or Paediatric (CPG 5/6.6.2 and CPG 5/6.7.13) 9. Burns > 10% total body surface area (excluding 1 st degree burns) C. Expected Leaving Scene to At Hospital time > 45 minutes AND Advanced Paramedic and/or Paramedic Discretion: The Practitioner on scene may request EAS Activation if the Patient s Clinical Status does not precisely fit any of the above criteria but he/she believes time critical treatment or transport is required and unachievable by ground transport EAS Activation Protocol Subject to Criteria above, request Ambulance Control to request EAS Activation via National Aero Medical Coordination Centre (NACC). NACC will check activation criteria prior to passing request to Aircraft Commander for final tasking acceptance.