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Civilian Air Medical Transport

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Aeromedical Evacuation

Abstract

In the United States, civilian air medical transport began developing in the 1960s. It grew from the US military medical evacuation (MEDEVAC) aeromedical evacuation (AE) systems, stimulated by the need to improve care for civilian trauma. Since then civilian air medical transport has grown into a major industry, with 1411 aircraft operating out of 1065 bases. Civilian air medical transport provides a full spectrum of transport services from neonatal, to high-risk obstetric, to pediatric and adult patients with severe trauma and critical illnesses requiring advanced life-support equipment, up to and including cardiopulmonary bypass. The size and scope of civilian air medical transport, and the fact that it operates at a high clinical volume every day, mean that this industry can keep pushing the boundaries of crew training and qualification, clinical procedures, and equipment. The civilian air medical transport environment is also more permissive of clinical research than the military system, which is operating in and out of combat zones. These civilian advances can be applied to military AE as they become mature. At the same time, military AE has evolved as a component of a highly integrated system of care, distributed around the globe. This casualty care system operates with a unity of purpose not seen in the civilian community, where issues of ownership and profitability prevent the same degree of mission alignment. This chapter describes the history and current status of civilian helicopter and fixed-wing air medical transport. It will also briefly describe special considerations that should be taken into account when transporting patients with various conditions by air.

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References

  1. Committee on Trauma and Committee on Shock, Division of Medical Sciences. National Academy of Sciences, National Research Council. Accidental Death and Disability: The Neglected Disease of Modern Society. National Academies Press. 1966. https://www.ems.gov/pdf/1997-Reproduction-AccidentalDeathDissability.pdf. Accessed 30 Sept 2018.

  2. Jurkovich GJ. Regionalized health care and the trauma system model. J Am Coll Surg. 2012;215(1):1–11.

    Article  Google Scholar 

  3. Air ambulance: effects of industry changes on services are unclear. US Government Accounting Office. September 2010. https://www.gao.gov/products/GAO-10-907. Accessed 30 Sept 2018.

  4. Habib FA, Shatz D, Habib AI, Bukur M, Puente I, Catino J, Farrington R. Probable cause in helicopter emergency medical services crashes: what role does ownership play? J Trauma Acute Care Surg. 2014;77(6):989–93.

    Article  Google Scholar 

  5. Association of Air Medical Services. Atlas & Database of Air Ambulance Services (ADAMS). 2017. Alexandra, VA. http://www.adamsairmed.org/pubs/atlas_2017.pdf. Accessed 30 Sept 2018.

  6. Shelton SL, Swor RA, Domeier RM, Lucas R. Medical direction of interfacility transports. Prehosp Emerg Care. 2000;4(4):361–4.

    Article  CAS  Google Scholar 

  7. Centers for Disease Control, MMWR. Ambulance crash-related injuries among emergency medical services workers - United States, 1991-2002. 2003;52(8):154–6.

    Google Scholar 

  8. Maguire BJ, Hunting KL, Smith GS, Levick NR. Occupational fatalities in emergency medical services: a hidden crisis. Ann Emerg Med. 2002;40:625–32.

    Article  Google Scholar 

  9. Diaz MA, Hendey GW, Bivins HG. When is the helicopter faster? A comparison of helicopter and ground ambulance transport times. J Trauma. 2005;58:148–53.

    Article  Google Scholar 

  10. Nix S, Buckner S, Cercone R. A review of risk analysis and helicopter air ambulance accidents. Air Med J. 2011;33(5):218–21.

    Article  Google Scholar 

  11. Hinkelbein J, Dambier M, Viergutz T, Genzwürker H. A 6-year analysis of German emergency medical services helicopter crashes. J Trauma. 2008;64(1):204–10.

    Article  Google Scholar 

  12. Handel DA, Yackel TR. Fixed-wing medical transport crashes: characteristics associated with fatal outcomes. Air Med J. 2015;30(3):249–51.

    Google Scholar 

  13. Wuerz RC, O’Neal R. Role of pilot instrument proficiency in the safety of helicopter emergency medical services. Acad Emerg Med. 1997;4:972–5.

    Article  CAS  Google Scholar 

  14. Galvagno SM Jr, Haut ER, Zafar SN, Millin MG, Efron DT, Koenig GJ Jr, Baker SP, Bowman SM, Pronovost PJ, Haider AH. Association between helicopter vs ground emergency medical services and survival for adults with major trauma. JAMA. 2012;307(15):1602–10.

    Article  CAS  Google Scholar 

  15. Galvagno SM Jr, Sikorski R, Hirshon JM, Floccare D, Stephens C, Beecher D, Thomas S. Helicopter emergency medical services for adults with major trauma. Cochrane Database Syst Rev. 2015;12:CD009228.

    Google Scholar 

  16. Delgado MK, Staudenmayer KL, Wang NE, Spain DA, Weir S, Owens DK, Goldhaber-Fiebert JD. Cost-effectiveness of helicopter versus ground emergency medical services for trauma scene transport in the United States. Ann Emerg Med. 2013;62(4):351–364.e19. [Erratum in: Ann Emerg Med. 2014 Apr;63(4):411.].

    Article  Google Scholar 

  17. Sasser SM, Hunt RC, Faul M, Sugerman D, Pearson WS, Dulski T, Wald MM, Jurkovich GJ, Newgard CD, Lerner EB, Centers for Disease Control and Prevention (CDC). Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011. MMWR Recomm Rep. 2012;61(RR-1):1–20.

    PubMed  Google Scholar 

  18. Doucet J, Bulger E, Sanddal N, Fallat M, Bromberg W, Gestring M, Emergency Medical System Subcommittee, Committee on Trauma, American College of Surgeons. Appropriate use of helicopter emergency medical services for transport of trauma patients: guidelines from the Emergency Medical System Subcommittee, Committee on Trauma, American College of Surgeons. J Trauma Acute Care Surg. 2013;75(4):734–41.

    Article  Google Scholar 

  19. Thomas SH, Brown KM, Oliver ZJ, Spaite DW, Lawner BJ, Sahni R, Weik TS, Falck-Ytter Y, Wright JL, Lang ES. An evidence-based guideline for the air medical transportation of prehospital trauma patients. Prehosp Emerg Care. 2014;18(Suppl 1):35–44.

    Article  Google Scholar 

  20. Garner A, Rashford S, Lee A, Bartolacci R. Addition of physicians to paramedic helicopter services decreases blunt trauma mortality (see comments). Aust N Z J Surg. 1999;69:697–701.

    Article  CAS  Google Scholar 

  21. Roberts K, Blethyn K, Foreman M. Influence of air ambulance doctors on on-scene times, clinical interventions, decision-making and independent paramedic practice. Emerg Med J. 2009;26:128–34.

    Article  CAS  Google Scholar 

  22. Scalea TM, Rodriguez A, Chiu WC, Brenneman FD, Fallon WF Jr, Kato K, McKenney MG, Nerlich ML, Ochsner MG, Yoshii H. Focused Assessment with Sonography for Trauma (FAST): results from an international consensus conference. J Trauma. 1999;46(3):466–72.

    Article  CAS  Google Scholar 

  23. Polk JD, Fallon WF. The use of focused assessment with sonography for trauma (FAST) by a prehospital air medical team in the trauma arrest patient. Prehosp Emerg Care. 2000;4:82.

    Article  CAS  Google Scholar 

  24. Polk JD, Fallon WF Jr, Kovach B, Mancuso C, Stephens M, Malangoni MA. The “Airmedical F.A.S.T.” for trauma patients--the initial report of a novel application for sonography. Aviat Space Environ Med. 2001;72(5):432–6.

    CAS  PubMed  Google Scholar 

  25. Press GM, Miller SK, Hassan IA, Alade KH, Camp E, del Junco D, Holcomb JB. Prospective evaluation of prehospital trauma ultrasound during aeromedical transport. J Emerg Med. 2014;47(6):638–45.

    Article  Google Scholar 

  26. Holcomb JB, Swartz MD, DeSantis SM, Greene TJ, Fox EE, Stein DM, Bulger EM, Kerby JD, Goodman M, Schreiber MA, Zielinski MD, O’Keeffe T, Inaba K, Tomasek JS, Podbielski JM, Appana SN, Yi M, Wade CE, PROHS Study Group. Multicenter observational prehospital resuscitation on helicopter study. J Trauma Acute Care Surg. 2017;83(1 Suppl 1):S83–91.

    Article  Google Scholar 

  27. Funder KS, Rasmussen LS, Siersma V, Lohse N, Hesselfeldt R, Pedersen F, Hendriksen OM, Steinmetz J. Helicopter vs. ground transportation of patients bound for primary percutaneous coronary intervention. Acta Anaesthesiol Scand. 2018;62(4):568–78.

    Article  CAS  Google Scholar 

  28. Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, Horn J, Hovdenes J, Kjaergaard J, Kuiper M, Pellis T, Stammet P, Wanscher M, Wise MP, Åneman A, Al-Subaie N, Boesgaard S, Bro-Jeppesen J, Brunetti I, Bugge JF, Hingston CD, Juffermans NP, Koopmans M, Køber L, Langørgen J, Lilja G, Møller JE, Rundgren M, Rylander C, Smid O, Werer C, Winkel P, Friberg H, Trial Investigators TTM. Targeted temperature management at 33 °C versus 36 °C after cardiac arrest. N Engl J Med. 2013;369(23):2197–206.

    Article  CAS  Google Scholar 

  29. Arrich J, Holzer M, Havel C, Warenits AM, Herkner H. Pre-hospital versus in-hospital initiation of cooling for survival and neuroprotection after out-of-hospital cardiac arrest. Cochrane Database Syst Rev. 2016;3:CD010570.

    PubMed  Google Scholar 

  30. Nguyen-Huynh MN, Klingman JG, Avins AL, Rao VA, Eaton A, Bhopale S, Kim AC, Morehouse JW, Flint AC. Novel telestroke program improves thrombolysis for acute stroke across 21 hospitals of an integrated healthcare system. Stroke. 2018;49:133–9.

    Article  Google Scholar 

  31. Maddry JK, Mora AG, Savell S, Perez CA, Mason PE, Aden JK, Bebarta VS. Impact of Critical Care Air Transport Team (CCATT) ventilator management on combat mortality. J Trauma Acute Care Surg. 2018;84(1):157–64.

    Article  Google Scholar 

  32. Haggerty L. Continuous electronic fetal monitoring: contradictions between practice and research [review]. J Obstet Gynecol Neonatal Nurs. 1999;28:409–16.

    Article  CAS  Google Scholar 

  33. Seymour CW, Gesten F, Prescott HC, Friedrich ME, Iwashyna TJ, Phillips GS, Lemeshow S, Osborn T, Terry KM, Levy MM. Time to treatment and mortality during mandated emergency care for sepsis. N Engl J Med. 2017;376:2235–44.

    Article  Google Scholar 

  34. King MA, Niven AS, Beninati W, Fang R, Einav S, Rubinson L, Kissoon N, Devereaux AV, Christian MD, Grissom CK. Evacuation of the ICU care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest. 2014;146(4 Suppl):e44S–60S.

    Article  Google Scholar 

  35. Lezama NG, Riddles LM, Pollan WA, Profenna LC. Disaster aeromedical evacuation. Mil Med. 2011;176(10):1128–32.

    Article  Google Scholar 

  36. Grissom CK, Thomas F, James B. Medical helicopters in wilderness search and rescue operations. Air Med J. 2006;25(1):18–25.

    Article  Google Scholar 

  37. Carpenter J, Thomas F. A 10-year analysis of 214 HEMS backcountry hoist rescues. Air Med J. 2013;32(2):98–101.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Col, USAF, MC, CFS (ret.), Senior Medical Director, Intermountain Life Flight and Virtual Hospital, University of Utah School of Medicine, Salt Lake City, UT, USA

    William Beninati

  2. Clinical Associate Professor (Affiliated), Stanford University School of Medicine, Stanford, CA, USA

    William Beninati

  3. LtCol, USAF, MC, CFS (ret.), National Aeronautics and Space Administration, Washington, DC, USA

    J. D. Polk

  4. Department of Policy, George Mason University, Fairfax County, VA, USA

    J. D. Polk

  5. Edward Via College of Osteopathic Medicine, Blacksburg, VA, USA

    J. D. Polk

  6. LTC, MC, USA (ret.), Trauma Surgery & Surgical Critical Care, Summa Health System, Akron, OH, USA

    William F. Fallon Jr.

  7. Department of Surgery, Case West Reserve University School of Medicine, Cleveland, OH, USA

    William F. Fallon Jr.

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  1. William Beninati
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  2. J. D. Polk
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  3. William F. Fallon Jr.
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Correspondence to William Beninati .

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Editors and Affiliations

  1. Col, USAF, MC, SFS (ret.), Chief Medical Officer, American Society for Reproductive Medicine, Professor Emeritus, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA

    William W. Hurd

  2. Col, USAF, MC, CFS (ret.), Senior Medical Director, lntermountain Life Flight and Virtual Hospital, University of Utah School of Medicine, Salt Lake City, UT, USA

    William Beninati

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Beninati, W., Polk, J.D., Fallon, W.F. (2019). Civilian Air Medical Transport. In: Hurd, W., Beninati, W. (eds) Aeromedical Evacuation. Springer, Cham. https://doi.org/10.1007/978-3-030-15903-0_4

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  • DOI: https://doi.org/10.1007/978-3-030-15903-0_4

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-15902-3

  • Online ISBN: 978-3-030-15903-0

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