Air Medical Transport Guidelines

• Air medical operations guidelines are for the safe and efficient use of air medical transport during emergencies.

Air Medical Assignment Considerations:

• Air transport consideration criteria include:
  • Patients meeting "Trauma Alert" criteria
  • Multi-casualty incidents
  • Time factors (dispatch, arrival), degree of illness/injury, landing locations, number of patients
  • When air transport enhances patient outcome and patients needing emergent blood product administration.

Air Medical Response Exclusions:

• Air transport exclusions include:
  • Patients in cardiopulmonary arrest (depending on air unit capabilities)
  • Patients contaminated by hazardous materials
  • Patients in law enforcement custody or posing a flight crew safety risk (except chemically sedated patients)
  • Patients with an unsecured or unmanageable airway.

Automatic Response Criteria:

• An air unit is automatically requested in these areas:
  • Areas south of St. Lucie West and White City
  • Areas north of Indrio Road
  • Western county areas
  • Incidents on major highways
  • Barrier island locations away from causeways.

Landing Zones:

• Ground personnel select and secure a safe landing zone, the pilot has final authority.
• A pre-designated LZ may be used if the incident scene is unsuitable.
• The LZ must be clear of hazards like utility poles, wires, trees, vehicles, and debris.
• A flat surface should be selected, avoiding sloped areas.
• The LZ must be physically inspected for hazards, communicating any to the flight crew.
• Corners of the LZ:
  • During the day, the LZ should be 100' x 100'.
  • At night, the LZ should be 200' x 200'.
• Flagging tape can be used on an antenna for wind direction during daylight.
• Avoid shining lights upward at the aircraft; turn off headlights aimed at the LZ to reduce visual obstructions, keeping emergency lights on to help the crew locate the scene.
• Precautions against rotor wash should be taken, including eye protection, securing loose objects, closing apparatus doors, and covering the patient.
• Loose sand or dirt should be wetted down.
• The LZ area should be secured from vehicles, pedestrians, and obstructions, including stopping traffic when using a roadway.
• The Incident Commander (IC) should appoint an LZ Officer; if not, the IC assumes LZ oversight.
• Civilians and nonessential personnel must stay back 200 feet from the aircraft.
• Air units require LZ security confirmation before landing "on-site", at the pilot's discretion.

Communication:

• Flight crews communicate with the Fire District's Communications Division.
• St. Lucie County Air Rescue uses the "Air Rescue" channel, Martin County Lifestar uses "Lifestar".
• If communications fail, The LZ Officer notifies the IC, who then notifies the Communications Division.
• The flight crew must communicate with the LZ before landing, and the IC or LZ Officer relays LZ information, hazards, patient condition, and weight.
• A separate tactical (TAC) channel is needed for incidents involving multiple aircraft.
• If Air Rescue and Lifestar aren't available, a TAC channel will be used for other agency aircraft.
• The aircraft notifies the IC, or LZ Officer once the LZ is identified, stating, "LZ in sight, on final to land," to which the IC or LZ Officer replies, "Clear to Land".
• The LZ Officer informs the IC and Communications Division after a safe landing.
• Continuous LZ monitoring is essential while the aircraft is on the ground.
• Post-liftoff, the LZ Officer notifies the IC and Communications Division of the aircraft's final destination.
• LZ integrity must be maintained for at least five minutes post-departure.

Safety

• Ground personnel need bunker coat, helmet, and eye and hearing protection.
• Eye and ear protection is considered for the patient.
• Loose items must be secured to the stretcher.
• LZ lights are needed on all low level lighting calls.
• Approach the aircraft ONLY when signaled or accompanied by a flight crewmember.
• Approach the aircraft in a crouched position at a 45-degree angle to the nose or a 90-degree angle to the side.
• Stay within the pilot's field of vision.
• Carry tools and equipment NO higher than waist level.
• A minimum of two people will accompany the patient to the helicopter.
• Exercise caution when walking around the skids.
• Exit the same way you entered, NEVER exit toward the rear of the aircraft.

Determination of Hospital Destination:

• Patients should be matched to an appropriate receiving facility.
• Specialty hospital transports (hyperbaric and burn center) need prior patient acceptance before departure
• Consider the following criteria when determining hospital destination:
  • Patient age
  • Type and severity of illness/injury
  • Incident location
  • Weather conditions
• Flight crews make the final determination of hospital destination.

Pediatric Trauma Centers:

• Patients under 16 are pediatric and go to a State Approved Pediatric Trauma Center (SAPTC):
  • Primary - St. Mary's Trauma Center (West Palm Beach)
  • Secondary - Delray Trauma Center
  • Tertiary - Arnold Palmer Children's Hospital (Orlando)

Burn Trauma Centers:

• Patients meeting Florida's trauma alert burn criteria can go straight to a burn center if no trauma surgery is needed.
  • Primary - Orlando Regional Burn Center
  • Secondary - Jackson Memorial (Ryder Trauma Center, Miami)
  • Tertiary - Tampa General Burn Unit

Hyperbaric Chambers:

• Patients with decompression sickness or carbon monoxide poisoning go to a facility with a decompression chamber.
  • Primary - St. Mary's Trauma Center (West Palm Beach)
  • Secondary - Florida Hospital South (Orlando)
  • Tertiary - Mercy Hospital (Miami)

St. Lucie County Air Rescue In-Flight Diversion:

• If a trauma patient experiences cardiopulmonary arrest, they should be treated per ACLS guidelines and transported to the trauma center.
• For interfacility transport patients in cardiopulmonary arrest, treat per ACLS and go to the nearest facility with a helipad and Air Rescue communications.
• Aircraft issues and weather can cause in-flight diversions.

Communication:

• The flight crew maintains communication with the Communications Division in the event of an in-flight diversion.

Passengers:

• Family members can request to accompany an airlifted patient, flight crew must approve with the final decision resting with the pilot.
• Parental consent is needed for a minor passenger.

St. Lucie County Air Rescue Interfacility Transport Procedure:

• Upon getting an interfacility transport request, the flight crew radios the Communications Division on COM 1 with facility names.