Medevac Utilization Protocol

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Questions and Answers

What is the maximum allowable slope for a landing zone?

20 degrees

10 degrees (correct)

15 degrees

5 degrees

What should be done if wires are present at or near the scene?

Relay the information to the flight crew prior to landing (correct)

Mark the wires with cones or flares

Remove the wires from the area

Ignore the wires and proceed with landing

Why should fixed objects that may be susceptible to wind damage be avoided in the landing zone?

They may obstruct the pilot's visibility

They may distract the pilot

They may cause noise pollution

They may become airborne as the AW-139 aircraft produces a significant amount of main and tail rotor wash (correct)

What should the LZ Officer do during night operations to detect wires in and around the LZ?

Use a flashlight directed down and up Signup and view all the answers

What is the purpose of the 45-Degree Test?

To identify obstacles at or above a certain height Signup and view all the answers

Why should loose material such as gravel be avoided in the landing zone?

The rotor wash will cause stones or gravel to become airborne, striking personnel and/or damaging vehicles Signup and view all the answers

What should be done when a roadway is to be used as a landing zone?

Stop traffic in both directions Signup and view all the answers

Who has the final authority when selecting a landing zone?

The flight crew Signup and view all the answers

Why should flares or cones not be used to mark the landing zone?

They may become airborne during the landing Signup and view all the answers

What is a consideration for medevac transport?

If ground transport would deplete limited EMS resources in the community Signup and view all the answers

What should personnel use when approaching the aircraft?

Hearing and eye protection at all times Signup and view all the answers

Who serves as the communications center for the dispatching and management of Maryland's public safety helicopter resources?

The Systems Communications Center (SYSCOM) at MIEMSS Signup and view all the answers

What is the purpose of the Medevac Request Data form?

To provide a consistent standard by which SYSCOM receives request information Signup and view all the answers

Who is responsible for completing the Medevac Data Request form?

Both the 9-1-1 center operator and the EMS clinician Signup and view all the answers

Which category requires acceptance at the Trauma/Medical/Specialty Center for medevac authorization before SYSCOM can dispatch the helicopter?

All of the above requests containing an asterisk ( *) Signup and view all the answers

What is the consideration for Priority 1 Patients when determining air transportation?

Time for helicopter response, patient turnover, flight time to appropriate facility, and weather conditions Signup and view all the answers

What is the minimum size of the optimal landing zone (LZ) required for helicopter safety?

150 x 150-foot area Signup and view all the answers

What is the purpose of consulting with a trauma/specialty center?

To obtain physician authorization for medevac transport Signup and view all the answers

What is the drive time threshold for considering medevac transport for Priority 2 Patients?

30 minutes Signup and view all the answers

Which of the following is NOT a consideration for medevac authorization?

Patient's age Signup and view all the answers

Who makes the formal medevac request?

The 9-1-1 center operator Signup and view all the answers

What is the primary consideration for determining the need for medevac transport?

Time to arrive at the receiving facility Signup and view all the answers

What information is gathered to complete the Medevac Data Request form?

Essential information such as incident type, location, and landing zone Signup and view all the answers

What is the purpose of the Medevac Dispatch section of the Medevac Data Request form?

To provide essential information for medevac dispatch Signup and view all the answers

Which category includes patients with a less serious condition yet potentially life-threatening injury or illness?

Priority 2 Patients Signup and view all the answers

What is the primary goal of medevac transport?

To ensure the patient arrives at the receiving facility more quickly Signup and view all the answers

Who is responsible for securing the landing zone?

The EMS clinician Signup and view all the answers

Which of the following is a requirement for medevac transport?

Patient's medical condition meets the specific criteria of the indicated protocol Signup and view all the answers

When can response personnel approach the aircraft?

Whenever they need to render assistance or rescue occupants of the helicopter Signup and view all the answers

What should personnel avoid doing when approaching the aircraft from the downhill side?

Avoiding the uphill side approaches Signup and view all the answers

Why should the patient not be brought to the aircraft prior to advising the Trooper/Flight Paramedic?

Due to very high noise levels found in the general proximity of the aircraft Signup and view all the answers

What should personnel do if debris gets in their eyes and impairs their vision?

Immediately take a knee and wait for assistance Signup and view all the answers

How far should vehicles be kept away from the aircraft?

200 feet Signup and view all the answers

Why should spotlights not be directed onto the landing area or at the aircraft?

To prevent disorienting the pilot Signup and view all the answers

What should personnel do if they need to go from one side of the aircraft to the other?

Walk around the front of the aircraft Signup and view all the answers

Why should personnel not wear hats and loose clothing when approaching the aircraft?

To prevent them from getting caught in the rotor blades Signup and view all the answers

What should personnel do if an aircraft door needs to be opened or closed?

Wait for the flight crew member to open or close it Signup and view all the answers

What is the definition of a patient in this protocol?

Any person encountered by in-service rescue or emergency medical personnel with an actual or potential injury or medical problem Signup and view all the answers

What is the primary purpose of this protocol?

To provide guidance for EMS clinicians on patient assessment and refusal of care Signup and view all the answers

Who is considered an authorized decision maker for a minor patient?

An adult who identifies themselves as the parent or guardian Signup and view all the answers

What is the first step in assessing a patient who has initially refused care?

Ask the patient if they would allow an assessment to determine if they are OK Signup and view all the answers

What is included in the visual assessment of a patient?

Level of consciousness, orientation, and gait Signup and view all the answers

What is the purpose of the secondary survey?

To direct the assessment based on the chief complaint Signup and view all the answers

What is considered when determining a patient's capability to make medical decisions?

The patient's level of consciousness and judgment Signup and view all the answers

What should be done if the authorized decision maker refuses to permit the EMS clinician to examine a minor patient?

Consider contacting law enforcement for assistance Signup and view all the answers

What is the purpose of the Patient-Initiated Refusal of EMS form?

To document the patient's refusal of care Signup and view all the answers

What is included in the primary survey of a patient?

Airway, breathing, circulation, and disability Signup and view all the answers

What should be considered when assessing a patient who has requested an EMS response due to alleged rape or sexual offense?

Notifying law enforcement or social services Signup and view all the answers

Which of the following conditions is a criterion for a patient to be considered medically capable of making decisions regarding their care?

Being 18 years of age or greater Signup and view all the answers

A patient who is being treated for an STI and is 17 years old can be considered medically capable of making decisions regarding their care under which condition?

If they are requesting treatment for the STI Signup and view all the answers

What should an EMS clinician do if a patient is refusing transport but has a 'no' answer to questions 1, 2, 3a, 3b, and 4 on the Patient-Initiated Refusal of EMS form, but a 'yes' answer to questions 5 through 8?

Consult with medical direction to obtain a second opinion Signup and view all the answers

Under which circumstance can a patient be transported to a hospital without their consent?

If the patient is attempting to harm themselves or others Signup and view all the answers

Which of the following is a reason why an EMS clinician should seek medical consultation?

If the EMS clinician is unsure of the patient's medical capacity Signup and view all the answers

What is the purpose of consulting with a Base Station hospital physician?

To decrease the non-transport of high-risk refusals Signup and view all the answers

Which of the following patients should be considered incapable of making medical decisions regarding care?

A patient who is experiencing altered mental status due to a medical condition Signup and view all the answers

What should an EMS clinician do if a patient is refusing transport and has a 'yes' answer to questions 1, 2, 3a, 3b, or 4 on the Patient-Initiated Refusal of EMS form?

Involuntarily transport the patient to the hospital Signup and view all the answers

Which of the following is a criterion for transporting a patient to a hospital without their consent?

The patient is experiencing altered mental status due to a medical condition Signup and view all the answers

What should an EMS clinician do if a patient is refusing transport and the clinician is unsure of the patient's medical capacity?

Consult with medical direction to obtain a second opinion Signup and view all the answers

What is the primary purpose of the Patient-Initiated Refusal of EMS procedure?

To document the patient's refusal of medical services Signup and view all the answers

What should the clinician do if the patient refuses examination?

Attempt to convince the patient or guardian to accept transport Signup and view all the answers

What is the purpose of the Physical Restraints procedure?

To prevent harm to the patient or others Signup and view all the answers

What information should the clinician gather to complete the Patient-Initiated Refusal of EMS procedure?

The patient's reason for refusing medical services Signup and view all the answers

When should the Physical Restraints procedure be utilized?

When the patient is exhibiting behavior that poses a danger to themselves or others Signup and view all the answers

What should the clinician do if they are unable to examine the patient?

Attempt to take vital signs Signup and view all the answers

What should the clinician do if the patient refuses transport?

Attempt to convince the patient or guardian to accept transport Signup and view all the answers

What information should be documented in the Patient-Initiated Refusal of EMS procedure?

The patient's reason for refusing medical services Signup and view all the answers

What is the primary goal of the Patient-Initiated Refusal of EMS procedure?

To document the patient's refusal of medical services Signup and view all the answers

What should the clinician do if they are unable to convince the patient or guardian to accept transport?

Contact medical direction for further guidance Signup and view all the answers

What is the primary reason a clinician would disagree with a patient's decision to refuse transport?

The patient has unstable vital signs or clinical factors uncovered by the assessment. Signup and view all the answers

When is a patient considered to have a higher risk of illness?

When they have one or more positive answers to questions 6 through 10 on the Patient-Initiated Refusal of EMS form. Signup and view all the answers

What should be done when a patient refuses to sign the refusal statement?

Contact a supervisor and explain the situation. Signup and view all the answers

What should be assessed when encountering a patient who is attempting to refuse EMS treatment or transport?

The patient's lack of medical decision-making capability and high risk criteria. Signup and view all the answers

What is the purpose of Section One of the Patient-Initiated Refusal of EMS form?

To document the patient's medical decision-making capability and high risk criteria. Signup and view all the answers

What should be done when a minor patient refuses EMS treatment or transport?

Consult with the parent or guardian. Signup and view all the answers

What should be documented in the eMEDS report?

The patient's refusal of treatment and/or transport. Signup and view all the answers

What is the purpose of completing Section Three of the Patient-Initiated Refusal of EMS form?

To document the initial disposition, interventions, and final disposition. Signup and view all the answers

Who should be contacted when a patient refuses to sign the refusal statement?

A supervisor. Signup and view all the answers

What should be considered when determining whether a patient has a higher risk of illness?

The patient's answers to questions 6 through 10 on the Patient-Initiated Refusal of EMS form. Signup and view all the answers

What is the recommended way to position a patient's extremities when using a Reeves™-type stretcher?

4-point restraints, with one arm up and the opposite arm down Signup and view all the answers

When is it acceptable to remove restraints during transport to the hospital?

When there is a complication from the use of restraints Signup and view all the answers

What is the primary consideration when deciding on the type of restraints to use?

The minimum restraint necessary to ensure safe transportation Signup and view all the answers

What should be done with the patient's hands if they are handcuffed by the police?

Reposition the patient in a face-up position with hands anterior and secured to the stretcher Signup and view all the answers

What should be done to the patient's head during transport?

Place padding under the patient's head to prevent injury Signup and view all the answers

What should be continuously monitored during transport?

The patient's airway status and vital signs Signup and view all the answers

What is the purpose of the Agitation protocol?

To assess for traumatic or medical causes of the patient's agitation Signup and view all the answers

What should be avoided when placing restraints on a patient?

Placing restraints in a way that interferes with medical treatment Signup and view all the answers

What should be done with the patient's extremities when using physical restraints?

Secure them in a neutral position Signup and view all the answers

What should be documented every 15 minutes during transport?

The patient's airway status and vital signs, along with the reason for restraint Signup and view all the answers

Study Notes

Medevac Utilization Protocol

The Medevac Utilization Protocol is a set of guidelines for requesting medical evacuation (MEDEVAC) transportation for patients in need of critical care.

Indications for Medevac Request

Trauma Category:
Alpha, Bravo, Charlie, and Delta
Specialty Category:
Burn, Hand, Eye, Head, and Spinal
Medical Category:
Stroke, STEMI, and Hyperbaric (CO, Toxic Inhalation, or SCUBA)
Consult-Approved Critical/Unstable:
Time-critical illness or disease requiring specialized care

Principles for Consideration of Medevac Transport

Priority 1 Patients:
Critically ill or injured patients requiring immediate attention
Consider air transportation if it will arrive at the receiving facility more quickly than ground transportation
Factors to consider:
- Time for helicopter response
- Patient turnover (loading time)
- Flight time to the facility
- Weather conditions
Priority 2 Patients:
Less serious conditions, but potentially life-threatening
Consider medevac transport if drive time is greater than 30 minutes
Special consideration: if ground transport would deplete limited EMS resources in the community

Contraindications for Medevac Request

EMS/DNR-B or MOLST B patients are not candidates for field medevac transport

Medevac Request Process

Through the Systems Communications Center (SYSCOM) at MIEMSS
The Medevac Request Data form is used to provide consistent information
The process involves:
1. Decision to request medevac based on indications and principles
2. Consult with trauma/specialty center for physician authorization
3. Gather essential information
4. Contact SYSCOM for formal medevac request
5. Select and secure a landing zone

Medevac Data Request Form

Identifies call origin and operator ID
Identifies request type (medevac, search & rescue, airborne law enforcement)
Includes incident type, location, and landing zone information
Requires information on primary condition, severity, and priority

Helicopter Safety

Optimal Landing Zone (LZ) Setup:
150 x 150-foot area, flat, firm, and free from obstructions
Maximum allowable slope is 10 degrees
Identify and report obstacles
Additional Landing Zone Tips:
Walk the area to check for hazards
Use the 45-Degree Test to identify obstacles
Avoid loose material such as gravel
Ensure security of the landing zone
Do not use flares or cones to mark the landing zone

Approaching the Aircraft

Hearing and eye protection should be used at all times
Approach the aircraft only when accompanied by an MSP flight crew member
Only approach the aircraft from the Safe Zone
Avoid the rear and tail rotor at all times

Miscellaneous Safety Tips

Vehicles should be parked at least 200 feet away from the landing zone
Do not direct spotlights onto the landing area
Keep emergency lights displayed until the aircraft is overhead
Reduce vehicle lighting to running lights or parking lights for night vision purposes### Patient-Initiated Refusal of EMS
A person at the scene of an emergency who requests an EMS response or is evaluated to have certain conditions shall be considered incapable of making medical decisions and shall be transported to the closest appropriate medical facility for further evaluation.
Conditions that render a person incapable of making medical decisions include:
- Altered mental status from various causes
- Attempted suicide, danger to self or others, or verbalizing suicidal intent
- Irrational behavior that impairs medical decision-making capacity
- Judgment impaired by severe illness or injury
- On an Emergency Petition
Patients who meet certain criteria require Base Station hospital physician consultation, including:
- When the clinician is unsure if the patient is medically capable of refusing transport
- When the clinician disagrees with the patient's decision to refuse transport due to unstable vital signs or clinical factors
- When the patient was involved in a mechanism that recommends transportation to a Trauma Center
- For minor patients with no available parent, guardian, or authorized decision maker, or when the clinician disagrees with the decision made by the parent, guardian, or authorized decision maker

Documentation

Clinicians must complete the Patient-Initiated Refusal of EMS form, which includes:
- Section One: patient medical decision-making capability and "At-Risk" criteria
- Section Two: clinician assessment and actions
- Section Three: Initial Disposition, Interventions, and Final Disposition
- Section Four: patient's reason for refusing care in their own words
The eMEDS report must also be completed, documenting the assessment, care provided, elements of the refusal, medical decision-making capability, and "At-Risk" criteria.

Physical Restraints

Physical restraints should be used only when necessary to prevent harm to the patient or others.
Indications for physical restraints include:
- Patient behavior that poses a danger to themselves or others
- Implied consent in situations where the patient is unable to provide consent
Procedure for physical restraints includes:
- Ensuring scene safety and sufficient personnel
- Positioning the patient for safe transport
- Securing extremities and using padding as necessary
- Monitoring airway status, vital signs, and reassessing pulse, capillary refill, motor, and sensory status
- Documenting findings every 15 minutes

Multiple Casualty Incident/Unusual Event

A Multi-Casualty Incident (MCI) or Unusual Event is any event where the number of injured persons exceeds the normal capabilities of the EMS Operational Program.
Local EMS Operational programs should have a plan or operational procedures that address response to multiple patient incidents.

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Description

This quiz covers the indications, contraindications, and principles of medevac requests, including the request process, standardized dataset, and safety recommendations for helicopter interactions.