Policy and Procedure Manual - Northern California Emergency ...

Nor-Cal EMS Policy & Procedure Manual
EMS AIRCRAFT MODULE
104 – EMS Aircraft Requests and Field Operations
AUTHORITY
Division 2.5 of the Health and Safety Code, Section 1797.220, Title 22, California Code of Regulations,
Division 9, Chapter 8; Title 21, Public Works Chapter Division of Aeronautics (Department of
Transportation), Public utilities Code Section 21662.1 and Federal Aviation Regulations.
PURPOSE
To ensure that patients who will benefit from EMS aircraft services receive the timeliest EMS response,
while public safety agencies have a coherent, coordinated and reliable resource when requesting and
coordinating EMS Aircrafts during an EMS system response.
DEFINITIONS
Refer to the “EMS Aircraft Definitions” policy for the definition of terms used in this policy.
SERVICE ZONES
1. The purpose of the air ambulance map is to assign Air Ambulance providers to specific air regions.
2. A current copy of the Air Ambulance map shall be maintained in all of the following: P.A. Dispatch
Centers, communications centers, ground provider’s dispatch centers, and on ground response units.
3. All employees shall be trained in the proper use of the air ambulance map.
EMS AIRCRAFT REQUESTS
4. An EMS Aircraft shall be dispatched in accordance with the EMS Aircraft Utilization policy upon
the request of any fire or law enforcement agency, ambulance personnel, or first responder or public
safety officer and may be simultaneously dispatched by the P.A. dispatch center..
5. The IC or his/her designee will function as the LZ Coordinator and initiate an EMS Aircraft by
providing the following information to the P.A. Dispatch Center:
a. Map coordinates, longitude and latitude, when known.
b. Location of landing site and topography.
c. Nearest landmarks (e.g., highways, railroad tracks, water towers).
d. Incident description, including location and number of patient(s).
e. Type and extent of injuries, if known.
f. Patient weight (this may be estimated if not known).
g. Landing limitations, e.g., weather conditions at scene (wind, rain, fog, snow, visibility).
h. HazMat information, if pertinent.
6. Consideration shall be given to dispatching of an Air Rescue provider in the event the incident
requires capabilities of the medical flight crew beyond the normal, i.e., mountain rescue, water
rescue, etc.
COORDINATION OF EMS AIRCRAFT REQUESTS
1. Dispatch Priority: EMS Aircraft shall be dispatched to medical and trauma incidents as follows:
a. Air Ambulance
b. ALS Rescue Aircraft
c. BLS Rescue Aircraft
d. Auxiliary Aircraft
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EMS AIRCRAFT MODULE EMS Aircraft Requests and Field Operations # 104
2. P.A. Dispatch Center:
a. May simultaneously dispatch an EMS Aircraft with the ground unit response when the
incident/patient information meets the criteria listed in the EMS Aircraft Utilization policy.
b. Shall dispatch the appropriate EMS Aircraft provider via the Communication Center’s designated
telephone line. Within the Shasta County region, REACH and PHI share the common dispatch
number (530) 245-6700, which is rotated between services every 24 hours at 0600.
c. Shall dispatch scene calls with private requests, as follows:
‣ Single Provider: Request the closest Air Ambulance in areas with a single air ambulance
provider regardless of patient request (patient preference).
‣ Multiple Providers: Request the appropriate Air Ambulance on rotation, unless a private
request (patient preference) has been expressed prior to liftoff.
d. Shall dispatch an EMS Aircraft immediately upon request from a ground ambulance while en
route to an emergency.
3. The Communications Center is responsible for dispatch, flight following, and providing accurate
ETAs. Any delay or an update of response is to be communicated immediately to ground providers.
When an EMS Aircraft arrives at scene greater than five (5) minutes from the ETA provided,
the prehospital care provider shall complete and submit an Unusual Occurrence Report,
located in the Provider Requirements Module.
ALS AIR RESCUE TRANSPORT
1. ALS Air Rescues may provide medical air transport of the ill and injured from scene calls to
appropriate medical facilities when the delay in Air Ambulance transportation is reasonably likely to
compromise patient care and outcome. This is only applicable when the ALS Air Rescue is the first
on scene, is the primary care giver, and an Air Ambulance is unavailable or not immediately available.
Efforts shall be made by the ALS Air Rescue to turn patient transportation over to air ambulances
when safety and patient condition permits.
a. References: California H & S Code, Section 1798.6, California Penal Code, Section 409.3, and
Nor-Cal EMS’s Responsibility for Patient Management Policy.
b. Prior to moving the patient, an ALS Air Rescue, shall make attempts to obtain the ETA of the air
ambulance from an appropriate source (e.g., incident commander (IC), P.A. Dispatch Center,
responding ground ambulance, or responding air ambulance).
c. When the patient is transported by the ALS Air Rescue, the source where the ETA of the air
ambulance was obtained by the ALS Rescue personnel shall be documented in the PCR.
PCR’s for those patients who were transported by ALS Air Rescue shall be submitted to Nor-Cal
EMS on a monthly basis.
GROUND AMBULANCE RESPONSE
1. A ground ambulance shall respond to a scene call when an EMS Aircraft has been dispatched (this
does not include private calls to clinics, medical facility, or physician’s office).
2. The ground ambulance unit responding to, or at the scene, shall not be canceled until:
a. The EMS Aircraft has left the scene with the patient aboard, or
b. The senior medical person on-scene has determined that patient transport is not required per the
EMS Aircraft Utilization policy.
3. A ground unit paramedic, who accompanies a patient in an Air Rescue shall assure the presence of
appropriate medical equipment and obtain orientation to the aircraft.
AIR COMMUNICATIONS
1. Providers are hereby authorized to utilize the Nor-Cal EMS UHF radio channels for EMS
coordination, dispatching of ambulances and providing patient reports, see the Communication Policy
located in the Miscellaneous Policies Module.
2. Air to Air: Shall be conducted on 123.025.
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EMS AIRCRAFT MODULE EMS Aircraft Requests and Field Operations # 104
3. Air to Ground:
a. If an air to ground frequency has not been established prior to dispatch, CALCORD (156.075)
shall be utilized as the initial air-to-ground contact coordination frequency. If CALCORD is busy,
the first choice shall be Med Alpha (155.340), sometimes known as “Old Med Net.”
b. When CALCORD is utilized as the initial frequency, the IC or designee may direct subsequent
medical traffic to an alternate frequency as specified.
4. Air to Receiving Facility: Patient report shall be provided to the Receiving Facility on the channel
outlined in the Receiving Facility Channels policy, located in the Miscellaneous Policies Module.
5. Notification: When a helicopter needs to utilize a helispot or helipad, notification and coordination
shall be made with the organization or person responsible for that landing site.
LANDING ZONE MANAGEMENT
Designation of Landing Sites:
1. Identify an Emergency Medical Services Landing Site that has been designated an EMS landing site
by an officer authorized by a public safety agency using guidelines outlined in Appendix A and any
criteria that the public safety agency has determined is reasonable and prudent for the safe
operations of EMS helicopters.
2. This landing site may be used, over any twelve month period, for no more than an average of six
landings per month with a patient or patients on the helicopter, except to allow for adequate medical
response to a mass casualty even if that response causes the site to be used beyond these limits.
3. Is not marked as a permitted heliport as described in Section 3554 of Title 21; and (4) is used only for
emergency medical purposes.
4. EMS Aircraft Staffing: If the EMS Aircraft is permitted by the provider agreement to be staffed with
either BLS or ALS personnel, per their classification and/or provider agreement, it is the responsibility
of the EMS Aircraft to notify the LZ Coordinator of their current staffing prior to landing, to assure that
adequate resources are available to the patient(s).
5. See Appendix A for Landing Zone Setup and Safety.
PATIENT DESTINATION
EMS Aircraft shall transport patient(s) according the Patient Destination Policy, located in the
Miscellaneous Policies Module.
HELICOPTER RENDEZVOUS
1. The ground ambulance may consider initiation of ground transport with an EMS aircraft rendezvous if
the patient is ready for evacuation and the air ambulance is not overhead or on scene. The IC or
designee with either the P.A. Dispatch Center or the communication center shall coordinate the
rendezvous.
2. The highest medical person in charge of the patient should avoid multiple attempts in rendezvousing
with EMS Aircraft, if the individual in charge of patient care determines that further delays are not in
the medical best interest of the patient.
3. When a safe landing site in proximity to the patient is not available at the incident:
a. The IC or designee shall consider arranging for an EMS aircraft rendezvous at an appropriate
location. The IC or designee in coordination with the ground ambulance (if communications
allow) shall select a rendezvous site.
b. If the rendezvous site is not an approved helipad or airfield landing site, the request for the EMS
aircraft rendezvous shall be handled in the same manner as a request for an EMS aircraft to the
scene. A public safety agency shall be on the scene at the rendezvous site.
4. Rendezvous at an approved helipad or airfield-landing site does not require presence of law
enforcement or fire personnel.
5. Once the ground ambulance is enroute, the ambulance crew should consider initiation a helicopter
rendezvous when:
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EMS AIRCRAFT MODULE EMS Aircraft Requests and Field Operations # 104
a. Patient condition deteriorates
b. Traffic conditions are impassable
c. Ground unit develops mechanical failure, or
d. Factors exist that will cause a delay or potentially negative outcome in patient transport.
e. In all instances, consideration should be given to possible ground transport to a closer facility.
6. When a hospital-operated ambulance is transporting a trauma patient (meets Nor-Cal EMS Trauma
Triage Criteria) to a Trauma Center per the Patient Destination policy, an ambulance may utilize a
helipad at a RF without the patient receiving a medical screening exam (MSE), for transport to a
more distant Trauma Center.
a. If a physician comes out to meet the patient at the helipad, s/he is then obligated to stabilize and
transfer out per the requirements listed in the Interfacility Transfer policy in the Facility
Requirements Module.
b. If, however, while at the helipad, the pts. condition deteriorates, the hospital at which the helipad
is located shall provide another MSE and stabilizing treatment within its capacity if requested by
the transporting personnel.
CANCELLING AN EMS AIRCRAFT REQUEST
1. Cancellation of EMS Aircraft may occur due to:
a. Pilot Judgment:
‣ The pilot shall immediately notify the Communications Center/P.A. Dispatch Center of the
SPECIFIC reason(s) for the response cancellation (e.g., weather enroute, weather at scene,
etc.).
b. Lack of emergency medical need:
‣ Shall be made by the Paramedic, EMT-I, or recognized First Responder working within the
EMS system who cancels the assigned EMS Aircraft because of lack of medical need, e.g.,
there are no patients at scene or when all patients at the scene are declining transportation
and have signed appropriate EMS Form.
‣ Shall be determined by either a Ground Response Unit or Ambulance on scene that the
patient(s) condition does not meet the EMS Aircraft Utilization Policy; personnel shall be ON
SCENE and have knowledge of the patient’s medical condition.
c. Other conditions at scene. If an ALS unit is not on scene, the IC may cancel any responding
EMS aircraft under the following conditions:
‣ When a landing zone cannot be secured – alternate landing zones should be considered.
‣ When landing condition(s) are unsafe.
2. The individual coordinating the EMS response may cancel responding EMS aircraft(s), only with the
concurrence of an ALS provider on scene or a report to the ALS responding unit and following
notification to the IC or designee, when:
a. No ALS intervention is required per the senior medical person on scene.
b. The level of patient care on scene is adequate and the patient would not benefit from the EMS
aircraft; patient transport does not meet the clinical AND time criteria listed in the EMS Aircraft
Utilization policy.
MULTICASUALTY RESPONSES:
EMS aircraft responding to multi-casualty incidents shall follow guidelines specified in the Nor-Cal EMS
Multi-Casualty Incident policy.
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