Friday, April 18, 2014

When a person is injured, is it better that they fly?

 An ambulance would not have been enough for Hannah Dardzinski.

The use of police helicopters to transport injured people is sometimes controversial, but Hannah and her mom, Sue, believe having a state police helicopter readily available saved her life.

In May 2011, a driver sped down an Interstate 70 exit ramp at 61 mph and rear ended a Honda Civic. Hannah, now 17, was in the Honda's backseat. She was immediately knocked unconscious.

Hannah was taken by ambulance to the Howard County Fairgrounds where she was met by Trooper 3, the Maryland State Police helicopter assigned to the Frederick barrack and housed at Frederick Municipal Airport.

"My injuries were so life threatening, I was apparently a minute away from dying," Hannah, an Eldersburg resident, said.

In the 15 to 20 minutes it took the helicopter to fly Hannah to R Adams Cowley Shock Trauma Center in Baltimore, Trooper First Class Lance Shank put a tube down her windpipe to keep her breathing and gave her a drug so she wouldn't wake up during the flight. Shank could immediately tell she had a dislocated hip, a broken femur and trouble breathing, which indicated lung damage, Hannah said.

Doctors at shock trauma discovered Hannah had a skull fracture; the bone was pressing into her brain. She also had a laceration on the back of her head, blood collecting in her head outside her brain, fractures in her back and pelvis, a bruised lung and kidney and a lacerated liver. She had one surgery to fix her skull fracture and another putting a rod in her femur. The rest of her injuries healed with time, she said.

Hannah still cannot remember her two weeks in shock trauma due to post-traumatic amnesia, but after another six weeks in rehabilitation re-learning how to walk, talk and move the right side of her body, she considers herself in the same shape she was before the crash.

She and her mother do not think this would be the case if they had needed to wait for an ambulance.

After a Maryland police helicopter carrying victims of a vehicle collision crashed in September 2008, such use of helicopters was questioned. That 2008 crash killed four of the chopper's five passengers, including a veteran pilot, a flight paramedic, a county emergency medical technician and one of the crash victims.

But a helicopter can move a patient more swiftly than an ambulance, especially during times of heavy road traffic.

"The first hour after an injury is huge," Sue Dardzinski said of Hannah's crash. "And it was rush hour, so it would have taken an hour [by ambulance] to get down to Baltimore."

How Trooper 3 is used

Trooper First Class William B. Jansen, a flight paramedic said Trooper 3 is used for law enforcement, homeland security checks, emergency medical services, critical infrastructure checks, and search and rescue.

The majority of Trooper 3 calls are for emergency medical services, according to Lt. Walter Kerr, commander of flight operations for the Maryland State Police Aviation Command Center. This is the case with all of Maryland's police helicopters.

Maryland bought new helicopters in June 2013, a fleet of 10 AgustaWestland AW139s, which Jansen described as more reliable, with larger engines and 21st century technology. The old helicopters were about 20 years old, according to Trooper 3 Pilot Russ Zullick. The new helicopters cost $11.8 million each.

The average pilot flies about four missions a day -- two at night and two during the day, Jansen said. Trooper 3 primarily serves Frederick, Carroll and Washington counties. Nine trooper paramedics are assigned to Trooper 3, according to Zullick. They are required to be state troopers but did not necessarily come from the Frederick barrack. Seven civilian pilots are also assigned in Frederick.

Flights are made with two pilots and two care providers -- either two paramedics or one parametric and one emergency medical technician, Zullick said.

When it comes to law enforcement, Jansen said, the helicopter can see things officers on the ground cannot, such as oncoming traffic or a person pointing a gun out of a car. Trooper 3 can also help find missing people using cameras that indicate the presence of humans based on their body heat.

"Your body will show up a different shade than the rest of the picture," Jansen said. "It's pretty frequent that we find people."

Critical infrastructure checks involve flying over areas that may be susceptible to criminal activity or the sites of mass gatherings, Jansen said.  A police helicopter flying over such areas could deter future criminal activity or stop it as it is in progress.

Areas that might require critical infrastructure checks include the Chesapeake Bay Bridge, Oriole Park at Camden Yards in Baltimore, Harry Grove Stadium in Frederick and Coniwingo Dam, Kerr said.

Homeland security and critical infrastructure checks are often done coming back from other missions or at the request of Department of Natural Resources Police, Jansen said.

"Every time we're coming back from our missions we try to do some type of patrol check."

State police helicopters cost about $5,000 per flight hour, according to Kerr. This includes operation of the aircraft, crew salaries and scheduled maintenance. Eighty percent of the helicopters' operating cost comes from Maryland's Emergency Medical Services budget and the other 20 percent comes from the Maryland State Police operating budget.

When people register their cars in Maryland a portion of the fee they pay goes to the EMS budget to help pay for the helicopters, Kerr said.

Emergency medical flights

Field responders decide whether someone needs to be flown to a shock trauma unit based on a number of different factors, according to Tom Coe, battalion chief of Emergency Medical Services with Frederick County Fire and Rescue. These responders could include police or firefighters, Kerr said.

In extremely critical cases, Coe said, 911 dispatchers can say "send a helicopter." Field responders might call a doctor to make the decision if a patient does not meet the qualifications for air transport, but the responders believe one is needed.

"Those are the things that might not be visible," Coe said.

A non-visible injury or ailment might still warrant a flight to shock trauma if the patient is very young or elderly, he said.

The most critical cases for ordering a helicopter could involve an emergency medical technician noticing decreased consciousness, unstable blood pressure or respiratory rate, or a traumatic injury, Coe said. Less common, but still life-threatening cases could involve a dive injury or exposure to carbon monoxide or harmful gases.

Helicopters are more likely to be called upon in rural areas such as Frederick County, Coe said, where a lot of traveling is required to get to an urban trauma center.

Not all states follow Maryland's model for police helicopter use. Pennsylvania's police helicopters are not flown for emergency medical transport, according to Trooper Adam Reed, public information officer with the Pennsylvania State Police. Such use is not funded and pilots are not trained in emergency medical services.

Pennsylvania's helicopters are used for police chases and search and rescue, Reed said. They "are not set up to do double duty as medical services helicopters."

Penn State Hershey Medical Center has a small fleet of helicopters stationed around South-Central Pennsylvania for emergency medical services.

The system works well, Reed said. "I've never run into a circumstance where (medical center helicopters) weren't there when requested. I don't believe it has hindered our operations in any way."

Even without emergency medical calls, Reed said the Pennsylvania State Police helicopters are "out and about almost every single day."

Maryland's emergency medical use of helicopters is what drew Jansen to the program in the first place. He said Delaware has a similar program but fewer helicopters than the 10 owned by Maryland.

Trooper 3 can get to shock trauma in about 18 minutes from most Frederick County locations, he said.

"Most states do not have what Maryland has," Jansen said. "The bottom line is when someone is seriously injured, every minute counts, and that's why we're here."

Why it's good

How seriously injured are most people who are flown to shock trauma? That's difficult to calculate.

According to a shock trauma fact sheet, 18.8 percent of patients are brought to the center via helicopter. Thirty-eight percent of all shock trauma patients are from vehicle collisions, 33 percent are from falls, 19 percent are from violence and 10 percent are from other causes.

Ninety-six percent of patients survive their injuries.

The average stay in shock trauma is 4.5 days, according to Karen Lancaster, University of Maryland Medical Center spokeswoman. Stays in shock trauma can range from a few hours to a few months, she said, but statistics are not kept on the length of each patient's stay and how they got there.

Discharge can mean going home, being transferred to rehabilitation or outpatient clinics, or needing follow-up surgeries, Lancaster said.

Hannah Dardzinski now volunteers at shock trauma and hopes to become a nurse. She said most people brought in by both ambulance and helicopter do not appear to have life threatening injuries.

"There's a lot of falls from elderly people," she said.

On the other hand, she said, many internal injuries do not initially appear life threatening even when they are.

"When I first came in, I didn't look life threatening, so it could be that type of situation, too," she said. "I just kind of looked like I got banged up and that was it."

Zullick is the pilot who flew Hannah. He has said he seen people who looked near death but then lived, he said, and also people who initially looked like their injuries were minor, but later died in the hospital.

Hannah has stayed in touch with both Zullick and Shank.

"It's nice to see a positive end result of what we do here," Shank said.

2013: A year in the life of Trooper 3

 -- 363 medical transports

-- 164 support missions, mostly including three months of training on new helicopters

-- 150 critical infrastructure checks coming back from other missions

-- 120 law enforcement assistances

-- 59 search and rescue missions

-- 2 homeland security missions

Source: Lt. Walter Kerr, commander of flight operations, Maryland State Police Aviation Command Center

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