Sunday, July 2, 2017

When is a medical airlift needed?



BENNINGTON — The recent air transport of an accident victim from Bennington to Albany Medical Center from a landing site in New York prompted the question of why the helicopter didn't utilize the local medical center's helipad.

The answer, said Forest Weyen, executive director of the Bennington Rescue Squad, is that everything depends on the specific factors in each case, all of which go into such decisions. He described a collaborative process for deciding on an airlift that he said has evolved in recent years and led to significant improvements.

The motorcycle rider reportedly sustained serious head and other injuries June 25 in an accident on Hardwood Hill (Route 7A) in Bennington. A determination was made that he should go to the Level I trauma center at the Albany, N.Y., hospital rather than first to Southwestern Vermont Medical Center in Bennington.

Health care and rescue personnel said patients with certain severe injuries would normally only be stabilized at SVMC before being transported to the Albany hospital, or possibly a facility like Dartmouth-Hitchcock Medical Center in Lebanon, N.H., another Level I trauma center.

In Vermont, only University of Vermont Medical Center in Burlington offers Level I emergency care.

If a determination of the need for trauma center care is made, based on established emergency medical services protocols, arrangements can be made to transport the person directly to a Level I center — by air or in an ambulance.

But why not meet the helicopter at the SVMC landing site in Bennington, rather than at a site on the Hoosac School campus in Hoosick, N.Y., about 9 miles away?

While speaking in general terms about the airlift process, Weyen said the patient's condition, the weather, the availability of airlift craft and/or pilots, and whether stabilizing a patient first at SVMC is more advisable than immediate transport to the trauma center all are factors that figure in whether or how to airlift a patient.

Essentially, he said, each certified squad member can make those type of decisions, based on a series of protocols and in communication or consultation with hospital personnel and police dispatchers in the squad's coverage region.

"We do not reject going to the helipad at SVMC: it really depends on each call," Weyen said. "We have actually used and will continue to use the helipad at the hospital when it meets the criteria of the call. SVMC staff and security are great to work with if we need it."

Regarding a decision to begin transporting the victim via ambulance, he added, "If the patient needs to be seen at a trauma center, we will start heading that way [west toward Albany] if a helicopter is still a ways out. The goal is to get that patient to a Level I trauma center as quick as possible, safely. If we are doing everything we can to reduce that time, that is better for the patient."

Another reason that decision would be made, Weyen said, is that "if the helicopter gets cancelled for any reason (weather, mechanical issue, pilot time out, etc.), we are that much closer to the trauma center and definitive care. Keep in mind that the number of patients that we take that way is relatively small. It is for those few patients that need care and capabilities that are not available locally."

Nearly all of the patients the rescue squad transports go to SVMC, including those who are later transported to a Level I center, he said.

Dr. Trey Dobson, a specialist in emergency medicine and chief medical officer at SVMC, said the airlift transport system "works very well. I have been here for 12 years, and we have certainly made improvements together."

Dobson said rescue personnel can schedule a pickup at the medical center's helipad independently, with or without help from ER personnel to stabilize the patient for the flight. In some cases, he said, the ER is notified for that purpose because a patient is having trouble breathing or has another issue that needs to be relieved before they are taken to a Level I center.

He said there is no question that collaboration among emergency medical personnel and others in the region has led to improvements in the airlift process in recent years, and the protocols and practices "are being revised constantly" through an ongoing dialogue.

Another significant benefit, Dobson said, has been a reduction in the number of expensive flights required. He said the protocols have been refined to the point only those flights adding a medical benefit are called in.

Concerning possible landing zones in the region, "we try to keep our options open," Weyen said.

In addition to Hoosac School athletic fields, sites in Pittstown, N.Y., further west on N.Y. Route 7; the Bennington Welcome Center property, a site near Prospect Mountain ski center in Woodford, and other sites in Pownal, the Northshire and the Wilmington area have been identified for possible emergency pickup zones.

Considerations, he said, include whether it is mud season and an open field might be impassable for an ambulance, whether there are utility poles and wires, and whether there is a game or other activity on a school athletic field.

In assessing the patient's injuries or condition, emergency personnel work with a set of established protocols, primarily from the Vermont Statewide Emergency Medical Services Protocols, Weyen said. Those include assessing a patient's vital signs and type or severity of injuries.

In arranging for an airlift, he said rescue squad members get assistance from town or state police dispatchers, who can coordinate with LifeNet of New York or another service for the air transports.

Five or 10 years ago, the current level of planning and coordination "was not as common," Weyen said. "But that is the way health care has evolved."

Steve Anderson, regional business development manager with the LifeNet of New York service, said LifeNet, an Air Methods Corp. program, and DHART, the Dartmouth-Hitchcock Medical Center program, provide air medical care for critically ill or injured patients in Vermont. The LifeNet air base that is primary to the Bennington area is located in Albany County, he said.

Additional support can come from bases in Montgomery and Essex counties in New York, he said, adding that the service has a total of 11 aircraft located throughout New York that are available 24 hours per day, year round.

The helicopters are staffed with trained flight nurses, flight paramedics and an aviation team of EMS pilots and mechanics. At the landing sites, the local rescue personnel hand off the patient to onboard emergency medical personnel.

The average flight time to Albany Medical Center from the Bennington area, about 45 miles, is 17 minutes, Anderson said.

LifeNet only responds when a first responder or physician deems it medically necessary for the patient, he said, adding, "We therefore have flown patients to UVM Health, Dartmouth-Hitchcock, hospitals in the Boston area, Westchester Medical Center and others."

Information about LifeNet is available at www.lifenetny.com/index.html

More information on Vermont emergency protocols can be viewed at www.healthvermont.gov/sites/default/files/EPRIP_2015ProtocolsLinkedLOCKED2015Oct1_000.pdf

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