Air medical services are the use of aircraft (both fixed-wing aircraft and helicopters) to provide various kinds of medical care (especially prehospital emergency medicine, paramedic service and critical care), typically to and from remote locations far away from hospitals, during outreach, critical couriers (e.g. pharmaceuticals, equipment and transplant organs), patient transfer, medical evacuation, disaster response and search and rescue operations.
History During World War I, air transport was used to provide medical evacuation from front line areas and the battlefield itself.
In 1928, in Australia, John Flynn founded the Flying Doctor Service (later the Royal Flying Doctor Service), to provide a wide range of medical services to civilians in remote areas; these included from routine consultations with travelling general practitioners, to air ambulance evacuations and other emergency medical services.
Fixed wing military air ambulances came into regular use during World War II. Helicopters became more commonly used for such purposes during the Korean and Vietnam wars.
Later, helicopters were introduced to civilian health care, especially for shorter distances, in and around large cities: transporting paramedics or specialist doctors as needed and transporting patients to hospitals, especially for major trauma cases. Fixed-wing aircraft remained in use for long-distance medical transport.
Advantages Air medical services can travel faster and operate in a wider coverage area than a land ambulance. This makes them particularly useful in sparsely populated rural areas.
Air medical services have a particular advantage for major trauma injuries. The controversial theory of the golden hour suggests that major trauma patients should be transported as quickly as possible to a specialist trauma center. Therefore, medical responders in a helicopter can provide both a higher level of care at the scene of a trauma and faster transport to a trauma center. They can also provide critical care when transporting patients from community hospitals to trauma centers. Oftentimes they carry more specialized equipment than ground ambulances, such as blood products, medication pumps, and ventilators, making them useful beyond reduction of transport and response times.
Disadvantages Air ambulance transport is expensive, and if utilised poorly is therefore not cost effective. When inappropriately deployed to a patient close to a hospital, an air ambulance may add delay to the patient reaching the hospital. In research from 1996, air ambulance services in England and Wales demonstrated no evidence of improvement in vehicle response times (i.e. time from 999 call to an ambulance vehicle being on-scene with the patient) for air ambulance attended patients compared to those attended by a land ambulance. The same review found patient did not arrive at hospital any quicker when attended by an air ambulance. When the same authors looked at health outcomes in Cornwall and London they found no evidence that the attendance of an air ambulance (HEMS) service improved survival in trauma patients.
Indications for air transport
Effective use of helicopter services for trauma depends on the ground responder's ability to determine whether the patient's condition warrants air medical transport. Protocols and training must be developed to ensure appropriate triage criteria are applied. Excessively stringent criteria can prevent rapid care and transport of trauma victims; relaxed criteria can result in the patient being unnecessarily exposed to the potential dangers of dangerous weather conditions or other aviation-related risks.
Crew and patient safety is the single most important factor to be considered when deciding whether to transport a patient by helicopter. Weather, air traffic patterns, and distances (such as from the trauma scene to closest level 1 trauma centre) must also be considered. Another reason for cancelling a flight is based on the comfort of the flight crew with the flight. The general rule of safety is upon the crew, when there is one pilot and two medical crew is:
Some have questioned the safety of air medical services.Meier, B, Saul, S. Fatal crashes provoke debate on safety of sky ambulances. New York Times, February 28, 2005.Levin, A, Davis, R. Surge in crashes scars air ambulance industry. USA Today, July 18, 2005. While the number of crashes may be increasing, the number of programs and use of services has also increased. Factors associated with fatal crashes of medical transport helicopters include flying at night and during bad weather, and postcrash fires.
Air ambulance
An air ambulance is a specially outfitted helicopter or fixed-wing aircraft that transports injured or sick people in a medical emergency or over distances or terrain impractical for a conventional ground ambulance. Fixed-wing aircraft are also more often used to move patients over long distances and for repatriation from foreign countries. These and related operations are called aeromedical. In some circumstances, the same aircraft may be used to search for missing or wanted people.
Like ground ambulances, air ambulances are equipped with medical equipment vital to monitoring and treating injured or ill patients. Common equipment for air ambulances includes medications, ventilators, ECGs and monitoring units, CPR equipment, and stretchers. A medically staffed and equipped air ambulance provides medical care in flight—while a non-medically equipped and staffed aircraft simply transports patients without care in flight. Military organizations and NATO refer to the former as medical evacuation (MEDEVAC) and to the latter as casualty evacuation (CASEVAC).
Air traffic control grants special treatment to air ambulance operations, much like a ground ambulance using lights and a siren, only when they are actively operating with a patient. When this happens, air ambulance aircraft take the call sign MEDEVAC (formerly LIFEGUARD) and receive priority handling in the air and on the ground.
History Military
Most historians believe the first true medical transport mission took place during World War I when a Serbian officer was flown in a French Air Service plane from the battlefield to the hospital. French records during World War I reported that the air ambulance cut the mortality rate of injured soldiers from 60% to 10%. The first official recorded air ambulance mission was in 1917 in Turkey when a British ambulance transported a soldier who had been shot to a hospital in 45 minutes.:File:A History of military Aeromedical Evacuation.pdf
As with many Emergency Medical Service (EMS) innovations, treating patients in flight originated in the military. The concept of using aircraft as ambulances is almost as old as powered flight itself. Although balloons were not used to evacuate wounded soldiers at the Siege of Paris in 1870,Lam DM. "To Pop A Balloon: Air Evacuation During The Siege of Paris, 1870." Aviation, Space, & Environmental Medicine, 59(10): 988-991, October 1988. air evacuation was experimented with during the First World War.
The first recorded British ambulance flight took place in 1917 in Ottoman Empire when a soldier in the Camel Corps who had been shot in the ankle was flown to hospital in a de Havilland DH9 in 45 minutes.First Recorded Aeromedical Evacuation in the British Army The same journey by land would have taken some 3 days to complete. In the 1920s several services, both official and unofficial, started up in various parts of the world. Aircraft were still primitive at the time, with limited capabilities, and the effort received mixed reviews.
Exploration of the idea continued, and France and the United Kingdom used fully organized air ambulance services during the African and Middle Eastern Colonial Wars of the 1920s. In 1920, the British, while suppressing the "Mad Mullah" in Somaliland, used an Airco DH.9A fitted out as an air ambulance. It carried a single stretcher under a fairing behind the pilot. Flight, 13 April 1956, p. 424. The French evacuated over 7,000 casualties during that period."Lam, DM. Wings of Life and Hope: A History of Aeromedical Evacuation." Problems in Critical Care, 4(4): 477-494, December 1990. By 1936, an organized military air ambulance service evacuated wounded from the Spanish Civil War for medical treatment in Nazi Germany. This service continued during the Second World War.
The first use of medevac with helicopters was the evacuation of three British pilot combat casualties by a US Army Sikorsky R-4 in Burma during WW2, and the first dedicated use of helicopters by U.S. forces occurred during the Korean War, between 1950 and 1953. The French used light helicopters in the First Indochina War. While popularly depicted as simply removing casualties from the battlefield (which they did), helicopters in the Korean War also moved critical patients to hospital ships after initial emergency treatment in field hospitals.
Knowledge and expertise of use of air ambulances evolved parallel to the aircraft themselves. By 1969, in Vietnam, the use of specially trained medical corpsmen and helicopter air ambulances led U.S. researchers to determine that servicemen wounded in battle had better rates of survival than motorists injured on California freeways. This inspired the first experiments with the use of civilian paramedics in the world."Accidental Death and Disability: The Neglected Disease of Modern Society." National Academy of Sciences (White Paper), 1966. The US military recently employed UH-60 Black Hawk helicopters to provide air ambulance service during the Iraq War to military personnel and civilians.Bearl, Spc. Daniel. "MEDEVAC Unit Stays on Alert to Save Injured Comrades." US Military News via army.mil/-news, February 9, 2007. Retrieved: December 4, 2010. The use of military aircraft as battlefield ambulances continues to grow and develop today in a variety of countries, as does the use of fixed-wing aircraft for long-distance travel, including repatriation of the wounded. Currently, a NATO working group is investigating unpiloted aerial vehicles (UAVs) for casualty evacuation.
Civilian