Helicopters R Us Helicopters OR Us Helicopters AND Us

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Helicopters R Us (Helicopters OR
Us) (Helicopters AND Us)

• Peter Goth MD, FACEP
• Critical Care Training Institute
• LifeFlight of Maine

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Think about

• 1. Helicopters are essential to medical
  transport systems
• Some helicopter use is
• unnecessary
• inappropriate
• dangerous
• How important is the helicopter?
• How important is the medical crew inside the
  helicopter?

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1. Helicopters are essential to medical transport

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• SPEED SAVES

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Speed Saves
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Fourth Annual AMTC Great Debate
 The use of auto-launch and early activation by
HEMS programs lowers the medical necessity
threshold for air medical transport and results
in corresponding over-utilization.
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????
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2. Helicopter use is sometimes unnecessary,
inappropriate, or dangerous
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UNNECESSARY ?
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Interfacility transfer (IFT)
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UNNECESSARY ?

• Hospital discharge less than 24 hours after
  helicopter transport
• a. 6
• b. 6-15
• c. 70

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INAPPROPRIATE ?
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Perverse Incentives

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The Rules

• Nature does not tolerate a vacuum
• Nature does not tolerate an empty helicopter
• Roehmers Bed Law
• If you build a hospital bed, you will fill it
• Corrolary
• If you autolaunch a helicopter, you will fill
  it

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DANGEROUS?
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Perverse Incentives
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Unavailable 25
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Medical Centerfold or Medical Necessity?
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3. How important is the CCT medical crew?
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• SPEED SAVES

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• SCOPE
  SKILL
• SPEED

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SPEED SCOPE SKILL SAVE
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• SPEED SCOPE SKILL SAVE

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SPEED
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Interfacility Transfer (IFT) _at_ 36 hours
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SPEED

• Time to Talent
• use as directed

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Time to Talent
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• SPEED SCOPE SKILL SAVE

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Critical Care Transport (CCT)

• Mobile teams
• - RN/EMT-P
• - RN/RN
• Advanced certification/training
• - e.g. CCEMTP
• - continuing education
• Supervision
• EMS
• IF and Scene- medical necessity need established
  prospective selection through protocol or OLMD
  retrospective utilization review

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Critical Care Transport (CCT)

• Advanced scope/skill
• - RSI
• - blood
• - chest
• - lines and pumps
• - ventilators
• - critical care meds
• - ultrasound?
• - telemedicine?

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Critical Care Transport (CCT)
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Rapid Sequence Intubation (RSI)
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Rapid Sequence Intubation (RSI)
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NHTSA Guide for Interfacility Patient
Transfer2003

• Stable with low risk
• Stable with medium risk
• Stable with high risk
• Unstable
• Specialty Care Transport (SCT)

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• SPEED SCOPE SKILL SAVE

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PERFORMANCE-BASED TRAINING
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PERFORMANCE-BASED TRAINING
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PERFORMANCE-BASED TRAINING
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Critical Care Transport (CCT)

• Tertiary level hospital skills
  by non-physicians
• PRACTICAL?
• POSSIBLE?

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Critical Care Transport (CCT)

• 1. Advanced certification training
• e.g. CCEMTP program UMBC (84 hours)
• 2. QAPI
• robust and no-nonsense
• 3. Continuing education
• performance-based
• responds to QAPI findings
• 4. Medical oversight

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Critical Care Transport (CCT) Time to Talent
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Critical Care Transport (CCT)

• Ground Air Air- fixed wing
• Air - rotor

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Critical Care Transport (CCT)

• Time to Talent

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SUMMARY
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? !