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Air Medical Safety and the Fire Service

Our recent news announcing proposed FAA rule revisions on Helicopter Emergency Medical Services (HEMS) and a public hearing by the NTSB in February 2009 cry out for fire service involvement (see: 2008 promises to end as the most catastrophic year in the history of HEMS. Sound familiar? Any firefighter would feel the deja vu. With a history of grabbing the safety bull by the horns, confronting tough issues, naming problems, and taking opportunities for improvement, I'd say the fire service has a whole lot to contribute to any industry in the throws of safety troubles. But wait, there's more. The FAA suggested last year that ground providers contribute to unsafe HEMS operations. We do this by "helicopter shopping" or calling around until we find a HEMS willing to respond in whatever adverse conditions exist at or around our scene. Is the fire service part of the HEMS problem? Maybe. Can we be part of the solution? Absolutely.

Mike McEvoy
EMS Technical Editor
Fire Engineering

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Comment by Chris Fleming on December 12, 2008 at 12:24pm
One last comment. I don't think that HEMS systems respond with malice, but it seems to me that the chase for dollars that was a result of privatized EMS systems has injected itself into this industry. Again, not that it is the fault of EMS workers, but this is another symptom of a medical system that has profit motives on an equal or greater footing than adequate care for all individuals.
Comment by Chris Fleming on December 12, 2008 at 12:19pm
I agree with Pat. These are very tough issues. A co-worker of mine was killed in an aircraft incident as a flight nurse. They were flying in adverse weather conditions with inadequate fuel. I too have seen HEMS units used for transfers that could have been done via the ground. I think the current HEMS system in my region does a decent job of training responders on the ground when and when not to call for a scene response, but I'm sure unneccessary responses occur. This industry needs to be regulated because it is clear they are unable to regulate themselves.
Comment by Patrick Brown on December 11, 2008 at 10:27pm
There are some tough issues. I am a nurse as well as a firefighter and paramedic. I was a flight nurse and medic with a HEMS that was very, very safe. I can hosnestly say I never felt uncomfortable in the air with the pilots and crew we had. It seems very obvious that some HEMS take more risks then others. Hospitals and pre-hospital providers are part of the problem. We call around looking for someone to take the trip after others have declined for weather reasons. This can not be tolerated. There needs to be strict guidelines enacted to keep this from happening. I recall an episode when we refused a trip due to weather...very low ceilings. A little while later we received a radio transmission asking if our pad was clear because another carrier was in bound with a patient. The helicopter came in but was not visible until it was a couple of hundered feet off the ground. We later learned this was the patient we refused to transport. Incredibly unsafe. The HEMS need to be fined and if need be their licenses revoked. Another issue is validity of transport. If have been involved in situations when a helicopter was called for a patient that was not critical enoughto require flight. I have also been involved in cases where the patient was completely non-salvagable (99% 3 degree burns) or dead and was flown any way. Again a waste of resources and too risky. HEMS needs to adopt the fire services risk benefit assessment...risk alittle to save alittle, risk alot to save a lot, risk nothing to save nothing. In other words, only fly when there is a reasonable chance that the patient will survive....and yes we have tools that can help with that determination (ie. trauma scores)

A dead rescuer is of no value to anyone. We have to be smart.
Pat Brown

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