Helicopter Rescue of Air Crash Victims

Aeromedical Transport

Photograph

By: Anonymous

Date: January 13, 1982

Source: "Helicopter Rescue of Air Crash Victims." Bettmann Collection. Corbis Corporation.

INTRODUCTION

Aeromedical transport usually occurs for one of several reasons. Medical transport may be required from the scene of an accident that occurred in a location that is difficult or impossible to access via ground transportation (traditional ambulance) in a safe or timely manner. A medical facility that lacks specialized equipment or technology required for a specific patient emergency often uses an air ambulance to transport the patient to a hospital that is able to provide the needed services. When time is of the essence, as in severe trauma, an air ambulance is often used. Finally, medical air transport is often the most efficient way to repatriate a patient, meaning moving the ill or injured person from an initial facility to one that is closer to home for reasons of cost or convenience.

There are currently two types of air ambulance: fixed-wing aircraft and rotary-wing aircraft. Fixed-wing aircraft are traditional airplanes, and can range from military transport planes to small jets to propeller-driven aircraft. Emergency medical transport helicopters (rotary-wing aircraft) can vary in size as well, but typically only transport one, or at most two, patients per trip.

The first significant use of fixed-wing air medical transport is generally considered to have occurred during World War II (1938–1941), when troop transport planes were used to evacuate injured Allied soldiers from near the battlefield to military and field hospitals. During the conflict in Korea in the early 1950s, the United States pioneered the use of helicopters for evacuating wounded troops in the battlefield. By the Vietnam War in the mid-1960s, helicopters were widely used to transport injured troops from the field directly to military trauma centers.

Currently, there are hundreds of aeromedical transport (AMT) companies operating worldwide. In the United States, they are typically affiliated either with federal or state government agencies (including the military), hospitals and medical centers, or are owned by private companies. Many medical transport operators have a fleet that includes ground transport ambulances, fixed wing and rotary wing aircraft. Some also offer medical assistance for patients who are able to use commercial flights services, but need minor medical assistance en route (such as those recovering from major surgery and being transported to rehabilitation or step-down medical facilities). In many cases, AMT providers are able to offer worldwide "bed to bed" transport, with ambulance transport from the sending facility to the fixed wing aircraft (equipped with specialized equipment, technology, and staff normally found in the intensive care unit of a medical facility), met by a waiting ambulance at the receiving airport for transport to the receiving medical facility.

At the initial scene of an aviation accident in January 1982, an early Park Service helicopter ambulance was the sole official responder to the disaster, after Air Florida Flight 90 crashed into the 14th Street bridge and then plunged into the Potomac River in Washington, D.C. Crowded, icy highways made it impossible for ground ambulances to respond in time to reach the few survivors who clung to the aircraft tail section floating in the river. The nearest Coast Guard vessel was occupied with another search-and-rescue mission at a distance downriver. The Park Service helicopter with one paramedic on board managed to arrive at the scene and serve as both rescue vehicle and ambulance for all but one of the survivors of the crash. Modern aeromedical transport organizations are continuously available, operating twenty-four hours daily, seven days per week.

PRIMARY SOURCE

HELICOPTER RESCUE OF AIR CRASH VICTIMS

See primary source image.

SIGNIFICANCE

Although both fixed- and rotary-wing transport are quite commonly used modes of patient transport, fixed-wing (plane) transport has been determined to be the safer and more cost-effective of the two in nonemergency situations. Helicopter transports are used most for short distance transports, for those where time is a critical factor for patient survival, or to evacuate patients from trauma scenes in which either the terrain or circumstance prohibits approach by ground vehicles, as in the case of a mountaineering accident occurring on a steep, roadless slope, or a battlefield evacuation of wounded troops. In those circumstances, the abilities of a helicopter to touch down without a fixed landing strip or to achieve a vertical take-off would be essential. In transporting individuals with spinal cord injury, helicopters are often used both for speed of transport and to ensure the smoothest possible ride, thereby minimizing the possibility of incurring additional central nervous system (CNS) trauma. In medical parlance, there is a time known as the golden hour, which is the first sixty minutes after an individual sustains a major trauma, a stroke, or a cardiac event. If access is gained to a major medical center within this timeframe, the likelihood of a successful outcome is substantially increased.

Nearly all fixed-wing air medical transport services are equipped with advanced life support (ALS) technologies, due to their use for longer distance, higher altitude transports. Many companies providing fixed-wing air medical transports are able to cover much in a single transport: for example, an American citizen goes to Geneva on business, gets involved in a motor vehicle accident, and sustains multiple and severe injuries. She is initially hospitalized in Geneva, given emergency treatment and undergoes orthopedic surgeries. She is stabilized, but needs several weeks of traction and relative immobilization, and then will need many months of recuperation, followed by a lengthy physical rehabilitation process. Her health insurer pays for the emergency and stabilizing treatments, and then requests that she be transferred to a medical facility in her home area for long-term treatment. An air medical transport could be arranged to provide bedside-to-bedside services; it would have all necessary equipment and personnel on board to be able to treat her en route, as well as to deal with any potential medical emergencies during the flight.

Emergency interim medical care is often available on rotary-wing transports. Some are utilized primarily for rapid trauma transport, and carry a physician, nurse, or emergency medical technician on board, as well as life-sustaining equipment and medications for emergency use. Others are operated as inter-hospital facilities, and provide continuous care from pick-up at one facility to arrival at the (destination) facility.

The evolution of the air medical transport model has greatly expanded the reach and the capacity of emergency and critical care medicine. It is now possible to pick up individuals who are injured or ill at isolated settings, and to rapidly transport them to an urgent care setting, providing emergency care en route. In this way, the likelihood of assuring medical intervention during the golden hour after a stroke, spinal cord injury, accident, or cardiac event is greatly enhanced.

FURTHER RESOURCES

Periodicals

Varon, Joseph, Robert E. Fromm, and Paul Malik. "Hearts in the Air: The Role of Aeromedical Transport." Chest. 124(5) (2003): 1636–1637.

Web sites

CAMTS: Commission on Accreditation of Medical Transport Systems. "Accreditation FAQs." http://www.camts.org/index.php?option=content&task=view&id=4&Itemid=27〉 (accessed December 29, 2005).

The Internet Journal of Emergency and Intensive Care Medicine. "Aeromedical Transport: Facts and Fiction." 〈http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijeicm/vol1n1/aeromed.xml〉 (accessed December 29, 2005).