Appropriate Air Medical Services Utilization and Recommendations for Integration of Air Medical Services Resources into the EMS System of Care: A Joint Position Statement and Resource Document of NAEMSP, ACEP, and AMPA

Abstract

Air medical services involves providing medical care in transit while using either fixed wing (airplane) or rotor wing (helicopter) aircraft to move patients between locations. The modern use and availability of air medical services has expanded access to various health system resources, including specialty care. While this is generally beneficial, such A c c e p t e d M a n u s c r i p t expansion has also contributed to the complexity of health care delivery systems.(1, 2) Since the publication of the 2013 joint position statement Appropriate and Safe Utilization of Helicopter Emergency Medical Services,( 3) research has shown that patient benefit is gained from the clinical care capabilities of air medical services independent of potential time saved when transporting patients.(4-6) Because the evidence basis for utilization of air medical services continues to evolve, NAEMSP, ACEP, and AMPA believe that an update regarding the appropriate utilization of air medical services is warranted, and that such guidance for utilization can be divided into three major categories: clinical considerations, safety considerations, and system integration and quality assurance considerations.

Patient Outcomes Based on the 2011 CDC Guidelines for Field Triage of Injured Patients

“…Although relationships between EMS findings that are similar to individual criteria of the 201 CDC Guidelines (i.e., prehospital index, high velocity impact, and EMT judgment) and trauma center need have been reported (Lavoie et al, 2010; Mulholland et al, 2008), we believe this finding relating two or more positive steps from the 2011 CDC Guidelines for Field Triage of Injured Patients and hospital outcomes has not been reported previously and has the potential to guide revisions of trauma triage protocols, especially related to destination and transport decisions for patients in remote regions. As has been suggested by others (Lyng et al, 2021), the high mortality rate of patients with two or more positive steps may suggest a need—for patients in remote locations—for early stabilization by air medical or nondesignated hospital teams prior to long-distance transport to a designated trauma center. More study is necessary.…”

Implementation and Management of a Flight Program

“…3 According to the 2021 update to the 2013 joint position statement of the National Association of EMS Physicians, American College of Surgeons, and Air Medical Physician Association, research has shown that patient benefit is gained from the clinical care capabilities of air medical transport independent of potential time saved when transporting patients. 4 These associations use current available evidence to provide guidance for air medical transport utilization. Three major categories that an air medical transport program must consider are clinical care, safety, and quality assurance (QA).…”

“…Paramedics will also need all the certifications: ACLS, BLS, PALS, PHTLS, or ITLS. 4 Staff also require a higher level of training to include physiological aspects of flight and how the patient will be affected. Aviation staff will follow Federal Aviation Administration regulations and their program's regulations.…”

“…Medical directors approve protocols, safety procedures, and biomedical equipment, and participate in all initial and continuing education of the medical personnel. 4 The size of the…”

“…Clinical competency evaluations occur annually and as needed by the medical directors and nurse managers. Annual training is required to maintain compliance and familiarity with Federal Aviation Administration regulations and aircraft operations, survival training, night vision goggle training, external power unit door and cart, emergency locator transmitter, emergency fuel shut off and maintaining obstacle clearance during takeoff and landing, and instrument flight rules training 4. Staff also require a higher level of training to include physiological aspects of flight and how the patient will be affected.…”