Chapter 48. Aeromedical evacuation
Medical aviation is now extremely sophisticated and can be conveniently divided into primary casualty evacuation and secondary patient transfer. The expertise and equipment required for each are different.
Primary casualty evacuation is the transport of a patient from the site of injury to a receiving hospital
This requires a medical crew which is expert in resuscitation, familiar with prehospital hazards and practised in cooperation with other emergency services. Equipment must be robust and specific for urgent interventions which may be required. The level of medical expertise determines the range and type of possible medical intervention. This, in turn, determines the nature of the medical equipment carried and varies greatly between systems. The flexibility of a helicopter system makes it ideal for the primary role, allowing the medical team to take the best possible medical care to the patient’s side. The helicopter can be reconfigured to take account of the specific requirements of its role.
Secondary patient transfer is the movement of a patient between hospitals
This requires a medical crew expert in the use of intensive care equipment, monitoring and drugs. Often, transfers occur over long distances and it is usually quicker and more cost-effective to use fixed wing aircraft rather than helicopters for this purpose. This is a specialised subject suited to the intensive care physician and is not normally the province of the paramedic.
Primary casualty evacuation
Helicopter systems vary widely. Their emphasis may be on patient transport or on medical care or a combination of the two.
Transport
The emphasis is on moving the patient from one location to another. Usually the casualty requires transfer from an incident scene that is remote by virtue of distance or terrain. There may be little medical expertise available (or required by the patient) and the system is cost-effective because it obviates the use of long and difficult land transport.
Treatment
A helicopter can bring together a rare clinical event and the required care provider, e.g. a severe head injury and a neurosurgical unit combining high-quality prehospital care with advanced medical skills, delivered by experienced doctors and paramedics.
Triage
Medical services have seldom been planned logically according to the needs of the resident population. Specialist units may have arisen as a result of historical accident or the enthusiasm of individuals. Aeromedical evacuation may offer the opportunity of ensuring the transfer of a patient to the most appropriate clinical receiving facility.
The medical crew
The crew required depends on the aims and use of the system.
• A team that includes an experienced doctor and paramedic will generally provide all the skills required
• The paramedics contribute their experience in the prehospital environment, familiarity with other emergency services and their procedures and experience in providing medical treatment outside hospital
• The inclusion of an appropriately trained doctor contributes advanced assessment skills and allows critical interventions that may be instantly required to treat the patient, including advanced anaesthetic and surgical skills.
The Helicopter Emergency Medical System (HEMS) is a set of criteria laid down by the Civil Aviation Authority on the operational safety of primary retrieval helicopters. It includes the requirements on training for HEMS crew-members.
Training required of HEMS crew members
Duties in the HEMS role
• Navigation (map reading, flight planning, navigational aid principles and use)
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