The assistance of medical transportation by air ambulance has been known to incorporate giving a more advanced level of and quality of treatment at the point where the injury occurred and giving patients a faster way to the hospital. MEDEVAC also maintains critical diagnostic care proficiency while transporting from local area hospitals to more sophisticated trauma centers.
What are they?
Any specifically fitted out aircraft that is used in the transportation of injured or really sick individuals in a clear medical emergency. They also convey patients over any area or grounds that would be considered impractical or dangerous for a regular ambulatory service. In some instances; such as wildfires or in the aftermath of hurricanes or earthquakes, they make use of these aircraft to look for people. Much like a the original ambulance, it is equipped with the medical support equipment that is so critical to take care of and observe the conditions of severely injured or ill patients. The normal equipment for these crafts may include some medications, ventilators for breathing support, ECGs and the monitoring units to go with them, CPR equipment, and of course stretchers.
Practical use of these aircraft services for injured persons rely on the first responding teams ability to decide whether or not the individuals condition or injury warrants transportation by air. There are certain rules and training that must be applied to be sure that the relevant triage protocols are used as a yardstick to decide. If the criteria is to binding in its rules, it may impede urgent treatment and transportation of the trauma victims; on the other hand if it is too lax, it could potentially end up in the expensive situation of life lighting a person who, while they might be injured superficially, is not actually critical and then have them be released upon arrival.
Of course, the crew and the patients safety and health are the biggest concerning aspect to be examined when figuring out whether a patient needs to be transported in this way. Weather and the distance to the facility are other things that need be considered. One other major reason for rescinding the order for any of these journeys is dependent upon the flight crew and their comfort with it. It makes sense that the prevailing order for the flights safe journey is given to the people trained to make that decision, the crew. When flying in these types of conditions, you must carefully consider all factors and that includes how safe the personnel feel, if for any reason one of the crew felt it unwise to fly, the flight would be cancelled.
Just like with so many other Emergency Medical Services, treating the injured while in flight has it’s origins in the armed forces.. The idea of using an aircraft of any kind as an ambulance was one of the first things thought of when we started using planes in times of war. Balloons hadn’t ever used to get wounded soldiers to medical personnel as they were considered to be too unstable and easily brought down air transportation was experimentally tried out with some small measure of success during wartime in those early years of aviation. However, the original air evacuation flight was by The French Air Service when an injured member of the military was flown from straight from the front lines to a hospital to be treated. Records of the time showed that; with the innovation of using planes to transport wounded, the percentage of fatalities of the soldiers was greatly reduced by evacuating by air and that troops rallied knowing that they stood a chance to survive where previously none had existed.
In the first several decades of the 1900’s several of these air services, both with official sanction and without, were put into effect in different areas of the globe. With aircraft being undeveloped in that period, and with subsequently limited effectiveness,the efforts got very mixed reviews, though saving days of travel for some and lives that would have been lost if traveling overland to a qualified physician.
Despite the variance in public opinion, research into this unprecedented idea continued. The country of France had put into place fully organized and capable (for the time period) air medical services. In 1920 an airplane that was outfitted to work as a primitive flying ambulance was used for triage and transportation. It was very simply rigged with a cot that had been set under an awning located at the rear of the pilot. By the late 1930’s, a more thoroughly organized military service could be seen as it worked to evacuate the most severely injured of the soldiers from the front lines for urgent medical treatments in an actual German hospital instead of the ragged conditions on the front..
The first usage of an evacuation that was purely medical using a helicopter was to be seen in the second World War when it was realized that they could be of as great or greater use as a medical transport as they could be when used as weaponry. As time went by, it became quite commonplace to use them. While the general population assumed that they were simply taking injured from the battlefields, they also took the severely injured to ships after they had received triage in the medical tents in the field.
Medical expertise and it’s usage in this particular field advanced alongside to that of the planes and helicopter technology itself. In fact by 1969, overseas, the usages for exceptionally trained medical enlisted and helicopter AirEvac technology and services compelled studies which would determine that the men who served their country and that had been injured while in the field often had a better chance of remaining alive than those injured in a motor vehicle accident. This level of success is what provoked the first forays into the many potential uses of private paramedics around the globe. The practice of utilizing military planes as MEDEVAC and CASEVAC to this day continues to expand today in an array of countries.
The first time that civilians had thought to use an aircraft as an ambulance service were probably contingent on accessibility. After seeing the successes of evacuating from obviously dangerous situations by the armed forces, places like Australia, Canada and in some Scandinavian countries, figured that this would be a lifesaving measure to implement. These secluded, sporadically colonized settlements are sometimes inaccessible by conventional means, even at times all year long. Even in the fascinating history of flight at its earliest, many people in these localities began to depend on pilots, who could pilot the smaller aircraft and deliver their mail and supplies along with doctors as needed. Bush pilots may have evolved out of convenience, and most likely were the first medically used pilots, but obviously there was a clear demand for this type of service was necessary. In the 1920s, Thailand was among the first to have an established system, as well as Sweden. Around 1925 the first directed service of this kind was authorized for use in Australia. This institution is still in full operation today.
MEDEVAC, having been quickly recognized as a useful and often life saving tool when it was applied in secluded locations,was still slow to be fully utilized in the more developed areas of the world. People in well-populated areas just didn’t see the need for a faster way to transport patients. A Mr. Schaefer was the founder of the first civilian services in the USA. It was established in the late 1940’s, in California and was the first to be certified by the FAA. When Schaefer services first started, paramedical services were still very many decades from what it is today, and if you didn’t already have a doctor or nurse on board they were mostly just used to transport. In the beginning, their usage was highly prone to improvisation and adaptation of aircraft used by the military for medical transport. In time, these efforts became more coordinated and standardized and the aircraft would be made with this specific purpose in mind. These days in America alone, helicopters and aircraft all around the country transport roughly a half a million patients per year
Two intensive research studies were established in the United States in order to see what they could foreseeably do to lower mortality rates in the private arena. The original Project was called CARESOM, and was set up and put into effect in the south in the 60’s. Several medical helicopters were outfitted and then placed into effect in the various quadrants around the state. The program considerably lowered the casualty rates and was thought to be a great success. The three areas were given an option to keep the helicopter and to keep using it as a MEDEVAC, however on one did. It was established and is considered to be the first successful program of its kind in America for the private sector. The second of such programs,which is called MAST, in Texas was put in place around the same time. These businesses were outstanding at showing exactly how needed these services were. The only thing that was yet to be seen was how these services could operate in a cost effective manner. Many agencies of civilian government, as they began to use the airplanes for other functions, pressed said aircraft into medical service making the venture cost effective as well as life saving.
The first hospital in the United States to institute a medical air evacuation program was St. Anthony’s in Colorado, 1972. They had only one helicopter in service. In Canada, they implemented a program 1977, and their program featured paramedics, and rarely doctors. Again, this originated with a solitary aircraft. The difference with this program was that it was more focused on transferring critical patients between facilities. Today they use an independent contractor and the operation has a total of 33 aircraft provisioned at 26 different locations spread across the country. Today MEDEVAC services are commonplace and can be seen across the globe.
In some places the government has provided for these medically necessary flight programs, either with their own aircraft stipulated for that purpose or through an arrangement with a third party. These services may have their focus on transporting patients who have been deemed critical to trauma centers, or just to give support to the EMS on the ground or any combination therein. Regardless of their designated roles, the government endows them with a clear protocol to follow to limit cost and any potential liabilities. But they generally take a back seat to the actual program running itself, leaving that to those qualified on the subject manner (doctors, pilots, EMS personnel) Canada’s and Poland have some fine representations of this category of system at work.
For some provinces and especially in remote places without a dense population, the actual cost of an operation like this is a big factor. The use of an aircraft solely for MEDEVAC is just not feasible in some areas and so they serve dual purposes to ensure cost effectiveness. These aircraft are generally used by the government or one of their agencies and can be made available for emergency situations For instance, in Australia, one of the helicopters that is used for medical needs is also then put to general use by a local utility company, with an ambulance service supplying personnel. In California, helicopters are used to fight brush fires, but are outfitted to work as a medical air transport with paramedics from the fire department on call. In some places the aircraft may have a full time staff but be used for another function such as an observer officer for the police when not in use medically.
Charity run (Public and Private)
Funding has always been and will always be, an issue with these services. Sometimes a local company or even large national companies have chosen to fund these services as an act of philanthropy or public relation endeavor. This is particularly seen in Europe, in England a large scaled business furnishes funds the MEDEVAC services and over in Germany the air ambulance is provided for by the ADAC, an automobile club. In most of these instances, while the company providing the funds gets a large amount of recognition through advertisements they leave the day to day operations in more capable and qualified hands.
Sometimes though, these duties may be found to be funded by voluntary fundraising which may be their only source of funding or may be supplemented at a government level. Even Scotland’s governing bodies have decided to fund the service directly, but it is being done through the regional charities this allowing for each sector to be covered by the service.
It is in the most recent years that these services have advanced into operation on a larger scale the services provided and have graduated to a doctor/paramedic level of care. There are protocols to be followed now by all members, from charities involved to the medical personnel must be willing to stand by.
The last area division of note, is the use of large aircraft for medical need, similar to a hospital emergency room. In previous times, civilians had no need of such a large scale operational craft, leaving such services to the armed forces whom had always used them for combat situations. Although the ADAC uses small and large planes to supply a level of care comparable to that which has been seen in critical care centers for people who have their insurance or protection plans.
It seems prudent to have stringent guidelines in place for both the pilots and the medical personnel for flying ambulatory services, since their flights are not often in ideal conditions and time is usually a factor as well. After a sequence of planes crashing in the 1990’s the CAMTS organization really amped up protocols, so that that every one of the pilots, medical personnel, and the aircraft used must be able to meet a much higher criterion than had been previously needed to operate.The CAMTS certification, which is only used in America, incorporates the rules requiring any company performing medical flights to own as well as operating its aircraft. Although technically the CAMTS certification is completely voluntary, most local governments require that if you are providing the service you have the certification in order to be open for operation.
In being made to have the accreditation prior to operation, the provider is showing that they meet or exceed national safety standards. Compliance is checked for continuing quality on a regular basis. The standards used to deem medical transport aircraft safe are upgraded to mirror the changing needs of an area and grow more technologically advanced as time passes. Even if you do not wish to be CAMTS certified, in states such as Texas you must take comparable testing, given by CAMTS trained professionals. Even though in its original context, this accreditation was merely to be used in the United States, some Canadian and South African companies have voluntarily become participants and become certified.
The most important aspect after a qualified pilot, is of course competent medical personnel. Generally in the past the combination used on these flights was doctor/nurse. But with the evolution of these services that need has been diminished with the ever increasing protocols and expanded training. Without the pressing need for a licensed doctor, most air ambulances have instead added a respiratory therapist to their repertoire. Still, depending on the rescue mission and varying situations they may be found in, a variety of different types of medical professionals may be found on these flights.
The criteria to work as a physician on a medical flight is different depending on where you are located. However, in America these doctors are generally well versed in critical and intensive care. They may also have training or specialize in general care with an emphasis on obstetrics and critical situations.
An in-flight paramedic is a generally a certified paramedic that has the extra courses to qualify as a flight paramedic (FP-C). They are usually very highly trained and generally have years of experience in a ground EMS program and lots of clinical experience with critical transports. Most of the people in this profession are either licensed as a CCEMT-P or a FP-C.
Flight nurses operate at the same general level as a flight paramedic, but without the specialized training needed to do chest tubes, surgical airways and such. They are there in a supportive role, to get medications and equipment and to establish a continuity of care while in route. Most states have a requirement in place that a flight paramedic be on board with a nurse for this reason. They can have their accreditation in either Flight Nursing (CFRN), or Critical Care (CCRN).
An expertly trained respiratory therapist can be an integral part of any MEDEVAC team. They are generally used when there is a long distance to be traversed, though they are extremely useful in short term situations as well. Transport Therapists are able to train and certify for many different accreditations including but not limited to, Neonatal Transport Specialist (NPT) and Neonatal Pediatric Specialist (NPS).
Air ambulances and MEDEVAC transportation services have been in use for well over a hundred years, they are adept at providing a vital service in both the civilian and military sectors. It is an interesting field of work and has many varied applications, from wartime to critical care transport to inter-facility transportation. The many positions available on these flights, be they helicopter or planes, offer a wide spectrum of job opportunities, and a valued service that saves lives across the world.