Over the last three decades, the air medical helicopter transport industry has grown to include hundreds of air medical transport helicopters nationwide. Thirty years ago, if the local, and solitary, air ambulance provider turned down or aborted a flight request due to weather, that was the end of it. Today, if a program turns down or aborts a flight for any reason, it is easy for EMS or hospital personnel to request an alternative aircraft from a variety of surrounding locations. The nationwide availability of multiple aircraft has created a situation in which EMS agencies may continue to call air medical resources until one responds. This situation has become so common it is known as "helicopter shopping."
The majority of fatal air medical helicopter accidents since 1998 have occurred at night, in bad weather, or both. While helicopter shopping is not the cause of these accidents, the International Association of Flight Paramedics (IAFP) believes it is a contributing factor. To clarify, we do not believe the request of additional air medical resources is an inherently hazardous event. "Helicopter shopping" creates an additional risk for crews and patients because of the way it is carried out. Poor communication and lack of information sharing between requesting agencies and air medical helicopter transport organizations is at the center of this issue. The IAFP believes that if one helicopter is unable to respond or has to abort a request for a patient transport, under certain conditions, another helicopter may be able to complete the mission safely.
The IAFP recommends the following practices to eliminate "helicopter shopping":
Establish an organized dispatch system in order to coordinate all helicopter requests in a particular region.
This dispatch system should be recognized by the EMS agency responsible for the same region. This system can be set up by individual county, regional area, state or any other boundary that defines the area of a geographic or service region. The boundaries are not important. What is important is that all agencies involved in the transport of air medical patients understand how the system works and agree to the process. A single air ambulance dispatch system or network from each region will improve communication and eliminate the need for repeated requests for air ambulances, especially in areas serviced by more than one provider. All requests for air ambulances from law enforcement, fire, ambulance and all other legitimate requesters in the area would be directed through the designated dispatch network. Any emergency agency may be designated to perform this coordinating duty. The type of agency that coordinates this air ambulance dispatch may vary from region to region. The dispatch network makes it easier for requesting agencies to call for air medical transport. This same network makes it easier for multiple air medical service providers to exchange information. If multiple air medical transport service providers operate in one region, especially if service areas overlap, they should openly communicate and share flight information.
Educate ground EMS agencies about the helicopter dispatching network.
The responsibility for educating ground EMS providers and associated agencies will fall to air medical transport service personnel. It is crucial that EMS and first responder personnel understand the necessity of allowing the regional helicopter dispatch network to locate and request the most appropriate mission-specific air ambulance provider and to understand why helicopters may not be able to complete the mission. The educational information should include weather minimums, weather behavior, appropriate patients and helicopter performance issues.
Communication between air medical transport service providers and ground emergency service programs is paramount to improving the safety of the air medical community. Helicopter shopping, like any other potential safety risk, is not the sole reason for the unsatisfactory air medical safety record over the last few years. However, the increasing number of air medical helicopters available and the willingness of requesting parties to "shop" have created a situation that must be mitigated in order to enhance the safety of the community. Establishing safe helicopter dispatch networks to be used for dispatching scene and interfacility requests for transport will help make helicopter shopping unnecessary and unacceptable. These dispatch networks will be supported by educating the requesting parties and their personnel regarding capabilities and limitations of air medical transport aircraft and crew. Open communication about weather and flight factors is the key to safer, more efficient operations.
Adapted from Cliff Larrabee's Position Paper on Helicopter Shopping,
www.flightparamedic.org/docs/HelicopterShopping.pdf. |
