Purpose To establish the Collier County EMS/Fire Department guidelines for MedFlight Operations and the associated coordination between allied ground resources. Procedure: 1. Deployment a. Automatic Page for Response: (Sunrise Sunset) Request by an on-scene Attending Medical Practitioner in which use of MedFlight will positively impact the patients outcome. Southern portion of Keewaydin Island Off-shore incidents as requested by marine units (may remain in-service for coinciding emergency incidents). Will not exceed either 10 nautical miles from the nearest shoreline or visual reference to the shoreline, whichever is less. Day only. Emergency inter-hospital transports to Lee County hospitals Trauma transport per Trauma Transport Protocol Possible trapped victims in need of water rescue Note: Based on credible information, Command Staff or a Flight Medic may choose to respond MedFlight to any incident. b. Automatic Page for Response: (Sunset - Sunrise) Request by an on-scene Attending Medical Practitioner in which use of MedFlight will positively impact the patients outcome. Trauma transports per Trauma Transport Protocol Emergency inter-hospital transports to Lee County hospitals Note: Based on credible information, Command Staff or a Flight Medic may choose to respond MedFlight to any incident. The MedFlight medical crew will monitor radio traffic for potentially serious incidents i.e. serious MVC, shooting, stabbing, etc. When a potentially serious incident is dispatched outside of MedFlight s automatic response guidelines, the Flight Medics will consult with the Duty Pilot as to the feasibility of the flight and immediately notify the responding units on EMS TAC 01. The goal is to immediately notify the responding unit(s) as well as command staff of the availability of MedFlight so appropriate resources can be allocated. Page 1 of 9
c. Alert Status (2200-0700) A page for Alert Status should originate from the responding crew or EMS Battalion Chief based on the best available information from dispatch or other credible sources. 2. MedFlight s Availability The Duty Pilot will immediately advise the Flight Medics and the Battalion Chief of a change in the availability of the helicopter due to issues such as unscheduled maintenance, scheduled maintenance, personnel challenges, etc. If known, the Duty Pilot will provide an estimated time of return to service. The Battalion Chief will forward all information to Control so the status can be broadcasted to all emergency services personnel. MedFlight s inability to respond due to inclement weather conditions will be immediately announced by the Flight Medic on the incident s assigned Control Channel. The Duty Pilot is responsible for the safety of the crew and patients. Decisions not to fly should be discussed amongst the crew honoring the three [3] to go and one [1] to say no principle. Decisions not to fly based on safety are final. 3. MedFlight Staffing There is a maximum weight limitation of 215 lbs per Flight Medic (flight suit, helmet, and boots). Normal staffing is two [2] Flight Medics and one [1] Pilot. During training additional crewmembers will be authorized. When MedFlight is considered out-of-service, the Battalion Chief will have discretion to place the Flight Medic staff onto a ground unit if this will benefit the department s operations. Appropriate priority will be given to return to normal MedFlight staffing levels when the helicopter returns to service. 4. Estimated Time En route (ETE) It is important to describe the procedure for providing an accurate estimated flight time to ground personnel. Once in-flight to the scene the Flight Medic shall obtain the Estimated Time En route (ETE) from the pilot. The Flight Medic will provide the ETE to the on-scene unit(s) via the assigned TAC or PS WIDE1 channels. Page 2 of 9
If the ETE varies significantly from the actual response time, it must be noted on an incident report by the MedFlight crew and noted during the post-flight debriefing. The MedFlight crew will forward these reports to the QM Committee which will investigate and track for trending purposes. Trends will be addressed and handled by the Chief Pilot. 5. Inbound Operations Transfer of Care An Attending Practitioner should focus on patient care and utilize the on-scene Incident Command (IC) in order to activate a MedFlight response. The following information should be provided, through the assigned Control Channel to the MedFlight crew prior to lift-off via the on scene Incident Commander (IC): Fixed location of the landing zone or GPS coordinates are required or in the case of a predesignated landing zone the identifier will be utilized. CCSO Dispatch shall provide MedFlight with the applicable GPS coordinates prior to aircraft dispatch, unless a predesignated landing zone is utilized (see attached list). o The preferred format for GPS coordinates of latitude and longitude is: Degree Decimal Minutes. Example: N26 44.22 W081 33.22 Patient condition reason for MedFlight transport i.e. trauma alert criteria Special needs i.e. patient must sit upright, restrained, multiple patients, etc. Patient(s) weight in pounds (lbs) or kilos (kg) specify Due to flight crew communications with the air traffic control tower, any routine radio communications between ground personnel and MedFlight should be held until the helicopter has cleared the airport controlled airspace (approximately 5 minutes after MedFlight reports responding to incident). MedFlight crew will NOT respond to radio calls until cleared of the appropriate airspace. Upon clearing the controlled airspace, the flight crew will utilize PS WIDE1 to provide Incident Command the estimated time of en route. An additional ETE will be given at the 5 minute away point. If the agency charged with securing the landing zone is unable to communicate on PS WIDE1, the flight crew will utilize the assigned Control Channel to patch/forward all dialogue referencing inbound operations. 6. Pre-designated Landing Zones MedFlight will utilize Pre-Designated Landing Zones during NIGHT OPERATIONS. A list of pre-designated Night Landing Zones has been distributed to all Collier County Fire Departments. In addition, maps with the LZ s have been disseminated throughout all first responders. Page 3 of 9
For the most current pre-designated landing zone list visit www.colliergov.net/medflight. Pre-designated landing zone suitability will be determined by the MedFlight Director of Operation/Chief Pilot. LZ information will be updated on a regular basis to ensure operational safety. If ground personnel observe hazards within a pre-designated landing zone that information shall be passed to MedFlight Director of Operations/Chief Pilot. 7. Improvised Landing Zones If possible, choose a landing zone such as a school or shopping center parking lot. At night, Pre- Designated Landing Zones will be utilized, see above. When selecting a daytime landing zone use the following as a guideline: Perimeter controlled 100 x 100 level surface, free of overhead obstructions, wires, trees, light poles, buildings, vehicles and loose ground debris. Landing site should be as level as possible, preferably concrete or asphalt. Sod grass or hardened earth is an acceptable alternative. Sandy areas should be avoided, if possible. The landing site should be located 100 200 feet downwind of any patient care area. Select an alternate landing zone in case the pilot feels the original is unsafe. When utilizing roads, ensure traffic is stopped in both directions Ground personnel MUST NOT approach the aircraft unless cleared to do so and in appropriate issued safety/fire helmet and eye protection gear. PS WIDE1 will be used for all MedFlight landing zone instructions and direct communications with the crew. EMS TAC 01 will be used for all patient information. 8. Landing Zone Ground Operations The elements involved in coordinating a landing zone with the Duty Pilot should only be conducted by personnel with appropriate communication equipment and formal Collier County MedFlight endorsed training. The items below are for reference, the MedFlight training slides can be found at www.colliergov.net/medflight: Maintain radio contact with the MedFlight Crew on PS-WIDE1 (located at dial position 12 on S1-EMS, N1-EMS, & A1-EMS) as he/she circles the area and lands the helicopter. The Pilot will circle before landing to determine the safety approach and departure paths and the general safety of the site. Page 4 of 9
Ensure all vehicles and people are away from the landing zone. If at any time the security of the landing zone is breeched during approach, notify the crew immediately with ABORT LANDING. No one shall approach the helicopter while it is running unless directed and briefed to do so by either the Pilot or Flight Medics. When approaching the helicopter, always approach from the front maintaining eye contact with the Pilot at all times. The tail rotor of the helicopter is extremely dangerous. Never approach the helicopter from rear. At night, if possible, make every effort to turn off any scene lights and/or spot lights that are pointing towards the intended landing zone. Intense lights can impair the use of Night Vision Goggles and can blind the pilot both can cause a dangerous situation. The Flight Crew may require assistance in moving/loading the patient into the aircraft. Only designated and briefed (by MedFlight crew) personnel shall approach the helicopter. Before loading the patient, the Flight Crew will explain the hazards of approaching the helicopter to the ground assistants prior to approaching the helicopter. Ground assistants should, at a minimum, wear a safety helmet with face shield down or wear a safety helmet with safety goggles. Once the patient(s) are loaded into the helicopter, ground personnel should move away from the aircraft and the landing zone. The Pilot will determine, with the assistance of the Landing Zone Commander) when the landing zone is clear and if it is safe for the helicopter to depart. Maintain radio contact with the Pilot on PS-WIDE1 (located at dial position 12 on S1- EMS, N1-EMS, & A1-EMS) as the helicopter lifts off and following departure for at least 2 minutes. Watch for anything that appears unusual with the helicopter, dripping fluids, anything hanging from the aircraft, or anything in the helicopter s path. Report anything unusual to the pilot immediately. It is of the utmost importance that the landing zone remains clear and the ground crew maintains radio contact with the pilot for two (2) minutes after departure in case the helicopter needs to land for any reason. MedFlight, predominantly utilizes a hot loading (aircraft running) technique for patient loading and off loading Page 5 of 9
9. Transport Limitations The following types of patients need to be properly restrained with arm, leg and/or chest restraints: Psychiatric / mental disorder Intoxicated / Overdose / Under the Influence Suicidal Any patient in the custody of a Law Enforcement Officer. At the request of the Flight Crew, a LEO may accompany the patient on the flight weight dependant. Weapons aboard the aircraft will be at the discretion of the Pilot Pepper spray or other capsicum spray devices are prohibited on the aircraft The following types of patients may pose restrictions in the confines of the aircraft and may not be able to be transported on MedFlight: OB patient with imminent delivery Adult patient requiring CPR if effective compressions cannot be delivered. Patient weighing in excess of 350 lbs or otherwise determined unable to fit within the patient area of safely loaded Patient unable to recline with the side rails in the up position Patient contaminated by hazardous materials Patient requiring respiratory isolation 10. Transport of Multiple Patients In the event that multiple patients are in need of transport by MedFlight, Incident Command or if necessary, the Attending Practitioner should inform MedFlight prior to it responding to the scene. In cases where it is determined that multiple patients may need transport after MedFlight is responding, the Duty Pilot and Flight Medics shall make all attempts to reconfigure the helicopter in order to facilitate safe transport. In the event capital equipment or personnel are left at the scene to accommodate multiple patients, a BC will be notified and arrangements will be coordinated to secure and retrieve the equipment. 11. Reduction of On Scene Time MedFlight crew members should strive for a 10-minute on scene time from patient contact to departure. Ground crews should assist flight medics by taking steps to assure the patient is Page 6 of 9
packaged and ready for transport. Exceptions are allowed when flight medics are performing Drug Assisted Intubation. These will be evaluated on a case by case basis. 12. Mutual Aid Inbound In an effort to coordinate appropriate resources, an Attending Practitioner (through any available Incident Command) will contact a Battalion Chief for all requests concerning a mutual aid response of air operational resources. All mutual aid requests MUST be routed through a Battalion Chief who will consult with the Duty Pilot concerning issues such as flight safety and weather. CCSO Dispatch is only to request mutual aid responses with approval from a Battalion Chief or the Collier County EMS chief or designee. Assigned aircraft will utilize the assigned Control channel. 13. Mutual Aid Outbound Lee County requests for mutual aid are immediately dispatched to MedFlight. A Battalion Chief may override the request from any outside agency based on policy or Collier County needs. Hendry County MedFlight will provide countywide mutual aid to Hendry County. During hours of darkness MedFlight will be restricted to landing at airports within Hendry County or the Correctional facility. Other jurisdictions Discretion of the Chief or designee based on policy and Collier County needs. 14. Inter-Facility Transports MedFlight s primary mission is pre-hospital patient movement into the trauma system; however, there are times when requested for inter-facility transports. There are several factors that must be addressed prior to any transfer taking place. All transfers will be documented and run number will be assigned for tracking whether the request is accepted or denied. When requested for an inter-facility transport the following procedures must be followed: Assure dispatch has assigned a run number Advise the duty pilot of the transfer to assure feasibility of flight based on weather and duty restrictions Assure there are no other emergency incidents within the County that would require the use of MedFlight Page 7 of 9
Complete MedFlight Inter-Facility Checklist prior to accepting the transfer which includes: o Collect All receiving facility information o If special equipment or medication required is out of Collier County paramedic scope of practice or protocol and cannot be discontinued for the transfer, the Collier County Medical Director or Deputy Medical Director must approve the transport. o Collect and document information of other air medical services that were contacted prior to the request for MedFlight and why the transfer was declined (If local transfer from ER to ER, prior contacts are not needed). o Assure patient is appropriately packaged and ready for transfer prior to departure (special considerations: procedures completed, patient belongings, family informed of transfer, etc.). o Confirm acceptance of transfer and facility location confirmation through verbal contact with receiving facility prior to departure o Gather information about helipad, radio communications and request resources if necessary i.e. ambulance needed, security informed, special equipment. o Advise an EMS Battalion Chief if transfer will be completed by MedFlight. o Prepare aircraft for transfer and assure oxygen and equipment is appropriate for length of transfer and patients needs. MedFlight does not perform inter-hospital cross country transfers(outside of Naples/Lee Counties) unless: The inter-facility checklist has been completed as outlined above and there are no exclusion criteria, and; MedFlight is the transport of last resort, and; The Medical Director or Deputy Medical Director has been contacted for approval of transfer If an inter-facility transfer is denied the reason must be documented on the Inter-facility Checklist. All Inter-facility Checklists must be filled in completely and turned in to the Flight Program Manager for processing. An Image Trend report must be completed regardless if the transfer was completed for run number accountability. Other Air Operators: Miami Tampa Life-Net (800) 806-1916 Aero-Med (800) 727-1911 Children s Hospital (888) 543-3358 Bay-Flight (800) 223-4494 Page 8 of 9
Lee Dispatch (LeeFlight) (239) 337-2000 Control will notify BC 80 of the request for MedFlight on any out-of-county transport. The request will be passed to the on-duty Flight Crew for the specific needs of the flight, complete the inter-facility checklist (attached), and for the Pilot to check weather conditions for the route. All IFT s will be performed in a time efficient manner without unnecessary delays. If a request for an inter-facility transport comes into MedFlight directly, the flight crew must notify a Battalion Chief of request. Special consideration shall be made by the Duty Pilot regarding the feasibility of the flight based on weather, aircraft, and duty time restrictions. 15. Administrative Flights Administrative Flights must be authorized by the Chief or his designee. Two [2] Flight Medics should be present on all flights (weight dependant). If more than one [1] passenger is approved by the Chief, the Duty Pilot will respond to MHQ to pick-up the necessary staff and drop off the passengers prior to responding to the medical incident. When MedFlight is dispatched to an emergency scene when a single passenger is on board, and the incident is closer than MHQ, the passenger will be transported to the scene and the passenger will obtain an alternative transportation method. The crew should encourage all passengers to bring a cell phone (not be used in-flight). Page 9 of 9