Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Helicopters and Airways

I have been presenting things in a very negative light, not because there is nothing positive to write about helicopters, but because too many people are ignoring the dangers. Dangers to patient and to flight crew. My comments apply to urban and suburban EMS – less than an hour transport by ground to a trauma center. So, not much reason to fly these patients – you are almost always too close to the trauma center to justify flying the patient.

If you disagree, provide some research to support your position.

I have chosen to fly patients, but only about one per year, since it is rare that a patient meets my criteria to fly.

  • The illness/injury has to be serious enough that I think, based on my assessment of the patient, that the patient will deteriorate significantly in the next half hour, or so. Never based just on mechanism.
  • The helicopter will make a significant difference in the amount of transport time to the right hospital.
  • The helicopter is available in the next few minutes (not 20 minutes away) and the landing zone can be quickly set up near by.
If any of these are missing, I see no reason to fly the patient.

What about airway?

A lot of people will call the helicopter for airway management. I do not see the benefit in this. The number of patients I have treated, who actually needed RSI, is small enough to count on one hand. This does not mean that using RSI in EMS is a bad idea, but we need to straighten out medical oversight before anyone should be taking away a patient’s respiratory drive.

So, you are too good for the helicopter?

No.

The helicopter is going to take a while to get to the patient.

If the patient has a difficult airway, then the patient should be managed by other means.

Calling a helicopter, because you do not want to show up at the hospital without a tube, is bad airway management.

Here is a list of important airway equipment:

  • Oxygen, regulator, and delivery tubing.
  • Suction – possibly the most important equipment.
  • NPA (NasoPharyngeal Airway).
  • OPA (OroPharyngeal Airway).
  • KY jelly.Lidocaine-type spray.
  • Waveform Capnography.
  • EDD (Esophageal Detector Device).
  • BVM (Bag Valve Mask).
  • LMA (Laryngeal Mask Airway).
  • CombiTube.King LT Airway.
  • Eschmann Introducer or Gum Elastic Bougie.
  • BAAM (Beck Airflow Airway Monitor).
  • Laryngoscope handles.
  • Laryngoscope blades.
  • Stylettes.
  • Batteries.
  • Bulbs.
  • Syringes (to inflate the cuff).
  • Something to secure the tube.
  • ETTs (EndoTracheal Tubes).
  • Retrograde intubation equipment.
  • Transtracheal Jet Oxygenation (it is not ventilation).
  • Surgical airway equipment.
Did I forget anything?

A helicopter!

There is a reason the helicopter is not on the list – it does not belong there. For the same reason you do not call a helicopter to start your IVs. For the same reason you do not call a helicopter to defibrillate your patients. For the same reason you do not call a helicopter to assess your patients. If you cannot do these things without the helicopter, you are in the wrong business.

If you call a helicopter to manage your patient’s airway and wait for the helicopter to manage your patient’s airway, what is your patient doing for oxygenation and ventilation in the mean time?

If the patient is breathing, maybe you did not need the helicopter?

If the patient is not breathing, maybe you needed to be at the closest hospital (no matter how bad at airway they may be)?

Maybe the patient does not need a really big fan to help with breathing.

Some of my other helicopter misuse posts are:

Interfactility Helicopter EMS

Helicopter EMS – The Starbucks Effect.

Dispatch would have told us if it were something serious.

Safety über alles!

.

Comments

  1. Never have I called a helo for airway support. I work in an urban ems system where the nearest trauma center is 10 minutes away on a good day. The helo comes from the same hospital. It is literally across the river from my city. You can see it if you stand on the bank of the river. Have we called the helo anyway for transport? Darn tootin. To get across the river you have to go through one of 2 tunnels. The downtown or the midtown. At peak traffic times that can take you up to an hour or more. It’s poor traffic engineering at its finest but you better believe I will launch that helo if I need it. If my patient needs an airway then they go to the Hospital in the city.(even though they can’t really manage an airway well at all)

  2. You miss out on all of the good times.Up here in the Phlyadelphia area, airway is just one of the reasons to call for a helicopter. Since the medical director is at the local hospital, best to avoid the possibility of having the medical director find out just how bad the medic is at airway management.It is Lowest Common Denominator heaven here – you know, where the bar is lowered even more than in your average LCD Land. Oh, did I say land? Well, land that helicopter right over here, we’ll write the chart to make it look necessary.

  3. Transtracheal Jet Oxygenation (it is not ventilation).HEHEHEHEEEEHEHEHE AMEN Brother! I remember talking to a Brand New Medic and having the “Jet” discussion. He was super impressed and told me:he had a friend, who knew someone, whose housekeeper dated the neighbor of a medic who “saved this guy’s life with one of those”I tried to explain the physics involved and it reminded me of the trying to teach a pig to sing paradigm. In the end I told him to take a 14g catheter and attempt to breath through it for..oh, say a minute.

  4. Vince,

    I wrote a post about your comment.

    I’m Leaving on a TransTracheal Jet Plane.