c.   Proximity of Transport

In general, the closest available unit will be dispatched, whether BLS or ALS.  In extreme cases, personnel requesting a helicopter may indicate “ALS priority” but should note that the ETA for ALS will often be longer by at least 20 minutes in areas covered by both BLS and ALS helicopters (i.e., Humboldt County).  Ground ambulances should always continue to a landing site which is toward, not away from, the receiving hospital.

d.   Dispatch Procedures Before Patient Contact.

1.         A request for a helicopter can be made prior to actual patient contact by EMS personnel, but the dispatching agency will attempt to make contact with the base hospital for the geographic area served by the ground ambulance prior to lift off as to medical necessity based upon all available information.

2.         MICNs and emergency department physicians are requested to assist the dispatcher with regard to the question of medical necessity of the helicopter in the case where patient contact has not yet been made by the ground ambulance.

3.         ALS personnel en route to a scene, where they have reason to believe that a helicopter transport may be necessary (i.e. based on First Responder report), may request the dispatching agency to contact air ambulance providers for a “status check” to prepare for the quickest possible dispatch in the event it is needed.

e.          Special Procedures for First Responders without Med-Net

Prior to requesting an EMS helicopter response from the scene of an emergency, First Responders without Med-Net communication capabilities may request a helicopter response through their own dispatch.  However, the appropriate helicopter dispatching agency is encouraged to contact the base hospital to confirm the medical necessity of the transport before dispatching, except in unambiguous cases. All First Responders should familiarize themselves with the indications/ contraindications for air ambulance transport, the capabilities of local providers, and the factors to consider (see IV.A.).

2.  Dispatch Procedures for Dispatching Agency Personnel

a.          Information 

Dispatchers will collect and convey as much information as possible regarding patient condition, scene, etc. (see B.1.b.) between ground and helicopter personnel, and will contact the base hospital for assistance, as appropriate.

b.    Proximity

In general, the closest available unit shall be dispatched, whether BLS or ALS, but ground personnel may indicate an ALS priority after consideration of ETA and patient condition (see B.1.c).  Dispatchers should clearly advise ground personnel of the time difference between the two units and note that the ETA for ALS may be longer by at least 20 minutes in areas covered by both BLS and ALS helicopters (i.e. Humboldt County).

c.          Dispatch shall inform EMS helicopter service providers which are contacted that they have no longer than 5 minutes to provide a return contact confirming availability, with a reliable ETA given to dispatch.  If this is not accomplished, dispatch will contact an alternate provider and cancel the first. 

d.         Dispatching agency will inform EMS ground personnel that a helicopter has been dispatched, which helicopter agency is responding and the ETA to the scene whenever possible.

e.          The EMS helicopter service provider will be advised that a ground ambulance has been or will be dispatched to the scene.

f.           Dispatch will assure (e.g. in cases where it is not practical or feasible for the ambulance) that the local base hospital is notified of EMS helicopter response times as follows:

1.       Time airborne

2.       Estimated time of arrival at the scene

3.       Time of departure from the scene

4.       Estimated time of arrival at receiving hospital.

g.     Considerations Regarding Coast Guard (CG) Helicopters:

The CG helicopter has special abilities and limitations which demand special consideration by dispatchers (see below).  Given these, as well as the time and dispatch resource limitations on CDF, the CG Helicopter should be considered the North Coast EMS medevac when other resources are not immediately available.

Other regional helicopter resources should be given primary consideration by CDF dispatch unless “water rescue” is required or there is an overriding circumstance that requires the CG helicopter’s special abilities.

      Unique Assets                                                                                           

      245’ hoist                                                                                                              

                        Main air resource in winter in Humboldt, when CDF helicopters are docked

                              Unique Limitations

            Not an ALS provider

                        Is willing but cannot always take an ALS personnel due to payload

            Limited to one litter patient with one ALS personnel on board

      3.  Dispatch Procedures for Helicopter Personnel

a.          The appropriate ground ambulance shall always be dispatched concurrently with the EMS helicopter.  The EMS helicopter personnel must insure that the ground ambulance has been notified of helicopter dispatch.

b.         No helicopter will fly to, or respond to, any location where there is a medical emergency incident unless specifically requested by approved dispatch (see IV.B.1.a.)

c.          The air ambulance should establish contact with the base hospital and receiving hospital, as soon as is feasible, to apprise them of ETA, patient condition, and additional information that will assist the hospital in being prepared for patient arrival.

d.         Once the helicopter reaches the patient, if the EMS helicopter personnel have determined that the patient is accessible by air and that there will not be a need for ground ambulance assistance, then the EMS helicopter may cancel the ground ambulance as well as notify the base hospital of this decision.

C.  Helicopter Patient Destination Policy

1.      The patient destination will generally be to the closest appropriate facility; however, determination of patient destination may be made concurrently by helicopter crew and ground unit personnel in consultation with the local base hospital (and if desired with the medical control hospital from the county of origin).  Considerations in determining patient destination shall include but not be limited to:  medical control, patient condition and severity, safety, weather, patient’s preference, fuel availability, and time of day.

2.      Helicopters transporting a patient will land at a hospital which has a Cal-Trans and Federal Aviation Agency (FAA) approved helipad unless there is an unanticipated situation where the safety of the aircraft or patient so requires an emergency landing at another site.

D.  Prehospital Care Guidelines

1.      County and regional EMS policies and procedures will apply to all EMS helicopter flights responding to a request for medical aid and/or transportation within the region.

2.      Medical crews shall be limited to their scope of practice in the county or region of origin.

3.      While the patient is being handled by LALS or ALS ground personnel, these personnel shall follow standard North Coast EMS medical control policies which state that their base hospital must supervise prehospital treatment, triage and transport, and advanced life support.

4.      When patient care is handled by helicopter personnel, medical control rests with the helicopter crew under the direction of their base hospital located in their county of origin (pursuant to existing reciprocity agreements between North Coast EMS and all surrounding jurisdictions).

5.      Helicopter personnel are requested to make patient destination decisions, whenever possible, in concurrence with LALS/ALS ground personnel and the ambulance’s base hospital (pursuant to existing participation agreements between North Coast EMS and air ambulance providers).

E.  Helicopter Cancellation Policy

1.      EMS helicopter response may be cancelled by the on-scene EMS personnel with the highest medical certification or licensure in communication with with the Incident Commander when it is determined that:

a.       Ground ambulance transportation is more appropriate;

b.      A patient refuses medical aid and/or transportation by EMS helicopter;

c.       The incident site, weather or visibility conditions are considered unsafe, inappropriate, or present an uncertain risk for the aircraft crew and/or personnel at the incident scene.

2.      Cancellations by either the Incident Commander or the base hospital emergency physician should be after consultation with the person on-scene with the highest medical certification or licensure.  Whenever possible, cancellations should be routed through the original requesting facility or other dispatcher.

F.  Continuous Quality Improvement

1.      North Coast EMS policies and procedures for CQI apply to all patient transports originating within the region, both ground and helicopter.  Individual cases, providers and system issues may be audited upon receipt of a Case Review Form or by determination of the North Coast EMS Medical Director.  Any ground ambulance or helicopter transport CQI issues involving units from other jurisdictions will be reviewed in concert with the provider and local EMS agency responsible for that jurisdiction.

2.      Emergency response flights which exceed the EMS air service provider’s initial ETA estimate by more than 25% shall be audited.

G.   Withdrawal from Operations in the North Coast EMS Region

1.      North Coast EMS reserves the right to suspend, probate or restrict helicopter services for cause, following an investigation and establishment of a practice pattern that is outside the parameters set in this policy.

2.      Either North Coast EMS or EMS helicopter service providers can terminate services with 60 days written notice.

3.      The decision of the North Coast EMS Medical Director and/or Executive Director will be final unless an appeal is presented to the North Coast Joint Powers Governing Board.

4.      North Coast EMS will notify the local EMS agency in the county or region of origin, and/or California EMS Authority of actions taken.