Helicopter Transport

There are 16 helicopter emergency ambulance services covering the whole country with reported average response times of 17 minutes, and transfer times of 10 minutes. The decision to use a helicopter is not straightforward and the transfer of a seriously injured patient by helicopter may be hazardous and transportation by road may often be a safer option. There are various guidelines for the appropriate use of helicopters to transport patients.^1,2,3

• Speed over long distances.
• Access to remote areas.
• Enable early initiation of management by highly trained medical staff and with special equipment.

• Staff training: minimum requirements include safety training, evacuation procedures for the aircraft and basic on board communication skills. Staff must also have a detailed knowledge of how medical conditions can be affected by helicopter transport.⁴
• Crashes: the risk is greatest at night and in poor weather conditions.⁵
• Expensive: helicopters are the most expensive form of patient transport and there is continued uncertainty about the cost-effectiveness. There is, however, good evidence for the benefit in serious blunt trauma patients.
• Noise and general stress: may lead to anxiety and disorientation and hamper communication.
• Vibration exacerbating bleeding/pain from fracture sites.
• Altitude:⁴
  • A fall in barometric pressure may lead to hypoxaemia. However hypoxia is unlikely unless there is cardiac or lung disease, anaemia, shock or chest trauma as helicopters rarely fly high enough.
  • A fall in barometric pressure also leads to an increase in the volume of gas filled cavities. Therefore any pneumothorax must be drained, nasogastric tubes should be inserted and placed on free drainage. Decompression sickness ('the bends'), pneumoperitoneum and intracranial air are relative contraindications to air transport. Tissues may also swell and plaster casts should be split. Dehiscence of abdominal wounds (therefore avoid flying for 10 days after surgery if possible) and renewed bleeding from a peptic ulcer. Drips may slow down.
  • Increased altitude is also associated with a fall in temperature. Patients should be laid on and wrapped in insulating cellular blankets or bubble wrap underneath warm blankets or duvets.
• Aircraft limitations, e.g. weather, landing site, limited carriage space (especially if additional medical personnel).
• Noise and vibration: may cause nausea, pain and motor dysfunction. Ear protectors should be worn and intercom headphones should be used for essential communication.
• Visibility: may be limited and may hamper observation of both the patient and monitor.

These include:⁶

• Patient in full arrest
• Terminally ill patient
• Active untreated communicable disease that would put the crew at risk
• Uncontrollable, combative patient
• Patient of sound mind who refuses transfer
• Unstable patient, who requires a procedure (i.e. laparotomy) which could be performed at the sending centre
• Stable patient in whom another means of transport would be more appropriate