Presentation to Latah County Emergency Management Life Flight Network Presentation to Latah County Emergency Management Dominic Pomponio RN, CCRN, CEN, CFRN, NREMT-I Base Manager, Life Flight 79 Lewiston, ID

Agenda Overview of Life Flight Network Crew Configuration Ownership and History Service Area Crew Configuration Activation and Air Medical Necessity Time Sensitive Illness’ Membership Landing Zone Safety Outreach, Education, and Training

Hospital Consortium Life Flight Network (LFN) is a medical transport service provided by a consortium of Oregon Health & Science University, Legacy Health, Saint Alphonsus Regional Medical Center, and Providence Health and Services LFN is one of the country's oldest, safest, and most respected air ambulance providers. Beginning in 1978 as Emanuel Life Flight, the program was the first hospital-based air ambulance on the West coast and only the 4th in the nation. In October 1, 2007 when LFN formally separated from the hospital structure with its two bases located in Hillsboro OR and Aurora OR where the headquarters currently are. Not long afterward we opened bases in Eugene, OR; and Dallesport, WA; to better serve our existing customers and to provide much needed air medical service to growing distant communities. LFN opened our base Longview, WA in 2008. LFN's first ground based critical care ambulance was placed into service January 1, 2009. In September 2009, Boise-based Saint Alphonsus Life Flight joined LFN with the addition of 4 bases in Idaho and Eastern OR. This merger helped LFN become one of the largest hospital consortium air medical companies in the United States.

History Founded 1978 as Emanuel Life Flight Became hospital/community hybrid in 2007 Expansion to Eugene and Dallesport in Spring 2008 Expansion to Longview in Fall 2008 Merge with St. Alphonsus Life Flight in Fall 2009 2009 Air Medical Program of the Year

Service Area

Flight Crew Information Pilot Flight Nurse Certified PALS, BLS, ACLS, NRP, PHTLS, TNATC Advanced skills training – chest tubes, emergent cricothyrotomy Flight Paramedic Field EMS Training NREMT-P PALS, BLS, ACLS, NRP, PHTLS BLOOD Safety is our #1 priority! Life Flight Network rotor pilots have extensive flight experience in rotor wing operations. . Most Life Flight Network rotor wing pilots far exceed those requirements, with an average of 5000 rotor wing flight hours.

We carry a full complement of Critical Care and Emergency medications Clinical Operations We carry a full complement of Critical Care and Emergency medications

Clinical Operations LTV 1200 Ventilator

2 units of O-Negative PRBCs Clinical Operations 2 units of O-Negative PRBCs

Activation Call 800-452-7434 Info Who are you? Where are you? Where is the patient going? Is the patient greater than 300lbs? Activation Off the ramp in less than 6 minutes Flight crew will obtain all signatures and paperwork (no need for faxing). Flight crew does NOT need an accepting MD or facility for activation, just prior to transport. Completion Flight crew will call back to sending facility and give updates. Equipment return Responding paramedic, first response incident commander, specific non-EMS personnel, or physician on scene How – Closest aircraft – area of about 150 miles, unlimited areas with FW Non-EMS personnel (logging crew bosses, wind farms, bonneville power, or police) 20 minutes for fixed wing Why – In most setting, this decision is a combination of either direct medical order via radio/telephone or standing orders based on trauma score and protocols.

General Criteria Position Papers from AAMS and NAEMSP Patient requires critical care life support Patient requires short out of hospital time High potential for delays with ground transport Remote area inaccessible to regular ground traffic Patient requires specific or timely treatment not available at the referring hospital or facility. Patient’s clinical condition is familiar to receiving hospital’s physicians Use of local ground transport team would leave the local area without adequate EMS coverage. Delays include road obstacles and traffic and delays are likely to worsen the patient’s clinical status 4. Remote locations with isolated injury patients that could create a prolonged painful transport (i.e. logging injury) 7b: Situations with limitations (mass casualty, lack of availability of ground transport or specialty care personnel) Why use air medical transport? To improve access to tertiary and specialized care To aim for a reduction in out of hospital time EMS regional or state-approved protocol identifies need for on-scene air transport; or EMTALA physician certified inter-facility transfer Risk of death from same injury or illness remains significantly higher in rural areas versus suburban and urban centers Studies confirm that rotor, fixed wing, and critical care ground transport are cost effective strategies that improve access to teriary and specialized care. – focus specifically on HEMS due to the questions about use and safety especially for scene responses. Time is as much a determinant of outcome as a specific injury or illness – the “Golden Hour” or other specific illness related time Deployment of critical care teams with intensive care equipment and skills brings the resources of the trauma or specialty care center directly to the patient’s side whether at an accident scene, remote medical facility, or community hospital. Physician level interventions are initiated closer to the time of injury or illness and the risk of deterioration during transport between hospitals is minimized by shortening out-of hospital time. Most recent national consensus criteria were developed by the National Association of EMS Physicians – endorsed by the AMPA and AAMS. Air Medical Physician’s Association has published a list of medical conditions and appropriate recommendation based upon the work done by the Medical Conditions Work Group of the NRM that developed the Medicare Fee Schedule. Other important and widely used guidelines have been developed by American College of Surgeons, American Academy of Pediatrics and the American College of Emergency Physicians. What I’ve done is consolidated the NAEMSP and AAMS recommendations

Air Medical Necessity Guidelines TRAUMA NON-TRAUMA Head and/or spine injuries Significant penetrating injury above mid-thigh, in torso, or head Chest injuries Unstable vital signs Burns >10% BSA or major burns Major electrical/chemical burns Amputation or near-amputation 2 or more long bone fractures or major pelvic fracture Scalping or degloving injury Significant mechanism of injury Any patient airway that cannot be maintained Cardiac disease with progressive deterioration Unstable cardiac patients Severe or acute neurological illness Toxic exposure or electrolyte disturbances Unstable vascular emergency Critically ill obstetric patients Critically ill pediatric/neonatal patients Transplant patients SICK patient Recommendations are from the Position Statement for the Air Medical Physician Association – want to emphasize non-trauma usage. Head injuries (GCS <10 or deteriorating, trauma score <12 or deteriorating, pediatric trauma score <10 or deteriorating, change in LOC and/or neurological deficits) & Spine injuries ( Chest injuries (possible tension pneumothorax, major chest wall injury, potential cardiac injury, penetrating chest wound) Major burns – hands, face, feet, or perineum Critically ill OB patients whose time of transfer between facilities must be minimized to prevent patient/fetal mortality Peds/neonates – respiratory, cardiac issues, metabolic acidosis, sepsis, meningities, Non-trauma neuro/vascular/sugrical all require urgent/time sensitive interventions Conditions requiring treatment in a hyperbaric oxygen unit.

STEMI Transfer Coordination Early Activation Call Life Flight First Medications/interventions may be started by Flight Crew if time does not allow You may activate without accepting MD/Facility Door to balloon in less than 90 minutes Life Flight can be at your facility within minutes Carla is going to speak more about the STEMI protocol so I don’t want to overlap her presentation 2008 Report done by Emergency Cardiac and Stroke Work Group; Washington State Emergency Medical Services and Trauma Steering Committee. Requires early recognition by patients Delays along the “Chain of survival” Also applicable to stroke patients Training done for hotloading patients

Membership Insurance Membership $60/year covers entire family Guarantees patient will have no out of pocket expense if flown by Life Flight Network or one of our reciprocal partners (NW. Medstar or Airlift NW) Life Flight Network has agreements with NW Medstar and others to honor memberships

Landing Zone Education Life Flight Instructional DVD Selection and preparation Helicopter safety Preapproved landing zones When aircraft arrives prior to 1st responders or LZ commanders. Helicopter safety covers setting up an LZ, bringing in the helicopter, safety around the helicopter rotors, loading the patient Longview to PDX = ~17-20 minutes

Outreach, Education, and Training ACLS, BLS, PHTLS classes Mock MCI Drills and Mock STEMI Transports Inservices Conferences and Public Education events Community Events Ride-along program Pediatric simulation event

Aviation Services Rotorcraft aviation services provided by Air Methods Corporation AMC provides the aircraft, pilots, mechanics AMC holds FAA Part 135 Certificate

Aviation Services Eurocopter A-Star AS350 B3 Eurocopter EC135

Aviation Services Fixed wing operations by Aero Air, LLC and Conyan Aviation, Inc. Both operators supply aircraft, pilots, and mechanics Both hold FAA Part 135 Certificates

Aviation Services Aero Air operates a twin- engine turbo prop Commander Conyan Aviation operates a twin-engine turbo prop Cheyenne III

Summary (or what I want you to remember) Air medical transport can make a significant difference in out of hospital time. Early activation and cut down on potential delays. Helicopters are not just for traumas. We love a good collaboration! BLOOD! After all that, if you have to sum up what you learned today that I want you to take home with you is this: We love to collaborate with EMS to develop auto launch policies, practice loading and unloading patients, and providing educational needs and join forces with hospitals for STEMI agreements, test MCI systems, and provide education at conferences and inservices. We want to continue to strengthen our relationships with the hospitals and communities that serve and will provide as much help as we can.

Questions?