1. Helicopter On-Scene Response Program Instructor Notes
Air Ambulance Helicopter On-Scene Response Program Emergency Health Services Air Ambulance Section
Introduce Program
overview of new policies related to Helicopter On-Scene Response
updates to initial program of 1997
Review Learner Objectives
Provide overview of delivery
lecture with large group discussion to highlight key points and application of Policies
introduction of Trauma Triage Guidelines
final question and answer period
Regional Training Network

2. Roles and Responsibilities
Helicopter On-Scene Response Program
Instructor Notes
Roles and Responsibilities
Caller
CACC Dispatcher
MATC Dispatcher
EMA/Paramedic
Flight Paramedic
Flight Crew
Discuss all those who could be involved in helicopter on-scene response decisions
Concentrate on roles of land paramedic
determination of travel and patient preparation times (including extrication time) to the most appropriate facility
identification of operational and clinical guidelines that would indicate a helicopter on-scene response
advising CACC of the need for helicopter on-scene response, or canceling an already dispatched helicopter if assessment of situation warrants it
designating a “Landing Site Coordinator”
working safely around helicopters
knowing the limitations of on-scene responses

3. Ontario’s Air Ambulance System
Helicopter On-Scene Response Program
Instructor Notes
Ontario’s Air Ambulance System
Provide brief overview of Ontario’s Air Ambulance System
specifically highlight new Preferred Provider Bases - replaces the previous Standing Offer Agreement (SOA) rotary wing charter air carriers - specify air bases in your area
new Preferred Provider Bases in London, Ottawa, Moosonee, and Kenora
preferred air bases provide Advanced Care Flight Paramedics, dedicated air bases provide Critical Care Flight Paramedics.
may still see isolated SOA fixed wing response in remote northern areas - all certified to Primary Care Flight paramedic level - SAED and SR
This program deals with helicopter on-scene response calls, as per policy 4.7
Dedicated Air Ambulance
Preferred Provider
SOA Charter Air Carriers

4. Policies Related to On-Scene Response
Helicopter On-Scene Response Program
Instructor Notes
Policies Related to On-Scene Response
Tell class: These are the policies applicable to Helicopter On-Scene response
Confirm everyone in class has personal copy of this policy - part of learner package
Policy approval and implementation date: Will be announced by EHS - training of CACC’s must also take place. This will be happening in near future.
Policy Preferable Mode of Emergency Response
Policy Landing Air Ambulance
Policy On-Scene Limitations
Policy Joint Land/Air Emergency Response

5. Helicopter On-Scene Response Program Instructor Notes
On-Scene Requests
Operational Guidelines
Clinical Guidelines
Judgement!
Requests for on-scene helicopter response should meet at least one Operational Guideline, and one Clinical Guideline
However - use judgement - if appropriate under current circumstances, helicopter on-scene response should be requested even if operational and/or clinical guidelines have not been met.
This review of the guidelines will enable EMAs/Paramedics to make sound decisions based on reliable indicators.

6. Operational Guidelines
Helicopter On-Scene Response Program
Instructor Notes
Operational Guidelines
Land response to scene >30 min.
Land response to hosp. > 30 min.
land and air response >30 min., but ALS required - not available on land
Multi-Casualty Incidents
Patient Accessibility
Judgement!
Review Operational Guidelines
Point 1
request helicopter if land response to scene is greater than 30 minutes, and air can reach the scene quicker.
Point 2
“closest appropriate hospital” now more clearly defined for trauma patients.
30 minute transport time includes extrication time, traffic and road/weather conditions, and those factors which affect response/transport time but cannot be predetermined
Point 3
both land and air response greater than 30 minutes, but approximately equal, and patient needs advanced paramedic level care which cannot be provided by responding land ambulance.
Points 4 and 5
multiple patients who meet guidelines and local land ambulance resources are overwhelmed
access issues include ravines, valleys, large park/conservation areas, etc
** CACC’s may establish geographical zones as opposed to time guidelines - see policy 4.7 page 3).
** Judgement - even if no operational guideline met, helicopter on-scene response can be requested if the current circumstances warrant.
** Land ambulance that has patient ready for transport will not wait for helicopter unless it can be seen on final approach (Policy 4.7, page 5). In this situation, land ambulance will proceed to closest hospital with an emergency department - air ambulance will proceed to that hospital (see policy for complete details).

7. Helicopter On-Scene Response Program Instructor Notes
Trauma Centres
For trauma patients only, the “closest appropriate facility” has been more clearly defined
consideration of time to hospital should be based on pt. arrival at a Lead Trauma Hospital
See Policy Definition
Studies prove that morbidity and mortality rates increase if patient is not taken directly to a Lead Trauma Hospital
Define Closest Appropriate Facility for Trauma Patients
designated Lead Trauma Hospitals
assigned in conjunction with local BH direction
Does not apply to patients meeting clinical criteria other than trauma e.g. medical, environmental, obstetrical, MOI
these patients may still meet guidelines for on-scene response, but time estimates based on travel to “closest appropriate facility”

8. Helicopter On-Scene Response Program Instructor Notes
Clinical Guidelines
Trauma*
Medical Category
Environmental Category
Obstetrical Category
Mechanism Of Injury Category
Judgement!
Review guidelines for each category except Trauma - this will be highlighted in Trauma Triage Guidelines - pages 6 to 8 in Policy 4.7.
Remind class that in these categories (all but trauma), the closest appropriate facility has not changed from current practice
requests for on-scene response in these situations still includes “patient extrication time, traffic and road/weather conditions, and other factors which affect response/transport time” guideline of more than approximately 30 minutes to closest appropriate facility, and only if air can be faster

9. Trauma Triage Guidelines
Helicopter On-Scene Response Program
Instructor Notes
Trauma Triage Guidelines
Clinical guidelines for Trauma patients are now more clearly defined in the Field Trauma Triage Guidelines - Policy 4.7 page 6
Composed of three sections - anatomical, physiological, and incident criteria
Trauma patients meeting any one characteristic in any of the three categories should be transported to the closest lead trauma hospital
Remember diversion to closest ER department possible in judgement of paramedic
Review the trauma triage guidelines with learners
** land ambulance is not to delay patient transport by waiting for the helicopter, unless it is seen on final approach. Transport to closest local hospital with ER - helicopter will proceed to that hospital - Policy 4.7 page 5
** Land ambulance will bypass other hospitals to go to lead trauma hospital if the closest lead trauma hospital is less than 30 minutes away by land ambulance. However, if at any time the EMA/Paramedic is uncomfortable with the safety of the patient during transport to the closest lead trauma hospital and bypassing other hospitals, the EMA/Paramedic may divert to the closest hospital with an emergency department - Policy 4.7 page 3.
**local direction can come from BH Medical Director
Anatomical Criteria
Physiological Criteria (>16 yrs)
Incident Criteria

10. Paediatric Trauma Guidelines
Helicopter On-Scene Response Program
Instructor Notes
Paediatric Trauma Guidelines
To be used for patients under the age of 16 years, or when unknown, in the absence of secondary sexual characteristics (judgement)
6 item scoring system - if patient scores 8 or less, they should be transported to the closest lead trauma hospital, provided it is less than 30 minutes away, and you do not suspect that the patient will not survive the extra transport time.
transport by air or land, which ever is appropriate using the operational guidelines and EMA/Paramedic judgement in consultation with CACC
paediatric trauma is relatively rare - may be useful to have this scoring system located in convenient place for future reference, e.g. pocket card, zip pack, patient compartment of ambulance
** Alternate BP measurement - Radial/Brachial Pulse present scores +2, femoral pulse present scores +1, and no pulse scores -1.
** Scoring of patient must be done in all six areas - one score per component - total the score for each of six components to achieve overall trauma score.

11. Helicopter On-Scene Response Program Instructor Notes
Landing a Helicopter
Safety
Landing Site
Site Safety
Working around a Helicopter
Review key points of policies 4.7
helicopter pilot will determine landing site from the air
landing site coordinator will work in harmony and under the direction of pilot

12. Response Limitations and Joint Response
Helicopter On-Scene Response Program
Instructor Notes
Response Limitations and Joint Response
Night Calls
Reassignment
Search/Rescue
Joint Land/Air Emergency Response
Review Policy 4.9 and 4.10
EHS helicopters are not permitted to respond to night calls which require a landing at other than night licensed airports, helipads, or night approved remote landing sites.
Diversion of helicopter from calls to on-scene calls must receive approval from MATC Base Hospital physician. Land EMA/Paramedics will still request in appropriate situations - availability will be determined through communication between CACC and MATC. ** Do not delay transport waiting for helicopter on-scene.
EHS helicopters are not permitted to take part in search and rescue calls
CACC may initiate both land ambulance for tiered response with air response
crew reaching the scene first is responsible for triage and scene management
highest medically trained personnel on-scene will normally be authority in patient/medical matters
if both land and air are ALS, the transporting crew will have authority over medical/patient matters