Air Med “101”
This document provides a brief overview of the number of helicopters in the domestic MedEvac fleet, the approximate number of patient transports annually, the drivers for EMS helicopters as part of the overall healthcare system, and an overview of patient conditions most often associated with medEvac transport.
Frequently Asked Questions about AAMS and/or MedEvac Transport
When was AAMS founded?
The Association of Air Medical Services (AAMS) was founded in 1980, under the original name American Society of Hospital Based EMS Air Medical Services (ASHBEAMS).
Why was AAMS founded?
AAMS was founded to serve providers of MedEvac transport systems by encouraging and supporting its members in maintaining a standard of performance reflecting safe operations and efficient, high-quality patient care. AAMS is built on the idea that representation from a variety of MedEvac services and businesses can be brought together to share information, collectively resolve problems and provide leadership in the MedEvac industry.
How many transports does the MedEvac industry complete each year?
We estimate that there are nearly 400,000 rotor wing transports annually, with an additional 150,000 patient flown by fixed wing aircraft each year. (US only)
When was the first MedEvac transport completed?
In 1926, the United States Army Air Corps used a converted DeHaviland aircraft to transport patients from Nicaragua to France Army Base in Panama, one hundred and fifty miles away. The first civilian air medical transport was completed in 1928 when a DeHaviland Fox Moth aircraft in the service of Australia’s Royal Flying Doctor Service took off on its first mission. The Royal Flying Doctor Service holds the distinction of being the first civilian air medical transport program.
What types of aircraft are typically used in MedEvac transport?
There is no standard aircraft utilized in MedEvac operations. Airplanes (fixed-wing aircraft) vary in size from single-engine turboprops such as the Pilatius PC-12 to twin-engine aircraft like the Cessna Citation, Beech B-200, and Lear 35. Most are either turboprop or jet aircraft which lends to faster, more versatile performance. In helicopter operations, again, no one make or model is the standard. Helicopters are chosen for a myriad of reasons such as payload capability, range, economy of operation, and geographic location. The most common helicopters found in medEvac use are the Bell 206/407, and Eurocopter AS-350 for single-engine aircraft. For multi-engine the medium sized Bell 222/230, Eurocopter BO-105, BK-117, and Agusta A-109 are widely used. The largest multi-engine helicopters in service with medEvac services across the nation are the Sikorsky S-76, Bell 412, and the Eurocopter AS-365. All aircraft used in medEvac operations have proven themselves with thousands of safe transports.
a. What are the benefits of twin-engine vs. single engine?
The debate among users continues with this issue. Some pilots and passengers have always believed two is better than one. On certain levels this is still true today. Anyone flying 100 miles offshore, or over mountainous terrain at night feels better knowing that there are two engines working for him or her. However, with the advent of truly reliable turbine engines, the probability of and engine failure is greatly reduced making the single-engine helicopter a safe and economical choice. A great deal depends on the type of missions flown, and the space required to accomplish it. All medium and large capacity helicopters are multi-engine, needed for the power required to lift the payload.
b. What does “IFR” mean?
“IFR” stands for “Instrument Flight Rules.” It refers to a set of rules governing the conduct of flight under weather conditions where navigation by Visual Flight Rules (VFR) is no longer reliable. The conditions for IFR flight and the flight rules themselves are contained in the FAA’s “Instrument Flying Handbook. (Advisory Circular 61-27C).”
c. What weather conditions can be flown in?
The weather minimums for safe flight operations are found within the Federal Aviation Regulations. AAMS recommends that medEvac services, regardless of AAMS membership, follow the CAMTS recommended standards of operation. Please visit www.camts.org for the most recent standards put forth by CAMTS.
When did “Fixed Wing” aircraft begin to be utilized for medical transport?
Fixed Wing aircraft were the first aircraft used in medEvac transport. A medical section of the Army Air Corps was created as early as June 1, 1925 using converted DeHaviland aircraft. Helicopters did not see use as medical transports until 1944.
Why are patients flown by fixed wing?
Patients are flown by fixed wing for many different reasons. These can range from the stable patient involved in an accident, or with a long-term medical condition, wishing to relocate closer to family for rehabilitative care, to the critical heart failure patient requiring intensive care transfer to receive a transplant. The fixed wing environment differs from the rotor wing environment primarily in that fixed wing travels farther, faster and higher. The fixed wing is primarily a facility-to-facility transport, typically long distance in nature.
Secondly, there are typically more choices of different types of aircraft, and selections that are less expensive per mile and/or per hour to operate. With licensure and accreditation standards available and easily verifiable, the care provided in the fixed wing environment is the same as the helicopter. The fixed wing is typically not in competition with the rotor wing in that the rotor wing service typically is for moving a patient from a scene to a primary care facility, or a tertiary care facility to a primary care facility.
What are the different types of medical team configurations?
There are many but some of the most common are: Nurse/Nurse, Nurse/Paramedic, Nurse/Respiratory Therapist, Nurse/Physician, Paramedic/Paramedic.
Who can request a MedEvac transport?
Physicians, Nurses, Pre-hospital personnel, Law Enforcement and any other personnel determined by state or local protocols.
What are the types of medical conditions for which patients are flown?
Trauma, medical (seizure, pulmonary, etc) spinal, burn, pediatric, replant, neonate, organ procurement, High risk OB, non-trauma neuro, and cardiac.
What is the typical mission profile for a MedEvac transport?
54% Inter-facility transports (hospital to hospital), 33% Scene response, and 13% Other (organ procurement/transport)
Do helicopters respond to accident scenes or do they do only hospital-to-hospital transports?
Helicopters do respond to accident scene when the pre-hospital personnel’s evaluation of the patient/scene meets local air medical transport guidelines.
Do pilots get involved in medical care / treatment of the patient?
No. Pilots are charged with the safe and efficient transport of the crew and patient without regard to what is happening ” in the back”. By isolating pilots from patient involvement, they can make crucial flight decisions without influence.
What is the typical shift worked (i.e. 8, 12, 24 hour shifts)?
Medical crew members typically work either 12 or 24 hour shifts.
Pilots must have 10 hours of consecutive rest immediately preceding reporting for duty, and therefore are limited to 14 hour shifts, although 12 hour shifts are common since the duration often coincides with the medical crew.
Where are patients flown (types of facilities)?
Level 1 Trauma Centers, Tertiary Care Centers, and Specialty Hospitals
Is there a governing body over the MedEvac Community?
There is no single “governing body” over medEvac services. Each service is independent, or could be part of a group of similar programs. There are however, several agencies that may have licensing or over sight for medEvac services. For the aviation components, medEvac services must adhere to rules and regulations established by the Federal Aviation Administration (FAA). They are also subject to periodic inspections by the FAA.
Minimal standards for reimbursement and/or licensing could also be established by third party payers (Medicare, Medicaid, managed care organizations) or by local legislation (state, county or city laws). Most states have minimum licensing requirements for medEvac personnel and the service.
In addition, MedEvac services may also follow national or regional standards. For those services that are hospital based, if the hospital is accredited by the Joint Commission on Accreditation of Health Care Organizations (JCAHCO) or other such organizations, such as the American College of Surgeons for trauma verification, the MedEvac service must also meet those minimum standards.
a. What s CAMTS certification?
The Commission on Accreditation of Medical Transport Systems (CAMTS) is an independent non-profit corporation, comprised of representatives from twenty member organizations, each representing some component of air and ground medical transport. Representatives to the CAMTS Board of Directors bring with them a wealth of experience and knowledge in their field of expertise. The Board of Directors develops and approves standards for all levels of medical transport – both air and ground. As standards are revised, they are shared with the member organizations and medical transport professionals at large for their comments and suggestions.
Accreditation by CAMTS is granted to those programs that voluntarily apply and demonstrate substantial compliance with the CAMTS Accreditation Standards. This is done through submission of documentation as well as a site survey performed by trained CAMTS surveyors, who have a depth of medical transport knowledge and experience.
b. What is the accreditation process for medical transport services?
Accreditation begins with an application form. The form indicates the service’s intentions to complete the process. The service then receives a Program Information Form (PIF). The PIF consists of a demographic section, a list of bases and a self-evaluation of the service, based on the CAMTS Standards. Response to the PIF self-study also requires attachments that include policies, education materials, quality management and safety processes. The PIF and attachments are submitted electronically within a year of applying for accreditation.
Once the PIF is complete and returned to the CAMTS office, it is reviewed by the CAMTS staff for completeness and sent to two Board members who will review contents for completeness and for additional questions that they document for the site surveyors. Site surveyors are then appointed, based on their experience and background related to the type of service (air/ground; fixed/rotor; critical care, ALS/BLS ground, etc.) they will visit.
The site visit is then scheduled at a time agreeable to both the service and site surveyors and at least 1 month prior to a Board of Directors meeting in order to be placed on the agenda for an accreditation decision. Once onsite the surveyors will conduct a series of interviews of personnel, look at training records, quality improvement programs, safety policies, etc. Their comments and observations are documented for the two Board members who present the program anonymously to the full Board. The programs are always presented by a six digit number – proper names and specific locations are not known by the full Board. If a Board member has a conflict of interest – he or she is excused while the program is presented and the Board deliberates.
Is this a required certification?
CAMTS accreditation is voluntary. However, several states and some governmental agencies have accepted or required CAMTS Accreditation for licensing, contracts or reimbursements.