HEMS means helicopter emergency medical services. If you live anywhere near a town of more than 100,000 people or so, or have seen a helicopter landing at an accident scene, or the local hospital, you’re seeing HEMS in action. This is an overview of those operations, details on who the operators, pilots, medical staff and assorted other personnel who make those HEMS aircraft fly, and what makes them a vital part of the health care system.
With all the discussion these days about the health care delivery system in this country, it’s likely that at some point various individual systems and operations will come under scrutiny. What’s even more likely, given the expense and highly visible nature of helicopters in the emergency rescue business, is that those aircraft and the various hospitals which have them will be studied in depth. Fortunately, and I use that term advisedly, helicopters and their utilization in industries of all types have been scrutinized for years, dismissed as ‘royal yachts’, relegated to the peripheral and luxurious category by those who misunderstand their utility. This article attempts to address some of the issues surrounding HEMS aircraft and the various operational considerations that seem to impact the national health care debate.
First, let me advance a disclaimer of sorts. I flew a HEMS operation in Iowa for twenty years. During that time I carried over 3,200 patients aboard my helicopter, in all manner of weather, in sunniest day, and darkest night. I saw every kind of patient known to modern medicine from cardiacs, trauma, medical emergency, electric shock, drowning, neonatal, cancer complications, stabbings, shootings, farm accidents, suicide attempts you name it I flew it. Unless someone has invented a different way to maim themselves since I stopped flying, it’s likely I’ve seen it all. So I can speak with some authority.
That said, I offer this criticism of the industry, just so you know I’m trying to be objective. I’ll be the first ex-HEMS pilot to tell you that there are too many helicopter rescue operations in this country. Nationwide there are over 200 such programs, serving 180 different hospitals, some with fewer than 200 beds. Given the million dollar price tag for a standard single engine aircraft operation, with peripheral personnel and logistics to serve it, it’s no small matter for a hospital to acquire a helicopter. Plus, given the fact that in many cases the helicopter is used to fly patients away from the primary base, effectively subsidizing a larger hospital by serving patients to it, the aircraft can be a money losing proposition. Still, much of modern medicine itself is based on unknown outcomes, and patchwork intervention, so continued use of helicopters certainly isn’t an aberration in that sense. They don’t call it practicing medicine for nothing.
Here’s how the system works, and why sometimes it doesn’t. At the basic hospital based operation, which is the typical HEMS arrangement, the aircraft is available 24/7, weather permitting, and the crew is available all the time as well. Most HEMS operations in this country operate on what is referred to as VFR, or Visual Flight Rules, meaning pilots must be able to see where they’re going to safely accept a mission. This may sound ridiculous, but visual means as opposed to IFR, or Instrument Flight Rules, that is, utilizing the FAA’s nationwide system of radio transmitted takeoff, navigation and landing infrastructure, with a readout in the cockpit, in order to get around. HEMS operations are, as a rule, VFR, because the onboard equipment is expensive, heavy, maintenance intensive and training intensive as well. With the average HEMS flight just over 40 minutes, and flown below 3,000 feet, VFR works just fine.
Most HEMS operations have a staff of four pilots, a mechanic, and usually ten to twelve medical personnel. Patients served by HEMS crews are very ill, or badly injured. They require the services of two medical staff enroute. Very few HEMS operations fly a physician; doctors’ time and talents are better suited to ERs and ICUs. In fact, flight nurses and flight paramedics are better trained and acclimated to the pre-hospital environment than most doctors are.
Given a mission request, the HEMS pilot will check weather, and, depending on conditions will either accept or reject the patient flight. The decision is always the pilots’, for safety and other reasons, such as FAA pilot in command regulations. If the pilot accepts the mission, the medical crew assembles at the aircraft, a short safety brief is conducted, and shortly the aircraft is enroute to either a smaller requesting hospital or the scene of an accident.
On arrival at the patient, the medical staff focuses on their client, the pilot becomes the observer, waiting, keeping track of weather conditions and flight-related matters. If the system works as it’s supposed to, that is in as safe and efficient manner as possible, the flight crew duties are sharply defined, with very little overlap. In my tenure as a HEMS pilot I never once did CPR; I never relinquished the flight controls to a nurse, either. It was a highly complimentary arrangement.
Once the patient is stabilized, and safely inside the helicopter, the pilot takes off, flies to whichever medical facility the nurses dictate, or the patient requests if they’re conscious. On arrival there, the patient is taken inside, and the pilot refuels, and supervises the housekeeping of the aircraft.
That’s the overview of the actual operation, the how of it. Here’s the why of it. As I mentioned, I feel there are too many hospital based helicopters. But for those remaining, they’re a vital part of the nation’s healthcare infrastructure just because of the basic nature of the aircraft: helicopters are little more than movable platforms that transport people and things across terrain that may be clogged with traffic, served only by a two lane road, is far removed from definitive medical care for a severely injured patient, or acts as another kind of obstacle. One of the primary uses for the helicopter is back up for local EMT/Paramedic teams. Though they generally do a fantastic job, these pre-hospital workers are the first to admit they’re in over their heads when a patient begins circling the drain. Calling the helicopter is a routine thing for them, following closely defined protocols. Something else the helicopter does is keep ambulance assets close to a home base, rather than take a rig away from a county or locale where EMS assets are already restricted.
But it’s saving time where the helicopter really shines. Rather than an hour, or two, or three in the back of an ambulance, a patient can be aboard the aircraft for half or a third of that time, all the while under the supervision and care of two highly trained and specialized medical personnel. Time is critical for many patients; time out of a hospital is even more so.
Medical people talk about morbidity. It means the diminution of a patient’s long-term prospects, based largely on their pre-hospital care. In my time in HEMS I saw many patients who should have either died, or at least had severe restrictions in their ability to function following their medical emergency. In many cases the helicopter saved lives, but the more valuable outcome for those patients who survived was that they had fewer long-term affects. This translates to lower long-term rehab and associated costs, and is just better all around.
The health care system needs to be fixed; in some ways it’s sicker than its clientele. Helicopters play a vital role in the overall picture of that repair. If HEMS aircraft save time, they need to be kept in place, and used appropriately to the benefit of everyone.
Byron Edgington is a former commercial helicopter pilot, public speaker, and author of the soon to be published aviation memoir, The Sky Behind Me. Byron and his wife, Mariah live in Ohio, where they promote solid marriages. They are the creators of http://www.caffection.com, a resource for married couples. Contact: email@example.com.