Medics train for emergency service in the air

MAT-SU -- Imagine running into a tree in a four-wheeling accident while riding near Point MacKenzie. Your riding partner has a cell phone, calls 911 and an ambulance responds, but responders decide the severity of your injuries require you to be transported by helicopter to Providence Alaska Medical Center in Anchorage. LifeGuard is unavailable, but the Alaska State Trooper helicopter can go. One problem -- although your medic has been trained in air operations, he's never actually taken care of a patient in the air and, truth be told, is a little leery of riding in a helicopter altogether.

The situation can leave both patient and responder a little unsettled, to say the least.

"It's a whole different set of [gravitational] forces, temperature ranges, noise and vibration levels you don't get in an ambulance," said Mat-Su Borough Emergency Services Coordinator Mel Vostry.

That's why, on July 31 through Aug. 2, Mat-Su Borough emergency responders took part in a training program aimed at giving them a little off-the-ground experience.

"This is the fourth year we've had it," Vostry said. "It is a state-approved air medivac and air operations class. It's somewhat unique -- we're the only class, the only agency ... that provides in-flight training for the medics who take it."

About 15 took the three-day course earlier this month. Those who took part in the class put their mettle to the test Saturday when they flew in Alaska State Troopers' Helo 1, the Civil Air Patrol Beaver and Alaska Division of Forestry's Aerocommand. Although Aeromed International's Lear jet, Providence Alaska Medical Center's LifeGuard helicopter and the Alaska Army National Guard's Blackhawk helicopter were scheduled to attend, all four were either away on missions or were grounded to allow their onboard staff mandatory down-time.

Vostry said those who took the class were emergency responders from both the fire and ambulance sides of the borough's emergency services.

"We tried to get people into the class who were going to be the most likely to be put in an air [medivac]," Vostry told the class July 31. "If we call for a medivac out on a small lake in the Willow area and get the AST helicopter or George's Flying Service, guess who's going on that air flight? Hopefully, the best-qualified person for that mission ... we'd rather have an EMT 2 who can go on a flight ... than a paramedic who's afraid of heights."

Vostry said the goal of the training was to give the emergency responders information about what resources are available, what gear is needed and what they need to be prepared for if they're asked to help transport a patient in the air. It doesn't happen often, Vostry said -- maybe three to four times each year -- but preparation is key and being prepared for any situation is a large part of fire and EMS training.

One of the key decisions in air transport, Vostry told responders, is knowing when to request transport and how to weigh the merits of transport by methods other than LifeGuard. The 210th Air National Guard, for example, is sometimes called to medivac a patient if other responders are busy, but Vostry said it takes about 1 1/2 hours for their helicopter to be ready, from startup to liftoff. Other transport options, such as the Division of Forestry helicopter, may be available only certain months of the year or, like LifeGuard or air taxi services, require a cost to the patient or the borough. Transporting the patient to Valley Hospital for treatment makes the most sense in the majority of cases, but there are some exceptions that warrant a more immediate response -- some of which may be surprising to those outside the emergency responder circle.

At the training meeting, Vostry presented several slides of injuries, gave responders a potential scenario and asked them to make the decision of how and where to transport the patient. One scenario involved a young boy who had mangled his hand in an accident with a grinder in Willow. Responders weighed the facts -- intricate surgery on hands is generally not done at Valley Hospital, but good vital signs and little blood loss meant transporting the patient by land may not put the patient in more danger, so transport by ambulance may be the easiest method of getting the patient to treatment.

In an incident such as the four-wheeling accident mentioned earlier, the severity of injuries would be weighed along with the risk to emergency responders. Traveling at high speeds to transport a patient in need of immediate treatment back down Knik-Goose Bay Road would, in that instance, raise the potential risk not only to the patient but to responders.

The decision to transport isn't always clear, and may be tempered by the availability and feasibility of other rescue forms. High winds could prevent helicopter rescue, as could distance from a safe landing space. Ultimately, Vostry told responders, there should be one clear goal in mind:

"Deliver the patient to their destination in a condition at least as stable as the time of departure and do no harm," he said.

Saturday, as the session was wrapping up, several of the responders had a new perspective on flight.

"I'd rather be in an ambulance all day," said Sam Reder, with Central Mat-Su Emergency Services.

Reder, along with Shawn Brown, also with Central Mat-Su Emergency Services, said flying with a patient presented a host of new problems, a lack of space being the most immediate.

"It's cramped," Brown said. He and Reder explained that the lack of space requires forward thinking. Devices such as blood pressure cuffs need to be on the patient before they're put on board, and any supplies needed for treatment, if options such as the AST helicopter are being used, must be carried on board with the medics.

Although having the knowledge and being prepared is important, Reder said many times those alternative options -- or LifeGuard, for that matter -- simply aren't available.

"They're spread pretty thin here," Reder said. "I have yet to call up LifeGuard and have them say we're available ... For us, sometimes it's just easier to stay in the ambulance."

"It's all about time," Brown said.

The planes and flight time for the yearly class are generally provided at little cost to the borough. Flight time and personnel time for the AST helicopter and pilot Mel Nading was donated by the division. Planes and pilot time for the Civil Air Patrol and Forestry planes were offered at a reduced rate, and Hinchinbrook Aerofuels of Palmer helped support the class by donating aviation fuel.