By DR. CHRIS MAGOVERN
As a cardiac surgeon, when I’m called from another hospital to accept the transfer of a critically ill patient in the midst of a heart attack or major cardiac event … I know that seconds count.
For years, the ground ambulance has served as the conventional means of providing this inter-facility transport, and it continues to be our workhorse today. But with the widespread availability of helicopter medevac transport, the landscape is now changing.
Certain life-threatening medical emergencies such as cardiac arrest, heart attack, stroke, burn injuries and trauma are best managed at tertiary medical centers that are able to provide more advanced levels of support than rural and community hospitals. Today, because of the availability of helicopter medevac transport, thousands of lives are saved every year because these critically ill patients are now able to receive sophisticated emergency care in minutes rather than hours.
If I expect to have to perform emergency cardiac surgery on a patient being transferred from another hospital, I will request a helicopter medevac transport. As the patient is being transferred, we will simultaneously prepare an operating room and have a team “scrubbed and ready to go,” so that once the helicopter lands on our roof, it will be only minutes before we’re able to start the life-saving operation.
The speed and efficiency of patient transport can mean the difference between life and death.
These are lessons we’ve learned from our military. Wounded soldiers in WWI that didn’t receive medical care for more than eight hours after their injuries had a survival rate of only 25 percent, yet those soldiers treated within an hour had a 90 percent chance of survival. It became clear that transporting these injured soldiers to field hospitals within an hour would now become a priority … we would soon discover that the helicopter would become the solution to this problem.
The introduction of the medevac helicopter during the Korean War in the 1950s revolutionized the evacuation of injured soldiers; it’s estimated that 20,000 injured soldiers were evacuated in this fashion. This new method of evacuation, in part, helped to double the survival rate of soldiers injured during the Korean War.
Military helicopter transport continued to evolve over the years.
During the Korean War, the Bell 47, with its classic bubble front (made famous in the movie and TV series “M*A*S*H”) was so small that there was only room for a pilot and crew of one or two onboard. Casualties were placed outside the helicopter in baskets mounted on the helicopter skids. These external liters did not allow for any medical care during transport.
During the Vietnam War, the Bell 47 was replaced with the Bell UH-1 or “Huey.” This was a larger helicopter that could now transport casualties inside the helicopter, where a crew of medics could perform procedures and stabilize injuries during flight. This in-flight care helped to further improve survival rates.
By 1970, military medevac transport was so efficient, that you were more likely to die from injuries in a motor vehicle accident on a freeway in California than from enemy fire in Vietnam. This inspired the introduction of paramedics and ultimately helicopter medevac transport into the civilian community.
Today there are more than 900 medevac helicopters in the United States that annually transport more than 400,000 patients. Of these flights, 55 percent involve transport of patients from one medical institution to another (for specialized medical care that the original institution was unable to provide), 30 percent involve evacuation of victims from the scene of an accident, and 15 percent are used for organ procurement for transplantation surgery.
Today’s medevac helicopter is a far cry from the original Bell 47; most are now medium to large capacity, multi-engine helicopters, capable of delivering state of the art care while in flight, equipped with oxygen, defibrillators, ventilators, monitoring equipment, and emergency medications. They are staffed by physicians, paramedics and in-flight nurses. Medevac helicopters are designed so that the pilot and his flight deck are completely isolated from the patient care area, to ensure that the pilot remains focused on his job, and isn’t distracted by the patient’s condition.
Consistent with what we have learned from our military, care of the trauma patient in the United States is founded on the principle of “scoop and run,” a practice that involves transporting the victim as quickly as possible, to a hospital that can provide the proper level of trauma care. This is a different approach than what is practiced in Europe.
Many European countries provide more extensive care of the trauma patient “in the field,” will transport patients to a hospital only after the patient has been stabilized and treated at the scene of the accident, and will not “race” to the hospital, for fear of aggravating injuries.
There is speculation that this European approach may have contributed to Lady Diana’s death following her motor vehicle accident in Paris in 1997, as almost two hours elapsed from the time the ambulance arrived at the scene until it ultimately arrived at the hospital. It is quite possible that a “scoop and run” approach might have saved her life.
Dr. Chris Magovern is a cardiothoracic surgeon at Morristown Medical Center and ABC News contributor.