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INTRODUCTION

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Air medical transport consists of helicopter (or rotor-wing) and airplane (or fixed-wing) transport and is an important component of EMS systems for prehospital care and interfacility transport. These specialized vehicles offer fast speeds, ranging from 100 to 200 miles per hour for helicopters to >500 miles per hour for airplanes. Although many ill and injured patients can be transported safely by ground, air medical transport provides added medical assessment and care capabilities beyond those of the paramedic-staffed ground ambulance. Guidelines for the use of air medical transport exist, but field EMS personnel and physicians involved in transfer decision making should be able to consider situational circumstances to determine the appropriate transportation mode.

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Weather can be an operational limitation, particularly for helicopters. The radius of service differs between helicopters and fixed-wing craft, but, as a general rule, fixed-wing transport is considered when weather conditions are poor or when transport distances exceed 150 to 200 miles.

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The complexity of air transport far exceeds the simple act of loading a patient on an airborne vehicle. National organizations such as the Air Medical Physician Association, the Committee on Accreditation of Medical Transport Systems, and the National Association of EMS Physicians have published texts, position statements, and guidelines covering aspects of air medical transport. The Air Medical Physician Association (http://www.ampa.org) Air Medical Physician Handbook is a particularly helpful resource for medical issues. The Committee on Accreditation of Medical Transport Systems (http://www.camts.org) accreditation standards address medical, aviation, organizational, and operational issues. The National Association of EMS Physicians (http://www.naemsp.org) has created detailed position statements and guidelines addressing helicopter EMS trauma and nontrauma triage criteria, as well as training of physicians involved as air medical crew or medical directors.

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Rigorous training programs, covering both cognitive and procedural skills, enable flight crews to provide a high level of intratransport care. In-flight communications capabilities should include the ability of the air medical crew to speak with medical control physicians, as well as arrange for any change of plan (e.g., direct transport to the operating suite) necessitated by patient condition.

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HELICOPTER TRANSPORT

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AVIATION ISSUES

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Individual hospitals, hospital systems, or private for-profit enterprises run most U.S. civilian air transport programs. Because helicopters are expensive (ranging from $750,000 to more than $5 million each) and other aviation needs (e.g., maintenance, pilot training) are also resource intensive, most hospital-based programs lease their helicopters from vendors. The air medical program typically provides and equips communications and medical personnel, whereas the aircraft vendor supplies the helicopters, pilots, and maintenance personnel. Although costs vary depending on geographic region, patient case mix, equipment and aircraft used, and even the methods used for their calculation, annual operating costs for a rotor-wing service typically exceed $2 million.

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Safety is an overriding consideration for air transport. Optimization of safety begins well before ...

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