Air Medical Dispatch Criteria

General Criteria

• Patient requires critical care life support
• Clinical condition requires that out of hospital time be minimal
• Potential delays associated with ground transport may worsen the patient's status
• The patient is located in an area which is inaccessible to ground traffic
• The patient requires specific or timely treatment not available at the referring agency
• The patient's clinical condition requires that care be given by a physician at the receiving hospital who is intimately familiar with the patient's history
• The use of local ground transport team would leave the local area without adequate EMS coverage

Physiologic and Hemodynamic Criteria

• Patient is Unconscious / Unresponsive to voice commands
• Respiratory or Airway difficulty
• Decreased level of consciousness (GCS <13)
• Penetrating injury to head, neck, torso or proximal extremity
• Two or more proximal long bone fractures
• Severe, uncontrollable hemorrhage
• Hypotension
• Unexplained tachycardia
• Depressed or open skull fracture
• Unstable pelvic fracture
• Flail chest or chest wall instability
• New onset paralysis or suspected spinal cord injury
• Revised Trauma Score <11
• Pediatric Trauma Score <9
• Amputation of limb proximal to wrist or ankle
• Trauma with concurrent burns of >15% BSA

Mechanism of Injury

• Vehicle roll-over
• Victim ejected from vehicle
• Auto vs Pedestrian or bicycle 
• Pedestrian thrown or run over
• Scalping or degloving injury
• Death of occupant in same vehicle in crash
• Extrication time in excess of 20 minutes
• Fall from > 20 feet (>10 feet for child)
• Victim of high-speed motor vehicle crash:  Adult >40 MPH / Child >20 MPH
• Major auto deformity, intrusion into passenger compartment
• Any motorcycle crash, especially if ejected

Miscellaneous Indications

• Multiple victims
• Difficult ground access
• Farm accident
• Aircraft Mishap
• Trauma victims with extremes of age <5 y/o or >55 Y/O
• Injured patient with underlying lung or cardiac disease
• Injured patient who is pregnant
• Injured patient who is immunosuppressed
• Injured patient with bleeding disorder or who is on anticoagulation medication
• Near drowning
• Major burns (without associated traumatic injury)

Information from - "Air & Surface Patient Transport, Principles & Practice" Third Edition, 2002

Central Nervous System

• Penetrating injury or depressed skull fracture
• GCS <14 or deteriorating GCS
• Spinal Cord Injury

Chest

• Widened mediastinum
• Pulmonary contusion
• Patients who may require prolonged ventilation

Pelvis / Abdomen

• Unstable pelvic ring fracture
• Open pelvic fracture

Extremity

• Severe open fractures
• Traumatic amputation with potential for re-implantation
• Ischemic Injury

Multisystem Trauma

• Injury to more than two body regions
• Major burns associated with multiple trauma
• Multiple proximal long bone fractures

Comorbid Factors

• Age 55 years
• Pediatric patients
• Cardiovascular disease
• Pulmonary disease
• Pregnancy

Secondary Deterioration

• Mechanical ventilation required
• Sepsis
• Multiple-organ system failure

American College of Emergency Physicians

Information from - "Air & Surface Patient Transport, Principles & Practice" Third Edition, 2002

1. The health and well-being of the patient must be the overriding concerns when any patient transport is considered.

2. The patient should be evaluated before transfer (from one facility to another).

3. The referring personnel should stabilize the patient (to the extent possible) before transport.

4. The patient and patient's family should be informed about the reasons for and the risks of transport.

5. The patient should be transferred to a facility that is appropriate to the medical needs of the patient and that has adequate space and available personnel.

6. The receiving facility must agree to accept the patient.

7. Economic reasons should not be the basis for transferring a patient to a receiving facility or refusing to admit a patient at a receiving facility.

8. Information about the patient's condition and initial care must be communicated to the receiving facility.

9. The patient should be transferred in a vehicle that is staffed by quality personnel and that contains the equipment necessary to provide appropriate treatment for the patient who is being transferred.

10. When possible, written protocols and transfer agreements should be in place.

Summary of American College of Critical Care Medicine Guidelines for the Transport of the Critically Ill or Injured Patient. 

Information from - "Air & Surface Patient Transport, Principles & Practice" Third Edition, 2002

1. The benefits of transferring the patient should outweigh the risks.

2. The practitioner needs to be aware of the legal implications of patient transfer and transport.

3. Before the patient is transported, physicians and nurses at the referring and receiving facilities should be in contact, a decision made about the mode of transportation to be used, and a copy of all medical records relevant to the patient's care should be secured.

4. Accompanying transport personnel should include a minimum of two patient care providers and a vehicle operator. At least 1 care provider should be a registered nurse.

5. The equipment (including monitors) and medications necessary to manage the patient's airway, breathing, and circulation should be available. Communication equipment used during transport should also be available.

6. Continuous monitoring should take place during transport. At a minimum ECG monitoring and monitoring of vital signs are required. Patients with specific problems may require additional monitoring, such as capnography and invasive monitoring.

Appropriateness of Air Medical Transport in Acute Coronary Syndromes

Information from "Air & Surface Patient Transport, Principles & Practice" Third Edition, 2002.

Background: Acute coronary syndromes and common reasons to utilize air medical transport.
Regionalization of cardiac care to highly specialized centers, increasing use of invasive and time-sensitive therapies, and efforts to minimize both the absolute time to therapy and the dangerous out of hospital time are significant drivers in improving cardiac care and for increasing the utilization of air medical transport.

Air Medical Physicians Association (AMPA) Position Statement. Approved by the AMPA Board of Trustees November 10, 2001.
AMPA supports the use of air medical transport for adult patients with acute coronary syndromes requiring or potentially requiring urgent/time-sensitive intervention not available at the sending facility As outlined by the American Heart Association, acute coronary syndromes represent the spectrum of clinical disease presenting with syndromes ranging from unstable angina to Q-wave an non-Q-wave myocardial infarction.

It is AMPA's position that the determination for the urgent/time-sensitive interventions is made by a physician, as documented on a written Certification of Medical Necessity.

Furthermore, AMPA acknowledges that scene air medical transport of acute coronary syndromes occurs routinely and supports that the medical necessity is determined by the requesting authorized provider based on regional policy and their best medical judgment at the time of the request for transport. AMPA supports that a receiving physician or the transport program medical director may complete the Certification of Medical Necessity on scene transports.

AMPA does not support the use of discharge ICD-9 codes or other methodologies that retrospectively determine medical appropriateness of acute coronary syndromes as this may adversely restrict access to appropriate care and may contradict the intent of EMTALA regulations. AMPA also believes that retrospective determination of medical appropriateness also negates the regional, environmental, level of pre hospital care, and situational issues that are important factors in determining medical appropriateness for air medical transport in acute and potentially acute coronary syndromes.