Life Flight Network

Life Flight Network

Life Flight NetworkPresentation to Latah County Emergency ManagementDominic Pomponio RN, CCRN, CEN, CFRN, NREMT-IBase Manager, Life Flight 79 Lewiston, IDAgendaOverview of Life Flight NetworkOwnership and HistoryService AreaCrew Configuration Activation and Air Medical NecessityTime Sensitive IllnessMembershipLanding Zone SafetyOutreach, Education, and Training

Hospital Consortium

Life Flight Network (LFN) is a medical transport service provided by a consortium of Oregon Health & Science University, Legacy Health, Saint Alphonsus Regional Medical Center, and Providence Health and Services

LFN is one of the country's oldest, safest, and most respected air ambulance providers. Beginning in 1978 as Emanuel Life Flight, the program was the first hospital-based air ambulance on the West coast and only the 4th in the nation. In October 1, 2007 when LFN formally separated from the hospital structure with its two bases located in Hillsboro OR and Aurora OR where the headquarters currently are. Not long afterward we opened bases in Eugene, OR; and Dallesport, WA; to better serve our existing customers and to provide much needed air medical service to growing distant communities. LFN opened our base Longview, WA in 2008. LFN's first ground based critical care ambulance was placed into service January 1, 2009. In September 2009, Boise-based Saint Alphonsus Life Flight joined LFN with the addition of 4 bases in Idaho and Eastern OR. This merger helped LFN become one of the largest hospital consortium air medical companies in the United States.

3HistoryFounded 1978 as Emanuel Life FlightBecame hospital/community hybrid in 2007Expansion to Eugene and Dallesport in Spring 2008Expansion to Longview in Fall 2008Merge with St. Alphonsus Life Flight in Fall 20092009 Air Medical Program of the Year

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Service Area

5Flight Crew InformationPilotFlight NurseCertified PALS, BLS, ACLS, NRP, PHTLS, TNATCAdvanced skills training chest tubes, emergent cricothyrotomyFlight ParamedicField EMS TrainingNREMT-PPALS, BLS, ACLS, NRP, PHTLSBLOOD

Safety is our #1 priority!Life Flight Network rotor pilots have extensive flight experience in rotor wing operations. . Most Life Flight Network rotor wing pilots far exceed those requirements, with an average of 5000 rotor wing flight hours. 6Clinical Operations

We carry a full complement of Critical Care and Emergency medicationsClinical OperationsLTV 1200 Ventilator

Clinical Operations2 units of O-Negative PRBCs

ActivationResponding paramedic, first response incident commander, specific non-EMS personnel, or physician on scene

How Closest aircraft area of about 150 miles, unlimited areas with FW

Non-EMS personnel (logging crew bosses, wind farms, bonneville power, or police)20 minutes for fixed wingWhy In most setting, this decision is a combination of either direct medical order via radio/telephone or standing orders based on trauma score and protocols.10General CriteriaPosition Papers from AAMS and NAEMSPPatient requires critical care life supportPatient requires short out of hospital timeHigh potential for delays with ground transportRemote area inaccessible to regular ground trafficPatient requires specific or timely treatment not available at the referring hospital or facility.Patients clinical condition is familiar to receiving hospitals physiciansUse of local ground transport team would leave the local area without adequate EMS coverage.Delays include road obstacles and traffic and delays are likely to worsen the patients clinical status

4. Remote locations with isolated injury patients that could create a prolonged painful transport (i.e. logging injury)

7b: Situations with limitations (mass casualty, lack of availability of ground transport or specialty care personnel)Why use air medical transport?To improve access to tertiary and specialized careTo aim for a reduction in out of hospital timeEMS regional or state-approved protocol identifies need for on-scene air transport; or EMTALA physician certified inter-facility transferRisk of death from same injury or illness remains significantly higher in rural areas versus suburban and urban centers

Studies confirm that rotor, fixed wing, and critical care ground transport are cost effective strategies that improve access to teriary and specialized care. focus specifically on HEMS due to the questions about use and safety especially for scene responses.

Time is as much a determinant of outcome as a specific injury or illness the Golden Hour or other specific illness related time

Deployment of critical care teams with intensive care equipment and skills brings the resources of the trauma or specialty care center directly to the patients side whether at an accident scene, remote medical facility, or community hospital. Physician level interventions are initiated closer to the time of injury or illness and the risk of deterioration during transport between hospitals is minimized by shortening out-of hospital time.

Most recent national consensus criteria were developed by the National Association of EMS Physicians endorsed by the AMPA and AAMS.

Air Medical Physicians Association has published a list of medical conditions and appropriate recommendation based upon the work done by the Medical Conditions Work Group of the NRM that developed the Medicare Fee Schedule.Other important and widely used guidelines have been developed by American College of Surgeons, American Academy of Pediatrics and the American College of Emergency Physicians.

What Ive done is consolidated the NAEMSP and AAMS recommendations

11Air Medical Necessity GuidelinesTRAUMAHead and/or spine injuriesSignificant penetrating injury above mid-thigh, in torso, or headChest injuriesUnstable vital signsBurns >10% BSA or major burnsMajor electrical/chemical burnsAmputation or near-amputation2 or more long bone fractures or major pelvic fractureScalping or degloving injurySignificant mechanism of injuryNON-TRAUMAAny patient airway that cannot be maintainedCardiac disease with progressive deteriorationUnstable cardiac patientsSevere or acute neurological illnessToxic exposure or electrolyte disturbancesUnstable vascular emergencyCritically ill obstetric patientsCritically ill pediatric/neonatal patientsTransplant patientsSICK patientRecommendations are from the Position Statement for the Air Medical Physician Association want to emphasize non-trauma usage.

Head injuries (GCS