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To the Choppa! Best Practice in Air Ambulance Utilization

November 5, 2021

Written by Aaron Lacy

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Air ambulances should only be used to accomplish the patient centered goals of providing initiation or continuation of locally unavailable advanced care, expedite delivery for time sensitive conditions, and/or assist with extrication from remote locations in which ground EMS would be unfeasible.

Why does this matter?
Air ambulance use is resource intensive, potentially financially crippling for patients, and is not without risk to both ground and air crews. We strive for proper resource utilization and safety in medicine, and air ambulances are not exempt.

Get to the Choppa?
This is a position statement from the National Association of EMS Physicians, ACEP, and the Air Medical Physicians Association and is an update from the last position statement published in 2013. There are three main components to the statement:

  1. Clinical Considerations
    Air Medical Services should be used to accomplish:
    – Initiation or continuation of advanced or specialty care that is not otherwise available
    – Expedited delivery of patients with time sensitive conditions (STEMI, stroke, etc)
    – Extraction, evacuation, and/or rescue from environments that are difficult to access (weather, geography, distance, etc).

    If these needs can be met by EMS ground resources, that is the preferred mode of transportation.

  2. Risk Identification and Safety Considerations
    – Before calling for an air ambulance, weigh the risk to patient and crew against the reasonably anticipated degree of medical benefit to the patient.
    – “Helicopter shopping,” the process of making calls to multiple air agencies after an initial service has declined due to safety concerns should not be engaged in. “Reverse helicopter shopping” is the process of air ambulance agencies seeking out and offering transfers that have already been declined by other agencies due to a safety concern. That’s also bad.

  3. System Integration and Quality Assurance Considerations
    – To ensure consistent and informed decisions, requests should be routed through a centralized coordinating center with access and oversight from EMS physicians.
    – All stakeholders should understand, adhere to, and update utilization guidelines.

I’m an emergency physician who engages air ambulances for transfers of patients and a practicing helicopter provider for my institution’s air ambulance service. I have seen firsthand how, when utilized correctly, we can provide great benefit to our patients – but only when used correctly. As EM physicians we need to feel empowered to engage all stakeholders and start dialogue to make sure this incredible patient resource remains sustainable.

Appropriate Air Medical Services Utilization and Recommendations for Integration of Air Medical Services Resources into the EMS System of Care: A Joint Position Statement and Resource Document of NAEMSP, ACEP, and AMPA. Prehosp Emerg Care. 2021 Oct 4;1-20. doi: 10.1080/10903127.2021.1967534. Online ahead of print.

What are your thoughts?