This morning, I received the horrible news that a fellow instructor for the wilderness medicine education company I work for, a flight nurse/paramedic, was killed in a medical helicopter crash. I knew him only by reputation, but given our small community it's a safe bet that we would have become good friends, as with so many of the other instructors I've worked with in my time with the company.
This is the second instructor that our professional family has lost to an airmedical crash in roughly 5 years, which is difficult to accept because our company has always believed, and taught our students, that helicopter rescue/transport is inherently high-risk and to be reserved for patients who will truly benefit from that risk. Lest we leave any ambiguity in our students' minds about "risk", we define it into two components; probability and consequence. I make it a point in every class I teach to say that although the statistical probability of a helicopter crash is low (http://helicopterannual.org/portals/27/pdf/ann_p2c5.pdf), the human consequences of a crash are often gut-wrenching.
Ironically, this concept (readily understood by professional guides, wilderness education college students, and outdoor enthusiasts) is largely misunderstood or ignored by medical professionals.
We frequently call for helicopter transport of trauma patients who will not benefit from it (http://www.ncbi.nlm.nih.gov/pubmed/16766969). This study identified that over HALF of patients transported by helicopter had minor injuries. A quarter of them were discharged from the hospital within 24 hours; internal data from a trauma center in the state I previously lived in upped that number to 50%. This overtriage of patients not only increases the probability of a crash, but also reduces the cost-effectiveness of helicopter EMS to society (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999834/). And even for those patients with "major trauma", the published research doesn't clearly show a significant benefit to helicopter usage (http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009228.pub2/abstract;jsessionid=F0489278656882C0B38725F70F5A44D3.f03t01).
We need to take a deep breath and evaluate how we use helicopters.
I use the CDC's most recent field triage guidelines to make risk-benefit decisions about flying patients to a trauma center (http://www.cdc.gov/fieldtriage/pdf/decisionscheme_pocketcard_a.pdf). As a general rule, patients with physiologic instability (step 1) will probably get flown. Patients with anatomic injuries (step 2) might get flown, based on distance to the appropriate trauma center and time sensitivity of their injuries. Patients with a concerning mechanism of injury (step 3) or special considerations (step 4) probably WON'T get flown; I'll either take them by ground to the trauma center or to a non-trauma center that has the diagnostic capabilities the patient needs (X-rays, CT scanners, etc.). Many providers I've worked with in the past have used the mechanism of injury as their sole basis for flying a patient; this is not a very accurate gauge of what care the patient needs (http://www.ncbi.nlm.nih.gov/pubmed/24165248).
It's time to focus on the injuries a patient HAS, not ones they MIGHT have, when we ask three people to risk their lives to transport that patient.
Our colleagues, friends, and mentors are counting on us for that.
