Air medical services

Air medical services is a comprehensive
term covering the use of air transportation, airplane or helicopter,
to move patients to and from healthcare facilities and accident scenes.
Personnel provide comprehensive prehospital and emergency and critical
care to all types of patients during aeromedical evacuation or rescue
operations aboard helicopter and propeller aircraft or jet aircraft.
The use of air transport of patients dates to World War I, but its role was
expanded dramatically during the Korean and Vietnam conflicts. The first
hospital-based air medical service began in Denver at St. Anthony hospital in
1972. Helicopters are used to transport patients between hospitals and from
trauma scenes; fixed-wing aircraft are used for long-distance transports.
Advantages The advantages of medical transport by
helicopter may include providing a higher level of care at the scene of
trauma and improving access to trauma centers. Helicopter-based emergency
medical service also provides critical care capabilities during interfacility
transport from community hospitals to trauma centers.
Indications for air transport Effective use of helicopter services for
trauma depends on the ground responder’s ability to determine whether the
patient’s condition warrants air medical transport. Protocols and training must
be developed to ensure appropriate triage criteria are applied. Excessively
stringent criteria can prevent rapid care and transport of trauma victims;
relaxed criteria can result in the embarrassing and costly situation of
transporting a patient by helicopter only to have the patient discharged in
good condition from the emergency department.
Crew and patient safety is the single most important factor to be considered
when deciding whether to transport a patient by helicopter. Weather, air
traffic patterns, and distances must also be considered. Another reason for
cancelling a flight is based on Flight Crew comfort with the flight. The
general rule of safety is upon the crew, when there is one pilot and two medical
crew is: 3 to go, 1 to say “NO”. If one Flight Member is not comfortable with
the flight for whatever reason, the flight is cancelled.
Some have questioned the safety of air medical services While the number of
crashes may be increasing, the number of programs and use of services has also
increased. Factors associated with fatal crashes of medical transport helicopters
include flying at night and during bad weather, and postcrash fires.
Air ambulance An air ambulance is a specially
outfitted aircraft that transports injured or sick people in a medical
emergency or over distances or terrain impractical for a conventional ground
ambulance. These and related operations are called aeromedical. In some
circumstances, the same aircraft may be used to search for missing or wanted
people. Like ground ambulances, air ambulances
are equipped with medical equipment vital to monitoring and treating injured
or ill patients. Common equipment for air ambulances includes medications,
ventilators, ECGs and monitoring units, CPR equipment, and stretchers. A
medically staffed and equipped air ambulance provides medical care in
flight—while a non-medically equipped and staffed aircraft simply transports
patients without care in flight. Military organizations and NATO refer to
the former as medical evacuation and to the latter as casualty evacuation.
= History= Military
As with many Emergency Medical Service innovations, treating patients in flight
originated in the military. The concept of using aircraft as ambulances is
almost as old as powered flight itself. Although balloons were not used to
evacuate wounded soldiers at the Siege of Paris in 1870, air evacuation was
experimented with during the First World War. The first true Air Ambulance flight
was made when a Serbian officer was flown from the battlefield to hospital
by a plane of the French Air Service. French records at the time indicated
that the mortality rate of the injured was reduced from 60% to just under 10%
if they were evacuated by air. The first recorded British ambulance
flight took place in 1917 in Turkey when a soldier in the Camel Corps who had
been shot in the ankle was flown to hospital in a de Havilland DH9 in 45
minutes. The same journey by land would have taken some 3 days to complete. In
the 1920s several services, both official and unofficial, started up in
various parts of the world. Aircraft were still primitive at the time, with
limited capabilities, and the effort received mixed reviews.
Exploration of the idea continued, however, and France and the United
Kingdom used fully organized air ambulance services during the African
and Middle Eastern Colonial Wars of the 1920s. In 1920, the British, while
suppressing the “Mad Mullah” in Somalialand, used an Airco DH.9A fitted
out as an air ambulance. It carried a single stretcher under a fairing behind
the pilot. The French evacuated over 7,000 casualties during that period. By
1936, an organized military air ambulance service evacuated wounded from
the Spanish Civil War for medical treatment in Nazi Germany; this service
continued during the Second World War. The first use of medevac with
helicopters was the evacuation of three British pilot combat casualties by a US
Army Sikorsky in Burma during WW2, and the first dedicated use of helicopters
by U.S. forces occurred during the Korean War, between 1950 and 1953. The
French used light helicopters in the First Indochina War. While popularly
depicted as simply removing casualties from the battlefield, helicopters in the
Korean War also moved critical patients to hospital ships after initial
emergency treatment in field hospitals. Knowledge and expertise of use of air
ambulances evolved parallel to the aircraft themselves. By 1969, in
Vietnam, the use of specially trained medical corpsmen and helicopter air
ambulances led U.S. researchers to determine that servicemen wounded in
battle had better rates of survival than motorists injured on California
freeways. This inspired the first experiments with the use of civilian
paramedics in the world. The US military recently employed UH-60 Black Hawk
helicopters to provide air ambulance service during the Iraq War to military
personnel and civilians. The use of military aircraft as battlefield
ambulances continues to grow and develop today in a variety of countries, as does
the use of fixed-wing aircraft for long-distance travel, including
repatriation of the wounded. Currently, a NATO working group is investigating
unpiloted aerial vehicles for casualty evacuation.
Early air ambulance efforts Civilian
The first civilian uses of aircraft as ambulances were probably incidental. In
northern Canada, Australia, and in Scandinavian countries, remote, sparsely
populated settlements are often inaccessible by road for months at a
time, or even year round. In some places in Scandinavia, particularly in Norway,
the primary means of transportation between communities is by boat. Early in
aviation history, many of these communities began to rely on civilian
“bush” pilots, who fly small aircraft and transport supplies, mail, and
visiting doctors or nurses. Bush pilots probably performed the first civilian
air ambulance trips, albeit on an ad hoc basis—but clearly, a need for these
services existed. In the early 1920s, Sweden established a standing air
ambulance system, as did Siam. In 1928 the first formal, full-time air
ambulance service was established in the Australian outback. This organization
became the Royal Flying Doctor Service and still operates. In 1934, Marie
Marvingt established the first civil air ambulance service in Africa, in Morocco.
In 1936, air ambulance services were established as part of the Highlands and
Islands Medical Service to serve more remote areas of Highland Scotland.
Australia’s Royal Flying Doctor Service Air ambulances quickly established their
usefulness in remote locations, but their role in developed areas developed
more slowly. After World War II, the Saskatchewan government in Regina,
Saskatchewan, Canada, established the first civilian air ambulance in North
America. The Saskatchewan government had to consider remote communities and great
distances in providing health care to its citizens. The Saskatchewan Air
Ambulance service continues to be active as of 2011.
J. Walter Schaefer founded the first air ambulance service in the U.S, in 1947,
in Los Angeles. The Schaefer Air Service, operated as part of Schaefer
Ambulance Service. Schaefer Air Service was also the first FAA-certified air
ambulance service in the United States. When the Saskatchewan and Schaefer
services began, paramedicine was still decades away, and unless a physician or
nurse accompanied the patient, air ambulances primarily provided medical
transportation. A great deal of the early use of aircraft as ambulances in
civilian life, particularly helicopters, involved the improvised use of aircraft
that belonged to the military. Eventually, this became more organized.
This occurred not only in the United States, but also in other countries, and
persists today. Today in the U.S., helicopters and airplanes carry out
approximately a half million transports per year.
Military aircraft supporting civilian air ambulance
Two research programs were implemented in the U.S. to assess the impact of
medical helicopters on mortality and morbidity in the civilian arena. Project
CARESOM was established in Mississippi in 1969. Three helicopters were
purchased through a federal grant and located strategically in the north,
central, and southern areas of the state. Upon termination of the grant,
the program was considered a success and each of the three communities was given
the opportunity to continue the helicopter operation. Only the one
located in Hattiesburg, Mississippi did so, and it was therefore established as
the first civilian air medical program in the United States. The second
program, the Military Assistance to Safety and Traffic system, was
established in Fort Sam Houston in San Antonio in 1969. This was an experiment
by the Department of Transportation to study the feasibility of using military
helicopters to augment existing civilian emergency medical services. These
programs were highly successful at establishing the need for such services.
The remaining challenge was in how such services could be operated most
cost-effectively. In many cases, as agencies, branches, and departments of
the civilian governments began to operate aircraft for other purposes,
these aircraft were frequently pressed into service to provide cost-effective
air support to the evolving Emergency Medical Services.
Government Agency Aircraft Performing Double Duty
As the concept was proven, dedicated civilian air ambulances began to appear.
On November 1, 1970, the first permanent civil air ambulance helicopter,
Christoph 1, entered service at the Hospital of Harlaching, Munich, Germany.
The apparent success of Christoph 1 led to a quick expansion of the concept
across Germany, with Christoph 10 entering service in 1975, Christoph 20
in 1981, and Christoph 51 in 1989. As of 2007, there are about 80 helicopters
named after Saint Christopher, like Christoph Europa 5, Christoph
Brandenburg or Christoph Murnau am Staffelsee. Austria adopted the German
system in 1983 when Christophorus 1 entered service at Innsbruck.
The first civilian, hospital-based medical helicopter program in the United
States began operation in 1972. Flight For Life Colorado began with a single
Alouette III helicopter, based at St. Anthony Central Hospital in Denver,
Colorado. In Ontario, Canada, the air ambulance program began in 1977, and
featured a paramedic-based system of care, with the presence of physicians or
nurses being relatively unusual. The system, operated by the Ontario Ministry
of Health, began with a single rotor-wing aircraft based in Toronto. An
important difference in the Ontario program involved the emphasis of
service. “On scene” calls were taken, although less commonly, and a great deal
of the initial emphasis of the program was on the interfacility transfer of
critical care patients. Operating today through a private contractor, the system
operates 33 aircraft stationed at 26 bases across the province, performing
both interfacility transfers and on-scene responses in support of
ground-based EMS. Today, across the world, the presence of civilian air
ambulances has become commonplace, and is seen as a much-needed support for
ground-based EMS systems. In other countries of Europe, like SFR
Yugoslavia, first air ambulance appeared in the 1980s. The most of the fleet was
previously used in military service. With the increased number of car
accidents in 1979 on highways, the Yugoslavian government made a decision
to buy new or redistribution of use of old helicopters.
Modern civilian air ambulances = Organization=
Air ambulance service, sometimes called Aeromedical Evacuation or simply
Medevac, is provided by a variety of different sources in different places in
the world. There are a number of reasonable methods of differentiating
types of air ambulance services. These include military/civilian models and
services that are government-funded, fee-for-service, donated by a business
enterprise, or funded by public donations. It may also be reasonable to
differentiate between dedicated aircraft and those with multiple purposes and
roles. Finally, it is reasonable to differentiate by the type of aircraft
used, including rotary-wing, fixed-wing, or very large aircraft. The military
role in civilian air ambulance operations is described in the History
section. Each of the remaining models is explored separately. It should also be
noted that this information applies to air ambulance systems performing
emergency service. In almost all jurisdictions, private aircraft charter
companies provide non-emergency air ambulance service on a fee-for-service
basis. Government operated
In some cases, governments provide air ambulance services, either directly or
via a negotiated contract with a commercial service provider, such as an
aircraft charter company. Such services may focus on critical care patient
transport, support ground-based EMS on scenes, or may perform a combination of
these roles. In almost all cases, the government provides guidelines to
hospitals and EMS systems to control operating costs—and may specify
operating procedures in some level of detail to limit potential liability.
However, the government almost always takes a ‘hands-off’ approach to actual
running of the system, relying instead on local managers with subject matter
expertise. Ontario’s ORNGE program and the Polish Lotnicze Pogotowie Ratunkowe
are examples of this type of operating system. The Polish LPR is a national
system covering the entire country and funded by the government through the
Ministry of Health but run independently, there is no independent
HEMS operator in Poland. In North East Ohio, including Cleveland, the Cuyahoga
County-owned MetroHealth Medical Center uses its Metro Life Flight to transport
patients to Metro’s level I trauma and burn unit. There are 5 helicopters for
North East Ohio and, in addition, Metro Life Flight has one fixed-wing aircraft.
In the United Kingdom, the Scottish Ambulance Service operates two
helicopters and two fixed-wing aircraft twenty-four hours per day. These
represent the UK’s only government-funded air ambulance service.
Multiple purpose In some jurisdictions, cost is a major
consideration, and the presence of dedicated air ambulances is simply not
practical. In these cases, the aircraft may be operated by another government or
quasi-government agency and made available to EMS for air ambulance
service when required. In southern New South Wales, Australia, the helicopter
that responds as an air ambulance is actually operated by the local
hydroelectric utility, with the New South Wales Ambulance Service providing
paramedics, as required. In some cases, local EMS provides the flight paramedic
to the aircraft operator as-needed. In the case of the Los Angeles County Fire
Department the helicopters are brush fire choppers also configured as air
ambulances with a paramedic provided from whichever fire department rescue
unit has responded. Sometimes the air ambulance may be run
as a dual concern with another governmental body – for example the
Wiltshire Air Ambulance is run as a joint Ambulance Service and police unit.
In other cases, the paramedic staffs the aircraft full-time, but has a dual
function. In the case of the Maryland State Police, for example, the flight
paramedic is a serving State Trooper whose job is to act as the Observer
Officer on a police helicopter when not required for medical emergencies.
Fee-for-service In many cases, local jurisdictions do
not charge for air ambulance service, particularly for emergency calls.
However, the cost of providing air ambulance services is considerable and
many, including government-run operations, charge for service.
Organizations such as service aircraft charter companies, hospitals, and some
private-for-profit EMS systems generally charge for service. Within the European
Union, almost all air ambulance service is on a fee-for-service basis, except
for systems that operate by private subscription. Many jurisdictions have a
mix of operation types. Fee-for-service operators are generally responsible for
their own organization, but may have to meet government licensing requirements.
Rega of Switzerland is an example of such a service.
Donated by business In some cases, a local business or even
a multi-national company may choose to fund local air ambulance service as a
goodwill or public relations gesture. Examples of this are common in the
European Union, where in London the Virgin Corporation previously donated to
the Helicopter Emergency Medical Service, and in Germany and the
Netherlands a large number of the ‘Christoph’ air ambulance operations are
actually funded by ADAC, Germany’s largest automobile club and DRF
Luftrettung. In Australia and New Zealand, many air ambulance helicopter
operations are sponsored by the Westpac Bank. In these cases, the operation may
vary, but is the result of a carefully negotiated agreement between government,
EMS, hospitals, and the donor. In most cases, while the sponsor receives
advertising exposure in exchange for funding, they take a ‘hands off’
approach to daily operations, relying instead on subject matter specialists.
Public donations In some cases, air ambulance services
may be provided by means of voluntary charitable fundraising, as opposed to
government funding, or they may receive limited government subsidy to supplement
local donations. Some countries, such as the U.K., use a mix of such systems. In
Scotland, the parliament has voted to fund air ambulance service directly,
through the Scottish Ambulance Service In England and Wales, however, the
service is funded on a charitable basis via a number of local charities for each
region covered, although the service to London receives most of its funding
through the National Health Service. Great strides have been made in the UK,
with the ‘Association of Air Ambulance’. This organization is widely credited for
having created the political climate that made the helicopter industry and
National Health Service recognise the enormous contribution charities make to
trauma care in the United Kingdom. In 2013, the AAA published the “Framework
for a High Performing Air Ambulance Service” which details many of the
developments from 2008 to 2013. In recent years, the service has moved
towards the physician-paramedic model of care. This has necessitated some
charities commissioning clinical governance services, however many air
ambulances operate under the tasking ambulances services clinical governance.
The AAA now publishes Best Practice Guidance on a range of operational and
clinical functions and provides a code of conduct that all full members, both
ambulance services and charities must uphold.
“Heavy-Lift” A final area of distinction is the
operation of large, generally fixed-wing air ambulances. In the past, the
infrequency of civilian demand for such a service confined such operations to
the military, which requires them to support overseas combat operations.
Military organizations capable of this type of specialized operation include
the United States Air Force, the German Luftwaffe, and the British Royal Air
Force. The Swedish National Air Medevac – SNAM is an exception to the military
only rule where the system is owned by the Swedish Civil Contingencies Agency
Myndigheten för samhällsskydd och beredskap and the Boeing 737 Next
Generation#737-800 aircraft is provided under contract when so required by
Scandinavian Airlines. Each operates aircraft staffed by physicians, nurses,
and corpsmen/technicians, and each can providing long distance transport with
full medical support to dozens of patients simultaneously.
However, in recent years, exceptions to the “military-only” rule have grown with
the need to quickly transport patients to facilities that provide higher levels
of care, or to repatriate individuals. ADAC, the German automobile club,
Phoenix Air, and Mercy Jets Worldwide Air Ambulance, use both large and small
fixed wing aircraft configured to provide levels of care that can be found
in Trauma centers for individuals who subscribe to their own health insurance
or affiliated travel insurance and protection plans.
Heavy Lift Capability = Standards=
Aircraft and flight crews In most jurisdictions, air ambulance
pilots must have a great deal of experience in piloting their aircraft
because the conditions of air ambulance flights are often more challenging than
regular non-emergency flight services. After a spike in air ambulance crashes
in the United States in the 1990s, the U.S. government and the Commission on
Air Medical Transportation Systems stepped up the accreditation and air
ambulance flight requirements, ensuring that all pilots, personnel, and aircraft
meet much higher standards than previously required. The resulting CAMTS
accreditation, which applies only in the United States, includes the requirement
for an air ambulance company to own and operate its own aircraft. Some air
ambulance companies, realizing it is virtually impossible to have the correct
medicalized aircraft for every mission, instead charter aircraft based on the
mission-specific requirements. While in principle CAMTS accreditation
is voluntary, a number of government jurisdictions require companies
providing medical transportation services to have CAMTS accreditation to
be licensed to operate. This is an increasing trend as state health
services agencies address the issues surrounding the safety of emergency
medical services flights. Some examples are the states of Colorado, New Jersey,
New Mexico, Utah, and Washington. According to the rationale used to
justify the state of Washington’s adoption of the accreditation
requirements, requiring accreditation of air ambulance services provides
assurance that the service meets national public safety standards. The
accreditation is done by professionals who are qualified to determine air
ambulance safety. In addition, compliance with accreditation standards
is checked on a continual basis by the accrediting organization. Accreditation
standards are periodically revised to reflect the dynamic, changing
environment of medical transport, with considerable input from all disciplines
of the medical profession. Other U.S. states require either CAMTS
accreditation or a demonstrated equivalent, such as Rhode Island, and
Texas, which has adopted CAMTS’ Accreditation Standards as its own. In
Texas, an operator not wishing to become CAMTS accredited must submit to an
equivalent survey by state auditors who are CAMTS-trained. Virginia and Oklahoma
have also adopted CAMTS accreditation standards as their state licensing
standards. While the original intent of CAMTS was to provide an American
standard, air ambulance services in a number of other countries, including
three in Canada and one in South Africa, have voluntarily submitted themselves to
CAMTS accreditation. In the UK, the AAA has a Code of Conduct
that binds one of the most regulated areas of operation together. It brings
the Fundraising Standards Board, CAA / EASA and the CQC together ensuring
fundraising, air and clinical operations are inline with national regulation and
best practice. The code goes further with an expectation of mutual support
and working within its policy and best practice guides.
Medical control The nature of the air operation
frequently determines the type of medical control required. In most cases,
an air ambulance staffer is considerably more skilled than a typical paramedic,
so medical control permits them to exercise more medical decision-making
latitude . Assessment skills tend to be considerably higher, and, particularly
on inter-facility transfers, permit inclusion of functions such as reading
x-rays and interpretation of lab results. This allows for planning,
consultation with supervising physicians, and issuing contingency
orders in case they are required during flight. Some systems operate almost
entirely off-line, using protocols for almost all procedures and only resorting
to on-line medical control when protocols have been exhausted. Some air
ambulance operations have full-time, on site medical directors with pertinent
backgrounds; others have medical directors who are only available by
pager. For those systems operating on the Franco-German model, the physician
is almost always physically present, and medical control is not an issue.
Equipment and interiors Most aircraft used as air ambulances,
with the exception of charter aircraft and some military aircraft, are equipped
for advanced life support and have interiors that reflect this. The
challenges in most air ambulance operations, particularly those involving
helicopters, are the high ambient noise levels and limited amounts of working
space, both of which create significant issues for the provision of ongoing
care. While equipment tends to be high-level and very conveniently
grouped, it may not be possible perform some assessment procedures, such as
chest auscultation, while in flight. In some types of aircraft, the aircraft’s
design means that the entire patient is not physically accessible in flight.
Additional issues occur with respect to pressurization of the aircraft. Not all
aircraft used as air ambulances in all jurisdictions have pressurized cabins,
and those that do typically tend to be pressurized to only 10,000 feet above
sea level. These pressure changes require advanced knowledge by flight
staff with respect to the specifics of aviation medicine, including changes in
physiology and the behaviour of gases. There are a large variety of helicopter
makes that are used for the civilian HEMS models. The commonly used types are
the Bell 206, 407, and 429, Eurocopter AS350, BK117, EC130, EC135, EC145, and
the Agusta Westland 109 & 149 and Sikorsky S-76. Due to the configuration
of the medical crew and patient compartments, these aircraft are
normally configured to only transport one patient but some can be configured
to transport two patients if so needed. Additionally, helicopters have stricter
weather minimums that they can operate in and commonly do not fly at altitudes
over 10,000 feet above sea level. Equipment and interiors
Challenges Beginning in the 1990s, the number of
air ambulance crashes in the United States, mostly involving helicopters,
began to climb. By 2005, this number had reached a record high. Crash rates from
2000 to 2005 more than doubled the previous five year’s rates. To some
extent, these numbers had been deemed acceptable, as it was understood that
the very nature of air ambulance operations meant that, because a life
was at stake, air ambulances would often operate on the very edge of their safety
envelopes, going on missions in conditions where no other civilian pilot
would fly. As a result, nearly fifty percent of all EMS personnel deaths in
the United States occur in air ambulance crashes. In 2006, the United States
National Transportation Safety Board concluded that many air ambulances
crashes were avoidable, eventually leading to the improvement of government
standards and CAMTS accreditation. Cost-effectiveness
Whilst some air ambulances do have effective methods of funding, in the UK,
they remain almost entirely charity funded, as improved cost-benefit ratios
are generally achieved with land based attendance and transfers. Health
outcomes, for example from London’s Helicopter Emergency Medical Service,
remain largely the same for both air and ground based services.
Medical personnel Medical personnel historically has been
a Physician/Nurse combination, Paramedic/Nurse, or a Nurse/Nurse
combination. The need for a Physician/Nurse combination has
diminished with more protocol and evidence-based applications for care by
nurses and other clinicians and so the inclusion of respiratory therapists in
all modes of air transport is becoming more prominent.
= Retrieval Doctor/Physician= Retrieval Doctor/Physician — Criteria
for working as a medical doctor in aeromedical services depends on the
jurisdiction. In Australia, where aeromedical retrieval medicine is a
well-established medical field, retrieval doctors must be experienced in
a critical care specialty as fully qualified specialists; specialty
registrars in advanced stages of training; or general practitioners with
broad experience in critical care and obstetrics.
= Flight Paramedic= Flight Paramedic — A licensed paramedic
with additional certification as a certified flight paramedic. The flight
paramedic is usually highly trained and has years of autonomous clinical
experience in high acuity environments of both pre-hospital emergency medicine
and critical care transport. Flight paramedics usually are either certified
as a FP-C or a CCEMT-P. Most hold certificates as instructors in various
fields and educational topics. = Flight Nurse=
Flight Nurse — a specialized nurse with additional credentialing as a Certified
Flight Nurse. The Flight Nurse performs as a member of an aeromedical evacuation
crew on helicopters and airplanes—providing for in-flight
management and nursing care for all types of patients. Other
responsibilities include planning and preparing for aeromedical evacuation
missions and preparing a patient care plan to facilitate patient care, comfort
and safety. Flight nurses may obtain board certification in Emergency
Nursing, Flight Nursing, or Critical Care.Some states require that Flight
Nurses must also have a Paramedic Certification. This is mainly because
the Flight Nurse does not have the “On scene” experience a Paramedic has. They
also lack the training in such areas such as Intubation, Chest tube
insertion, Surgical airways, securing patient Cervical Spine through use of
Spine Boards or KED. Some States require the Flight Crew Must have at least One
Paramedic aboard the aircraft for this reason.
Civilian Flight Nurses Civilian Flight Nurses work for
hospitals, Federal, State, and Local governments, private medical evacuation
firms, fire departments, and other agencies.
Military Flight Nurses The military flight Nurse performs as a
member of the aeromedical evacuation crew, and functions as the senior
medical member of the aeromedical evacuation team on Continental United
States, intra-theater and inter-theater flights – providing for in-flight
management and nursing care for all types of patients. Other
responsibilities include planning and preparing for aeromedical evacuation
missions and preparing a patient positioning plan to facilitate patient
care, comfort and safety. Flight Nurses evaluate individual
patient’s in-flight needs and request appropriate medications, supplies and
equipment, providing continuing nursing care from originating to destination
facility. They act as liaison between medical and operational aircrews and
support personnel in order to promote patient comfort and to expedite the
mission, and also initiate emergency treatment in the absence of a physician
for in-flight medical emergencies. = Transport Respiratory Practitioner=
Transport Therapist — A highly trained respiratory practitioner, typically
utilized in long-distance transport situations, though able to provide care
during shorter transfer. Transport Therapists may obtain Adult Critical
Care Specialist, Neonatal Transport Specialist and Neonatal Pediatric
Specialist certifications from the National Board for Respiratory Care.
Associations and organizations Association of Air Ambulances
Aerospace Medical Association — an umbrella group providing a forum for
many different disciplines to come together and share their expertise for
the benefit of all persons involved in air and space travel.
Association of Air Medical Services — an international association which serves
providers of air and surface medical transport systems.
Air medical organizations AASP – Atom Air Ambulances
AAA – Association of Air Ambulances PAA – Prime Air Ambulance
ALEA – Airborne Law Enforcement Association
AAMS – Association of Air Medical Services
AMOA- Air Medical Operators Association AMPA – Air Medical Physicians
Association APFC – Association of Professional
Flight Chaplains HAI – Helicopter Association
International IAFP – International Association of
Flight Paramedics NAACS – National Association of Air
Medical Communications Specialists NEMSPA – National EMS Pilots Association
PFAAA – Patient First Air Ambulance Alliance
RFDS – Royal Flying Doctor Service Air medical publications
Air Medical Journal EMS Magazine
Waypoint AirMed & Rescue Airway
See also Air Ambulances in the United Kingdom
Air Ambulances in the United States Air ambulance in Greece
CareFlight Commission on Accreditation of Medical
Transport Systems Emergency medical service
Emergency Medical Retrieval Service Golden hour
MEDEVAC Medical escort
Norwegian Air Ambulance Foundation Royal Flying Doctor Service
Safety of emergency medical services flights
Westpac Life Saver Rescue Helicopter Service
References External links
Association of Air Ambulances Air Ambulances Services in India
Association of Air Medical Services U.S. State Department information on
U.S. based air ambulance and medevac companies
“Lifeguard” flight tracker HEMS Pictures by State
Air & Surface Transport Nurses Association
International Air Ambulances Services Air Medical Net
Flightweb Royal Flying Doctor Service

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