| | Air Transport - Getting Patients to the Right Level of Care as Soon as Possible
Impact
There is a short window of opportunity if one is critically ill or injured. Gundersen Lutheran MedLink AIR and Eau Claire Mayo Two air programs worked collaboratively to develop a patient centered Autolaunch program that was easily accessible by the requestor, reduced response time for air medical services in a shared service area, advocated appropriateness of transport and treatment: and improved patient access to tertiary care without increasing costs or over-utilization of resources.
Aims
1. Initiate air resources during the response phase to minimize the time to definitive care for the patient.
2. Avoid duplication or over-utilization of medical air transport services.
3. Ensure that costs of implementation do not out weigh the benefits of the program.
Changes
Implemented a criteria based system that:
· promotes activation of air transport by the Public Service Answering Point (takes 911 calls) at the same time as all other emergency responders are activated
· ensures timely unduplicated delivery of air medical services coordinated by the medical air service providers.
Results
Appropriateness for Air Transport n = 82 |
Flight Appropriateness Evaluation | Outcome of Patients Transported by Air |
90% of patients fell into Level 1 or 2 categories which are appropriate for air transport*
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89% of patients were admitted for further care and treatment or expired after arrival in the Emergency Room
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*Level 3 and 4 comprised 10% where air transport may have not been needed; but this is somewhat subjective as not all locations have Advanced Life Support Ambulance Services available for ground transport.
· Only seven times was care of the patient returned to local Emergency Management Systems after Air Crew assessment - 3.6% of 192 requests.
Costs:
A total of 21.5 hours was spent on aborted flights, canceled requests and non-transports. Using an operating figure of $1000/hr for the aircraft and $3.00/ gallon of fuel, the direct cost of our Autolaunch Program during this time period was $27,300.
Conclusions
1. With air transport, a critically ill patient can reach a tertiary care center three times faster.
2. Determination of the need for air transport was appropriately initiated in at least 90% of transported patients and was consistent with the outcome of requiring hospitalization in 89% of patients who were transported. Only 7 patients were returned to local EMS after assessment.
3. The cost of the Autolaunch Program as implemented by Gundersen Lutheran MedLink Air and Eau Claire Mayo Two are insignificant when compared to the decreased time in providing a patient with the right care and the empowered decision making of front line emergency personnel.
Next Steps
Gundersen Lutheran MedLink Air and Eau Claire Mayo Two will look to expand their Autolaunch program to two more counties in their service areas in the upcoming year.
Activity Leader
Mike McKee, BNS, MBA – MedLink Air Manger - mgmckee@gundluth.org
Background
Autolaunch generally is defined as any mechanism with promotes early activation of air medical transport to respond to a scene request, providing advanced medical resources in the pre-hospital environment. It varies in how activation is achieved and generally has some sort of check and balance built in, so that not just anyone is able to activate the process.
Each state has a defined Emergency Management System (EMS). In very general terms, the Wisconsin Trauma System is a method to insure that patients are transported by the closest available service, to the closest appropriate facility. Wisconsin has been developing their trauma system for several years and it is mandated by legislative language based upon the American College of Surgeon guidelines and recommendations. All hospitals are designated to one of four levels. Hospitals that are not Level 1 or 2 Trauma Centers must have plans that stabilize and appropriately transfer patients requiring care beyond their capabilities. In addition, the American College of Surgeons Committee on Trauma has provided defined criteria as to when early activation should be used to improve patient access for advanced transport care not available to local EMS, which includes transportation of patients to a Trauma Center for definitive care. The state is further divided into 9 Regional Trauma Advisory Committees (RTAC). An RTAC is the unifying foundation responsible to design, implement and evaluate the trauma system and to insure quality care for trauma patients in Wisconsin.
How does the local EMS system work? Activation starts with a 911 phone call by a bystander to the Public Service Answering Point (PSAP). The PSAP dispatcher locates the event, identifies appropriate responding agencies, and actives those resources. With an Autolaunch system approach, aircraft are requested to respond at the same time as the local 1st Responding agencies such as Fire Department, Law Enforcement Center, or First Responders.
There are at least four air transport services within our geographic region. Most service areas cover a 150 mile radius from the home base, so MedLink AIR serves patients in Northeast Iowa, Southwestern Wisconsin, and Northeast Minnesota. Eau Claire Mayo Two serves patients in Northern Wisconsin and Southeast Minnesota. The two programs utilize the same type of aircraft, software to manage flights, and staff mixes.
Methods
MedLink AIR and Mayo Two Dispatch Centers received 192 total Autolaunch requests for Trempealeau County from March 1, 2005 through June of 2006. Of these requests, 82 transports or 42.7% of the total requests were completed. All completed transports were reviewed after each flight according to each programs continuous quality assurance processes using the following scales to determine appropriateness: Level 1 - Delay in transport or major interventions would have clearly endangered life or limb, Level 2 - A major deterioration of vitals could have been expected, though the patient remained stable en route and on arrival, Level 3 - The patient’s condition was critical due to medications, equipment, and expertise needed, yet the patient is stable; Level 4- Patient condition was deemed such that routine transport by an ALC ground unit would not have jeopardized the patient’s outcome. Outcome was categorized by whether or not the patient was admitted to tertiary care for further treatment or discharged from the hospital within 24 hours? Actual flight time and fuel usage are captured for all flights.
Acknowledgements
Quentin Lamers, RN - MedLink AIR Flight Supervisor
Vicki Brye - MedLink AIR Dispatcher
Janelle Weaver,RN MedLink AIR
Tony Kath - Paramedic MedLink AIR
Lori Bresnahan, RN MedLink AIR
Lyle Groves, Nurse Manager, Mayo Two
Jeff Stearns, RN, Mayo Two
Kirk Gunderson, Paramedic, Mayo Two
Patricia Andersen, RN – QI Gundersen Lutheran
Cheryl Strom, RN – QI Gundersen Lutheran |