Category:Medevacs and Transport

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OVERVIEW

Weather, patient acuity, commercial plane availability and limited medevac resources can make routine, urgent and emergency medical transportation a tremendous challenge on a daily basis. Health aides and more experienced providers can give you ideas on how to get non-emergency patients into Bethel based on weather, plane schedules and sometimes alternative travel options. YKHC also operates LifeMed, a medevac company that provides services statewide. There is a dedicated Bethel-based crew for local Medevacs and Anchorage/Fairbanks based crews for transporting patients to Anchorage 24/7. Emergency Medevacs require careful coordination and collaboration with LifeMed dispatch, activating physicians and ER physicians. Emergency medevacs are a limited resource and patient acuities in the hospital units and in the villages need to be considered, weighed and prioritized on an ongoing basis.

  • Always Consult an experienced provider before you make the decision to transfer or medevac a patient until you become familiar with our system. Generally it requires about 6 months of getting advice before medevacs, unless the medevac is obvious (GSW, trauma, sepsis, respiratory failure, etc.)

Medevacs

Village to Bethel Medevacs

Our Bethel based Lifemed team is made up of two experienced paramedics and a pilot. The paramedics live in Anchorage and rotate through Bethel for five or more days at a time. They are able to resuscitate, intubate, and put chest tubes in both adult and pediatric patients. The team has a single dedicated fixed wing plane and pilot available 24/7. The paramedic team often flies out multiple times in a day. Occasionally the team times out and they are grounded for a period for rest. A second team will then be activated and sent to Bethel to provide relief, but there will be no village to Bethel medevacs available until the new team arrives. When weather is very poor and the regular medevac plane is unable to reach a critical patient, LifeMed dispatch will activate the Rescue Coordination Center (RCC) in Anchorage to potentially activate the National Guard Blackhawk helicopter.

An OB patient in a village will require a medevac to Bethel if she is in labor that can not be stopped and if the gestational age is <34 weeks (or unknown), there is a high-risk pregnancy, or there are concerning maternal/fetal signs. A family practitioner and a pediatrician will accompany the LifeMed team if there is a considered risk of the patient delivering in the village or on the plane. The LifeMed team has a full premature/full term delivery kit and a baby warmer for resuscitation and transportation. The family medicine physician must pick up the OB delivery kit and supplies from OB before leaving the hospital. For more details see pediatric and family medicine village delivery protocols and preterm delivery RMT Note: OB medical control remains with the family medicine physician on the flight or the FP that activates the medevac.

Sick and preterm newborns that deliver in the village and require transfer to ANMC or Providence will benefit from early activation of an Anchorage based PNP/neonatal team to pick up the baby in the village (this occasionally can be arranged) or to meet the team in Bethel to assume care in our nursery or for a ramp transfer if appropriate.

Bethel to Anchorage Medevacs

Anchorage and Fairbanks Medevac teams are comprised of two paramedics on a Lear jet. Thismight be a paramedic and a nurse pair. It takes 1.5 to 3 hours (or longer due to weather or resource availability) to get a plane to Bethel so activate as soon as you know you need to medevac a patient.

If LifeMed is not able to dispatch a LifeMed crew in a timely fashion, they will make arrangements to send another medevac company’s team out to pick up a patient if appropriate.

OB medevacs to Anchorage are possible when a patient is not in active labor and the benefit of a transport outweighs the risk of a possible delivery en route. YKHC does not have a nursery, therefore all high risk OB patients and possible preterm deliveries would benefit from being delivered at a higher level of care for both mother and baby. The FP and the pediatrician can consult with the high risk OB doctor on call, accepting OB physician and the peri-natologist if needed in extremely difficult cases.

Newborn medevacs from YKHC to ANMC or Providence may be done by regular medevac if the baby is very stable and is not expected to require resuscitation, intubation or any specialty care. For babies that are unstable in any way, a NICU PNP with accompany the medevac team to Bethel

ANMC to Bethel Inpatient Unit and Bethel Inpatient Unit to village Medevacs. These are unusual occurrences and they must be evaluated and approved on a case-by-case basis. Occasionally ANMC will request a patient return to YKHC inpatient unit to finish up a prolonged course of treatment or an end-of-life YKHC inpatient may want to return to a village and is not able to travel commercially. If this request is made by ANMC or a YKHC inpatient physician, the medevac request will have to be reviewed and pre-approved by YKHC and LifeMed administrators. These medevacs do not require emergency care and are not eligible for reimbursement.

Lifemed Detailed Information for medevac roadblocks and alternative options: Lifemed Dispatch, the crew and experienced providers may work together to get patients directly from a village or Subregional Clinic (SRC) to Anchorage without coming to the Bethel ER. In some cases the Bethel-based team will fly to the village and care for the patient until an Anchorage team gets to the village OR a ramp transfer may be arranged at a SRC or Bethel airport. Below are some options and limitations…

Runway Lights: Most of the villages in the YK Delta have runway lights, which are pilot-controlled. Kwigillingok and Newtok do not have pilot-controlled runway lights, however they do have portable runway lights that are FAA approved for fixed wing aircraft. Legally, we are no longer allowed to land our aircraft in the dark at an airport that does not have FAA approved runway lights. Crooked Creek, Lime Village, Red Devil and Stony River do not have any form of FAA approved runway lights, so we can land our aircraft there only during daylight hours.

Rescue Coordination Center: If for some reason LifeMed is unable to complete the medevac, the RCC can help with finding military medevac aircraft. If the Bethel Based Army National Guard is available, the Bethel Lifemed Med Crew may fly with them on their aircraft to complete the medevac. If the Bethel Guard Helicopter is not available, RCC will dispatch an aircraft from somewhere else in the state, usually from the 210 or 211 Rescue Squadron based in Anchorage. LifeMed Dispatch can take care of all of those transportation arrangements for you.

Helicopter Destinations: When a military helicopter transports the patient to Anchorage, they can land only at Providence, Alaska Regional, Elmendorf AFB, and Mat-Su Regional Medical Center. ANMC does not have a helipad, therefore a helicopter cannot land on the ANMC campus. It is an EMTALA violation to have the patient transported directly from the helicopter to ANMC via ground transportation without the receiving hospital doing an initial evaluation of the patient. Therefore, if a patient is sent from the YK Delta to Anchorage on a helicopter, the patient must be seen initially by the hospital the helicopter landed at. Arrangements can then be made between the receiving hospital and ANMC to have the patient transferred to ANMC via ground transportation.

LifeMed Pilots: LifeMed Pilots make the decision to fly based solely on aviation, weather and runway condition factors. They are not provided any information about the patients in order to prevent them from feeling any pressure to fly based on a patient’s condition. They know only the pick-up point, weight and destination of the patient. The dispatchers will not allow you to speak with a pilot regarding the medevac. If you want to know the reason for a pilot’s decision (i.e. weather, runway condition, etc.), the dispatcher can provide you with that information.

Medical Crews on Standby: There are times when either the Bethel-based Caravan crew or the requesting physician place the Anchorage-based Lear Jet on standby. This moves the pilots and medical crew to the hangar to prepare at that time. The pilot can check weather and determine how much fuel will be needed and the medical crew can assemble any additional medical supplies they will need for that medevac. The crew will then be standing by awaiting the call to launch or cancel. Putting the crew on standby will decrease response time by 40-60 minutes because the crew has the aircraft ready to go. Putting the Lear Jet crew on standby allows more patients to be ramp transferred and transported directly to Anchorage without having to be seen at YKHC.

Contacting Medical Crews Directly: Please contact the medical crews thru Dispatch. They know where the crews are in their sleep cycle and whether they are on crew rest. For non-urgent communications, you can contact the crews on the Base Quarter’s phone at 543-5036. The crews turn the ringer off when they are on crew rest.

Medevac Ride Along/Observers

Ride-a-longs are scheduled on a first-come first-serve basis. A LifeMed Rider Observer waiver must be filled out prior to a medevac and given to the Bethel Medical Crew.

1. Fill out the form, but leave the date blank.

2. Fax the completed form (minus date) to the medevac house, 5 to dial out then 907-543-1262. Also, keep a copy with you in case it needs to be re-faxed since you are here for 6 to 8 weeks at a time.

3. On the day you want to ride along call the Lifemed house in Bethel 543-5036. They will confirm they have received your Observer form If no one else has requested to ride along they will take your phone number. Give them your resident work cell number to call or another line you are using in Bethel. Confirm the hours that you want them to call you before hanging up.

The medevac team will call you when they get a call and you have 15-20 minutes to make it to the hangar. You must be ready to get in a cab and go the first time to the hangar without going home for rain gear or other gear. After you know where it is, you can drive out there and leave your truck there during the medevac. They will not wait if you are not there when they are ready for takeoff since by definition, the patient waiting is in an emergency situation.

If you are in the ED this process is much easier and you may get a ride from one of the techs.

The most important tip is to come prepared. You may be riding in a boat, snow machine or ATV from the village airport to the clinic. You may also have to spend lots of time outside and so if it is cold, bring the gear. A headlamp is helpful.

Medevac Activation Process

Activate Medevacs as soon as possible to avoid delays in patient’s getting to the higher level of care they need. If you are too busy to activate…get someone else to do it for you.

Obtain an accepting physician. For Native (beneficiary) patient’s you must obtain an ANMC accepting physician—even if the patient is going to another facility. For non-native patients you must obtain an accepting physician from a Providence or Alaska Regional ER physician or an on-call specialist.

  • Communicate clearly with the receiving physician the reason for transfer ie deterioration of clinical status, potential surgical intervention, need for diagnostic and specialty care not available in Bethel or need for a higher level of care that is not available in Bethel (this may be nursing).
  • Let the accepting physician know you are calling to transfer the patient to their facility (You are not calling to ask for advice on managing them in Bethel).

NOTE: If you think the patient needs to be transferred to a higher level of care, the on call specialist should not refuse the transfer. If there is any issue with obtaining an accepting physician, page the Clinical Director (CD) on call for assistance.

Activate a medevac by calling LifeMed Dispatch 800-478-5433. (speed dial 96). Please do not call the team directly as they may be busy or sleeping.

Have an accepting doctor and pertinent information including patient name, DOB, weight (and escort weight if indicated) to give to the dispatch center when you make your call

Complete a Patient Transport Form (PTO)

Village to Bethel Medevacs

  • Take the completed PTO to the ER with pertinent patient and sign it out to the ER doc
  • ER doc will place the medevac on the ER white board
  • ER doc will assume medical control except for OB patients and for some pediatric patients where the pediatrician keeps medical control until the patient arrives in the ER OR the patient has been stabilized and is turned back over to the ER physician for medical control

Bethel to Anchorage Medevacs (inpatient/OB/ER patients)

  • Complete the PTO and a patient transport packet
  • Talk to med control doctor
  • Write a detailed transfer note
  • Make sure patient records and health summary are copied and that x-rays are teleraded to ANMC (unless going to another facility) and a disk is made to go with the patient
  • Stay in touch with the medical control physician if needed. Update them on the condition of the patient prior to LifeMed team assuming care if patient’s status has changed.

Transportation/Transports

Stable patients, that do not require a medevac, can usually be transferred from villages, outpatient clinics, ER, the inpatient unit and the OB/Newborn unit to a higher level of care via commercial flights. These transfers are often needed to obtain diagnostic evaluations not available in a village, SRC or Bethel and to be closer to surgical and intensive care resources if needed.

Commercial Flights From Village to Bethel: Patients can be sent to Bethel via regular commercial flights. These flights are expensive. Only patients who are covered by Medicaid or Denali Kid Care have their travel, meals and housing covered. Some patients have medical insurance, but often they have to get reimbursed for travel and there is no coverage for meals and housing. The CHAs and village clinic office staff complete patient travel from village to Bethel. Remember to have CHAs remind patients to bring money, extra cloths, diapers, medications, neb machines, ID etc. in case they have a prolonged stay in Bethel.

If a patient is sick but stable, they must pay their own way in or be managed in the village. If a patient is sick and you feel the patient needs to get to Bethel, the administrator on call may be paged to authorize one-way travel to Bethel. If admin approves travel, the patient will need money for food, cabs and the hostel (or have a place to stay).

If urgent or emergency travel is required (and the patient is stable enough for a commercial flight), the inpatient or ER physician may approve one way travel to the ER without paging the administrator on call.

Commercial Flights From ER/Inpatient to Anchorage: Patients may need to take a commercial flight from Bethel to Anchorage after being discharged from the ER, OB or the inpatient unit. The patient may be going to a specialist f/u appt. the next day, to ANMC ER for re-admission or for further evaluation or the patient might be a direct admission to the pediatric unit, etc. These patients have been discharged from our facility, but YKHC has assisted in the patient’s travel and there is an accepting physician at the next facility expecting the patient with an agreed upon plan of care.

For patients traveling commercially to Anchorage without Medicaid, the travel payment and authorization protocol is the same as it is for the village patients. YKHC travel makes the travel arrangements. Patients will still need funds for cabs plus food and lodging if they are not admitted. Sometimes ANMC can assist the patient with housing on campus once they arrive.

Behavioral Health: The Behavioral Health department and clinicians will arrange for patients who are medically stable to travel from village to Bethel and from Bethel to Anchorage. BH inpatients that require psychiatric hospitalization will be transferred with a BH escort, via a commercial flight, to Alaska Psychiatric Institute (API) after they are medically cleared.

Creative Alternative Transports: When weather is down or there are no flights available, a stable patient might come in to Bethel or an SRC by boat, snow machine, snowmobile, river cab or private vehicle on the ice highway. In extreme situations, a CHA may accompany a very sick patient to another close-by village for more help/supplies/medevac access OR bring them to Bethel if able. Having a CHA leave the village to accompany a patient requires approval of the Community Health Aide Administrator on call (a CHA must not leave the village without appropriate health aide coverage)

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