On Sunday, December 20th a serious car accident occurred in Londonderry. This was the Eighth time this year we reported DHART or MedFlight used in Londonderry. In April two different accidents brought two landings one on Route 102 and a pickup of a patient at the Parkland Landing Pad.
One of the comments by a reader on the Gilcreast Road story asked some questions regarding the procedure involved when determining if a patient needs a med-flight.
- What are the criteria for air transport?
- Who determines that a helicopter is necessary for transport and which facility to transport to?
- Who pays for the air transport charges… the patient? (Did they have a choice?)
To research our reader’s questions we contacted Captain Doug Cardwell at the Londonderry Fire Department. Captain Cardwell was in command at the scene Sunday evening December 20th at the Gilcreast Accident. Captain Cardwell stated that “I cannot speak to this particular patient directly,” but was willing to give us some references.
Cardwell explained, “We transport based on the most appropriate facility for patient treatment. Somebody with burns will go to a burn hospital or pediatric patients to a pediatric hospital. Incidents that include trauma patients fall into the “Golden Hour”. This means that the patient should be at the operating room within one hour. Our on-scene portion of that is called the “Golden Ten Minutes” and air ambulance transport is a consideration with long extrication times such as Sunday night. ”
“In general, for scene transport to be efficacious, the helicopter response should take less time then it takes to travel by ground to the closest appropriate facility. If this is not the case, strong consideration should be given to activating the helicopter from the scene, and meeting at the local hospital. This decision should be made in conjunction with local medical control. This is particularly important for head injured and hypotensive patients. Also, patients should always be transported to the closest appropriate facility whether by air or ground. The destination should be determined by local medical control.”
Captain Cardwell provided us with a list of when helicopter transport is recommended:
Head injured patients with one of the following:
- GCS less than 12 or deteriorating
- Focal neuro findings
Penetrating injury or open fracture
Patients with the following chest injuries:
- Possible tension pneumothorax
- Major chest wall injury
- Potential cardiac injury
- Penetrating chest wound
Patients with unstable vital signs including hypotension, tachypnea, severe respiratory failure
Burn patients with potential airway involvement
Patients with spine injuries with neurologic involvement and potential airway/breathing compromise
Exceptions (patients who may require transport but do not meet the above indications):
- Long distance transports of critical patients (more than 2 hours by ground)
- Situations where resources at the sending facility are severely limited
- Mass casualty situations
- Lack of availability of ground transport
- Lack of availability of critical care personnel to accompany patient
- Weather conditions that make ground transport dangerous (e.g. icy roads but clear skies)
Exclusions (patients who do not meet criteria for air transport):
- Traumatic/Cardiac arrest prior to activation of DHART helicopter
The cost for transport by ground and or air ambulance is the patient’s responsibility.
Since DART being stationed at the Manchester Airport, it has assisted in many incidents in Londonderry and the surrounding communities. It has significantly increased the ability to get a serious patient quickly from the incident scene to a proper medical facility.
DHART has new base of operations was a story we did when DHART announced it was locating a new unit at the Manchester-Boston Regional Airport. A movie of the Night Vision they use onboard is available. In 15 years DHART has transported 10,631 patients by air.
The region is also serviced by MedFlight this landing was at south school for a Single Car MVA on Mammoth on August 6th of this year. For all the film of the transport from the South School parking lot click HERE to visit our darkroom.
If you are interested in details of other Medflight and DHART operations in Londonderry “Read More” for links to some stories we have done. Many contain dramatic On-Demand audio of the operations.
Two Car Rollover Route 93 Closed for one hour July 16, 2008
Three in Londonderry seriously hurt ATV vs. Car on Yellowstone August 21, 2008
Two Medflights for Londonderry Today April 15, 2009
Single Car MVA on Mammoth, Patient Evacuated to Boston Medflight August 6, 2009 Includes slide show of landing and departure of Medflight.
Dramatic 93 Rollover Ejects Two from Car “Medflight 6 minutes out” October 9, 2009
Fiddlers Ridge Road Violent Attack Wednesday Night in Londonderry October 22, 2009
Fatal Thanksgiving Day Crash takes life South of Exit 5 in Londonderry November 27, 2009
Eric Barbarossa 21 of Dracut Massachusetts Killed in Mammoth Road Head on December 5, 2009
Crash Victim on Gilcreast Road Evacuated by DHART December 20, 2009
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First of all Kathy, thank you for researching this for me.
However, did you realize that most of your article is a word-for-word lift from the guidelines that Dartmouth-Hitchcock list on their “activation guidelines”, including the quote which starts “In general” which you attribute to Captain Caldwell?
(http://www.dhmc.org/webpage.cfm?site_id=2&org_id=85&morg_id=0&sec_id=0&gsec_id=1872&item_id=1872)
Anyhow, the question that is even more in my mind as to pressure to use the helicopter resource remains valid (especially if our first responders are using criteria that the owners of the helicopter generated).
Again, not to say that helicopter transport is always a bad idea, but to use it just because it’s there isn’t a good call either. (The dozens of patients who have died in Helicopter EMS accidents are evidence of that fact.)
Thanks again for taking the time to write up the article… I won’t call the plagiarism police this time!
LOL
Kathy had that link in the story, when I did the edits I took it out because I added the direct links in the text to both DHART and MedFlight as well as the link to our announcement of DHART at MHT. When the night vision video is launched it takes you right to the DHART page too.
We can put this under the no good deed goes unpunished category.
Also the count of 8 flights this year (and two flights considered) as well as the number of 2 in 2008 should be used with caution. As stated they are after researching the stories on this site. I do know in 2008 we did not follow the police and fire as close as we do now. While they all happened in those years, some may have occurred that we did not record. Especially those that were considered but not requested since they were not as newsworthy.
Good question and thoughtful conversation on the subject, thank you for that.
I was going to provide my personal experience with DHART here, but it would be best to end this conversation as an editor and log in personally for that. It is Christmas Eve morning and I have a few other items on my plate and in my head but will be back as soon as possible.