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Avoiding “Helicopter Shopping”
By Rob Nickel, Pilot and Air Methods Field Safety Representative
You came into work at the hospital this morning
and the weather was drizzly and gray. Three hours
later, you are looking at a patient who needs to be
flown to another medical facility. Your first call is
to the flight program that you normally use. You
are informed five minutes later that the flight has
been turned down due to weather. What now? The
patient needs to be transported.
Should you choose to call upon another air medical
program, your request to any additional flight
program needs to have one small addition to it: You
need to state the program(s) that you have already
contacted for that same request and verbalize that
they have turned down the flight due to weather,
or any reason for that matter. This can be a critical
piece of safety information when a pilot is making a
weather go/no-go decision for your patient.
The knowledge that another pilot has turned
down a flight request constitutes, in aviation
terms, a Pilot Report (PIREP). PIREPs are used in
aviation to fill in the blanks that are left between
weather-reporting stations. It is essential that this
information is relayed to the pilot receiving your
request so he or she can take it into consideration
when evaluating his/her own flight path.
Miami Valley Hospital
CareFlight Air and Mobile Services
One Wyoming St.
Dayton, Ohio 45409
Nonprofit Organization
U.S. Postage Paid
Permit Number 79
Dayton, Ohio 45409
“helicopter shopping”. This term refers to the
practice of calling various agencies until an air
medical program agrees to take a flight assignment
without sharing with the subsequent agencies that
the flight was declined by the previously called
agency or the reasons why. Omitting this information
can lead to a pilot initiating a flight that he or she
might have declined if he or she had been aware of
all of the facts surrounding the assignment.
Summer 2016
Air
Currents
The worst form of helicopter shopping is the “race
to the patient” request. This is the disreputable
practice of contacting two or more flight programs
at the same time for the same patient. A particularly
dangerous situation is set up when two aircraft
are requested to the same location without letting
them know about each other’s approach. The
outcome of this could be catastrophic.
How do you avoid “helicopter shopping?”
It’s quite simple, just follow these two basic rules:
1. DO NOT request more than one aircraft per
patient.*
2. When making a request, ensure that you notify
the flight program of any previous requests that
were turned down by other programs.**
Not telling one agency of another agency’s weather
refusal constitutes a dangerous practice termed
* At CareFlight Air and Mobile Services, all aircraft
have a two-patient capability. If you have more
than one patient, inform the Access Center
(or Communication Center for scene requests).
We may need to send only one aircraft for every
two patients.
**At CareFlight Air and Mobile Services, we
have three aircraft strategically located north,
central, and south of the Dayton area for this
exact reason, so that a single flight request
into our Communication Center gives the
requesting agency access to any one of the
three geographically located aircraft. While one
aircraft might not be able to accept a particular
flight due to local weather conditions, another
aircraft might be able to complete the same
flight without encountering those same weather
conditions due to their geographic location.
CareFlight Air and Mobile Services was honored
to return as the air medical standby for the
Vectren Dayton Air Show June 18-19, 2016!
Miami Valley Hospital
One Wyoming Street
Dayton, Ohio 45409
CareFlight
(800) 251-2273
Mark Shaker
President and Chief
Executive Officer
Candy Skidmore
Vice President Service
Integration Emergency/
Trauma/CareFlight
Beth Calcidise, RN
CareFlight Air and Mobile
Services and Premier
Transportation Director
Angela Sebald, RN
Editor
Contributing Writers
Andrew C. Hawk, MD
CareFlight Air and Mobile
Services Medical Director
Mandy Via, RN
Rob Nickel, Pilot
Miami Valley Hospital
Mission
We will build healthier
communities with
others who share
our commitment
to provide high-quality,
cost-effective health
care services.
P-C-CFT61486
EMS Star of Life Awards
“Each day in Ohio, EMS providers save lives and perform countless noteworthy acts of caring, kindness and service to their
community. These awards are a tribute to those individuals and organizations whose overall contributions go beyond their basic
duties and responsibilities and who represent the finest traditions of our profession. The EMS Star of Life Awards were created by
Ohio ACEP and the Ohio Division of EMS to recognize outstanding achievements and to honor those in Ohio’s EMS system whose
accomplishments rise above the day-to-day excellence of that system.”
See more at: www.ohiofirechiefs.com/aws/OFCA/pt/sd/news_article/117702/_PARENT/layout_details/false#sthash.JaQccDYu.dpuf
The Troy Fire Department is one of the well-deserved recipients
of the 2016 Star of Life Award in recognition of their life-saving
care of a pediatric burn patient. Last March, Troy Fire
Department crews were dispatched to the scene of an
8-year-old boy who was severely burned. This young boy had
been engulfed in the flames of a recreational bonfire and
sustained full thickness burns to approximately 80 percent of
his body. It was because of Troy Fire Department’s immediate
initiation of life-saving medical care and their expeditious
execution of resource utilization by having the boy flown by
one of CareFlight Air and Mobile Services’ medical helicopters
directly to a pediatric burn center that he was given every
fighting chance of survival. Better yet, this child not only
survived his injuries; he is thriving along his path of recovery.
Along with the Troy Fire Department, the Miami County sheriff’s
department, Miami County Communications Center, and
CareFlight Air and Mobile Services were all recognized by the
Ohio Department of Public Safety’s Division of Emergency
Medical Services (EMS), the State Board of Emergency Medical,
Fire, and Transportation Services (EMFTS), and the Ohio
Chapter of the American College of Emergency Physicians (Ohio
ACEP) at the 16th Annual EMS Star of Life Awards ceremony in
Columbus, Ohio.
Other 2016 EMS Star of Life Award recipients include: EMS Stars,
Akron Fire Department, Damascus Fire Department, North
Olmsted Fire Department, Plymouth Fire Department, Ravenna
City Fire Department, and Washington Township Fire Department.
Difficult Airway Predictors
Outreach Update
By Angela Sebald, BS, RN, CFRN, NREMT-P
By Mandy Via, RN, Outreach Manager
One of the most critical components of airway
management in the pre-hospital and transport settings
is identifying patients who may be difficult to
intubate. If these patients are identified early, then
medical providers can plan to utilize alternative
airway management procedures. The goal of patient
airway management is always to provide effective
ventilation and oxygenation, and ideally, the
placement of a definitive airway.
Several scoring systems have been used in the hospital
setting to predict challenging airway patients, but
many of these scoring systems are not as practical
outside of the hospital. When patients are
unconscious or unable to follow instructions, such as
“open up and say ‘ah’” to allow the medical provider
to evaluate the oropharynx, a pre-procedure
assessment may be difficult to obtain. In these
situations, it is important for medical providers to
identify some of the most common anatomic and
physiologic criteria of a difficult airway.
In the November/December 2015 issue of Air Medical
Journal, the association between difficult airway
predictors and failed pre-hospital endotracheal
intubation was studied. In this article, it was noted
that the difficult airway predictors present in most
of the failed pre-hospital endotracheal intubations
included one or more of the following: blood in the
airway, emesis in the airway, facial trauma, airway
edema, spinal immobilization, a short neck, and a
NASCAR Partners with Premier Health at the
Eldora Speedway
large tongue. A suggested mnemonic to remember
this is BE FAST (Blood, Emesis, Facial trauma, Airway
edema, Spinal immobilization or short neck, and
large Tongue). Furthermore, if more than one of
these difficult airway predictors is present on the
same patient, then the complexity of ventilating
and oxygenating the person, let alone obtaining a
definitive airway, only increases.
At CareFlight Air and Mobile Services, our transport
crews on the aircraft and Mobile Intensive Care Units
are prepared to handle all types of difficult airways.
Every vehicle is equipped with oral and pharyngeal
airways, direct laryngoscopy supplies, nasal intubation
supplies, a GlideScope portable video laryngoscope,
and a gum-elastic bougie endotracheal tube
introducer. CareFlight crews also have the option to
use sedate-to-intubate medications (sedation only)
or rapid-sequence intubation medications (sedation
plus paralytic) for achieving patient compliance during
intubation. Other advanced airway procedures that
CareFlight crew members are trained to perform
include: needle cricothyrotomy, surgical
cricothyrotomy, and supraglottic airway placement
(laryngeal airway masks). Last but not least, our
crews carry post-intubation sedation medication and
transport ventilators, thus offering comprehensive
out-of-hospital airway management available for
every patient, every time.
Drive Smart Program
The 2016 Drive Smart program was viewed by more
than 5,000 high school students!
As our Drive Smart season winds down, I would
like to take a moment to personally thank all of the
departments that we have worked with to provide
mock crashes to schools. It truly takes a team effort
to make this type of event a success while leaving
a lasting impression in the students’ minds. The
teamwork that has been exhibited by EMS, fire
departments, law enforcement, dispatchers, funeral
homes, towing companies, parent speakers, the
schools, and the students has been tremendous.
Many students have approached the participants
after the program offering their personal stories,
as well as thanking participants for putting this
program on. Please know that the Drive Smart
program has made an impact on many students,
and this is our ultimate goal. If we can keep kids safe
then we are doing our jobs.
Again, thanks for all that you do to help keep young
drivers educated and safe.
Safety Sessions
Summer is coming up and now is a great time
to schedule your safety session with CareFlight.
These sessions include a one-hour presentation
on industry safety standards. Weather permitting,
the presentation will conclude as participants gain
actual experience under the direction of the flight
crew on how to load the aircraft with the rotors
in motion. This presentation is free of charge,
provides two continuing education credits, and can
be presented at your convenience and location of
choice. If you would like to schedule a safety session,
please contact Mandy Via at (937) 208-4399.
This year, the fourth NASCAR Camping World Truck
Series will be held July 19-20 at Eldora Speedway in
Rossburg, Ohio. The new, state-of-the-art Premier
Health Infield Care Center that opened last year is the
on-site facility designated to provide medical services
to infield drivers and pit crews during NASCAR
events. This infield care center is fully equipped to
manage any emergency, including trauma, acute
events like heat attack or stroke, burns, and other
medical emergencies. In fact, the NASCAR medical
liaisons have partnered with a team of physicians,
nurses, paramedics, and ancillary staff from Miami
Valley Hospital’s Trauma Center to undergo NASCARspecific training so that together they can provide the
highest level of trauma care immediately from the
time of injury or onset of illness. Additionally, one of
Premier Health’s CareFlight Air and Mobile Services
helicopters plus a mobile intensive care unit will
both be dedicated on-site at Eldora exclusively to the
NASCAR event, thereby providing an immediate link
to Miami Valley Hospital, the Dayton region’s only
Level I Trauma Center.
Miami Valley Hospital is the largest health care
provider in the Dayton area with 800 staffed beds.
It has the Dayton area’s only:
“NO DESAT”: Nasal Cannula at 15 L/minute
• High-Risk Obstetrics and Perinatal Center in the
same facility
Andrew C. Hawk, MD, Medical Director, CareFlight Air and Mobile Services
• Level III-B Neonatal Intensive Care Unit and
Perinatal ICU in the same facility
Andy Hawk, MD
One of Dr. Levitan’s latest (and greatest) causes is the
mnemonic “NO DESAT.” This stands for “Nasal Oxygen
During Efforts Securing A Tube.” The goal is to avoid
oxygen desaturation during the intubation sequence.
According to him, “a nasal cannula set at 15 L/minute
is the most readily available and effective means” to
accomplish this.
the non-rebreather mask to the BVM apparatus (also at
15 L/minute). Keep the nasal cannula in place at 15 L/minute
under the mask.
What? A nasal cannula turned up past 6 L/minute in an
adult? And placed under a non-rebreather mask or a
BVM device? The answer to both is...YES! When an
advanced airway is anticipated or necessary in an adult,
consider initiating a nasal cannula at 15 L/minute. If
the patient is breathing, add a non-rebreather mask,
also at 15 L/minute. If breathing becomes inadequate
and positive pressure ventilation is needed, transition
The initial approach may even be immediate BVM
ventilations and a nasal cannula, both at 15 L/minute, in
the apneic or hyperventilating patient. Remember, this
double-oxygen delivery can be utilized by EMS providers
at all levels (with the “availability challenge” of providing
two oxygen sources).
At the end of the day, it’s about maximizing oxygenation/
ventilation in the compromised patient. And it’s about
maximizing pre-oxygenation prior to any advanced airway
intervention. If intubation is performed, don’t forget to
leave the nasal cannula in place at 15 L/minute during the
actual intubation procedure (to provide so-called “apneic
oxygenation”) and to help ensure “NO DESAT.”
As always, please feel free to contact me at
[email protected] or (937) 208-6633 with
questions or comments.
Reference: Weingart SD, Levitan RM. Preoxygenation and
prevention of desaturation during emergency airway
management. Ann Emerg Med. 2012; 59:165-175.
• Premier Health is proud to announce that our
very own Liz Denlinger, RN, Director, Emergency
Department MVH main campus and Jamestown,
MVH Trauma Program was honored with the 2015
Eldora Speedway Woman of the Year Award for
her continued dedication to auto racing and Eldora. Liz Denlinger, RN
The award was signed by Tony Stewart.
• We are also proud to share that our Premier Health
medical team was recognized by NASCAR Medical
Liaisons at the annual NASCAR Summit with its
‘Teamwork Award’ for the NASCAR Camping World
Truck Series event on dirt.
About Miami Valley Hospital
• Level I Trauma Center
Dr. Rich Levitan is my airway hero. An emergency
medicine physician from up east, he has published and
lectured extensively on the subject of emergency airway
intervention. In my opinion, he is the guru of emergency
intubation and everything related. Dr. Levitan was the
guest lecturer at our CareFlight/EMS symposium in
Dayton back in September 2001 (just after 9/11).
Unlike any medical facility at any other dirt track in
the world, Premier Health Infield Care Center exceeds
the criteria set forth for NASCAR’s National Series.
In fact, it meets the same standards as the Daytona
International Speedway and the Indianapolis Motor
Speedway. The same care that Eldora Speedway’s
owner Tony Stewart has available at every race he
attends is also now available to the dirt track drivers
at Eldora.
• CareFlight Air and Mobile Services (Aircraft and
Mobile ICU)
• NeoFlight (Aircraft and Mobile ICU)
• Blood and Marrow Transplant Unit
• Adult Burn Center
The hospital is served by 5,800 employees and
1,100 physicians in 50 primary and specialty medical
practice areas. It holds Magnet Status in nursing and
is a 2012 recipient of the HealthGrades Distinguished
Hospital Award for Clinical Excellence, placing it among
the top 5 percent of hospitals in the United States.
Miami Valley Hospital is a member of Premier Health,
which also encompasses Miami Valley Hospital South
in Centerville, Good Samaritan Hospital in Dayton,
Atrium Medical Center in Warren County, Upper Valley
Medical Center in Miami County, Good Samaritan
Hospital North Emergency Center in Englewood,
Atrium Health Center Mason Emergency Center
in Mason, and Miami Valley Hospital Jamestown
Emergency Center in Jamestown.