Helicopter Request

Section 2 - EMERGENCY OPERATIONS

230.09 Helicopter Request

PURPOSE:

To establish safe and efficient procedures regarding medical helicopter responses with the goal of providing the most appropriate mode of transport for the patient based on patient condition, destination, scene location and any other key factors. The use of a medical helicopter should be thought of as an extension of the receiving facility. NOTE: This policy is to be used as a guide during non-medical helicopter operations and adjusted by the scene Officer to address any unique situations.

DEFINITIONS:

• Active Request: A helicopter is to be immediately dispatched to respond upon the request of Command or Officer responding to, or on the scene of a call.
• Standby Request: A helicopter will be placed on stand-by if Command or the responding Officer anticipates the need for a helicopter. If on standby, the helicopter crew will transition to the aircraft awaiting confirmation to respond.

POLICY

This procedure applies to all Fire Rescue personnel.

PROCEDURE:

Availability:

• The communications center is responsible for tracking the availability of helicopter resources in conjunction with EM-Systems.

Requesting Helicopter Transport - Flight Considerations:

• Command, an Officer, or a Paramedic in charge of or responding to the scene shall determine if helicopter transport is appropriate and can be carried out safely.
• Weather conditions, patient condition, patient destination, scene location, transport time and aircraft availability will be used as the key factors in deciding the most appropriate mode of transport for patients who meet helicopter transport criteria. As a rule, helicopter transport should only be considered where transport by ground would exceed 25 minutes.
• When a helicopter response is requested, communications shall contact the appropriate helicopter transport agency(s) to determine their availability. The communications center will then notify the responding units or command whether an aircraft is or is not available to respond.
• If the first called helicopter agency cannot fly due to poor weather, you can expect that other helicopters will have similar restrictions depending on their location. It is the responsibility of the helicopter agencies in contact with the communications center to determine if another helicopter resource is a viable alternative. If aircraft availability cannot be readily confirmed, ground transport should not be delayed.

Dispatch Guidelines:

• General Dispatch: The communications center shall monitor significant calls that might become candidates for helicopter transport based on the location and any available information about the call. Therefore, when a scene unit announces a Trauma Alert, Cardiac Alert, or Stroke Alert from a remote scene location, the communications center may immediately challenge the scene unit to ascertain if a helicopter will be required. This early challenge allows for the communications center to get the helicopter(s) and support units dispatched in a timely manner.
• When it is determined that a helicopter response is needed, Command or an Officer responding to, or on the scene shall initiate an Active Request and a helicopter is to be immediately dispatched.
• If Command or the responding Officer to, or on the scene anticipates the need for a helicopter, they may initiate a Standby Request and the helicopter crew will transition to the aircraft awaiting confirmation to respond.
• Acknowledging the Call and Responding: If a helicopter is airborne at the time of dispatch, a flight crewmember should report the aircraft’s response on the alarm TAC. If the helicopter is not airborne at the time of dispatch, a flight crewmember shall acknowledge receipt of the call on the alarm TAC. (Acknowledging the call does not indicate the aircraft is responding) A flight crewmember will report responding at the time of liftoff.
• Additional Units: The following additional units shall be dispatched any time a medical helicopter is included or added to any alarm. Command may alter this response based on specific needs of the incident.
  • Battalion Chief or EMS Officer
  • LZ Engine: To establish a suitable and safe landing zone (LZ) and to function as the suppression unit in the event of an emergency.
  • Law Enforcement may be requested to assist with the LZ, especially in cases where FD units are delayed or unavailable.

Incident Location Information:

• As much incident information as possible will be gathered by the communications center and relayed to the flight crew. Such as:
  • Street address
  • Geographic description based on landmarks or cities
  • Latitude/longitude coordinates
  • Pertinent landing zone information
  • Other aircraft responding

Landing Zones (LZ):

• Identification: A minimum of 100 ft. X 100 ft. area is required for any LZ. During day landings the LZ shall be marked at all four corners with traffic cones placed on their sides with the point of the cone directed toward the center of the LZ. During night landings the LZ shall be marked at all four corners with landing zone strobes. Do not mark the LZ with burning road flares and never direct any scene lights or flashlights at the aircraft. The LZ area should be free from overhead and ground obstructions as well as any loose debris. Ideally the LZ should be at least 300 feet from all other activities. If the LZ must be located closer to the scene, additional precautions regarding rotor wash should be taken: (i.e. covering patient, securing any loose objects and protecting eyes from dirt and dust).
• Security: The LZ officer is responsible for securing the LZ area is clear of vehicles, pedestrians, and any other objects that may interfere with the safe landing or departure of the aircraft. This includes stopping traffic flow in both directions when landing on a roadway. The LZ officer shall not stand in the middle of the LZ area; instead they shall stand well beyond the perimeter of the LZ and maintain an orientation facing toward the front of the aircraft. NOTE: In most instances the pilot will land and depart into the wind. The LZ suppression unit committed to the LZ should remain a safe distance, preferable 50-75 feet away while maintaining visual contact with the LZ. The minimum level of PPE to be worn by an LZ officer shall consist of helmet, safety goggles and a traffic vest. Other LZ engine personnel should be if full PPE in the event of an emergency.
• Communications: The aircraft must establish communications with the LZ officer and have all pertinent information regarding the LZ prior to final approach. LZ descriptions that indicate geographic directions from a fixed object are usually best, such as North of Engine-24 in the southbound lane. LZ information should also include description and compass orientation of any obvious hazards such as: overhead wires, trees, cell towers (i.e. “overhead wires are located along the east side of the LZ). The LZ information shall also include the estimated weight of the patient. If there is too much radio traffic on the assigned alarm TAC, a command consideration may be to use another channel for the LZ radio traffic.
• Requesting Clearance to Land: After the LZ had been identified, the LZ information provided and the LZ approved by the pilot; a flight crewmember will notify Command that they are ready to request Emergency Traffic. Once the Command approves the request, a flight crewmember will call “(call sign) to LZ officer; LZ in sight, are we clear to land?” The LZ officer shall respond “LZ, (aircraft call sign), you are clear to land.”
• Final Approach: After being cleared to land, the aircraft will call “(call sign) communications center, on final approach, request emergency traffic only”. The Communications Center will transmit a solid alert tone and announce “All units TAC-(TAC number), emergency traffic only.” During this time there is to be no regular radio communications. This silent period enables anyone that may see a previously undetermined hazard or any dangerous condition that may jeopardize the safe landing of the aircraft to call off the landing over the radio. This shall be done by calling “(call sign) Abort, Abort, Abort” and the reason for the aborted landing. For example, “(call sign) Abort, Abort, Abort. Wires” on the LZ channel. The flight crew will immediately call “(call sign) executing missed approach” to acknowledge hearing instructions to abort landing. Upon resuming a safe orbit over the scene, the aircraft will call “(call sign) communications center, holding, request normal traffic.” The communications center will release the TAC channel to normal traffic, and the aircraft will communicate with the LZ officer for new landing instructions and the landing radio procedures for final approach will be repeated.
• Upon Landing: After a safe landing, the aircraft will call “(call sign) communications center, on scene, request normal traffic. After landing the pilot will use the estimated patient’s weight to complete a weight/balance form. While on the ground the LZ Officer shall act as or assign a tail rotor guard person to maintain a clear area around the tail rotor.
• Other Helicopter Providers or Uses: When utilizing other helicopter providers who may be unfamiliar or unrehearsed with these LZ procedures; the LZ officer should be prepared to assume responsibility for providing radio traffic on behalf of the aircraft, specifically to declare and then later clear Emergency Radio traffic. Specifically, the LZ Officer shall declare Emergency Radio traffic on behalf of the aircraft as soon as it is observed to be on a final approach descent path below 500 feet in altitude. NOTE: If helicopters are being utilized for nonmedical operations (forestry, refueling, etc.) The guidelines for LZ operations, suppression units, and level of PPE may need be adjusted by the scene officer to address any unique situations.

Approaching, Transfer of Patient Care and Loading:

• Approaching: Never approach any aircraft without the direction of a flight crewmember. Approach should always be from the front within view of the pilot and never from the rear. Before approaching with a patient, stop to secure all loose objects, papers, sheets, straps, etc.
• Transfer of Patient Care: The ideal transfer of patient care if the situation allows, is for the patient to have been placed within the patient compartment of a rescue or ambulance. This allows for a well-lit and sound controlled environment to allow a good assessment, pass on and also the ability of the flight crewmembers to complete any patient specific treatment (i.e. RSI) prior to loading the patient into the helicopter for transport.
• Loading and Unloading: Flight crewmembers are responsible for directing the loading and unloading of patients by using the fewest number of ground crewmembers to safely handle the patient. Ground crewmembers should not open or close helicopter doors or load and unload helicopter equipment unless directed by a flight crewmember. After the patient has been loaded into the aircraft, a flight crewmember will give a completed weight/balance form to a member of the ground crew. The ground crew shall safely exit the LZ in the same direction that they approached. The ground crew will retain the weight/balance form until shift change, unless otherwise directed.
• Aircraft Departure: Once the aircraft has safely departed the LZ, units should remain on-scene keeping the LZ open for approx. 2-3 min to assure fire suppression and transport capability is available should the aircraft need to return to the LZ.

Additional Attendants:

• If it becomes necessary for fire rescue ground personnel to “ride in” with the patient in the helicopter, the ground crewmember shall follow the instructions of the flight crewmembers at all times.

Emergency Landing Procedures:

• When the aircraft has incurred a serious emergency and the crew’s safety is in jeopardy. Flight is no longer possible and immediate landing is necessary.
• Flight Crew: Transmit “Mayday, Mayday, Mayday” on all functioning radios Provide GPS position and closest street location if time permits. For rural areas provide geographic direction from nearest landmark.
• Communications Center: Tone “Emergency Traffic Only”. Listen for additional transmission from the aircraft. Dispatch the nearest emergency equipment based on last known position. Notify appropriate Command Staff. Follow Aircraft Emergency Check-List.
  

Reference Material:

• Orange County EMS System Protocol – Aircraft Utilization
• Air Care Landing Operations Guide