Boston MedFlight - Outreach

Can you take family members aboard during patient transport in the helicopter, fixed wing aircraft or ground critical care vehicle?
How high does the helicopter fly?
How does the helicopter decide on a landing location when flying directly to a scene?
Is there a bill for services if BMF is requested then canceled en route to a hospital or to a scene?
Why do you wrap people in that silver foil?
What kind of education does the medical crew receive at Boston MedFlight?
What kind of specialty medical equipment does Boston MedlFlight carry?
Does BMF have a system of equipment retrieval for patients flown from the scene or trauma patients flown from hospital Emergency Departments?
How does BMF decide which vehicle is most appropriate on interfacility transport requests?
Are the medical crew trained as co-pilots and are the pilots medically trained?

1.	Can you take family members aboard during patient transport in the helicopter, fixed wing aircraft or ground critical care vehicle?
	The decision as to whether or not a family member can accompany the patient is multifaceted. In the event of helicopter or fixed wing transport, the weight and balance of the aircraft must be considered by the KFS or BAC Pilot In Command (PIC). This is basically the maximum weight that the aircraft can transport safely at any given time. This includes the weight of the flight crew, equipment, fuel, pilot(s), and patient. Second, the needs of the patient are taken into account. Third, the overall space in the patient care area is considered. With certain transports, there may not be sufficient room to accommodate a family member. Finally, the emotional state of the family member contributes to the decision. Due to weight and capacity constraints of the aircraft, Boston MedFlight is often not able to accommodate a family member. Boston MedFlight provides road maps to the receiving hospitals and advises the receiving facility of the arrival of family members. With respect to the critical care ground vehicle, one family member may accompany the patient and crew during the transport. Regulations require that family members must travel in the passenger seat with seatbelts fastened.

2.	How high does the helicopter fly?
	Several factors determine the altitude of the helicopter. The pilot may be assigned a specific altitude by air traffic controllers when the aircraft is operating within controlled air spaces. The pilot must also factor in the height of obstructions, such as radio towers, so that they may fly well above the obstruction. Additionally, realizing that several noise sensitive areas exist, every effort is made to avoid flight in these air spaces; however, avoidance is not guaranteed as flight is dictated by safety considerations first. Typically, the altitude flown within the Boston MedFlight service area is between 1,000 and 2,000 feet.
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3.	How does the helicopter decide on a landing location when flying directly to a scene?
	Communication between the entire team and ground personnel is of critical importance when BMF responds to different towns. As part of our ability to provide service to EMS, each town Fire Department together with our contracted pilots (PIC's) and Communications Specialists, coordinate a set of landing zones which meets all of the criteria for a safe landing. When responding to a scene, BMF Communications Specialists communicate with Fire and Police Department personnel to determine which pre-designated landing zone is most appropriate. BMF is also capable of landing on highways, roadways, and parking lots, provided direct communication between BMF and ground personnel exists, assuring landing zone safety.

4.	Is there a bill for services if BMF is requested then cancelled en route to a hospital or to a scene?
	No. As part of a Critical Care Transport System, BMF understands that situations change while en route to the requested area. BMF does not bill the requesting agency or hospital on cancelled requests.
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5.	Why do you wrap people in that silver foil?
	There are two reasons for the foil, or space blanket. The space blanket helps maintain normothermia, or normal body temperature, through its reflective property. Hypothermia in the critically ill or injured patient population has been associated with increased morbidity and mortality. The space blanket also serves to protect the transport vehicle, equipment and staff by acting as a barrier against body fluids and blood.

6.	What kind of education does the medical crew receive at Boston MedFlight?
	Each crewmember must complete yearly rotations at the consortium hospitals in areas such as high-risk obstetrics, pediatric and adult respiratory therapy, pediatric and adult operating room, SICU (surgical intensive care unit), radiology, intra-aortic balloon pump management, NICU (neonatal intensive care unit), ATLS, and EMS. Additional rotations can be added if a crewmember has particular interests. In addition, there are bi-weekly case reviews and topic presentations at staff meetings.
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7.	What kind of specialty medical equipment does Boston MedFlight carry?
	Specialized, critical care equipment is available in all Boston MedFlight vehicles. All transport vehicles are equipped with transport ventilators capable of several modes of ventilation; invasive line monitoring equipment; internal and external pacing; external defibrillation; infusion pumps; Doppler; pulse oximetry; non-invasive blood pressure monitoring; extensive pharmacy and end tidal capnography. The transport vehicles can be reconfigured to accommodate an intra-aortic balloon pump or a neonatal isolette.

8.	Does BMF have a system of equipment retrieval for patients flown from the scene or trauma patients flown from hospital Emergency Departments?
	Yes. As a courtesy to all EMS providers, BMF has a dedicated equipment retrieval employee who makes every effort to retrieve, clean, and deliver equipment to the Fire and Police Departments, hospitals, and EMS agencies. It is very important that pieces of equipment be LABELED clearly with the agency's ENTIRE name to facilitate tracking at different hospital locations.
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9.	How does BMF decide which vehicle is most appropriate on interfacility transport requests?
	BMF makes every effort to send the most appropriate vehicle to the requested hospital based on safe and efficient transportation. This is most often decided upon by Communications Specialists in conjunction with the BMF Medical Crew. In the event of any uncertainty, BMF online Medical Control is available to discuss vehicle selection with referring/receiving physicians and BMF staff. Once the decision is made, mission completion is dependent on several factors. First is safety. If the helicopter is requested, the Era Med pilot must accept/reject the mission. If helicopter transport cannot be completed safely, BMF will offer the hospital BMF's ground critical care unit or contracted fixed wing jet service, if appropriate and available. The advantages are same crew configuration and same medical equipment. The biggest disadvantage of the critical care ground vehicle and the fixed wing jet is usually a longer wait time on the part of the sending facility. The critical care unit must travel by ground vehicle to the requested hospital. Likewise, fixed wing transport necessitates travel from airport to airport along with ground travel to the final destination. Second is patient condition. If the patient is in need of emergent services unavailable at the sending facility, such as a cardiac catheterization lab or an operating room, BMF will triage the request to the Era Med Rotor Wing PIC. If the patient requires nonemergent transport, such as transport to a hospital for elective procedures, and is being maintained on therapies beyond the scope of ALS providers, BMF will triage this request to the ground critical care unit or the fixed wing Pilot in Command, if available and appropriate. This allows for appropriate utilization of resources by enabling the helicopter to be available for time sensitive requests. Third is location. Long distance transfer outside of helicopter range will be triaged to fixed wing jet services. The fixed wing jet is capable of traveling 1400 miles without refueling and is less affected by weather considerations. In instances where travel is required outside of the immediate Boston area, fixed wing jet services provide expedited and economical transport between facilities.

10.	Are the medical crew trained as co-pilots and are the pilots medically trained?
	Cross training is critical and, as such, each member knows pertinent information and has a healthy respect for each other's roles. The medical crew is considered part of the aviation team and assists the pilot in safety awareness in and about the aircraft. Medical crew assist the pilot in identifying and calling out hazards, such as other aircraft, wires, debris, and any other obstructions which may impact flight safety.The Pilots, although not employed by BMF, are an integral part of our team.

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