Air medical services are the use of aircraft, including both fixed-wing aircraft and helicopters to provide various kinds of urgent medical care, especially prehospital, emergency and critical care to patients during aeromedical evacuation and rescue operations.
124-574: The Great Western Air Ambulance Charity ( GWAAC ) is a charity air ambulance service in South West England . It operates for the relief of sickness and injury, with a specialist paramedic in critical care and a critical care doctor, providing response by helicopter or car between the hours of 7:00 am and 1:00 am, 365 days a year. The service covers Bristol , North Somerset , Bath and North East Somerset , South Gloucestershire , Gloucestershire , and surrounding areas. GWAAC
248-440: A paramedic and doctor, who provide a remote emergency department to the patient. The crew carry blood and fresh frozen plasma to help treat patients who have suffered major trauma to stabilise them for transport, usually to a Major Trauma Centre , for adults or children. This has been found to result in significantly improved patient outcomes. Local blood bike charity Freewheelers EVS assists NHS Blood and Transplant with
372-494: A strain of coronavirus known as "severe acute respiratory syndrome coronavirus 2" ( SARS-CoV-2 ). COVID-19 is mainly transmitted when people breathe in air contaminated by droplets / aerosols and small airborne particles containing the virus. Infected people exhale those particles as they breathe, talk, cough, sneeze, or sing. Transmission is more likely the closer people are. However, infection can occur over longer distances, particularly indoors. The transmission of
496-442: A 40% increase in cabin volume, allowing the team to offer better inflight treatment. It had an extra seat, allowing medics to be trained on-board or a child patient to be airlifted with a parent. It can also land on elevated hospital helipads , and allows side loading. On 1 August 2017, GWAAC upgraded to an EC135 T2+ model, registration G-GWAC, leased from Babcock Mission Critical Services Onshore , which has more advanced features and
620-462: A business enterprise, or funded by public donations. It may also be reasonable to differentiate between dedicated aircraft and those with multiple purposes and roles. Finally, it is reasonable to differentiate by the type of aircraft used, including rotary-wing , fixed-wing , or very large aircraft. The military role in civilian air ambulance operations is described in the History section. Each of
744-419: A certain critical size, generally thought to be <100μm diameter, evaporate faster than they settle; due to that fact, they form respiratory aerosol particles that remain airborne for a long period of time over extensive distances. Infectivity can begin four to five days before the onset of symptoms. Infected people can spread the disease even if they are pre-symptomatic or asymptomatic . Most commonly,
868-468: A combination of these roles. In almost all cases, the government provides guidelines to hospitals and EMS systems to control operating costs—and may specify operating procedures in some level of detail to limit potential liability. However, the government almost always takes a 'hands-off' approach to the actual running of the system, relying instead on local managers with subject matter (physicians and aviation executives) expertise. Ontario's ORNGE program and
992-692: A consideration in some contexts, in the United States, the primary measure of effectiveness is patient outcomes. Improvements in ground ambulance prehospital care have created uncertainty as to whether helicopter emergency medical services transport is associated with better patient outcomes compared with ground transportation. A U.S. study using 2014 data found that after adjusting for age, Injury Severity Score, and gender, trauma patients who were transferred by helicopter were 57.0% less likely to die than those transferred by ground ambulance (95% CI 0.41 to 0.44, p<0.0001). A retrospective review study reached
1116-622: A great deal of experience in piloting their aircraft because the conditions of air ambulance flights are often more challenging than regular non-emergency flight services. After a spike in air ambulance crashes in the United States in the 1990s, the U.S. government and the Commission on Air Medical Transportation Systems ( CAMTS ) stepped up the accreditation and air ambulance flight requirements, ensuring that all pilots, personnel, and aircraft meet much higher standards than previously required. The resulting CAMTS accreditation, which applies only in
1240-684: A higher level of care at the scene of a trauma and faster transport to a trauma center. They can also provide critical care when transporting patients from community hospitals to trauma centers. Air ambulance transport is expensive, and if utilised poorly is therefore not cost effective. When inappropriately deployed to a patient close to a hospital, an air ambulance may add delay to the patient reaching hospital. In research from 1996, air ambulance services in England and Wales demonstrated no evidence of improvement in vehicle response times (i.e. time from 999 call to an ambulance vehicle being on-scene with
1364-422: A higher risk of developing severe symptoms. Some complications result in death. Some people continue to experience a range of effects ( long COVID ) for months or years after infection, and damage to organs has been observed. Multi-year studies are underway to further investigate the long-term effects of the disease. COVID‑19 transmission occurs when infectious particles are breathed in or come into contact with
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#17327866640991488-966: A local business or even a multi-national company may choose to fund local air ambulance service as a goodwill or public relations gesture. Examples of this are common in the European Union , where in London the Virgin Corporation previously donated to the Helicopter Emergency Medical Service, and in Germany and the Netherlands a large number of the 'Christoph' air ambulance operations are actually funded by ADAC , Germany's largest automobile club and DRF Luftrettung. In Australia and New Zealand , many air ambulance helicopter operations are sponsored by
1612-722: A longer range. In 2012, it was announced that Filton airfield, where GWAAC and the National Police Air Service (NPAS) had been based, was to close. Their landlord, BAE Systems , agreed to find a new site and construct an airbase for the services. A site was identified in South Gloucestershire, adjacent to the Almondsbury M4/M5 Interchange , approximately 2 miles (3.2 km) north of the Filton base. Planning permission
1736-421: A non-medically equipped and staffed aircraft simply transports patients without care in flight. Military organizations and NATO refer to the former as medical evacuation (MEDEVAC) and to the latter as casualty evacuation (CASEVAC) . Air Traffic Control (ATC) grants special treatment to air ambulance operations, much like a ground ambulance using lights and a siren, only when they are actively operating with
1860-433: A not-for-profit mutual insurance company, specifies the circumstances in which costs for air medical services are covered. The medical personnel of a helicopter ambulance has historically been a Physician/Nurse combination, Paramedic/Nurse, or a Nurse/Nurse combination. The need for a Physician/Nurse combination has diminished with more protocol and evidence-based applications for care by nurses and other clinicians and so
1984-575: A paramedic provided from whichever fire department rescue unit has responded. Sometimes the air ambulance may be run as a dual concern with another governmental body - for example, the Wiltshire Air Ambulance was run as a joint Ambulance Service and police unit until 2014. In other cases, the paramedic staffs the aircraft full-time, but has a dual function. In the case of the Maryland State Police, for example,
2108-430: A patient. When this happens, air ambulance aircraft take the call sign MEDEVAC (formerly LIFEGUARD) and receive priority handling in the air and on the ground. As with many Emergency Medical Service (EMS) innovations, treating patients in flight originated in the military. The concept of using aircraft as ambulances is almost as old as powered flight itself. Although balloons were not used to evacuate wounded soldiers at
2232-423: A range of effects, such as fatigue , for prolonged periods after an initial COVID-19 infection. This is the result of a condition called long COVID , which can be described as a range of persistent symptoms that continue for months or years. Long-term damage to organs has been observed after the onset of COVID-19. Multi-year studies are underway to further investigate the protracted effects of long COVID. Reducing
2356-520: A similar conclusion: "Patients transported by helicopter to an urban trauma centre ... had improved survival than those arriving by other means of transport." Patient survival is not the only possible measure of patient outcome. In the case of stroke patients, for instance, various outcome measures could be used. There are many considerations in determining whether to dispatch air medical services. Availability, distance and flight conditions are primary considerations. Even when available, an air ambulance
2480-525: A single rotor-wing aircraft based in Toronto. An important difference in the Ontario program involved the emphasis of service. "On scene" calls were taken, although less commonly, and a great deal of the initial emphasis of the program was on the interfacility transfer of critical care patients. Operating today through a private contractor ( ORNGE ), the system operates 33 aircraft stationed at 26 bases across
2604-892: A standing air ambulance system, as did Siam (Thailand). In 1928 the first formal, full-time air ambulance service was established in the Australian outback . This organization became the Royal Flying Doctor Service and still operates. In 1934, Marie Marvingt established Africa's first civil air ambulance service, in Morocco. In 1936, air ambulance services were established as part of the Highlands and Islands Medical Service to serve more remote areas of Highland Scotland . Air ambulances quickly established their usefulness in remote locations, but their role in developed areas developed more slowly. After World War II ,
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#17327866640992728-827: A typical paramedic, so medical control permits them to exercise more medical decision-making latitude. Assessment skills tend to be considerably higher, and, particularly on inter-facility transfers, permit the inclusion of functions such as reading x-rays and interpretation of lab results. This allows for planning, consultation with supervising physicians, and issuing contingency orders in case they are required during flight. Some systems operate almost entirely off-line, using protocols for almost all procedures and only resorting to on-line medical control when protocols have been exhausted. Some air ambulance operations have full-time, on-site medical directors with pertinent backgrounds (e.g., emergency medicine); others have medical directors who are only available by pager. For those systems operating on
2852-422: A wider coverage area than a land ambulance. This makes them particularly useful in sparsely-populated rural areas. Air medical services have a particular advantage for major trauma injuries. The controversial theory of the golden hour suggests that major trauma patients should be transported as quickly as possible to a specialist trauma center . Therefore, medical responders in a helicopter can provide both
2976-744: Is a novel severe acute respiratory syndrome coronavirus. It was first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan. All structural features of the novel SARS-CoV-2 virus particle occur in related coronaviruses in nature, particularly in Rhinolophus sinicus (Chinese horseshoe bats). Outside the human body, the virus is destroyed by household soap which bursts its protective bubble . Hospital disinfectants, alcohols, heat, povidone-iodine , and ultraviolet -C (UV-C) irradiation are also effective disinfection methods for surfaces. SARS-CoV-2
3100-410: Is a specially outfitted helicopter or fixed-wing aircraft that transports injured or sick people in a medical emergency or over distances or terrain impractical for a conventional ground ambulance . Fixed-wing aircraft are also more often used to move patients over long distances and for repatriation from foreign countries. These and related operations are called aeromedical . In some circumstances,
3224-425: Is an increasing trend as state health services agencies address the issues surrounding the safety of emergency medical services flights . Some examples are the states of Colorado, New Jersey, New Mexico, Utah, and Washington. According to the rationale used to justify the state of Washington's adoption of the accreditation requirements, requiring accreditation of air ambulance services provides assurance that
3348-571: Is associated with COVID-19 and is reported in as many as 88% of symptomatic cases. Published data on the neuropathological changes related with COVID-19 have been limited and contentious, with neuropathological descriptions ranging from moderate to severe hemorrhagic and hypoxia phenotypes , thrombotic consequences, changes in acute disseminated encephalomyelitis (ADEM-type), encephalitis and meningitis . Many COVID-19 patients with co-morbidities have hypoxia and have been in intensive care for varying lengths of time, confounding interpretation of
3472-433: Is available, guidelines and recommendations for hypertensive patients remain. The effect of the virus on ACE2 cell surfaces leads to leukocytic infiltration, increased blood vessel permeability, alveolar wall permeability, as well as decreased secretion of lung surfactants. These effects cause the majority of the respiratory symptoms. However, the aggravation of local inflammation causes a cytokine storm eventually leading to
3596-402: Is because pregnant women with COVID‑19 appear to be more likely to develop respiratory and obstetric complications that can lead to miscarriage , premature delivery and intrauterine growth restriction . Fungal infections such as aspergillosis , candidiasis , cryptococcosis and mucormycosis have been recorded in patients recovering from COVID‑19. COVID‑19 is caused by infection with
3720-522: Is closely related to the original SARS-CoV . It is thought to have an animal ( zoonotic ) origin. Genetic analysis has revealed that the coronavirus genetically clusters with the genus Betacoronavirus , in subgenus Sarbecovirus (lineage B) together with two bat-derived strains. It is 96% identical at the whole genome level to other bat coronavirus samples (BatCov RaTG13 ). The structural proteins of SARS-CoV-2 include membrane glycoprotein (M), envelope protein (E), nucleocapsid protein (N), and
3844-458: Is not always the faster choice in comparison to ground ambulances. Ground ambulances are more numerous and more ubiquitous, so will often be closer to the scene. Ground ambulances can depart their base almost immediately, while air medical services must complete preflight routines prior to departure. A nearby suitable landing site may not be available due to trees, wires, etc. Air medical services tend to have an advantage where ground access routes to
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3968-499: Is one pilot and two medical crew is: "3 to go, 1 to say 'NO'". If one flight member is not comfortable with the flight for whatever reason, the flight is cancelled. Some have questioned the safety of air medical services. While the number of crashes may be increasing, the number of programs and use of services has also increased. Factors associated with fatal crashes of medical transport helicopters include flying at night and during bad weather, and postcrash fires. An air ambulance
4092-482: Is sometimes better to wait for air medical services with a specialized team to transport a patient even though a local land ambulance and an ad hoc local medical team may be able to transfer a patient from a remote hospital to definitive care faster than air ambulance. In the United States, insurance coverage may be a factor. For example, the Coverage Policy Manual for Arkansas Blue Cross BlueShield,
4216-595: Is the cause of the bud release and the formation of the viral envelope. The N and E protein are accessory proteins that interfere with the host's immune response. Human angiotensin converting enzyme 2 (hACE2) is the host factor that SARS-CoV-2 virus targets causing COVID‑19. Theoretically, the usage of angiotensin receptor blockers (ARB) and ACE inhibitors upregulating ACE2 expression might increase morbidity with COVID‑19, though animal data suggest some potential protective effect of ARB; however no clinical studies have proven susceptibility or outcomes. Until further data
4340-402: Is the single most important factor to be considered when deciding whether to transport a patient by helicopter. Weather, air traffic patterns, and distances (such as from the trauma scene to closest level 1 trauma centre) must also be considered. Another reason for cancelling a flight is based on the comfort of the flight crew with the flight. The general rule of safety is upon the crew, when there
4464-469: Is the viral component that attaches to the host receptor via the ACE2 receptors. It includes two subunits: S1 and S2. Studies have shown that S1 domain induced IgG and IgA antibody levels at a much higher capacity. It is the focus spike proteins expression that are involved in many effective COVID‑19 vaccines. The M protein is the viral protein responsible for the transmembrane transport of nutrients. It
4588-938: The Alpha variant (B.1.1.7, formerly called the UK variant), first found in London and Kent, the Beta variant (B.1.351, formerly called the South Africa variant), the Gamma variant (P.1, formerly called the Brazil variant), the Delta variant (B.1.617.2, formerly called the India variant), and the Omicron variant (B.1.1.529), which had spread to 57 countries as of 7 December. On December 19, 2023,
4712-470: The Korean and Vietnam wars. Later, helicopters were introduced to civilian health care, especially for shorter distances, in and around large cities: transporting paramedics or specialist doctors as needed and transporting patients to hospitals, especially for major trauma cases. Fixed-wing aircraft remained in use for long-distance medical transport. Air medical services can travel faster and operate in
4836-552: The Learjet 35 and 36 , Learjet 31 , King Air 90 , King Air 200 , Pilatus PC-12 & PC-24 , and Piper Cheyenne . Due to the configuration of the medical crew and patient compartments, these aircraft are normally configured to only transport one patient but some can be configured to transport two patients if so needed. Additionally, helicopters have stricter weather minimums that they can operate in and commonly do not fly at altitudes over 10,000 feet above sea level. Beginning in
4960-671: The SARS-CoV-1 and MERS-CoV outbreaks, and consistent with other pandemics in human history. Social and environmental factors including climate change , natural ecosystem destruction and wildlife trade increased the likelihood of such zoonotic spillover . The disease quickly spread worldwide, resulting in the COVID-19 pandemic . The symptoms of COVID‑19 are variable but often include fever, fatigue, cough, breathing difficulties , loss of smell , and loss of taste . Symptoms may begin one to fourteen days after exposure to
5084-664: The Second World War . The first use of medevac with helicopters was the evacuation of three British pilot combat casualties by a US Army Sikorsky R-4 in Burma during WW2 , and the first dedicated use of helicopters by U.S. forces occurred during the Korean War , between 1950 and 1953. The French used light helicopters in the First Indochina War . While popularly depicted as simply removing casualties from
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5208-744: The Siege of Paris in 1870, air evacuation was experimented with during the First World War . The first recorded British ambulance flight took place in 1917 in Ottoman Empire when a soldier in the Camel Corps who had been shot in the ankle was flown to hospital in a de Havilland DH9 in 45 minutes. First Recorded Aeromedical Evacuation in the British Army The same journey by land would have taken some 3 days to complete. In
5332-588: The Spanish flu , Middle East respiratory syndrome , and Zika virus . In January 2020, the World Health Organization (WHO) recommended 2019-nCoV and 2019-nCoV acute respiratory disease as interim names for the virus and disease per 2015 guidance and international guidelines against using geographical locations or groups of people in disease and virus names to prevent social stigma . The official names COVID‑19 and SARS-CoV-2 were issued by
5456-944: The United States Air Force , the German Luftwaffe , and the British Royal Air Force . The Swedish National Air Medevac - SNAM is an exception to the military only rule where the system is owned by the Swedish Civil Contingencies Agency Myndigheten för samhällsskydd och beredskap and the 737-800 aircraft is provided under contract when so required by Scandinavian Airlines. Each operates aircraft staffed by physicians, nurses, and corpsmen/technicians, and each can provide long-distance transport with full medical support to dozens of patients simultaneously. However, in recent years, exceptions to
5580-652: The Westpac Bank . In these cases, the operation may vary but is the result of a carefully negotiated agreement between government, EMS, hospitals, and the donor. In most cases, while the sponsor receives advertising exposure in exchange for funding, they take a 'hands-off' approach to daily operations, relying instead on subject matter specialists. In some cases, air ambulance services may be provided by means of voluntary charitable fundraising, as opposed to government funding, or they may receive limited government subsidy to supplement local donations. Some countries, such as
5704-482: The small intestine . The virus can cause acute myocardial injury and chronic damage to the cardiovascular system . An acute cardiac injury was found in 12% of infected people admitted to the hospital in Wuhan, China, and is more frequent in severe disease. Rates of cardiovascular symptoms are high, owing to the systemic inflammatory response and immune system disorders during disease progression, but acute myocardial injuries may also be related to ACE2 receptors in
5828-710: The spike protein (S). The M protein of SARS-CoV-2 is about 98% similar to the M protein of bat SARS-CoV, maintains around 98% homology with pangolin SARS-CoV, and has 90% homology with the M protein of SARS-CoV; whereas, the similarity is only around 38% with the M protein of MERS-CoV . The many thousands of SARS-CoV-2 variants are grouped into either clades or lineages . The WHO, in collaboration with partners, expert networks, national authorities, institutions and researchers, have established nomenclature systems for naming and tracking SARS-CoV-2 genetic lineages by GISAID , Nextstrain and Pango . The expert group convened by
5952-520: The "military-only" rule have grown with the need to quickly transport patients to facilities that provide higher levels of care or to repatriate individuals. Air medical companies use both large and small fixed-wing aircraft configured to provide levels of care that can be found in Trauma centres for individuals who subscribe to their own health insurance or affiliated travel insurance and protection plans. In most jurisdictions, air ambulance pilots must have
6076-526: The 1920s several services, both official and unofficial, started up in various parts of the world. Aircraft were still primitive at the time, with limited capabilities, and the effort received mixed reviews. Exploration of the idea continued, however, and France and the United Kingdom used fully organized air ambulance services during the African and Middle Eastern Colonial Wars of the 1920s. In 1920,
6200-399: The 1990s, the number of air ambulance crashes in the United States, mostly involving helicopters, began to climb. By 2005, this number had reached a record high. Crash rates from 2000 to 2005 more than doubled the previous five year's rates. To some extent, these numbers had been deemed acceptable, as it was understood that the very nature of air ambulance operations meant that, because a life
6324-548: The B.1 lineage. Several notable variants of SARS-CoV-2 emerged throughout 2020. Cluster 5 emerged among minks and mink farmers in Denmark . After strict quarantines and the slaughter of all the country's mink , the cluster was assessed to no longer be circulating among humans in Denmark as of 1 February 2021. As of December 2021 , there are five dominant variants of SARS-CoV-2 spreading among global populations:
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#17327866640996448-661: The British, while suppressing the " Mad Mullah " in Somaliland , used an Airco DH.9A fitted out as an air ambulance. It carried a single stretcher under a fairing behind the pilot. The French evacuated over 7,000 casualties during that period. By 1936, an organized military air ambulance service evacuated wounded from the Spanish Civil War for medical treatment in Nazi Germany ; this service continued during
6572-542: The CNS, possibly within an infected white blood cell. Research conducted when Alpha was the dominant variant has suggested COVID-19 may cause brain damage. Later research showed that all variants studied (including Omicron) killed brain cells, but the exact cells killed varied by variant. It is unknown if such damage is temporary or permanent. Observed individuals infected with COVID-19 (most with mild cases) experienced an additional 0.2% to 2% of brain tissue lost in regions of
6696-562: The COVID-19 infection may have different symptoms, and their symptoms may change over time. Three common clusters of symptoms have been identified: a respiratory symptom cluster with cough, sputum , shortness of breath , and fever; a musculoskeletal symptom cluster with muscle and joint pain, headache, and fatigue; and a cluster of digestive symptoms with abdominal pain, vomiting, and diarrhea. In people without prior ear, nose, or throat disorders, loss of taste combined with loss of smell
6820-456: The CQC together ensuring fundraising, air and clinical operations are in line with national regulation and best practice. The code goes further with an expectation of mutual support and working within its policy and best practice guides. The nature of the air operation frequently determines the type of medical control required. In most cases, an air ambulance staffer is considerably more skilled than
6944-466: The European Union, almost all air ambulance service is on a fee-for-service basis, except for systems that operate by private subscription. Many jurisdictions have a mix of operation types. Fee-for-service operators are generally responsible for their own organization but may have to meet government licensing requirements. Rega of Switzerland is an example of such a service. In some cases,
7068-569: The Franco-German model, the physician is almost always physically present, and medical control is not an issue. Most aircraft used as air ambulances, with the exception of charter aircraft and some military aircraft, are equipped for advanced life support and have interiors that reflect this. The challenges in most air ambulance operations, particularly those involving helicopters, are the high ambient noise levels and limited amounts of working space, both of which create significant issues for
7192-643: The German system in 1983 when Christophorus 1 entered service at Innsbruck. Also in the year 1975 Hans Burghart, one of the inventor of the civilian air rescue in Germany, presented at one Academic conference in the US the concept "Rescue Helicopters in Primary and Secondary Missions" which had impact for the aviation training at Fort Rucker , Alabama . The first civilian, hospital-based medical helicopter program in
7316-494: The John S. Dunn Helistop, one of the busiest helipads in the world, with space for four helicopters. A final area of distinction is the operation of large, generally fixed-wing air ambulances. In the past, the infrequency of civilian demand for such a service confined such operations to the military, which requires them to support overseas combat operations. Military organizations capable of this type of specialized operation include
7440-858: The Polish Lotnicze Pogotowie Ratunkowe (LPR) are examples of this type of operating system. The Polish LPR is a national system covering the entire country and funded by the government through the Ministry of Health but run independently, there is no independent HEMS operator in Poland . In North East Ohio, including Cleveland , the Cuyahoga County -owned MetroHealth Medical Center uses its Metro Life Flight to transport patients to Metro's level I trauma and burn unit. There are 5 helicopters for North East Ohio and, in addition, Metro Life Flight has one fixed-wing aircraft. In
7564-780: The Saskatchewan government in Regina, Saskatchewan, Canada, established the first civilian air ambulance in North America. The Saskatchewan government had to consider remote communities and great distances in providing health care to its citizens. The Saskatchewan Air Ambulance service continues to be active as of 2023. J. Walter Schaefer founded the first air ambulance service in the U.S., in 1947, in Los Angeles. The Schaefer Air Service operated as part of Schaefer Ambulance Service . Two research programs were implemented in
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#17327866640997688-511: The U.K., use a mix of such systems. In Scotland, the parliament has voted to fund air ambulance service directly, through the Scottish Ambulance Service. In England and Wales, however, the service is funded on a charitable basis via a number of local charities for each region covered. Great strides have been made in the UK, with the 'Association of Air Ambulance (AAA)'. This organization is widely credited for having created
7812-474: The U.S. to assess the impact of medical helicopters on mortality and morbidity in the civilian arena. Project CARESOM was established in Mississippi in 1969. Three helicopters were purchased through a federal grant and located strategically in the north, central, and southern areas of the state. Upon termination of the grant, the program was considered a success and each of the three communities were given
7936-540: The United Kingdom, the Scottish Ambulance Service operates two helicopters and two fixed-wing aircraft twenty-four hours per day. In some jurisdictions, cost is a major consideration, and the presence of dedicated air ambulances is simply not practical. In these cases, the aircraft may be operated by another government or quasi-government agency and made available to EMS for air ambulance service when required. In southern New South Wales, Australia,
8060-540: The United States began operation in 1972. Flight For Life Colorado began with a single Alouette III helicopter, based at St. Anthony Central Hospital in Denver, Colorado. In Ontario, Canada, the air ambulance program began in 1977, and featured a paramedic-based system of care, with the presence of physicians or nurses being relatively unusual. The system, operated by the Ontario Ministry of Health, began with
8184-517: The United States, includes the requirement for an air ambulance company to own and operate its own aircraft. Some air ambulance companies, realizing it is virtually impossible to have the correct medicalized aircraft for every mission, instead charter aircraft based on the mission-specific requirements. While in principle CAMTS accreditation is voluntary, a number of government jurisdictions require companies providing medical transportation services to have CAMTS accreditation to be licensed to operate. This
8308-475: The WHO declared that another distinctive variant, JN.1, had emerged as a "variant of interest". Though the WHO expected an increase in cases globally, particularly for countries entering winter, the overall global health risk was considered low. The SARS-CoV-2 virus can infect a wide range of cells and systems of the body. COVID‑19 is most known for affecting the upper respiratory tract (sinuses, nose, and throat) and
8432-759: The WHO on 11 February 2020 with COVID-19 being shorthand for "coronavirus disease 2019". The WHO additionally uses "the COVID‑19 virus" and "the virus responsible for COVID‑19" in public communications. The symptoms of COVID-19 are variable depending on the type of variant contracted, ranging from mild symptoms to a potentially fatal illness. Common symptoms include coughing , fever , loss of smell (anosmia) and taste (ageusia), with less common ones including headaches , nasal congestion and runny nose , muscle pain , sore throat , diarrhea , eye irritation , and toes swelling or turning purple, and in moderate to severe cases, breathing difficulties . People with
8556-551: The WHO recommended the labelling of variants using letters of the Greek alphabet , for example, Alpha , Beta , Delta , and Gamma , giving the justification that they "will be easier and more practical to discussed by non-scientific audiences". Nextstrain divides the variants into five clades (19A, 19B, 20A, 20B, and 20C), while GISAID divides them into seven (L, O, V, S, G, GH, and GR). The Pango tool groups variants into lineages , with many circulating lineages being classed under
8680-634: The battlefield (which they did), helicopters in the Korean War also moved critical patients to hospital ships after initial emergency treatment in field hospitals. Knowledge and expertise of use of air ambulances evolved parallel to the aircraft themselves. By 1969, in Vietnam , the use of specially trained medical corpsmen and helicopter air ambulances led U.S. researchers to determine that servicemen wounded in battle had better rates of survival than motorists injured on California freeways. This inspired
8804-515: The brain connected to the sense of smell compared with uninfected individuals, and the overall effect on the brain was equivalent on average to at least one extra year of normal ageing; infected individuals also scored lower on several cognitive tests. All effects were more pronounced among older ages. The virus also affects gastrointestinal organs as ACE2 is abundantly expressed in the glandular cells of gastric , duodenal and rectal epithelium as well as endothelial cells and enterocytes of
8928-591: The brain found as complications leading to death in people infected with COVID‑19. Infection may initiate a chain of vasoconstrictive responses within the body, including pulmonary vasoconstriction – a possible mechanism in which oxygenation decreases during pneumonia. Furthermore, damage of arterioles and capillaries was found in brain tissue samples of people who died from COVID‑19. COVID‑19 may also cause substantial structural changes to blood cells , sometimes persisting for months after hospital discharge. A low level of blood lymphocytess may result from
9052-428: The brains of those who have died from COVID‑19, but these results need to be confirmed. While virus has been detected in cerebrospinal fluid of autopsies, the exact mechanism by which it invades the CNS remains unclear and may first involve invasion of peripheral nerves given the low levels of ACE2 in the brain. The virus may also enter the bloodstream from the lungs and cross the blood–brain barrier to gain access to
9176-409: The clear jelly liquid found in lung autopsies of people who died of COVID-19. One possibility addressed in medical research is that hyuralonic acid (HA) could be the leading factor for this observation of the clear jelly liquid found in the lungs, in what could be hyuralonic storm, in conjunction with cytokine storm . One common symptom, loss of smell, results from infection of the support cells of
9300-406: The data. Of people who show symptoms, 81% develop only mild to moderate symptoms (up to mild pneumonia ), while 14% develop severe symptoms ( dyspnea , hypoxia , or more than 50% lung involvement on imaging) that require hospitalization, and 5% of patients develop critical symptoms ( respiratory failure , septic shock , or multiorgan dysfunction ) requiring ICU admission. At least a third of
9424-726: The evolving Emergency Medical Services. As the concept was proven, dedicated civilian air ambulances began to appear. On November 1, 1970, the first permanent civil air ambulance helicopter, Christoph 1 , entered service at the Hospital of Harlaching , Munich, Germany. The apparent success of Christoph 1 led to a quick expansion of the concept across Germany, with Christoph 10 entering service in 1975, Christoph 20 in 1981, and Christoph 51 in 1989. As of 2007, there are about 80 helicopters named after Saint Christopher , like Christoph Europa 5 (also serving Denmark), Christoph Brandenburg or Christoph Murnau am Staffelsee . Austria adopted
9548-721: The expression of ACE-2, thereby facilitating the SARS-Cov2 virus to enter cells and to replicate. A competition of negative feedback loops (via protective effects of interferon alpha) and positive feedback loops (via upregulation of ACE-2) is assumed to determine the fate of patients suffering from COVID-19. Additionally, people with COVID‑19 and acute respiratory distress syndrome (ARDS) have classical serum biomarkers of CRS, including elevated C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer , and ferritin . Systemic inflammation results in vasodilation , allowing inflammatory lymphocytic and monocytic infiltration of
9672-428: The eyes, nose, or mouth. The risk is highest when people are in close proximity, but small airborne particles containing the virus can remain suspended in the air and travel over longer distances, particularly indoors. Transmission can also occur when people touch their eyes, nose or mouth after touching surfaces or objects that have been contaminated by the virus. People remain contagious for up to 20 days and can spread
9796-525: The face. While drugs have been developed to inhibit the virus, the primary treatment is still symptomatic , managing the disease through supportive care , isolation , and experimental measures . During the initial outbreak in Wuhan , the virus and disease were commonly referred to as "coronavirus" and "Wuhan coronavirus", with the disease sometimes called "Wuhan pneumonia". In the past, many diseases have been named after geographical locations, such as
9920-498: The feasibility of using military helicopters to augment existing civilian emergency medical services. These programs were highly successful at establishing the need for such services. The remaining challenge was in how such services could be operated most cost-effectively. In many cases, as agencies, branches, and departments of the civilian governments began to operate aircraft for other purposes, these aircraft were frequently pressed into service to provide cost-effective air support to
10044-499: The first experiments with the use of civilian paramedics in the world. The US military recently employed UH-60 Black Hawk helicopters to provide air ambulance service during the Iraq War to military personnel and civilians. The use of military aircraft as battlefield ambulances continues to grow and develop today in a variety of countries, as does the use of fixed-wing aircraft for long-distance travel, including repatriation of
10168-621: The flight paramedic is a serving State Trooper whose job is to act as the Observer Officer on a police helicopter when not required for medical emergencies. In many cases, local jurisdictions do not charge for air ambulance service, particularly for emergency calls. However, the cost of providing air ambulance services is considerable and many, including government-run operations, charge for service. Organizations such as service aircraft charter companies, hospitals, and some private-for-profit EMS systems generally charge for service. Within
10292-473: The ground responder's ability to determine whether the patient's condition warrants air medical transport. Protocols and training must be developed to ensure appropriate triage criteria are applied. Excessively stringent criteria can prevent rapid care and transport of trauma victims; relaxed criteria can result in the patient being unnecessarily exposed to the potential dangers of dangerous weather conditions or other aviation-related risks. Crew and patient safety
10416-523: The heart. ACE2 receptors are highly expressed in the heart and are involved in heart function. A high incidence of thrombosis and venous thromboembolism occurs in people transferred to intensive care units with COVID‑19 infections, and may be related to poor prognosis. Blood vessel dysfunction and clot formation (as suggested by high D-dimer levels caused by blood clots) may have a significant role in mortality, incidents of clots leading to pulmonary embolisms , and ischaemic events (strokes) within
10540-589: The helicopter that responds as an air ambulance is actually operated by the local hydroelectric utility, with the New South Wales Ambulance Service providing paramedics, as required. In some cases, local EMS provides the flight paramedic to the aircraft operator as-needed. In the case of the Los Angeles County Fire Department, the helicopters are brush fire choppers also configured as air ambulances with
10664-399: The hospital are congested and for locations more distant from hospitals. In some situations, it may be desirable to dispatch a ground ambulance that can arrive on the scene first to provide immediate patient care, and an air ambulance to transport the patient(s) to a trauma center. It also should be borne in mind that faster may not always be better. In the context of interhospital transport, it
10788-503: The host cell. Following viral entry, COVID‑19 infects the ciliated epithelium of the nasopharynx and upper airways. Autopsies of people who died of COVID‑19 have found diffuse alveolar damage , and lymphocyte-containing inflammatory infiltrates within the lung. From the CT scans of COVID-19 infected lungs, white patches were observed containing fluid known as ground-glass opacity (GGO) or simply ground glass. This tended to correlate with
10912-428: The improvement of government standards and CAMTS accreditation. Whilst some air ambulances do have effective methods of funding, in England, they remain almost entirely charity funded, as improved cost-benefit ratios are generally achieved with land-based attendance and transfers. Health outcomes, for example from London's Helicopter Emergency Medical Service , remain uncertain. Although cost-effectiveness may be
11036-549: The inclusion of respiratory therapists in all modes of air transport is becoming more prominent. Coronavirus disease 2019 Coronavirus disease 2019 ( COVID-19 ) is a contagious disease caused by the coronavirus SARS-CoV-2 . The first known case was identified in Wuhan , China, in December 2019. Most scientists believe the SARS-CoV-2 virus entered into human populations through natural zoonosis , similar to
11160-597: The increased number of car accidents in 1979 on highways , the Yugoslavian government made a decision to buy new or redistribution of use of old helicopters. Air ambulance service, sometimes called Aeromedical Evacuation or simply Medevac , is provided by a variety of different sources in different places in the world. There are a number of reasonable methods of differentiating types of air ambulance services. These include military / civilian models and services that are government -funded, fee-for-service, donated by
11284-528: The infection, children may develop paediatric multisystem inflammatory syndrome , which has symptoms similar to Kawasaki disease , which can be fatal. In very rare cases, acute encephalopathy can occur, and it can be considered in those who have been diagnosed with COVID‑19 and have an altered mental status. According to the US Centers for Disease Control and Prevention , pregnant women are at increased risk of becoming seriously ill from COVID‑19. This
11408-436: The logistics of keeping the helicopter supplied with blood and plasma. In 2018, GWAAC were called to 1,887 incidents, their busiest year since the service started in 2008. During the COVID-19 pandemic the service responded to COVID-19 cases, and crew members joined a team carrying out inter-hospital transfers for COVID-19 patients requiring intensive care. Air medical services During World War I , air transport
11532-454: The lower respiratory tract (windpipe and lungs). The lungs are the organs most affected by COVID‑19 because the virus accesses host cells via the receptor for the enzyme angiotensin-converting enzyme 2 (ACE2), which is most abundant on the surface of type II alveolar cells of the lungs. The virus uses a special surface glycoprotein called a " spike " to connect to the ACE2 receptor and enter
11656-409: The lung and the heart. In particular, pathogenic GM-CSF-secreting T cells were shown to correlate with the recruitment of inflammatory IL-6-secreting monocytes and severe lung pathology in people with COVID‑19. Lymphocytic infiltrates have also been reported at autopsy. Multiple viral and host factors affect the pathogenesis of the virus. The S-protein , otherwise known as the spike protein,
11780-489: The medical profession. Other U.S. states require either CAMTS accreditation or a demonstrated equivalent, such as Rhode Island, and Texas, which has adopted CAMTS' Accreditation Standards (Sixth Edition, October 2004) as its own. In Texas, an operator not wishing to become CAMTS accredited must submit to an equivalent survey by state auditors who are CAMTS-trained. Virginia and Oklahoma have also adopted CAMTS accreditation standards as their state licensing standards. While
11904-447: The moment a person first becomes infected and the appearance of the first symptoms. The median delay for COVID-19 is four to five days possibly being infectious on 1–4 of those days. Most symptomatic people experience symptoms within two to seven days after exposure, and almost all will experience at least one symptom within 12 days. Most people recover from the acute phase of the disease. However, some people continue to experience
12028-462: The new airbase was officially opened by Prince Richard, Duke of Gloucester . The charity serves a population of 2.1 million. It has received grants in the past from the national government, but does not receive operational funding from the government or National Lottery , and is normally funded by public donations. In 2020, the charity raised income of £4.0 million, including £190,000 from government grants. It spent £4.1M, of which £2.6M
12152-480: The olfactory epithelium , with subsequent damage to the olfactory neurons . The involvement of both the central and peripheral nervous system in COVID‑19 has been reported in many medical publications. It is clear that many people with COVID-19 exhibit neurological or mental health issues . The virus is not detected in the central nervous system (CNS) of the majority of COVID-19 patients with neurological issues . However, SARS-CoV-2 has been detected at low levels in
12276-735: The opportunity to continue the helicopter operation. Only the one located in Hattiesburg, Mississippi did so, and it was therefore established as the first civilian air medical program in the United States. The second program, the Military Assistance to Safety and Traffic (MAST) system, was established in Fort Sam Houston in San Antonio in 1969. This was an experiment by the Department of Transportation to study
12400-583: The original intent of CAMTS was to provide an American standard, air ambulance services in a number of other countries, including three in Canada and one in South Africa, have voluntarily submitted themselves to CAMTS accreditation. In the UK, the AAA has a Code of Conduct that binds one of the most regulated areas of operation together. It brings the Fundraising Standards Board, CAA / EASA and
12524-509: The patient) for air ambulance attended patients compared to those attended by a land ambulance. The same review found patient did not arrive at hospital any quicker when attended by an air ambulance. When the same authors looked at health outcomes in Cornwall and London they found no evidence that the attendance of an air ambulance (HEMS) service improved survival in trauma patients. Effective use of helicopter services for trauma depends on
12648-488: The peak viral load in upper respiratory tract samples occurs close to the time of symptom onset and declines after the first week after symptoms begin. Current evidence suggests a duration of viral shedding and the period of infectiousness of up to ten days following symptom onset for people with mild to moderate COVID-19, and up to 20 days for persons with severe COVID-19, including immunocompromised people. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
12772-411: The people who are infected with the virus do not develop noticeable symptoms at any point in time. These asymptomatic carriers tend not to get tested and can still spread the disease. Other infected people will develop symptoms later (called "pre-symptomatic") or have very mild symptoms and can also spread the virus. As is common with infections, there is a delay, or incubation period , between
12896-529: The political climate that made the helicopter industry and National Health Service recognise the enormous contribution charities make to trauma care in the United Kingdom. In 2013, the AAA published the "Framework for a High Performing Air Ambulance Service" which details many of the developments from 2008 to 2013. In recent years, the service has moved towards the physician-paramedic model of care. This has necessitated some charities commissioning clinical governance services, however many air ambulances operate under
13020-431: The primary means of transportation between communities is by boat. Early in aviation history, many of these communities began to rely on civilian "bush" pilots, who fly small aircraft and transport supplies, mail, and visiting doctors or nurses. Bush pilots probably performed the first civilian air ambulance trips, albeit on an ad hoc basis—but clearly, a need for these services existed. In the early 1920s, Sweden established
13144-423: The province, performing both interfacility transfers and on-scene responses in support of ground-based EMS. Today, across the world, the presence of civilian air ambulances has become commonplace and is seen as a much-needed support for ground-based EMS systems. In other countries of Europe, like SFR Yugoslavia , first air ambulance appeared in the 1980s. Most of the fleet was previously used in military service. With
13268-660: The provision of ongoing care. While equipment tends to be high-level and very conveniently grouped, it may not be possible to perform some assessment procedures, such as chest auscultation , while in flight. In some types of aircraft, the aircraft's design means that the entire patient is not physically accessible in flight. Additional issues occur with respect to pressurization of the aircraft. Not all aircraft used as air ambulances in all jurisdictions have pressurized cabins and those that do typically tend to be pressurized to only 10,000 feet above sea level. These pressure changes require advanced knowledge by flight staff with respect to
13392-552: The remaining models is explored separately. This information applies to air ambulance systems performing emergency service. In almost all jurisdictions, private aircraft charter companies provide non-emergency air ambulance service on a fee-for-service basis. In some cases, governments provide air ambulance services, either directly or via a negotiated contract with a commercial service provider, such as an aircraft charter company. Such services may focus on critical care patient transport, support ground-based EMS on scenes, or may perform
13516-416: The respiratory tract, people with severe COVID‑19 have symptoms of systemic hyperinflammation. Clinical laboratory findings of elevated IL‑2 , IL‑6 , IL‑7 , as well as the following suggest an underlying immunopathology: Interferon alpha plays a complex, Janus-faced role in the pathogenesis of COVID-19. Although it promotes the elimination of virus-infected cells, it also upregulates
13640-859: The risk of long COVID includes staying up to date on the most recent COVID-19 vaccine, practicing good hygiene, maintaining clean indoor air, and physical distancing from people infected with a respiratory virus. Complications may include pneumonia , acute respiratory distress syndrome (ARDS), multi-organ failure , septic shock , and death. Cardiovascular complications may include heart failure, arrhythmias (including atrial fibrillation ), heart inflammation , thrombosis , particularly venous thromboembolism , and endothelial cell injury and dysfunction. Approximately 20–30% of people who present with COVID‑19 have elevated liver enzymes , reflecting liver injury. Neurologic manifestations include seizure , stroke, encephalitis , and Guillain–Barré syndrome (which includes loss of motor functions ). Following
13764-428: The same aircraft may be used to search for missing or wanted people. Like ground ambulances, air ambulances are equipped with medical equipment vital to monitoring and treating injured or ill patients. Common equipment for air ambulances includes medications , ventilators , ECGs and monitoring units, CPR equipment, and stretchers . A medically staffed and equipped air ambulance provides medical care in flight—while
13888-429: The service meets national public safety standards. The accreditation is done by professionals who are qualified to determine air ambulance safety. In addition, compliance with accreditation standards is checked on a continual basis by the accrediting organization. Accreditation standards are periodically revised to reflect the dynamic, changing environment of medical transport, with considerable input from all disciplines of
14012-550: The specifics of aviation medicine, including changes in physiology and the behaviour of gases. There are a large variety of helicopter makes that are used for the civilian HEMS models. The commonly used types are the Bell 206 , 407 , and 429 , Eurocopter AS350 , BK117 , EC130 , EC135 , EC145 , and the Agusta Westland 109 , 169 & 139 , MD Explorer and Sikorsky S-76. Fixed-wing aircraft varieties commonly include
14136-606: The tasking ambulances services clinical governance. The AAA now publishes Best Practice Guidance on a range of operational and clinical functions and provides a code of conduct that all full members, both ambulance services and charities must uphold. Memorial Hermann Life Flight is a not-for-profit hospital-based critical care air ambulance service in Houston , Texas , USA. As of 2023, it operates six EC-145 twin-engine helicopters. The service relies on community support and fundraising efforts. Memorial Hermann Life Flight operates from
14260-516: The virus acting through ACE2-related entry into lymphocytes. Another common cause of death is complications related to the kidneys . Early reports show that up to 30% of hospitalised patients both in China and in New York have experienced some injury to their kidneys, including some persons with no previous kidney problems. Although SARS-CoV-2 has a tropism for ACE2-expressing epithelial cells of
14384-752: The virus even if they do not develop symptoms. Testing methods for COVID-19 to detect the virus's nucleic acid include real-time reverse transcription polymerase chain reaction (RT‑PCR), transcription-mediated amplification , and reverse transcription loop-mediated isothermal amplification (RT‑LAMP) from a nasopharyngeal swab . Several COVID-19 vaccines have been approved and distributed in various countries, many of which have initiated mass vaccination campaigns . Other preventive measures include physical or social distancing , quarantining , ventilation of indoor spaces, use of face masks or coverings in public, covering coughs and sneezes, hand washing , and keeping unwashed hands away from
14508-509: The virus is carried out through virus-laden fluid particles, or droplets, which are created in the respiratory tract, and they are expelled by the mouth and the nose. There are three types of transmission: "droplet" and "contact", which are associated with large droplets, and "airborne", which is associated with small droplets. If the droplets are above a certain critical size, they settle faster than they evaporate , and therefore they contaminate surfaces surrounding them. Droplets that are below
14632-464: The virus. At least a third of people who are infected do not develop noticeable symptoms . Of those who develop symptoms noticeable enough to be classified as patients, most (81%) develop mild to moderate symptoms (up to mild pneumonia ), while 14% develop severe symptoms ( dyspnea , hypoxia , or more than 50% lung involvement on imaging), and 5% develop critical symptoms ( respiratory failure , shock , or multiorgan dysfunction ). Older people are at
14756-601: The wounded. Currently, a NATO working group is investigating unpiloted aerial vehicles (UAVs) for casualty evacuation. The first civilian uses of aircraft as ambulances were probably incidental. In northern Canada, Australia, and in Scandinavian countries, remote, sparsely populated settlements are often inaccessible by road for months at a time, or even year-round. In some places in Scandinavia, particularly in Norway,
14880-549: Was at stake, air ambulances would often operate on the very edge of their safety envelopes, going on missions in conditions where no other civilian pilot would fly. As a result, nearly fifty percent of all EMS personnel deaths in the United States occur in air ambulance crashes. In 2006, the United States National Transportation Safety Board ( NTSB ) concluded that many air ambulances crashes were avoidable, eventually leading to
15004-586: Was created in 2008. At launch, it operated a Eurocopter EC135 , but as flying hours increased the funding was not available, so the charity moved to a MBB Bo 105 helicopter. In 2012, the charity started a campaign to raise the money needed to return to the EC135. The goal was reached in 2014, and in October the EC135 (registered G-GWAA) arrived at the base in Bristol Filton Airport . The EC135 had
15128-491: Was granted in August 2016. Work started at the site in late 2017, with both services moving to the new base in October 2018. In July 2018, GWAAC launched a public appeal to raise funds to buy the new airbase from BAE Systems, following it being put up for sale during its construction. GWAAC raised £1.3 million towards the purchase, which completed in December 2018. NPAS remain on site as tenants of GWAAC. In September 2019,
15252-484: Was spent operating its helicopter and critical care cars. Within four minutes of an emergency call being received the helicopter can be in the air, and it can be anywhere within the region it covers in 20 minutes. GWAAC also operates critical care cars, used at night or when the helicopter is not feasible – for example due to the location of the patient, or the helicopter being at another job, or otherwise unavailable. The specialist critical care team consists of
15376-796: Was used to provide medical evacuation – either from frontline areas or the battlefield itself. In 1928, in Australia, John Flynn founded the Flying Doctor Service (later the Royal Flying Doctor Service), to provide a wide range of medical services to civilians in remote areas; these included from routine consultations with travelling general practitioners , to air ambulance evacuations and other emergency medical services . Fixed wing military air ambulances came into regular use during World War II. Helicopters became more commonly used for such purposes during
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