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Flown to safety: The process behind medevac flights


We’ve all seen them on their way to the scene of a dangerous accident.

They’re the blue and white Suffolk County Police Department helicopters, equipped with medevac services designed to move patients as quickly as possible to the county’s only Level 1 Trauma Center at Stony Brook University Hospital. 

These emergency helicopters are lifesaving machines called when it seems an ambulance just won’t suffice.

But what’s the tipping point that constitutes air travel over a standard ambulance ride?

North Fork first responders say it all boils down to protocol.

“There’s time constraints on getting a trauma patient to a hospital — to a trauma center,” said Rod Richardson, assistant chief at Riverhead Volunteer Ambulance Corps. “With lights and sirens from Riverhead, it’s about a half-hour drive to Stony Brook. If the patient is out farther east, say Jamesport and Aquebogue, we need that helicopter to get the patient to the hospital within the time limits. It just makes life a lot easier.”

As explained in the 2014 edition of the Suffolk County Emergency Medical Services Advanced Life Support Protocol manual, calling a medevac is based on numerous circumstances, such as a patient’s condition and distance from a specialty hospital.

Injuries that qualify for airlift are those that require specialized care and medications, services offered by an air crew that can’t be offered by an ambulance crew, a “life or limb” threatening situation, critical burns or trauma.

Kevin Brooks, first assistant chief of the Riverhead Fire Department, said another consideration emergency medical technicians must make is the mechanism of injury, or the damage that occurs to the car involved in an accident.

“If the car is smashed up to a point where EMTs would assume that there were internal injuries … The ambulance makes that decision [to call a medevac],” Mr. Brooks said.

The county currently has four helicopters that are flown between 1,900 and 2,000 times each year. According to Suffolk County Police Department, there have been 1,484 missions since Jan. 1, 2015. Of these flights, 105 were to the North Fork, which means the towns of Riverhead and Southold have a combined average of approximately 2.6 flights each week. According to SCPD, the number of missions flown each year has remained relatively flat since 2010.

A major factor in deciding if a medevac needs to be called is figuring out the difference in ground and air transportation times.

Ground transport time factors in removing the patient from the scene and stabilizing them, loading them into the ambulance and driving them to the hospital. Elements that can delay travel time, such as weather, traffic, road conditions and time of day, also need to be considered.

For air travel, time calculation includes helicopter preparation, flight time to scene, drive time to landing zone and flight time to trauma center, as explained by the Suffolk County EMS protocol.

“If you need surgery at the MVA, [you can get] flown to Stony Brook and be in the OR within an hour,” Southold Fire Chief Peggy Killian said, calling it the “golden hour.” In medicine, the golden hour is the first hour after the traumatic injury occurs, which is considered the most critical for successful emergency treatment.