Air Medical Consultants

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The New York State Emergency Medical Advisory Committee (SEMAC), at the March 29, 2005 meeting acknowledged that Air Medical Service (AMS) providers typically have very large areas of operation that encompass multiple Regional EMS Council (REMSCO)/ Regional Emergency Medical Advisory Committee (REMAC) service areas. Because of these circumstances, the approval process may be lengthy, complex. As a result, the SEMAC supported the protocol approval process to take place in the region in which the AMS maintains its New York State headquarters.

PURPOSE
While the air medical services in New York State operate within the scope of emergency medical services and prehospital care, many of these operations do not lend themselves to the existing protocol and credentialing process. The intent of this policy statement is to streamline the process of approval of protocols, patient care providers and air medical services.

SCOPE
Article 30 of the New York State Public Health Law states:
SECTION 3004-A. REGIONAL EMERGENCY MEDICAL ADVISORY COMMITTEES.
1. Regional emergency medical advisory committees shall develop policies, procedures, and triage, treatment, and transportation protocols which are consistent with the standards of the state emergency medical advisory committee and which address specific local conditions. Regional emergency medical advisory committees may also approve physicians to provide on line medical control, coordinate the development of regional medical control systems, and participate in quality improvement activities addressing system-wide concerns.

AIR MEDICAL SERVICES PROTOCOLS
In order to have the AMS protocols approved, the SEMAC/SEMSCO, with concurrence
from the Department, has approved the following process:

1. The medical director of an air medical service will develop agency protocols to suit that service’s needs. These protocols will be submitted for approval to the REMAC where the air medical service maintains its state corporate offices (primary REMAC). Included with this document will be a listing of all other REMACs/REMSCO’s in which the agency provides air medical service.
2. Each of the affected REMACs will be provided copies of the air medical service protocol for review and comment. The comments must be returned to the primary REMAC within 60 days. The comments will be considered by the primary REMAC, who will work with the air medical service agency.
3. The REMSCO will submit the approved protocol to SEMAC’ Medical Standards Sub-committee for review. The sub-committee may ask the applicant to modify/amend its protocols and have the local REMAC approve the modifications. Once approved by the Medical Standards/Protocol Subcommittee it will come to SEMAC for approval.

In the event that an Air Medical Service agency makes revisions to its approved protocols, it will follow the current and established approval procedures.

AIR MEDICAL SERVICES PREHOSPITAL EMS WORKER CREDENTIALING
Prehospital EMS providers operating within an air medical service will often have occasion to care for patients in multiple regions. In following with the described approval process for Air Medical Service Protocols, the SEMAC/SEMSCO has approved the following process for credentialing of pre-hospital EMS providers affiliated
with air medical services:

• Approval for Emergency Medical Service personnel to utilize Air MedicalService protocols will be granted by the primary REMAC/REMSCO where theair medical service maintains its state corporate offices.

Guidance on Air Medical Transport for SARS Patients
This updated guidance is intended to assist air medical transport (AMT) service providers in using specialized and/or specially equipped aircraft to transport SARS patients while ensuring the safety of patients and transport personnel. It should not be generalized to commercial passenger aircraft. The recommendations are based on standard infection control practices, AMT standards, and epidemiologic information from investigations of SARS, including experience from air transport of patients during the 2003 outbreak.

Currently recommended infection control measures for hospitalized patients with SARS http://www.cdc.gov/ncidod/sars/guidance/I/index.htm include Standard Precautions (with eye protection to prevent droplet exposure) plus Contact and Airborne Isolation Precautions. Respiratory protection using respirators providing at least 95% filtering efficiency (e.g., NIOSH-certified N-95 or higher-level filtering facepiece respirator) with appropriate fit-testing (www.osha.gov/SLTC/etools/respiratory/oshafiles/fittesting1.html) is recommended.

A. Air Transport of SARS Patients: General Considerations
• SARS patients should be transported on a dedicated AMT mission with the minimum number of crew members. Whenever possible, no passengers or patients who do not have SARS should be on board. If a parent is accompanying a sick child, the parent should use personal protective equipment (PPE) during transport as described in “Infection Control,” below.
• If possible, a primary caregiver should be assigned to the SARS patient.
• The number of caregivers should be limited to those required to provide essential care during the trip.
• Infection control measures should focus on:
o Source control (i.e., confining the spread of respiratory secretions at the patient level)
o Engineering controls to limit airborne dissemination of the virus
o Containment of the area of contamination (i.e., designating “clean” and “dirty” areas on the aircraft)
o Use of PPE
o Use of safe work practices to prevent exposure
The size and type of aircraft will influence the extent to which these measures can be implemented. When available, use of a portable isolation unit may be considered.
• Consideration must be given to the need for “PPE breaks” during long trips. Personnel will need to use the lavatory and have meals; removal of respiratory protection is unavoidable. An area at the front of the plane (or “upwind” from the patient, depending on cabin air flow), as far as possible from the patient, should be designated for this purpose.