Ark. Builds $25 Million-a-Year Trauma System


 
 

Carolyne Park | | Wednesday, May 27, 2009


LITTLE ROCK, Ark. -- Registered nurse Amber Henthorne reached her hand through the circular hole on the side of the incubator to gently rub the infant's stomach in hopes of soothing his cries.

At 13 days old, Brian Finney was more than 4,000 feet above the ground. He was being whisked through the air at 140 mph to Arkansas Children's Hospital in Little Rock on the first helicopter ride of his young life.

Just five minutes earlier back at Sparks Regional Medical Center in Fort Smith, Brian and Amanda Finney had kissed their son's tiny head and watched with worry as the Angel One Medical Transport team loaded Brian onto the air ambulance.

"We'll take good care of him," Henthorne assured them before climbing in next to the baby.

Angel One is one of 25 air ambulance services in Arkansas, including helicopter and fixed wing jet services for longer distance flights. Such services will be integral to a new statewide trauma system approved by legislators last session, said David Taylor, the Arkansas Department of Health's section chief of emergency medical services and trauma systems.

Arkansas officials are in the early phases of developing the $25 million-a-year system, which will provide for better communication and coordination between hospitals and emergency providers statewide. It's designed to ensure patients injured in car crashes, falls or other traumas are transported as quickly as possible to the nearest facility best able to treat their injuries, Taylor said.

It will be at least two years before the trauma system is fully in place.

"Air ambulance services are going to be a vital component because Arkansas is a vast rural state," he said.

Angel One does only patient transports, with about 1,300 transports by air and 600 to 800 by ground ambulance annually. The state's 21 other helicopter air ambulance services do patient transports and respond directly to accident scenes.

Along with Arkansas' 176 ground ambulance services, they play a crucial role in getting patients to needed medical care, Taylor said.

"They're extremely valuable and the first line of defense when you start thinking about a trauma system," he said. "They're on the front lines and they're going to make that determination of where that patient's going to be transported." Nationwide, a critically ill or injured patient is transported by air ambulance every 90 seconds, according to the Association of Air Medical Services. That's 400,000 patients a year.

MedFlight is a helicopter service based at Baptist Health Medical Center Little Rock, and was Arkansas' first air ambulance service. In its 25-year history, MedFlight has transported more than 15,000 patients from every Arkansas county to needed medical care, said Doug Weeks, the hospital's senior vice president and administrator.

MedFlight responds to accident and disaster scenes, and transports patients from rural hospitals or clinics, including mothers with high-risk pregnancies or premature newborns.

Such services are a lifeline in a state where much of the population lives in rural areas that don't have the level of medical care offered in the bigger cities, he said.

"It's all about saving lives," Weeks said.

No Transport the Same

Doctors in the intensive care nursery at Sparks Regional decided to transport Brian on Wednesday after becoming alarmed by his erratic blood-oxygen levels. They hoped specialists at Arkansas Children's could help find the problem and fix it before it got more serious.

His father Brian Finney said he and his wife would hit the road to follow their son to Little Rock as quickly as they could scrape up the money for the unplanned trip.

"He was supposed to come home in 48 hours that's what they told us yesterday," Brian Finney said.

"Now we're going to Little Rock. It's nerve-racking." Amanda Finney sobbed and sunk to the ground as the helicopter took off and carried her son away.

A flight nurse with Angel One for two years, Henthorne said no patient or trip is the same. Most of their patients are severely ill children or newborns who need either emergency or long-term specialized medical care.

It's a job that requires flexibility, compassion and fast thinking.

"Every transport is different," she said.

Within minutes, she was able to calm Brian. Nestled inside the warmth of the incubator, he was soon asleep from the vibration of the flight. For the next 45 minutes Henthorne watched him like a hawk, repeatedly checked a monitor with his vital signs and entered notes into a computer.

Across from her, respiratory therapist David Easom also kept watch over the sleeping baby, occasionally adjusting controls to the double-paned incubator.

Easom has helped transport hundreds of patients from throughout Arkansas and surrounding states in 17 years with Angel One. When he first started, newborns averaged 800-900 grams, but medical advances mean doctors are able to care for babies as small as 500-600 grams.

"There's no such thing as a typical day in transport," Easom said.

Angel One has eight full-time pilots and two others on staff who fly when needed. They also have 13 respiratory therapists and 13 registered nurses. Everyone works 12-hour shifts, alternating between days and nights.

The flight crew varies depending on the patient's needs, but typically includes a flight nurse, respiratory therapist and a physician.

Medical personnel do everything they can for a patient before they put them on the helicopter, Easom said. They want to stabilize the patient and minimize the amount of treatment they have to provide en route to make the trip as smooth as possible.

If everything goes as desired, the flight back to Arkansas Children's is uneventful, with infants sleeping or children watching DVD animated movies on a small television affixed to the side of the cabin.

"We really want the patient as stable as we can before we transport them," he said.

"Our philosophy is when we land, you're in Children's Hospital. Treatment starts when we get there."

Getting to Needed Care

In the front cabin, pilot Van Walker flew the helicopter carrying young Brian. The skies were clear as he guided the craft toward Little Rock, with only occasional air pockets rocking an otherwise smooth ride.

Angel One can fly anywhere in the state in under an hour, Walker said.

The call about Brian came into Angel One's communications center at 11:27 a.m. Within 12 minutes, doctors at both hospitals had discussed the case and made the decision to bring him to Arkansas Children's.

The medical flight team was in the air in 16 minutes and landed on the helipad outside the emergency department at Sparks Regional at 12:51 p.m.

Before becoming an air ambulance pilot, Walker flew crewmen and oil company executives to and from off-shore oil rigs.

"This is more rewarding than just taking guys back and forth. It never gets monotonous; every day, every flight is different," he said. "It's rewarding. You're helping a kid get the kind of care they can't get otherwise." At Angel One's communication center in Little Rock, Communications Coordinator Anne Marie Morse spends her days taking calls from doctors at hospitals statewide.

An average of 8,000 phone calls come into the center each month. Morse's job is to connect doctors in rural areas with specialists at Arkansas Children's who can consult with them about patients.

A team is sent to transport patients only in the most critical cases, or when patients need long-term medical care they can't get closer to their hometowns, said B.J. Raysor, director of operations for Angel One.

The service does about 180 transports a month.

"Everything comes in here and everything goes out here," Raysor said. "We don't want to transport patients if we don't have to." The majority of Angel One's transports are in state, but they've sent helicopters to assist with emergencies in New Orleans, Oklahoma City, St. Louis, Dallas and elsewhere, Raysor said.

The hospital originally contracted with other agencies to run Angel One, but Arkansas Children's took it over in 2002.

Having everyone in-house helps them keep up with the latest safety systems and ahead of Federal Aviation Administration requirements, Raysor said.

Pilots and medical staff undergo regular training and have to maintain several professional certifications. Angel One's two Sikorsky S-76 helicopters are equipped with the latest safety equipment that warn pilots if any objects or other aircraft come within a few miles of them. A flight recorder onboard allows them to study each flight, and a quality assurance system alerts staff to any potential problems that need to be fixed.

Everything's designed to ensure children are transported safely, Raysor said.

"We all got into this because we want to help children," Raysor said.

"That's why I can go home after 12 or 14 hours and feel pretty good about what I did that day." The flight carrying Brian took off from Fort Smith at 1:56 p.m., and arrived in Little Rock 48 minutes later. A medical team met the craft as it landed and took Brian directly to the hospital's neonatal intensive care unit.

By Monday, Brian had been released from the hospital and was back home with his family in Fort Smith.




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Related Topics: Extrication and Rescue, Head and Spinal Injuries, Medical Emergencies, Operations and Protcols

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