January 5, 2018

Hospitals get ‘air ambulance’ accord off the ground

One of the Airbus EC135 helicopters used by Dartmouth-Hitchcock Advanced Response Team to move emergency patients to other hospitals. Dartmouth-Hitchcock will work with UVM Medical Center to offer a similar service to a broader area. PROVIDED PHOTO


BURLINGTON — Dr. Ryan Clouser tells the story of a recent heart attack victim who needed advance medical treatment that couldn’t be provided by the local hospital. So an ambulance was dispatched to take the patient to the University of Vermont Medical Center in Burlington.

The patient survived, but Clouser said because the trip took several hours, it jeopardized the patient’s chances for recovery.

“That is why helicopter transport is really helpful,” said Clouser, a medical officer for the UVM Transport System.

Cases like the one cited by Clouser are the reason Vermont’s largest hospital teamed up with Dartmouth-Hitchcock Medical Center to provide air transport for critically ill patients in Vermont and northern New York.

The UVM Health Network signed a contract with the Dartmouth-Hitchcock Advanced Response Team (DHART) to provide air ambulance service at the Burlington hospital.

Hospitals routinely rely on ground ambulance service, but when it comes to critical care patients, ground transport isn’t sufficient.

Officials say that means those patients need to be transported as quickly as possible to a higher-level medical facility.

“Trauma is a big one. Anyone with an acute heart attack, stroke, anyone that’s critically ill with sepsis or septic shock,” Clouser said. “The things that we need to get our hands on the patient as soon as possible.”

The UVM Health Network encompasses 40,000 square miles and 11 network and non-network hospitals in Vermont and upstate New York.

Ground ambulance service in the region continues to be the primary transportation between smaller hospitals and medical centers in Burlington, Plattsburgh and Barre.

“We depend on the local transport agencies to be involved and to provide the care to these patients that come from all of the hospitals in the region to the secondary and tertiary care centers, which in our region are UVM Medical Center, CVPH over in Plattsburgh, and CVMC down in (the) Barre-Montpelier area,” said Dr. John Fortune, a UVM trauma surgeon and interim medical officer for the Regional Transport System.

He said UVM has a history of relationships with aero-medical services that can be utilized as needed, but no formal relationships like the one just completed with DHART.

Fortune said UVM looked at other air options but decided “DHART best met our needs.”

He said as a nonprofit, DHART was able to provide a cost-effective service. Fortune also said as an academic medical center, Dartmouth-Hitchcock was aligned with UVM’s mission.

In addition, DHART has an outstanding safety record, which “is certainly one of our major concerns,” Fortune said.

He said based on an analysis, UVM anticipates the DHART service will transport between 400 and 500 patients a year from outlying hospitals to the UVM Medical Center.

UVM has no plans at present to deploy DHART for accident-scene transports or for other trauma-related injuries, though Fortune said that could be an option in the future.

“We’re embarking upon this program very cautiously … and eventually may evolve into something more,” he said.

Plans call for DHART to base a helicopter 24/7 at the Burlington International Airport, a short distance from the helipad at the UVM Medical Center. Arrangements are also being made for hangar space and quarters at the airport for DHART pilots.

UVM Health Network will provide the medical personnel, which initially will include five flight-certified paramedics and five flight-certified nurses.

Clouser said medical personnel will undergo eight weeks of aviation safety training by DHART.

“Once they complete that, our teams will be staffing the helicopters to transport here on campus,” Clouser said.

The UVM/DHART service is expected to be operational in July.

Fortune said the air ambulance service is part of a comprehensive communication program where a hospital physician will place one call that will determine the best transport method and appropriate hospital for the critically ill patient.

“You have to remember that not all patients that are going to be transferred are going to be transferred by the aero-medical program,” Fortune said. “And it’s going to be up to us to make sure that we choose those patients appropriately, because we don’t want to overuse this system and increase the cost to the health-care program.”

Tara Pacy, director of the UVM Regional Transport System, said the goal is to “get the patient to the right place the first time.”

DHART Director Kyle Madigan said the UVM contract is the first of its kind for DHART.

“We have primarily operated just our own program here out of Lebanon and Manchester,” Madigan said. “And so, we’re going out with a new opportunity with UVM to enhance the services to the population there in northern Vermont as well as northeastern New York State.”

The Dartmouth-Hitchcock air ambulance service has been in operation since July 1994.

DHART, which contracts with Metro Aviation of Shreveport, Louisiana, for the pilots and mechanics, has two Airbus EC135 helicopters, one based at Dartmouth and another in Manchester, New Hampshire. There is also a backup helicopter.

Both UVM and DHART declined to disclose the contract price.

Madigan did say a new, fully equipped EMS helicopter is priced between $5 million and $6 million.

DHART has a staff of 13 flight nurses and 13 flight paramedics. There are also nine Metro Aviation pilots.

DHART air lifts 1,400 patients a year, with the majority between hospitals.

“Of those 1,400 patients that we transport by helicopter, 85 percent of our requests are from one hospital to another hospital,” Madigan said.

Only 15 percent of calls are “scene calls,” where DHART picks up accident victims, he said.

Operating 24 hours a day, seven days a week, the DHART team transports patients to any appropriate medical facility in New England.

Madigan said about 40 percent of DHART transports go to other hospitals, including Albany, New York; Boston and Worcester, Massachusetts; and Portland, Maine.


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