1. Introduction

Healthcare surveies focus largely on treatments about handling patients in secure installations ( a infirmary. patient’s place or other installations ) . The treatments will so concentrate on certain subjects that concern certain wellness and safety factors and elaborate in inside informations sing the surveies and sweetenings made within that peculiar subject of treatments. Because of the importance of those surveies and sweetenings. such treatments are really much appreciated and supported. Merely a few researches nevertheless. take to detect on the wellness and safety factors of the patients before they reach a unafraid installation of intervention.

Ironically. all patients must travel through a phase where they are brought to the infirmary within a status of illness or enduring hurts. Furthermore. Cunningham. et. Al ( 1997 ) reveals that the first hr of intervention ( particularly for exigency patients ) is the most of import stage of medical interventions. which greatly influence the quality of overall intervention received by patients.

This hr is by and large known as the aureate hr and it normally involves people who come in contact with the patient instantly after a health-related incident occurs. For most happenings. the aureate hr includes activities of first assistance ( assist given by households or people near by ) . initial attention by paramedic experts and transporting patients to the intervention installation.

Refering the of import of transporting patient to infirmaries instantly. this paper will discourse about the many sorts of transit and lucubrate the implicit in grounds behind the choice of manner of transit. which is based on the patients’ status and grade of illness.

1. Paramedic Transportation system

II. 1. History

The most normally known paramedic transit tool is the ambulance. Even a cart with Red Cross on its sides was called ambulance. In the past nevertheless. ambulance did little more than pick the patient up and rush them to the nearest infirmary. However. as the newest research revealed the importance of the ‘golden hour’ and first assistance. ambulance and paramedics hold enhanced importance in health care. Today. ambulance paramedics receive assorted preparations and they must themselves understand the jobs that might confront them in the field and how to get the better of them.

A newer term in the paramedic transit vocabulary is ‘air ambulance’ . It is the usage of airborne vehicles to transport patients to safety or the intervention installation. The most normally used vehicle is a chopper. The usage of civilian chopper to transport patients began in the Vietnam when soldiers are besides carried by the choppers that brought them down. The first civilian chopper dedicated entirely to transport patients nevertheless. was non introduced until 1972. Today. nevertheless. the usage of chopper for medical intents is a instead common activity. The development of choppers as air ambulance is besides based on the aureate hr rule delivered by R. Adams Cowley.

II. 2. Ambulance

Under a instead modest position. transporting patients utilizing ambulance and air ambulance might non signal many jobs to be faced. Nevertheless. researches indicated that it is common for patients to decease in the ambulance because deficiency of a proper attention. A study published in 1999 by an institute of medical specialty indicated that every bit many as 98. 000 patients died because of errors made by hospital workers. including paramedics. Even without the human-error factor. there are assorted other things that could travel against the patient’s best involvements such as. unfortunate conditions conditions. turbulency or quivers of the vehicle that makes it impossible to execute any medical intervention within the vehicle. vehicle malfunctions. etc.

In order to avoid or minimise such state of affairss from taking topographic point. healthcare direction should take the type of vehicle that best suited for both the environmental state of affairs and the status of the patient. In following subdivision ( subdivision III ) . we will execute a comparing of ground-based ambulance and airborne ambulance based on several literatures ( diaries ) .

• Comparison of Air and Ground Transportation for Paramedic Care

III. 1 Air Transportation

Air conveyance is doubtless going the pick of many travellers when covering with the benefits they obtain compared to other manners of transit like land or H2O transit.

In general. the air transit provides dependable intercontinental transit systems. which attract many concern and tourers to utilize the services. The status is obvious since 40 % of international tourers use air transit worldwide. Furthermore. the fast travelling by air transit put aeroplane and chopper to be the dependable transit when covering with exigency events. The status highlights the benefits of utilizing air transit for paramedic attention where about high-end infirmaries have helipads on the rooftops.

In general. the usage chopper provides several advantages and disadvantages as followers:

Advantages of Helicopter Transport

1. Helicopter can go at velocity 100-200 miles per hour for long distance conveyance
2. Does non limited by traffic or route quality
3. twin-engine choppers that fly under instrument flight regulations can run safely in poorer conditions
4. Smoothness of drive vs. land for a patient with a spinal column hurt

Figure 1 Helicopter for Paramedic Services

Beginnings: Corbis. 2008

Disadvantages of Helicopter Transport

1. conditions can be an operational restriction for single-engine choppers with ocular flight regulations
2. bringing of patients by utilizing chopper would be really expensive fue to the high-costs of chopper care. pilot preparation
3. Having the ability to make a secure set downing zone

In add-on to the usage of chopper as the chief manner of transit. paramedic attention besides uses the other air transit manner. the jet aeroplane. However. the usage of aeroplane is non every bit good as chopper since this manner of transit requires runaway path that would non be exists in some occasions if the patients located in distant countries.

However. the usage of jet aeroplane still has the undisputed benefits. in add-on to the advantages. as followers:

Advantages of Airplane Transport

1. On a per stat mi footing. fixed wing conveyances are less expensive than chopper EMS conveyances
2. Preferred when distance exceeds 150-200 stat mis
3. They cruise at 200-300 miles per hour
4. Has the least sum of conditions restrictions vs. rotor-wing conveyance

Figure 2 Jet Airplanes for Paramedic Services

Beginnings: Southeast IOWA Ambulance Services. ( 2008 )

Disadvantages of Airplane Transport

1. Cabin force per unit area should be recorded because of the importance of force per unit area issues ( if intubated fright of the endotracheal tubing is possible. every bit good as problem with Swan-Ganz catheters. ventilators must be recalibrated ) Effectss of barometric force per unit area ( decompression illness. intellectual arterial gas intercalation )
2. Must be able to set down at airdrome with land conveyance at both terminals
3. Instrumentality concerns ( tamponading devices for esophageal variceal bleeding )

III. 2 Ground Transportation

In add-on to two sorts of air transit. the usage of land paramedic vehicles is still common. They besides have the advantages and disadvantages as followers:

Advantages of Ground Transport

1. The most readily available
2. least expensive manner of conveyance

Figure 2 Jet Airplanes for Paramedic Services

Beginnings: Southeast IOWA Ambulance Services. 2008

Disadvantages of Ground Transport

1. Limited by surface conditions or traffic congestion
2. Not suited for usage of conveyance greater than 30 stat mis

1. Comparison of Paramedic Transportations

One of the most practical methods of comparing the viability of transit tools as agencies of back uping medical attention is by measuring clang ( accidents ) statistics of the transit tools. This factor nevertheless. is non itself a sufficient consideration stuffs for comparing between different transit tools. Other factors like velocity. stableness. possibility of confronting jobs on the field and operational plus care disbursals of the vehicles will be discussed in following sub-chapters.

IV. 1 Crash Statistics for Ground-based Ambulances

For traditional ambulances. the NHTSA Fatality Analysis Reporting System indicated that between 1991 and 2002 there are about 300 fatal ambulance accidents which resulted 82 deceases of patients and paramedics within the ambulance and 275 drivers and riders of other vehicles involved within the accidents. Although this tells us that modern ambulance autos have been designed better to protect their residents compare to other autos. the figure of deceases is still a job to be solved. 60 % of the accidents occurred during the emergent drive and 40 % did non ( Thomas. 2002 ) .

There are assorted factors that straight contribute to the happening of an accident. some of them are: the addition hazard of safety while going through intersections. increased hazard of driving in a crowded afternoon. slippery roads when raining. etc. Generally. a ground-based ambulance has larger possibilities to run into problems in the field. However. they besides have less possibility of human death when accidents do go on.

IV. 2 Crash Statistics for Airborne Ambulances

For air ambulances. the sum of deceases related to air ambulances is higher since the twelvemonth 2000. comparison to the decennary predating it. Air ambulances have different factors that contribute straight to happenings of accidents. For case. because air ambulances are comparatively faster and harder to command than ground-based ambulances. visibleness issue becomes of import. 49 % of the accidents from 1978 – 1998 in air ambulances happened at dark.

Another factor that significantly contributes to the happening of accidents of air ambulance is the conditions. The conditions is much more influential for air ambulances than it is to ground-based ambulances. 75 % of conditions related clangs in air ambulances result in a doomed of at least a individual life. Statisticss besides indicated that 32 % of all the clangs occur before the air ambulance of all time reach the patient. 49 % of the clangs happened at dark and 68 % of the clangs result-in human deaths ( Arfken. 1998 ) .

IV. 3 Procedure and Procedure Enhancements

To cover with the human mistake job and other preventable mechanical jobs. healthcare direction establishes widely applied criterions that will hopefully cut down accidents and job in paramedic transit.

Measuring these criterions is a sound method of comparing between the viability of ground-based ambulance comparison to air ambulances. Standards of crash bar exist in many signifiers ; they could in the signifier of informations direction criterions. operational ordinances. accreditation of medical conveyance services. forces developing. etc.

IV. 4. Technology

In footings of engineering. ground-based ambulances are merely one measure further signifier fiting equipments and devices within air ambulances. If ground-based ambulances have EMS systems. air ambulances have on-board black box tracking device. Both vehicles have GPS to help their travel.

However. to cover with visibleness issues. air ambulances are equipped with dark vision goggles. Due to fatal hazard of holding accidents in the center of the air. of course air ambulances are in demand of better engineering than ground-based ambulances.

IV. 5. Other Considerations

IV. 5. 1 Speed and Practicality

Air ambulances are by and large faster than ground-based ambulances because they are non bound by two dimensional traveling capablenesss. Nevertheless. a survey revealed that the clip required to do determinations and so fix a chopper might merely countervail the clip salvaging generated by the travel.

Furthermore. ground-based ambulances have more picks on where to park. while air ambulances must carefully take a secure location to land. The research indicated that the mean clip of air ambulance conveyance is similar to the best ground-based ambulances. This is a instead little difference sing the immense sum of cost and disbursal differences when the two types of conveyance are compared.

IV. 5. 2 Cost Effectiveness

Surveies indicated that despite the immense difference of acquisition and care costs between a traditional ambulance and the air ambulance. siting on a chopper alternatively of a minivan merely benefited really small sum of patients. For case. a survey indicated that utilizing air ambulances is better for victims of terrible caput injury. There are merely little per centums of all accident victims that are really sing such a terrible caput injury. Another survey indicated that there are higher survival rate for air ambulance conveyance comparison to ground-based ambulances if the patients are badly injured or traumatized ( ‘Facts’ . 2002 ; Gearhart. 1997 ; Thomas. 2002 ) .

Overall. we can reason that utilizing the air ambulance is non every bit cost-efficient as the traditional ground-based ambulances. However. for certain intents. the usage of air ambulances is necessary. Recent development is that health care directions developed a computerized system to cipher whether an accident requires the presence of air ambulances or non.

1. Decisions

V. 1. Overall Comparison

In an overall comparing. ground-based ambulances still holds the better trade for health care direction. This is chiefly because of considerations sing the disbursal of the operations. Air ambulance does hold several benefits over ground-based ambulances. but the benefits are non outweighing the disbursal required to supply such a service.

To sum up. airborne paramedic transits have the high land in footings of hazard direction. safety processs. forces developing. operational quality. engineering use. informations direction and betterment possibilities. Its failings include: more sensitive to endure alterations. prone to do human deaths when accidents do go on and visibleness issues at dark.

The ground-based ambulances on the other manus. have the benefit of a faster response clip. practicality in nearing patients in the field. and it is far more cost effectual. Its failings nevertheless. are as follows: more prone to accidents due to external causes. more prone to human mistakes. more dependent upon the status of the traffic and less suited for sensitive patients like victims of caput injury. etc.

V. 2. Integration

The latest development in the health care community indicated a joint coaction between air and land conveyance to back up paramedics. This is possibly the most effectual because each has their ain benefits when confronting different state of affairss. As mentioned earlier. there have besides been developed a computing machine package that could measure all the hazards and benefits of the exigency state of affairss and suggested the best alternate between ground-based or air transit. This indicates that the hereafter might be in the way of such coaction between air and ground-based paramedic transit.

Bibliography

Arfken. Cynthia L. . Shapiro. Marc J. . Bessey. Palmer Q. . and Littenberg. Benjamin. 1998. ‘Effectiveness of Helicopter versus Ground Ambulance Services for Interfacility Transport’ . Journal of Trauma-Injury Infection & A ; Critical Care. 45 ( 4 ) : 785—790

Corbis. “Paramedics Taking Patient from Emergency Helicopter. ” 2008. Retrieved April 17. 2008 from hypertext transfer protocol: //pro. corbis. com/search/Enlargement. aspx? CID=isg & A ; mediauid=560336AF-948B-4219-AA37-F39568002A73

— . “Medical Team Transporting Patient to Helicopter. ” 2008. Retrieved April 17. 2008 from hypertext transfer protocol: //pro. corbis. com/search/Enlargement. aspx? CID=isg & A ; mediauid=339BF935-0AE3-4D11-87BE-DB696845765D

Cunningham. Paul. Rutledge. Robert. Baker. Christopher C. . Clancy. Thomas V. . A. 1997. ‘Comparison of the Association of Helicopter and Ground Ambulance Transport with the Outcome of Injury in Trauma Patients Transported from the Scene’ . Journal of Trauma-Injury Infection & A ; Critical Care. 43 ( 6 ) . 940–946.

‘Facts about Concussion and Brain Injury’ . 2002. Centers for Disease Control and Prevention. Version 2. 2002. 4

Gearhart. PA. . Wuerz R. Localio AR. 1997. ‘Cost-effectiveness analysis of chopper EMS for injury patients’ . Ann Emerg Med. ; 30 ( 4 ) . 500—506

Gebremichael. Mesfin MD ; Borg. Habashi. Nader M. MD. Cottingham. Christine RN. Cunsolo. Lori RN. McCunn. Maureen MD. Reynolds. H. Neal MD. 2000. ‘Interhospital conveyance of the highly sick patient: The nomadic intensive attention unit’ . Critical Care Medicine. 28 ( 1 ) . 79–85

IATA. “Fact Sheet – Economic & A ; Social Benefits of Air Transport” . 2008. Retrieved April 17. 2008 from hypertext transfer protocol: //www. iata. org/pressroom/facts_figures/fact_sheets/economic_social_benefits. htm

RTH. “German Helicopter Emergency Medical System. ” 2002. Retrieved April 17. 2008 from hypertext transfer protocol: //www. rth. info/english/english. php

Southeast IOWA Ambulance Services. “About Us. ” Retrieved April 17. 2008 from hypertext transfer protocol: //www. seiowaambulance. com/

Thomas. Stephen H. . Harrison. Timothy H. RN. EMTP. Buras. Wende Reenstra. Ahmed Waleed. Cheema. Wedel. . Suzanne K. 2002. ‘Helicopter Transport and Blunt Trauma Mortality: A Multicenter Trial’ . Journal of Trauma-Injury Infection & A ; Critical Care. 52 ( 1 ) . 136–145