Re: FW DNR

["Nick Nudell" <nick@glacierems.com>]

> I do HATE to fly terminal/dying pt's and offer alternatives whenever
> possible, my current service will do it, but most I am sure do their
> best to turf to ground or move family to the pt, or other
> alternatives.?.?.?
>
> Just my .2


The most comprehensive info on the subject that I could find is at:
http://www.naemsp.org/Position%20Papers/SpecResAirMedTrans.html . The
position appears to be that a flight may be justified for DNR patients if
the reason is not related to their DNR status...
-------------------------------------

For the military viewpoint of medevac take a look at the folowing site:
Air Evac When: "the speed of transport, skill of the medical team, and/or
ability of the [aircraft] to overcome environmental obstacles is likely to
contribute to an improved patient outcome."
http://www.usafp.org/op_med/fldmedopns/airevac.htm
-----------------------------

6. Fixed Wing Air Ambulance (FW): Fixed wing air ambulance is provided when
the patient's medical condition is such that transportation by either basic
or advanced life support ground ambulance is not appropriate. In addition,
fixed wing air ambulance may be necessary because the point of pick-up is
inaccessible by land vehicle, or great distances or other obstacles (for
example, heavy traffic) are involved in getting the patient to the nearest
hospital with appropriate facilities.

7. Rotary Wing Air Ambulance (RW): Rotary wing air ambulance is provided
when the patient's medical condition is such that transportation by either
basic or advanced life support ground ambulance is not appropriate. In
addition, rotary wing air ambulance may be necessary because the point of
pick-up is inaccessible by land vehicle, or great distances or other
obstacles (for example, heavy traffic) are involved in getting the patient
to the nearest hospital with appropriate facilities.
http://www.astna.org/HCFA_document.html

---------------------------------
http://www.ampa.org/medical_conditions.pdf

t. Air Ambulance
Air ambulance transportation service, either by means of a helicopter or
fixed wing aircraft, if medically appropriate, is a covered service
regardless of the state or region in which it is rendered.

Effective for dates of service on and after January 1, 2001, air ambulance
services are defined as follows:

Fixed Wing Air Ambulance (FW) - Fixed wing air ambulance is furnished when
the beneficiary's medical condition is such that transport by ground
ambulance, in whole or in part, is not appropriate. Generally, transport by
fixed wing air ambulance may be necessary because the beneficiary's
condition requires rapid transport to a treatment facility, and either great
distances or other obstacles, e.g., heavy traffic, preclude such rapid
delivery to the nearest appropriate facility. Transport by fixed wing air
ambulance may also be necessary because the beneficiary is inaccessible by a
land or water ambulance vehicle.

Rotary Wing Air Ambulance (RW) - Rotary wing air ambulance is furnished when
the beneficiary's medical condition is such that transport by ground
ambulance, in whole or in part, is not appropriate. Generally, transport by
rotary wing air ambulance may be necessary because the beneficiary's
condition requires rapid transport to a treatment facility, and either great
distances or other obstacles, e.g., heavy traffic, preclude such rapid
delivery to the nearest appropriate facility. Transport by rotary wing air
ambulance may also be necessary because the beneficiary is inaccessible by a
land or water ambulance vehicle.

Air ambulance transportation services, may be determined to be covered only
if:

The vehicle is specially designed and equipped for transporting the sick or
injured. It must have customary patient care equipment including a
stretcher, clean linens, first aid supplies, oxygen equipment, and it must
also have such other safety and life saving equipment as is required by
state or local authorities.

The ambulance crew must consist of at least two members. One of these
members must have adequate first aid training.

The beneficiary's medical condition required immediate and rapid ambulance
transportation that could not have been provided by land ambulance; and
either

1. The point of pick-up is inaccessible by land vehicle (this condition
could be met in Hawaii, Alaska, and in other remote or sparsely populated
areas), or

2. Great distances or other obstacles (for example, heavy traffic) are
involved in getting the patient to the nearest hospital with appropriate
facilities for treatment. The term "appropriate facility" refers to a
hospital that is capable of providing the required level and type of care
for the patient's illness and has available the type of physician or
specialist needed to treat the beneficiary's condition.

Air ambulance transport is covered for the transfer of a patient from one
hospital to another if the medical necessity criteria are met, and the
transferring hospital does not have adequate facilities to provide the
medical services needed by the patient.

The medical appropriateness is only established when the beneficiary's
condition is such that the time needed to transport a beneficiary by land,
or the instability of transportation by land, poses a threat to the
beneficiary's survival or seriously endangers the beneficiary's health.

The following is a list of examples of cases for which air ambulance
transportation could be justified. The list is not all inclusive, nor is it
intended to justify air transportation in all locales in the circumstances
listed:

Intracranial bleeding which requires neurosurgical intervention;
Cardiogenic shock;
Burns requiring immediate treatment in a burn center;
Conditions requiring treatment in a hyperbaric oxygen unit;
Multiple severe injuries; or
Life-threatening trauma.
Air ambulance transport is covered for the transfer of a patient from one
hospital to another if the medical appropriateness criteria are met and the
transferring hospital does not have adequate facilities to provide the
medical services needed by the patient. Examples of such services include
burn units, cardiac care units, and trauma units. The ambulance transport is
covered only if the hospital to which the patient is transferred is the
nearest one with appropriate facilities.

http://www.hgsa.com/professionals/bguides/pf-ambulance.shtml

---------------
Then for an excellent discussion of Pediatric Considerations (mostly off
this topic) look at:
http://www.indianpediatrics.net/august2000/august-853-871.htm .


Be safe.
Nick



____
Nick Nudell, NREMT-P, CCEMT-P
Education Coordinator
Glacier County EMS
www.glacierems.com
nudell@prehospital-perspective.com

"What we are communicates far more eloquently than anything we say, even
more than anything we do.." -- Steven Covey







----- Original Message -----
From: "Tom Waters" <tom@tomwaters.net>
To: <flightmed@flightweb.com>
Sent: Wednesday, October 02, 2002 11:39 AM
Subject: RE: FW DNR


> >From an earlier post from Nick Nudell:
>
> "Is it common practice in your area to fly patients who have a DNR?"
>
> I have determined code status on every patient I am able to, ground or
> air, my entire career.  I am just wondering do you mean "Fly
> terminal/end stage patients"?
>
> I have a DNR myself, and think it wholly appropriate to know my pt's DNR
> status, for the sick or not-so-sick patient, in the unlikely event of
> in-flight complication, AMI, unanticipated controlled flight into
> terrain (crash) thrombus, etc.
>
> I do HATE to fly terminal/dying pt's and offer alternatives whenever
> possible, my current service will do it, but most I am sure do their
> best to turf to ground or move family to the pt, or other
> alternatives.?.?.?
>
> Just my .2
>
> Tom
>
>



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