When and when not to "hot offload" a patient — in other words ingress or egress with the main helicopter rotor disc spinning — has been the subject of debate for years. Negatives associated with the practice include the possibilities of getting clipped by the main rotor or walking into a spinning tail rotor.
We saw the risk associated with moving around engaged helicopters again recently, when a mechanic lost his life after apparently being struck by a spinning tail rotor blade in Iowa in June.
Many helicopters used today, including models like the Airbus H130, H135, H145; MD 902; and the Bell 429, feature either no tail rotors, shrouded tail rotors, high tail booms, rear-loading clamshell doors, or a combination of these features to reduce the likelihood this kind of unsavory accident.
However, the military has hot-offloaded medevac patients for years, and now new data from the rural Missouri Baptist Medical Center (MBMC) and Salem Memorial District Hospital (SMDH) seem to indicate the value of hot offloading when transporting certain high-risk heart attack patients.
Working with HEMS provider Air Evac Lifeteam, the hospitals began the practice of hot-offloading STEMI — ST segment elevation myocardial infarction — heart attacks, a particularly deadly variation that needs immediate treatment.
A STEMI results when a coronary artery is completely blocked and the section of the heart muscle — generally a significant portion — supplied by that artery begins to die. It presents itself by a signature elevation in the ST segment of the EKG. Minutes are precious for patients having a STEMI.
SMDH began investigating ways to chop the transport time of these patients from its facility to a higher level of care at MBMC. Two years ago, it took 50 minutes to process, diagnose and transport (aka door-in, door-out) STEMI patients; now it's down to 21 minutes.
After conducting a series of mock drills, changes made in patient treatment and transport protocol included immediately administering an EKG and administering stabilizing agents — intravenous fluids, oxygen, and drugs — to patients presenting with chest pain, immediately summoning the EMS helicopter, and transporting the patient directly to the helipad to await the arriving helicopter.
Once the helicopter arrives, the engine stays on and the blades keep turning. It takes six to eight minutes to exchange the appropriate information and load the patient.
Hot offloading is not always appropriate or even necessary. But knowing when, and when not to, hot offloads can mean the difference between life and death for a patient.
