Medevac Helicopters: When Your Heroine's Life Is On the Line

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(Photo credit: Wikipedia)

Recently I had the opportunity to meet a helicopter rescue team from Virginia Commonwealth University Health Systems. What a fascinating job!











It was a nighttime landing at a church parking lot. The helicopter circled to come in with the wind direction. I was ready for wind - I was not ready for the gale that swallowed me. Debris flew by, and I ended up ducking between cars for safety.

Helicopter with patient (Photo credit: Wikipedia)

* On the VCU Health Systems team,
    rescuers work four
   days a month: two twenty-four-
   hour days and two eight-hour days.
* The teams from V.C.U. work as a
   group of three to include:
   1. The pilot - who knows nothing
       about the patient in order to maintain his
       focus on piloting safely.
   2. A medevac nurse

   3. A flight paramedic
* Team members are rotated so that:
   1. they are used to working with everyone from
       their location
   2. to avoid complacence
   3. to avoid bad habits.
* Surprisingly, most of their work is not flying crash victims to the hospital.
   Most of their work involves moving patients from smaller hospitals, where the
   equipment, medication, or expertise is lacking, to a larger
   hospital which is better positioned to handle the medical crisis.
* Getting a patient into the right environment within a 1-3 hour window creates a significantly higher
   survivability rate.
* The VCU team flies up to Maryland, Washington D.C., down to North Carolina,
   and west to Virginia Tech. While many of the large universities have their own flight evac teams
   and their own hospitals that they represent, on this level there is a great deal of comradery, reciprocity,
   and shared resources. The teams will transport for each other depending on availability and location.

Video Quick Study (6:00) Excellent overview of a simulated rescue moving a patient from a lower level
hospital to a trauma center. In this video:
* The average take off time for this team is 6 minutes
* They like the team to touch the helicopter in 90 seconds
* As they are flying in the hospital is gearing up. They can be in surgery cutting into the patient
   within 3 minutes of landing.

Video Quick Study (4:00) Response to a car accident with head trauma.
Video Quick Study (11:00)  GRAPHIC IN NATURE - please consider your tolerance. A soldier with a
                              brain trauma is being treated on the flight. This is NOT A SIMULATION. You may
                              want to mute the music to focus on the organization of the medical equipment and the
                              medical interventions that are being performed on the floor of the helicopter.
             

This job is considered one of the most dangerous jobs in the United States. 

One of the bad thing that can happen is called: Flicker Vertigo
* Is not caused by inner ear issues like normal vertigo - it is a visual issue
* Causes queasiness and confusion
* Can effect the patient as well as the pilot. This is particularly concerning where a patient
   has a history of motion sickness or epilepsy.
* Full face visors work like sunglasses to protect against this.

PDF resource that is much more thorough
Video Quick Study (0:23) experience flicker vertigo

Another big danger happens in landing around power lines.
* Lines are difficult to see especially at night. (Which you can easily see in my video above)
* The helicopters are equipped with hooks that would trap and cut the line to protect the helicopter
   and the rescue workers.

Video Quick Study (3:00) Skip right to the 2:10 mark. Helicopters and power lines are a bad combo.

If you are writing a flight evac scene, you will need to make a lot of decision, just like real-life rescuers do.

What about the weather?
* Before any information about the patient or the situation is offered, the weather is checked.
* It is important that a safe decision is made based on data alone, without figuring in the heroics of the rescue
   team.
* Once the weather is determined to be safe, then other decisions are considered.

Is the woman pregnant and is it possible that she will go into labor?

 (Photo credit: Wikipedia)

* From the position of the gurney on the helicopter, the
   rescue team does NOT have access to the lower half
   of the patient's body.
* A woman in labor is a no-go on the helicopter

Will the patient fit?
* The space is limited.
* These  rescue workers have had a patient
   with an enormous girth before. They had to lubricate
   him in order to squeeze him in to the cramped space - it
   makes for an uncomfortable ride, and it ups the danger quotient.

Weight.
* A helicopter can only carry so much weight.
* The flight crews weight is documented and put into a mathematical calculation as is the weight of the
   passenger they are going to pick up.
* Jet fuel weighs about 7 lbs per gallon. The pilot calculates for distance. It takes 1.1 gallons of fuel
   per minute of flight. They are flying at 120-140 nautical miles per hour. A nautical mile is 20%
   longer than a regular mile - so this is equivalent to about 188 mph. The pilot indicated that this was the
   speed of a NASCAR driver on a medium track. Of course they are moving in linearly, unlike a car,
   so the distance is shorter. (And how much does that fuel at 1 gallon per 1.1 second cost? As of the writing
   of this post it was $4.90 per gallon tp $6.50 depending on contracts. YIPES! That's an expensive
   rescue!) At any rate, the pilot is calculating whether or not he can hold enough fuel for the distance of the
   rescue.

Once the patient is stabilized, packaged, and loaded:

The  nurse and flight paramedic have all of the resources of an emergency room to include:

* Respiration apparatus

* Defibrillators

* Medications

* Wound dressing

HELICOPTER SAFETY

Approach

* The helicopter has two engines

* The blades move at 450 mph which about six times per second.

* The blades can flex downward which is a decapitation hazard.

* To approach safely only do so from the front.

* If you are positioned to the rear of the helicopter make a large arc to the front

* Get permission to approach by signaling the pilot either by radio or hand signal of your intention and wait

    for a thumbs up.  

Video Quick Study (2:05) approach

Heliports

 (Photo credit: Wikipedia)

*Are one of the most dangerous places at a hospital.
* Nurses, technicians, and maintenance workers are
   all trained to minimize risk - but we all know in
   an emergency sometimes our bodies just act. This
   is the wrong place for that to happen.
* Hospitals have a dedicated elevator ONLY for
    medevac rescue.

Video Quick Study (1:00) Medevac helicopter landing
                                           on a hospital roof heliport.

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Footwear Evidence for Writers – by Patti Phillips

Conferences are a blast for the mystery/thriller writing crowd these days. And not just because of the workshops improving our craft and technique providd by the many writing organizations. I appreciate those I do. But for all-out, slam-dunk fun, I go to the Writers' Police Academy (founded by Lee Lofland). It’s a three day, hands-on, mind-blowing experience that demonstrates the nuts and bolts of police and fire and EMS procedure – taught by professionals and experts actively working in the field. All with the purpose of getting writers to improve their technical knowledge so that they can get it right on the page.

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Along with several other strands of study, the last two WPA conferences provided classes in bloodstain patterns, fingerprinting, and alternate light sources (ALS) conducted by Sirchie instructors. Because of the standing room only enthusiasm for these classes, Sirchie offered a five-day Evidence Collection training session for writers at their own complex in North Carolina. Sirchie makes hundreds of products for the law enforcement community and I felt this would be a great opportunity for Detective Kerrian (my protagonist) to learn more about the latest and best gadgets being used to catch the crooks.

Wolverine cast

Criminals rob, murder, rape or otherwise inflict bodily harm upon their victims. Physical evidence at a crime scene is an essential part of figuring out what happened. It is up to the police officers, investigators, and examiners to recognize what is and is not part of the evidence and then interpret the importance of each fiber, fingerprint, bloodstain, and other material in order to secure a conviction of the correct individual.

One of the most overlooked pieces of evidence at a crime scene is created by footwear.

If a window breaks as a thief enters the premises during the commission of a burglary, the glass will fall into the house, and onto the floor or rug below the window. When the thief steps through the window, unless the thief has wings, he/she will probably plant a foot right in the middle of the glass. And walk through the house, most likely tracking minute pieces of that glass. That glass may also become embedded in the grooves of the sole of the shoe, creating a distinctive footprint.

If the investigating officer can place a suspect at the scene with the footprint, then there is probable cause to fingerprint that suspect and hopefully establish a link to the crime.

A new method of eliminating suspects right at the scene involves stepping into a tray that contains a pad impregnated with a harmless clear ink that doesn’t stain, then stepping onto a chemically treated impression card. (So safe that it’s often used on newborn babies for the hospital records) No messy cleanup, immediate results, and it can even show details of wear and tear on the shoe. This can be a way to establish a known standard (we know where this impression came from) to compare with multiple tread prints at the scene.

Footwear Clear Ink Impression

Another tool for creating a known standard is the foam impression system. It takes a bit longer, (24 hours) but clear, crisp impressions can be made, including of the pebbles and bits stuck deep into the grooves and the writing on the arch. Very helpful when trying to place suspects at the scene. A rock stuck in the sole is a random characteristic that can’t be duplicated, so becomes another point of identification.

We definitely wanted to try this method for ourselves. Each of the writers stepped into the box of stiff-ish foam – a bit like stepping into wet sand.

Using foam impression system

An impression is made instantaneously. Look at the detail – down to the wear on the heel.

Foam impression of Wolverine boot

We used pre-mixed dental stone (made with distilled water and the powder) to fill the impression.

 Making the cast with pre-mixed dental stone

We waited 24 hours for them to become firm enough to pop out of the foam. We now had permanent records of the footwear treads, which could be used for comparison to other prints found at the scene. There were more than a dozen of us walking through that room every day on a regular basis and assorted other visitors tramping through the perimeter. If a crime occurred before we left for the week, we’d have a LOT of eliminating to do, but we were ready!

Photo: Footwear casts

Occasionally footprints are found on the ground outside a window or in the gardens surrounding a house after a burglary or homicide. Ever see a crime show on TV  where the fictional investigator makes a snap judgment about the height and weight of the owner of the footprint because of the depth of the impression? That’s merely a plot device and is not scientific evidence in real life. A crime scene photographer or investigator can photograph the footprint (next to a measurement scale), make a take away cast, and then compare the impression with those of the suspects or other bystanders at the scene. Beware: making a cast of the print destroys the print, so a photograph must be taken before pouring that first drop of dental stone.

Footprints can be found at bloody crime scenes as well. The suspect walks through the blood, tracks it through the house, cleans it up, but the prints are still there, even though not obvious to the naked eye. As we learned during the ‘Blood and Other Bodily Fluids’ session, blood just doesn’t go away, no matter how hard you try to get rid of it. It seeps into the cracks and crevices of a floor and even behind baseboards.

A savvy investigator will collect sections of carpet (or flooring) taken from where the suspect might have walked during the commission of the crime, then conduct a presumptive test for blood (LCV - Aqueous Leuco Crystal Violet), find a usable footprint, compare it to a known standard, and then be able to place the suspect at the scene.

Footwear Print

Kudos to Robert Skiff, the Sirchie Training Manager/Technical Training Specialist who conducted the classes with his assistant, Chrissy Hunter, all week. He fielded our many (sometimes wild) questions with solid expertise as we attempted to find the perfect scenarios for our fictional crime-fighters and criminals.

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Patti Phillips is a transplanted metropolitan New Yorker/north Texan, now living in the piney state of North Carolina. Her best investigative days are spent writing, cooking, traveling for research, and playing golf. Her time on the golf course has been murderously valuable while creating the perfect alibi for the chief villain in “One Sweet Motion.”

Did you know that there are spots on the golf course that can’t be accessed by listening devices? Of course, it helps to avoid suspicion if you work on lowering your handicap while plotting the dirty deeds.

Patti Phillips writes the www.kerriansnotebook.com blog and the book review site www.nightstandbookreviews.com

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