A demographic review: Aeromedical Services 2009 - 2012 In memory of Dr John Boden. A life dedicated to Prehospital EMS
HISTORY • 4 May: First Helicopter flight May 2009 request Gauteng • 5 May: First mission • First Fixed Wing Charter Dec 2009 flight February • Cape Helicopter launched • 14 March: First mission 2010
FLEET RW Cape FW RW Gauteng FW (Jet) Town (Turboprop) • Long Ranger • BO105 • King Air 90 • Falcon 20 L4 and 200 • Base 4 • AMI/ • HALO Aviation • HALO Allegiance Aviation Aviation Air
PROCESS Call received Contact Cape Town: Flight crew Centre decision 3 min take off MO Auth process Patient flight screening by MO prior to take off 5 minute auth to airborne (Helicopter) 1.5 hour fixed wing auth to airborne (local flights)
CALL VOLUMES ORIGIN
CALL VOLUMES ORIGIN CALL VOLUME AS A PERCENTAGE OF TOTAL FLIGHT VOLUME 2010 - 2012 RW - Primary RW - IHT FW - Primary FW - IHT Total Eastern Cape 2.2 0.5 0.1 0.9 3.8 Free State 1.5 1.2 0.3 1.0 3.9 Gauteng 26.4 3.6 0.1 2.0 32.1 Kwa Zulu 1.7 1.5 0.0 1.8 5.0 Limpopo 1.3 2.0 0.1 0.2 3.6 Mpumulanga 3.1 3.3 0.0 0.5 7.0 Northern Cape 1.0 0.6 0.1 4.1 5.8 North West 5.5 1.0 0.1 0.8 7.4 Western Cape 14.6 3.8 0.1 2.8 21.3 Africa 0.1 0.3 0.4 8.7 9.4 World 0.0 0.0 0.0 0.8 0.8 57.4 17.9 1.2 23.6 100.0
CALL VOLUMES HELICOPTER CALL VOLUME Flights vs ER24 world Year Flights serviced 2007 0.23% 2009 77 2008 0.32% 2010 222 2009 0.28% 2011 320 2010 0.28% 2012 61 2011 0.39% 2012 0.24% Average 0.32%
DECLINED CALLS Reasons for declined flights 2010 - 2012 Weather Busy Prov. Auth 3% 1% 2% Daylight Cost 6% 8% Declined by Assist. 7% Dedicated Standby 0% Distance 2% Equipment 1% Maintenance Outside flight criteria 2% 49% Other SP activated 19% No doctor 0%
AIR MEDICAL DESPATCH GUIDELINES • South African Industry criteria • Based on Air Medical Services Committee National Association of EMS Physicians • Consider logistical and clinical picture 80% cases found to be valid flight on retrospective independent audit
CASE LOAD MIX Funder 2010 - 2012 WCA Indigent 18% 16% Private 8% Medical Aid/ Govt Auth 58%
FIXED WING OPERATIONS • Mostly non core business beyond South Africa • 40% calls outsourced to local service providers (AMS, Aerocare, Aldersons) • Existing local client base from contracted schemes, very small African client base • Most patients are between 40 and 50 years old Fixed Wing Clinical Categories 2010 - 2012 Trauma 39% Medical Neonate 57% 3% Obgyn 1%
CLINICAL GOVERNANCE • Review includes panel of doctors/ external audit • Retrospective and Prospective components • Clinical Audit • Patient follow up • Morbidity and Mortality • Logistical data: response times, distance, hospital network • Clinical recording accounted for 52% external audit concerns • 9% Audit rejection (key areas: Ventilation, Immobilisation, poor clinical notes) • 4 Sentinel events to date
KEY CHALLENGES • Cost containment and clinical excellence • Doctor based fixed wing service beyond South Africa • B Tech for rotor wing appears to address airway management concerns • Crew based helicopter flight authorisation triage with 3 criteria: Distance (10km), logistics, mechanism • Scene based clinical medical officer authorisation for flight • International and local aviation related delays (clearances, port health, take off procedures)
Any Questions ? Dr Robyn Holgate. CMO, ER24. +27 (0) 83 454 1638 For all medical emergencies call 084 124 (local) +27102053052 (International)
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