Scene Response Briefing

Emergency Health Services Nova Scotia began its scene response program in 1998, responding directly to or near-by the scene. Scene response is a province wide initiative where by all prehospital emergency personnel have had the opportunity to take a 4 ½ hour certification course. Safety, teamwork and proper utilization of LifeFlight are the focus points of this course. The goal of this program is to provide patients with a quicker time to definitive care, for major time-dependant injuries associated with trauma. In keeping with the "golden hour" philosophy, the definitive treatment for trauma is the operating room.

However, most medical, non-surgical scenarios, as previously described in this manual, can often be treated by the local hospitals and do not require air medical transport. If a patient does require air transport for a medical / cardiac / non trauma condition, we would prefer this decision be left to the hospital's discretion, where the medical expertise is higher. The only time that LifeFlight will respond to an out-of-hospital acute medical / cardiac condition is in the remote setting as described further on.

Indications for EHSNS Paramedics to "Launch" LifeFlight to the scene for "Trauma" patients:

"EHSNS Paramedics should launch LifeFlight if the patient is a victim of penetrating and/or blunt trauma, with one or more of the following indications present and if it will take longer than 30 minutes (from the time that they arrive on the scene, including extrication and drive time) to transport the patient to a District or Tertiary Trauma Center. If it will take less than 30 minutes, the ground Paramedics will notify the LifeFlight MCP of the situation and patient condition. The LifeFlight MCP will be call conferenced to the District Trauma Center Emergency Room Physician to see if they would like LifeFlight launched to their facility.

  • Anatomic Criteria:
    • Amputation proximal to elbows or knees
      • o Two or more suspected long bone fractures o Suspected spinal cord injury o Severe facial injuries with possible airway compromise o Burns greater than 15% Body Surface Area (2o, 3o, chemical or inhalation) o Pediatric Trauma Score < 8
  • Physiologic Criteria:
    • Glasgow Coma Scale < 12
      • o Respiratory rate < 10 or > 29 breaths per minute o Shock, or significant hypotension (BP < 90 mmHg systolic)
  • Logistical Criteria:
    • Simultaneous occurrence of three or more trauma patients, and/or local resources are overwhelmed with victims
  • Mechanism Criteria:
    • Gunshot wound proximal to elbows or knees
      • o Any significant penetrating wound to the head, neck, chest, abdomen or groin
  • Other:
    • Paramedic Judgement

Once the need for LifeFlight has been established via the criteria listed above, the EHSNS Paramedics at the scene must contact EHSNS Communications Center to "Launch" LifeFlight. The Paramedics will then be call-conferenced with the LifeFlight Medical Control Physician (MCP), providing them with the following information:

  • Patient age, pertinent medical findings, mechanism of injury, and current vitals;
  • Pertinent past medical history; and,
  • Treatment given thus far, and response.

The LifeFlight MCP has the final say whether the LifeFlight crew shall continue with the mission or abort. The LifeFlight MCP will advise the Paramedics at the scene on how to proceed with patient care and pre-flight patient preparation. They are also able to provide "Patch Orders" as per EHSNS provincial protocols if needed.

For daylight hours scene response, the LifeFlight MCP will direct the Paramedics on the scene to either: 1) Stay at the scene and await LifeFlight's arrival; 2) Proceed to the closest pre-designated landing zone (LZ) and meet LifeFlight there; or, 3) Proceed to the closest hospital and LifeFlight will meet you there. The LifeFlight MCP will make this decision based upon the scene logistics, patient condition, the distance to the closest hospital, in conjunction with input from EHS Dispatch / Communications Centre. If the MCP chooses to have LifeFlight meet the patient at the closest hospital, they will alert the hospital of the helicopter's pending arrival and patient condition.

For night-time hours, the LifeFlight MCP will direct the Paramedics on the scene to: 1) Proceed to the closest pre-designated LZ and meet LifeFlight there; or, 2) Proceed to the closest hospital and LifeFlight will meet you there. The LifeFlight MCP will make this decision based upon the scene logistics, patient condition, the distance to the closest hospital, as before. If the MCP chooses to have LifeFlight meet the patient at the closest hospital, they will alert the hospital of the helicopter's pending arrival and patient condition.

EHS LifeFlight will not land at the scene at nighttime, as the aviation risk factors of such a response are extremely high.

In Nova Scotia the average time for emergency crews to respond to the scene is approx. 15 minutes. The average on-scene time for the Paramedics (if the patient is not trapped) is 15 minutes. Obviously, if the patient is trapped, this on-scene time will be lengthened proportionately. The average response to the closest hospital is another 15 minutes. If LifeFlight is put on standby as the crews are responding to the scene and the Paramedic launches LifeFlight immediately after their primary assessment, the response time by LifeFlight can be minimized.

The further out that LifeFlight travels from our base, the harder it is to justify the ground Paramedics to stay at the scene and await LifeFlight arrival, unless the patient is trapped. But with this early launch for life threatening traumatic injuries, LifeFlight can often arrive at the closest hospital at the same time or shortly after the arrival of the patient. This will help to ensure that if the patient requires treatment at a larger regional centre or at a tertiary care centre, the time from the incident to the OR can be drastically reduced. If, upon the patient's arrival, the attending physician deems that the patient's condition is such that they will not require treatment at a higher level of care, they can inform LifeFlight that they will not be required.

Remote Medical/Trauma Scene Response

In the remote setting, quick access to the patient by EHSNS ground Paramedics may not always be possible, such as at a hunting or fishing camp. In this case LifeFlight can justify responding to the scene for serious trauma injuries as well as acute life-threatening medical illness. Ground personnel should consider LifeFlight if the patient is in a remote/isolated area where access/extrication is difficult or impossible by ambulance. If the "Remote" patient presents with a significant traumatic injury or an acute medical condition, EMS should contact LifeFlight via EHSNS Communication as soon as possible. The agency with the highest medical training at the scene may request LifeFlight to launch, but they will be call-conferenced with the LifeFlight MCP first. The on-scene personnel will provide the scene specifics and patient findings.

The LifeFlight MCP will decide if LifeFlight will be launched.