Patient Dies In Emergency Helicopter Transport Due To Pilot Switch Delay

Case Overview

This case involves a 3-year-old girl from a rural town in Minnesota who awoke in the early morning with a headache and emesis. She was brought by ambulance to the local emergency department and immediately intubated. A head CT revealed a cerebral hemorrhage and the decision was made to airlift her to a larger hospital for neurosurgical intervention. While en route, the air transportation team took a detour to switch pilots based upon pilot shift change rules. Because of the delay, the child died en route to the hospital.

Questions to the Emergency Medicine expert and their responses

What considerations are involved when deciding to airlift a pediatric patient for emergent care at another facility?

Key considerations when planning a pediatric critical care transport include, but are not limited to patient condition, distance to definitive subspecialty care, weather condition, and the level of care needed during transport. In many cases like this, a pediatric specialty transport from a hospital will be on board the helicopter to supplement the normal crew configuration.

When air transporting a pediatric patient, who is involved in the medical decision making of the patient if there is an issue with the aircraft or the pilot?

In a simple adult interfaculty transport the sending hospital is primarily responsible for transport decisions. However, in this case, the hospital (or pediatric ED/division of mixed tertiary care center) likely played a role in the decision. The HEMS agency would also either choose to accept or decline the call. During the transport itself, there is typically a base station physician who would be overseeing the flight (direct medical control). Even though a medical operation, it is the pilot who ultimately is responsible for the aircraft.

If it is discovered in flight while transferring an emergent patient that the pilot is extended beyond regulatory flying hours what steps are taken?

It would be interesting to know if the pilot had truly timed out based on FAA regulation or simply had exceeded their normal shift (which is typically less than the maximum allowable by the FAA). The Part 135 holder typically has policies in place governing this.

About the expert

This highly qualified expert has been involved in pre-hospital care for nearly 20 years, beginning his career as a firefighter and emergency medical technician. He received his DO at the New York College of Osteopathic Medicine before completing a residency in emergency medicine and a fellowship in emergency medical services at the University at Buffalo. This expert is double board certified in emergency medicine and emergency medical services, and he was named one of the top 10 Innovators in EMS in 2017 by the Journal of Emergency Medical Services. He previously worked as a flight physician at Mercy Flight of Western New York and he has worked as an emergency medicine attending at Brooks Memorial Hospital and the Veterans Administration Hospital. He currently works as an associate professor of emergency medicine and as the EMS fellowship director at a distinguished regional medical school. He also serves as the associate medical director of a medical transportation company that services the transportation needs of 20 hospitals and more than 100 nursing homes and healthcare facilities in New York.

E-044017

Specialties:

Emergency Medicine