Traffic Forces More Medical Flights As traffic worsens, more critically injured patients transported by helicopter.

By Ari Cetron
November 9, 2006

Dr. Samir Fakhry is no stranger to seeing his patients flown in on a helicopter. He was trained by surgeons who served in Vietnam. Those doctors had soldiers airlifted out of war zones and impressed upon him the importance of quickly getting people to the proper treatment.

But 10 years ago, when he came to the Inova Regional Trauma Center at Inova Fairfax Hospital, he encountered a new phenomenon.

"I came here to a situation where the helicopter was used to overcome traffic," said Fakhry, chief of trauma services at the center.

With Northern Virginia's roads clogged with traffic, first responders are increasingly using helicopters to get patients to the hospital quickly.

"This is something that's been trending up over the past few years," said Jeremy Brown, manager of business development and marketing for Aircare Medevac. Brown's company provides some helicopter services for Inova Fairfax Hospital.

According to VDOT there were 25.6 million vehicle miles traveled on the roads of Fairfax County in 2005. This marks an increase of about 2.5 million miles (more than 10 percent) since 2001. The increase alone is more than five round trip journeys to the moon.

Meanwhile, the number of helicopter trips made by Aircare Medevac has more than doubled in just one year. In 2005, the company's four helicopters in Northern Virginia (based in Manassas, Leesburg, Fredericksburg and Winchester) made 606 trips to Inova Fairfax Hospital. So far in 2006, the same four helicopters have made 1,250 trips, according to Brown.

In Fairfax, the county's police helicopter is the primary method of helicopter transport. Last year was the busiest ever for the county's two helicopters which together flew 340 medevac missions said Lt. Richard Perez, a police spokesperson. In 1999, the helicopters flew 219 medevac missions, Perez said.

In addition to traumas, Brown's company will sometimes need to transport patients between hospitals. When that happens, he often gets calls from insurance adjustors who question the expense. For example, taking a patient from Fair Oaks hospital to Fairfax hospital is only about six miles on the ground — a distance which sounds reasonable to be covered by an ambulance. "But, at five o'clock in the afternoon on a Friday, that six miles could take 45 minutes," Brown said.

Time is one of the most important elements during a major medical emergency, Fakhry said. Surgeons during Vietnam realized anecdotally that they had a better chance to save patients if they could treat them soon after being injured. Subsequent studies found that up to 30 percent of people with severe trauma will die within the first two hours of the incident if left untreated, Fakhry said.

"We developed this idea of what we call the 'golden hour,'" Fakhry said. "If you could get [patients] to the place where you could fix them very quickly, you could potentially save their life."

In Northern Virginia, Fakhry said, that means getting people to Inova Fairfax's trauma center, the only level one center serving a region stretching south as far as Spotsylvania County and west into West Virginia.

While the outlying jurisdictions would likely need to fly their trauma patents in under most circumstances, trauma victims in Fairfax County are transported by helicopter to circumvent traffic more and more frequently.

When a call for a car crash or other emergency comes in, Fairfax County paramedics go to the scene. Often, just based on the circumstances such as the time of day, or location of the crash, paramedics can anticipate its severity, said Joel Kobersteen who drives an ambulance in the Lorton area.

"If we know it's a bad situation, or has a history of bad accidents, we may pre-alert the helicopter," Kobersteen said.

The call goes into the county's dispatch center to contact the police helicopter. In situations where the helicopter is needed, transporting an injured person takes precedence over any other activity, such as searching for a fugitive, said Marshall Thielen, head of the police union."The reason for that is very simple. It's a matter of life and death."

If there is some other problem, such as weather making it too dangerous to fly, then dispatchers would try to contact another helicopter, such as Aircare Medevac, or the Park Police.

Kobersteen has been working in Fairfax County for five years. In that time, he has seen traffic getting worse, and has also noticed an increase in the number of times ambulance crews need to call in the helicopters for transport.

"Just this morning, we had a report of a vehicle fire," Kobersteen said last month. But trying to get there, his ambulance was stymied by the other cars. "We were crawling all the way."

"At certain points, it's not even practical to be blowing your sirens or blowing your horn because there's nowhere to go," Kobersteen said. "There's just nowhere to go."

Driving the ambulance through the traffic is becoming more challenging, he said. People hear the sirens and usually try to get out of the way, but they sometimes inadvertantly block the ambulance. Other times, motorists don't move at all when they hear the sirens. "I have to be very cautious and cognizant," Kobersteen said.

While the helicopter can fly above the traffic, Kobersteen's ambulance ends up stuck behind a line of cars. In some situations, it's better for him to remain stuck. "Sometimes it's not safe to be pushing people into the intersection," he said.

Police are facing the same sorts of problems in responding to their own emergencies, said Thielen.

Although he noted that in some situations, police in their more maneuverable vehicles have a slightly easier time. "We're lucky in the sense that our police cars can go places that ambulances can't."

While he said that Fairfax County's ambulances are "world class," given the choice, Fakhry said he prefers to have patients transported by helicopter. Besides getting to the hospital faster, some procedures, such as inserting a breathing tube, can be more easily accomplished by helicopter crews, he said.

In either case, Fakhry said that Fairfax citizens will be in good hands.

"I'm convinced that both our ground emergency medical services and our Fairfax County police helicopter are among the best in the country."