The changing face of HEMS during Covid-19

By Jen Boyer | August 5, 2020

As Covid-19 spread across the United States, the world of helicopter emergency medical services (HEMS) operations rapidly changed.

In addition to incorporating multiple and often-shifting new safety procedures and protocols, many HEMS operators experienced significant drops in transports and scene calls. In some cases, flights decreased by between 50 and 70 percent.

Some of the decrease was due to stay at home orders and closed recreation areas. Fewer people getting out or on the road meant fewer accidents. A temporary halt on elective surgeries also played a part. There also was a significant drop in the steady flow of heart attacks, strokes, and non-Covid-related breathing issues typically seen across the nation. Medical experts today believe this may have been a result of a combination of less activity and fear of going to the hospital where there was a chance of catching the coronavirus.

Yet, the deepest valley of the lull didn’t last long; just a few weeks to a month in most places. When the flights began to resume, HEMS faced a whole new landscape. Perhaps the most significant change is an increase in transporting more acute illnesses.

“People were and still are afraid to call 911 or go to the hospital, delaying their medical care out of a fear of catching Covid,” said Dr. Scott Van Poppel, medical director for PHI Air Medical, who supports PHI’s HEMS operations in North Texas. “This has been a huge issue. Because they’re scared to come in with chest pain and other issues that could have been treated right away, they’re waiting until it has progressed to a critical stage.”

As the year progressed, other trends related to Covid emerged. Classic Air Medical, an operator serving rural areas across the intermountain region — Utah, Wyoming, Colorado, Idaho, Arizona, and New Mexico — reported a disturbing trend a month-and-a-half after the first Covid cases hit their region.

“We started seeing people who had Covid six weeks before that were pretty critical and intubated when they had the disease,” said April Larsen, executive director of clinical operations at Classic Air Medical. “They’re back with complications and further issues as a result of Covid. They don’t have it anymore, but the complications can be as life-threatening at times due to the damage the disease caused.”

Van Poppel is seeing the same trend.

“Covid causes hypercoagulability, a thickening of the blood, which is causing strokes, heart attacks, blood clots, and breathing issues,” he said. “We’re now transporting people who are sicker because of these complications from when they had Covid. Also, younger people are getting it this second time around this summer, and they’re coming in sicker than the first wave. I personally think this is due to the younger generation feeling they can beat this, so they stay home and take over-the-counter medications for several days before becoming so critical they call 911.”

In St. Petersburg, Florida, flight nurse Michele Armstrong reports yet another trend brought on by Covid. Flying transport-only flights with LifeLine Johns Hopkins All Children’s Hospital, Armstrong sees the effect Covid is having on children and the people who care for them.

Medical experts across the U.S. report children aren’t experiencing severe symptoms of the disease in as large numbers as adults. Since Covid came to Florida and people began staying at home from work and school, Armstrong has seen very few very young Covid patients, but more children are getting hurt during the pandemic.

“Child submersions and unintended trauma are up as parents are forced to work from home with no childcare,” Armstrong said. “People are stressed and struggling to balance home and work. Parents and guardians are more distracted. In some cases, they have grandparents watching them with new hazards such as medications laying around and a lack of awareness of how best to keep the kids safe. This all results in a reduction of child supervision and that’s where kids get hurt, or worse.”

Armstrong sees social isolation brought on by Covid contributing to an uptick in air medical transports. Incidents of attempted suicide and drug abuse is up in middle and high schoolers while non-accidental trauma (child abuse) in younger children is also on the rise due to outbursts from over-taxed adults. She is also seeing increased incidents of neonatal abstinence syndrome as more pregnant mothers turn to drugs.

“Overall, I really can’t say our numbers are higher since Covid,” Armstrong said. “They just feel more pronounced.”

As the virus continues to spread throughout the U.S., HEMS operators and their teams continue to adjust regularly to safely provide the best service in a constantly shifting environment.

“Today, our fragile healthcare systems are being stressed like never before and supporting them with air transportation vehicles has proven to be a critical service,” said Vicky Spediacci, West Region Air COO overseeing air operations for REACH Air Medical Services and Guardian Flight. “This continues to be the marathon effort of our front-line caregivers, pilots, maintenance technicians, and communication specialists.”

Watch for a more in-depth story on the effects of Covid on HEMS operations in a future issue of Vertical Valor.