Origins of Trauma Care Systems and Emergency Medical Transportation

1-1

Care of the Injured and Air Medical transport-the U.S. Experience

1-2

Integrated Trauma and Helicopter Emergency Systems in the U.S.

1-3

    Trauma Centers vs. Trauma Systems

1-4

    National Priorities and Development of Trauma/HEMS Systems

1-5

    Professional Associations and Trauma/HEMS Advancements

1-10

Helicopter Air Medical Transport Today

1-11

San Francisco Bay Area Air Medical Transportation

1-12

Conclusions

1-13

Basis for the Study

2-1

Bay Area and San Francisco Trauma Care

2-4

    Bay Area Trauma Centers and Air Medical Access

2-4

    San Francisco Trauma Care System

2-6

    Evolution of Trauma Care in San Francisco and the Role of San Francisco

    General Hospital Trauma Center

2-7

The San Francisco Trauma Care System Environment

2-9

    Geography and Demographics

2-9

    Trauma Care System Design

2-10

Current Air Medical Access System

2-11

Strengths and Vulnerabilities of the Trauma Care System

2-12

    Single Designated Trauma Center

2-12

    Capacity Saturation

2-15

    Environmental, Geographical and Medical Transport Constraints

2-16

    Multiple Casualty Incident Risk-Natural and Geopolitical

2-17

    Pediatric Trauma

2-17

    San Francisco Off-shore Rescues and the Neighboring Region

2-18

Trauma System Needs Related to Air medical Access

2-19

    Consistently Available Trauma Resources

2-19

    Comprehensive Pediatric Trauma Care

2-19

    Timely Access to Advanced Trauma Care and Improved Patient Transport

2-19

Previous Air Medical Access Studies in San Francisco

2-20

    Medical Use vs. Commercial Use

2-20

    The Vertiport Study

2-20

    The McKesson Report

2-21

    Findings and Conclusions

2-22

Introduction

3-1

General benefits of HEMS

3-2

    Trauma Transport

3-4

    Scene Transport Studies

3-4

    Interfacility Transfer Studies

3-6

    Transfers from a Referring Hospital to Trauma Center

3-6

    Transfer from Scene Accident to Trauma Center

3-7

    Non-Trauma Transport

3-8

Primary Benefit: Mitigation of Trauma System Vulnerabilities

3-9

    The Care of Injured Children

3-10

    Standard Trauma Care-Consistently

3-10

    Multiple Casualty Incidents

3-11

    Primary Benefit Summary

3-12

Secondary enefit-Financial Support and Maintaining Quality at the Trauma Center

3-12

    Economic Benefit of Air Medical Access

3-13

    Patient Volume and Trauma Center Performance

3-14

    Medical Staff Recruitment and Retention

3-15

Tertiary Benefits-San Franciscans Injured in San Francisco and Northern California

3-15

Additional Benefit to the Bay Area Region

3-15

Conclusions

3-16

Introduction

4-1

Helipad Design Criteria

4-1

Objectives

4-2

Design criteria

4-2

    Heliport, Helistop or Helipad?

4-2

Potential Helipad Sites

4-8

    Rooftop Helipad

4-8

Conclusions

4-17

Structural Capabilities

4-18

    Code Requirements

4-21

    Building Description

4-21

    Assumptions

4-21

    Conclusions

4-22

Elevator Requirements

4-22

Preliminary Cost Estimates and Schedule

4-24

    Timeline

4-25

Helipad Permitting Process

4-25

    Federal Government

4-25

    State Government

4-25

    City and County of San Francisco

4-26

Safety Assessment and Analysis Criteria

5-1

    Types of Compatibility Concerns

5-1

Safety

5-2

    Measurement

5-3

    Basis for Criteria

5-3

    HEMS Accident Data Base

5-5

    When Do HEMS Accidents Occur

5-7

    SFGH Accident Potential

5-8

    HEMS Accident Rate Comparison

5-9

    Risk Assessment Factors

5-10

    Deaths and Injuries in the Community

5-10

Airspace Protection

5-11

    Compatibility Objectives

5-11

    Measurement

5-12

    Compatibility Strategies

5-12

    Basis for Criteria

5-12

Overflight

5-13

    Compatibility Objectives

5-13

    Measurement

5-13

    Compatibility Strategies

5-13

    Basis for Criteria

5-14

Conclusions

5-14

Introduction

6-1

Noise Impact Criteria

6-2

    Noise Measurement Methods

6-2

    Impact Criteria

6-5

Existing Sound Levels

6-5

Proposed Flight Paths

6-7

Helicopter Models

6-8

Helipad Noise Prediction

6-8

    Helipad Noise Analysis

6-8

Noise Impact Assessment

6-10

Helicopter Noise Abatement Options

6-11

    On Approach

6-11

    On Departure

6-12

Conclusion

6-13

Goals of Outreach Effort

7-1

Public Meetings

7-2

    Neighborhood Groups

7-2

    Healthcare Provider Community Groups

7-2

    Civic Organizations

7-2

    Description of Community Meetings: Neighborhood Groups

7-2

    Description of Community Meetings: Healthcare Provider Organizations

7-6

    Description of Community Meetings: Civic Organizations

7-8

Expert Opinions and Letters of Support

7-8

Helipad Hotline

7-9

Community Outreach Materials

7-9

Summary of Community Concerns

7-9

Conclusion

7-9