CAMTS
Commission on Accreditation for Medical Transport Systems
Currently 12th edition, effective 1/1/23
Flight terminology
VFR - Visual Flight Rules
VMC - Visual Meteorological Conditions
IFR - Instrument Flight Rules
IMC - Instrument Meteorological Conditions
Flight Following
All operations during flight:
Time between communications must not exceed 15 minutes
…Includes flight tracking data
All operations on scene:
Time between communications must not exceed 45 minutes
…radio, mobile phone
Flight following (Con’t)
Position must be reported every 15 minutes.
If no report is given at 15 minutes, note loss of communication
If no report is given after another 15 minutes (30 minutes total), an incident is assumed.
Action is taken according to post-accident policy or procedure.
CAMTS staffing (critical care)
Nurses:
CEN/CCRN no longer recognized for flight
Current flight nurses with CEN/CCRN must obtain CFRN or CTRN by 2025
…Advanced certification required within 2 years of hire per CAMTS
Advance practice nurse, PA-C, MD/Resident are also acceptable
Paramedics:
3 yrs of experience and 4,000 hrs of critical care experience
Paramedics employed with the same program for more than 2 years are strongly encouraged to hold NRP
Must obtain PF-C and/or CCP-C within 2 years of hire date
Shift requirements
24 hours - acceptable, provided that:
…clinicians are not required to perform duties beyond transport services.
…access to uninterrupted rest
…ability to call “time out.”
A risk management system is in place to combat the effects of fatigue.
Shift requirements (con’t)
In excess of 24 hours
…base averages <1 transport per day
…provides at least 10 hours of rest in each 24-hour period
…location of base/program is remote (one way commute inn excess of 2 hours)
Protective equipment
Hearing protection (in addition to helmet)
Appropriate clothing for environment in which your program conducts routine operations.
Boots or sturdy footwear
…“What is a mandatory piece of equipment?” - Answer: BOOTS
Helmets also required - visor down, chin strap fastened
Reflective material
Properly fitted flight suit - no more than 1/4 inch between skin and flight suit.
Minimum equipment
Patient securing system with at least 3 points of contact
Two sources of oxygen (main and portable)
Two suction units (mounted and portable)
Defibrillation capabilities
EtCO2 waveform capnography
…Transcutaneous EtCO2 (tcPCO2) monitoring is acceptable for neonatal transport teams
Specialty transport teams
NICU
ECMO
CAMTS provides guidelines for interactions between special teams and medical transport services
Per Guidelines:
Specialty teams MAY TRANSPORT without a designated safety officer from the partnering service; provided that the special team has completed AMRM training and is current.
Special teams THAT HAVE NOT COMPLETED AMRM TRAINING must be accompanied by a safety officer from the partnering service during transport
Special teams that have completed AMRM training MAY CHOOSE to transport with a designated safety officer from the partnering service.
NICU teams MUST hold advanced certification:
Paramedic: FP-C
Nurse: CFRN
Respiratory therapist: C-NPT
Didactic training
Advanced airway
altitude physiology
A&P
Patient assessment
metabolic/endocrine emergencies
aviation safety
hemodynamic monitoring
high-risk OB
infectious/infection disease
trauma - peds/adults
pharmacology
survival training
burn emergencies
GI
environmental
Sepsis
Shock
Neurological
Mechanical ventilation - neo, pedi, adult
Clinical requirements/training
Program must provide testable training with either:
clinical rotation in:
critical care
…ER
…ICU
…OB
…Prehospital/EMS
…OR
OR
HPS training (Human patient simulation)
at least annually
…adult
…high risk OB
…pediatric
…neonate
Pilot qualifications
Each base has minimum of 4 pilots; must be staffed 24/7
FAA requires a duty day less than 12 hrs, not to exceed 14 hrs with a pt on board.
Must have commercial rating
Must have instrument rating (IFR)
Must have 2000 total flight hrs
Must have 1200 flight hrs in rotorcraft
…May include 500 hrs in tiltrotor airframe
Must have 1000 hrs PIC (pilot in charge)
Must have 100 PIC hrs at night
“2000, 1000, 100”
Must have 500 hrs turbine time
…1000 hrs strongly encouraged
Airline Transport Pilot (ATP) rating required within 5 yrs of hire
Pilot training
1 cause of air medical crashes is controlled flight into terrain due to IIMC
Local orientation including GOM
…(general operations manual)
Assigned aircraft orientation
Partner agency relationships (EMS)
Local weather patterns
Local landing zones and hospitals
5 hrs orientation with 2 hrs night PIC
Inadvertent Instrument Meteorological Conditions (IIMC) recovery procedures
Any time med crew is onboard, the aircraft is operating under FAA part 135
Instrument rating per program guidelines
Area/terrain
Flight safety
Sterile cockpit
…crew focuses only one essential tasks
…during any critical phase of flight
…ie takeoff and landing
Situational awareness
Clear communication
Hazard identification
Safety oriented crew resource mgmt
Seatbelts - communicate if unrestrained
“3 to go, 1 to say no”
FAA VFR Minimums
VFR = Visual Flight Rules
See chart
Local daytime minimums:
Non-mountainous
800 ft altitude
2 mile visibility
Mountainous
800 ft altitude
3 mile visibility
Helipad Markings
MTW (max weight in lbs)
(# x 1,000 lb)
Diagonal line = no weight limit
D (controlling dimension)
the greater of overall length or width
D40 = 40 ft max length or width
If arrow pointed towards H, that signifies the approach direction.
FATO: final approach and takeoff area
TLDF: Touchdown and liftoff area
TDPC: touchdown/positioning circle
In-flight emergency
Lay pt flat
Secure pt straps (should always be)
Turn off O2
Secure equipment
Secure yourself
Helmet visor down with chinstrap secure
Crash position
Emergency Response
ELT - emergency locator transmitter
…FAA mandates every aircraft must have either ELT or real-time GPS transmission during flight
Activation occurs automatically when 4G impact detected.
ELT operates on 406 mHz frequency
New system optimized for speed/accuracy.
Know where it is on aircraft and how to activate
In event of a crash
To shut down aircraft:
Throttle
Fuel
Battery
Rotor brake
Oxygen
(In that order)
Exit aircraft ONLY AFTER rotor blades have stopped.
Meet at 12:00 position, next 3:00 position
Secure shelter, then water, then food
How does aircraft know it’s airspeed
Pitot tube
Radio Communication (simplex)
Simplex system
…single channel for transmission
…marine radio
…old radio system
…air-to-air
Radio Communication (duplex)
Duplex system
2-channels; send and receive
Requires a repeater or tower
Half-duplex
Portable radio, older cell phones
Push-to-talk
Full-duplex
New cell phone system
Transmit and receive at same time
-
Flight Physiology34
-
Oxygen Dynamics56
-
Acid-base blitz24
-
Lab Values75
-
Pulmonary Radiography22
-
RSI25
-
Mechanical Ventilation71
-
Endocrine26
-
Head Injuries30
-
Pharmacology7
-
Cardiac Resuscitation91
-
Advanced Hemodynamics32
-
IABP35
-
Waveforms4
-
Trauma39
-
Environmental Toxicology43
-
OB/GYN Emergencies54
-
Neonatal / Pediatric Resuscitation43
-
CAMTS44
-
Practice exam review416
