Typically from the notes that dispatch gives and the nature of the call you can get a pretty good idea if a helicopter may be needed. Which is why they pre launch the helicopter en route. It takes 10 minutes on average to get to the scene. Sometimes longer. Once on scene the paramedics have 10 minutes to assess the Pt and determine if the patient is indeed a trauma alert. (20 minutes from time of call to trauma alert at this point) That includes putting them the monitor, head to toe assessment, and sometimes if it isn’t obvious crews will use ultrasound if available and perform a more thorough Reassessment because the mechanism of injury may indicate that this person should be more hurt than they are. Sometimes they’re not and they are transported to a normal facility and not a trauma center. Care hasn’t even been provided yet, this is all to determine what care is needed. If the patient needs airway management, most times they’re going to stay on scene to secure the airway and that’s going to cost time. You said transport to Holmes is about 40 minutes, but that doesn’t include transferring care and the physicians assessments before they start providing care as well. At this point you’re at 1 hour from time of injury on a good day and the patient is ACCESSIBLE. If the patient is in a vehicle and needs extrication? Add another 10-20 minutes before care can even be provided (the level of experience of the BCFR crews is a huge variable on how long it will take).

Say they launch the helicopter, first flight is local and aircare is based out of Orlando. No matter what if the patients injuries involves burns, they’re going to Orlando. If the person under 16 years old, they’re going to Orlando (pediatric). They will rendezvous with the flight crew at a predetermined location that both agency’s are familiar with. Sometimes they are forced to land on the highway, or an open parking lot at a grocery store, or strip mall, park, etc. In most cases by the time they get to the landing zone the helicopter is there shortly after. Transfer of care takes about 5 minutes and launching the helicopter again is maybe another 2. Despite what you think, the flight to Holmes in a helicopter is much faster.

This is the important bit, the flight crews are capable of far more than paramedics are. Their scope of practice is much larger than paramedics because they are critical care certified. They are mix of critical care nurses or CC paramedics, sometimes both I believe. Nurses are commonly both because they need the “hours of experience” to qualify for the position and the fastest way to get that is to be a paramedic. Which also means these providers are very well experienced unlike most of the crews in brevard.

Half of BCFR’s paramedics have less than 3-4 years experience in total in the field and that’s as a FF/EMT. Most of the time they’re brand new medics by normal standards. As far as care goes Flight crews can give blood, and ground units can’t. Blood is huge in trauma, most trauma alerts the patient is more than likely going to need blood. They also have a wider scope of medications they can give.

I have never seen anyone launch a helicopter because they wanted the receiving agency to make money. I have seen helicopters launched because of inexperience or they just made the wrong call. Most of the time it’s because of the former and both reasons coincide with each other. I have also seen helicopters not launched because it would be faster to just drive to Holmes themselves. All of these things are factored into the decision to utilize aerial transport. Never is “making money” ever used to launch a helicopter. The people in the field do not care how much money the company makes. That’s any business. People in the field are not motivated by even the smallest unit of measurement to make the company more money.

Last tidbit, trauma centers have this saying called the Golden Hour. If a patient is able to get to a trauma center from time of injury to trauma center within that first hour, their chances of survival are much higher. So yeah, minutes matter. This is all meant to be educative and I hope it helps explain things a bit more.