Bypassing the ER: New Process Cuts Time to Definitive Therapy by an Average of 30 Minutes

A new helipad-to-OR process, launched at Memorial Hermann-Texas Medical Center in August 2018, enables Memorial Hermann Life Flight nurses and paramedics to transport qualifying patients directly from the helipad to the OR, bypassing the ER. Data compiled by Memorial Hermann shows that, to date, the process has reduced patients’ time to definitive therapy by an average 30 minutes.

‘The next biggest thing since giving prehospital blood’

“Our first patient was a gunshot wound in the abdomen, from Baytown. The time from his gunshot to his arrival in the Memorial Hermann-TMC OR was only 57 minutes,” says Life Flight paramedic Josh Cools. “That’s astronomical. In my opinion, it’s the next biggest thing since giving prehospital blood.”

Cools says only certain patients are eligible. “To be considered, a patient must have a positive focused assessment with sonography exam (FAST), be receiving blood products and have penetrating trauma to the chest or abdomen. If, when we arrive at the scene, Life Flight determines the patient needs the helipad-to-OR process, once we have the patient loaded into the aircraft, we call our dispatch and request bypassing the ER. On that call, we state that the patient meets the three criteria. It is then up to the attending physician to determine whether or not we can bypass the emergency room for the OR,” says Cools.

New Trauma Hybrid OR

The new Susan and Fayez Sarofim Pavilion, which opened at Memorial Hermann-TMC in February 2020, features a trauma hybrid OR, equipped with highly-advanced technology. There, surgeons are able to perform both diagnostic and therapeutic procedures, including CT scans of the head, neck, chest, abdomen and pelvis on the operating room table, and angiographic and open procedures. With the opening of the new Pavilion, Memorial Hermann Life Flight was relocated to the top of the Sarofim Tower, allowing the new helipad-to-OR process to remain intact, now making it a helipad-to-Hyrbid OR process. Memorial Hermann affiliated surgeon Michelle McNutt, MD, says, “Early hemorrhage control improves survival in trauma patients. Select trauma patients will be transported directly from the helipad or ambulance bay to the Hybrid OR to expedite surgical hemorrhage control. This should improve outcomes in our most critically injured patients.”

Knowledge Transfer to Other EMS Providers

Given the success Life Flight and Memorial Hermann have experienced employing the helipad-to-OR procedure, Life Flight hopes to help other agencies across the nation adopt the process in their operations. “We hope to use our data, our research, and our numbers to help other systems—in both ground and air transportation—implement a helipad-to-OR process. Our data indicate that when you look at those three parameters—the penetrating trauma, the positive FAST and the blood transfusion protocol—those patients will almost always benefit from emergent OR access,” says Cools.