The scene of a traumatic accident can be chaotic, and determining the victims’ injuries and where to send them can be a matter of life or death.

“It is a hard job,” said Dr. Scott Robinson, medical adviser for Lawrence-Douglas County Fire & Medical. “There’s no question about that.”

Douglas County has the ability to simultaneously dispatch an air ambulance and ground ambulance.

“Sometimes a first responder will, just based on the likelihood that someone might be seriously injured, call Douglas County, and Douglas County would go ahead and have us launch even though they don’t have a paramedic on the scene to actually assess the condition of the patient,” said Greg Hildenbrand, executive director of LifeStar, which has a base at Lawrence Memorial Hospital and provides about 90 percent of the air ambulance services in Douglas County.

Paramedics and their supervisors use physiologic and anatomic criteria to determine whether to use an air ambulance and send victims to a trauma center.

These would include symptoms such as shock, altered mental status, penetrating injuries and limb paralysis.

They also consider the “mechanism of the injury” such as whether it was a rollover accident, a pedestrian hit at speeds over 5 mph or if the occupant was ejected from the vehicle.

The “mechanism of injury” can be harder to diagnose. For example, if one person in the accident is dead and another occupant is walking and appears fine, could that person have internal injuries that aren’t apparent?

“They may seem fine for about an hour, and then all of a sudden it catches up with them, and they can die pretty quickly if that’s not diagnosed and fixed,” Hildenbrand said.

In 2006, 88 air ambulances were used to transport patients from Douglas County to trauma centers, about 10 percent of the 817 injury accidents. That is similar to 2005, when there were 71 air ambulances used and 729 injury accidents. In the first six months of this year, 52 air ambulances have been used, and about 395 injury accidents have occurred.

“Our system, I think, is a very good and tight one,” Robinson said. “We’re not sending everybody willy-nilly to a trauma center, but we have some criteria.”

He said it not only saves the trauma centers from taking care of people who don’t need to be taken care of, but can save on patients’ costs.

The average cost of an air ambulance flight is $10,000. LifeStar charges a base rate of $5,400 and mileage transport charge of $40; it doesn’t bill anyone unless it transports a patient. Meanwhile, the base rate for a ground ambulance is between $450 and $500. The mileage transport cost is $5.50. Health care insurance will cover both types of transportation.

LifeStar, which has its headquarters in Topeka, has a pilot, nurse and paramedic at its Lawrence Municipal Airport base 24 hours a day. If that helicopter is busy, then its communications center will find the next closest helicopter, which would be Life-Net’s base in Olathe or LifeStar’s base in Osage City. And it doesn’t take long for any helicopter to respond when they travel at 130 mph.

“It makes up time pretty quickly,” Hildenbrand said, adding that the 40-mile flight from Lawrence to Kansas University Hospital in Kansas City, Kan., takes about 15 minutes.

And minutes matter in traumatic situations.

“For trauma patients specifically, we call it that golden hour where you really have a very short time frame to determine what those life-threatening injuries are and provide the right intervention,” said Liz Carlton, trauma services manager for KU Hospital. “So the sooner they get to definitive care, the better their outcomes are going to be, and that’s well proven in the literature.”