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Thu Apr 29 14:46:16 BST 2004

Hi list,

I'm looking for *anything* (articles/studies/books/etc) on pain control/analgesia/anaesthesia in wilderness rescue - from the basics (TLC) right up to regional anaesthesia etc.  I've spent the last two weeks searching and come up with a pittance, so I'm either missing the boat entirely (in which case, you may viciously point this out provided you can give me reference to the material...) or there is nothing solid in the literature - which I will find hard to believe.

Thanks in advance for your help.
R.

------------------------------------------------
Ross Hofmeyr
Medical Student (MBChB V)
Stellenbosch University
Delta Search and Rescue, and
Wilderness Search and Rescue
Cape Town, South Africa.
Mobile:  +27 83 353 8848
Email:     rossh at sun.ac.za
------------------------------------------------

________________________________

From: trauma-list-bounces at trauma.org on behalf of Mike MacKinnon
Sent: Wed 21-Apr-04 04:06
To: Trauma & Critical Care mailing list
Subject: Re: Helicopter-EMS vs. ground-EMS transport in urban center -notgood

hehe well sufficed to say none of my friends who bought tickets won a damn thing :) But it was a great success and im sure will be put to good use.

Mike MacKinnon

	----- Original Message ----- 
	From: sarah robinson <mailto:ut-ohh at excite.com>  
	To: trauma-list at trauma.org 
	Sent: Tuesday, April 20, 2004 6:56 PM
	Subject: Re: Helicopter-EMS vs. ground-EMS transport in urban center -notgood

Mr. Mackinnon, i didnt know you worked for barrow. would you mind sharing how the health/wealth raffle did this year? ive been meaning to look it up. there was not so much media attention this year. not even a list of winners on the web. btw, i agree with you wholeheartedly on this discussion. 

anyone know of the statistics on ground accidents caused by ambulances??

--- On Tue 04/20, Mike MacKinnon < mmackinnon at cox.net > wrote:

	From: Mike MacKinnon [mailto: mmackinnon at cox.net]
	To: trauma-list at trauma.org
	Date: Tue, 20 Apr 2004 18:21:06 -0700
	Subject: Re: Helicopter-EMS vs. ground-EMS transport in urban center -notgood

	K

	Believe me I have looked for such a paper. It doesn't exist. prehospital research is difficult as I am finding out with the needle thoacotomy research I started.
	Having said that, I have also read many of the papers written disparaging air medical. I freely admit much of it is true, even valid. >From the point of view of a flight RN I cant believe what we fly sometimes in the name of "mechanism and medical legal liability". 

	Though I do not believe I need a study to prove that time to definitive care is better for the patient (there are already many). I have flow patients many times from areas with only emt's (BLS) available and ALS over 1 hour away. These people would have died if not for the flight crews. I have also flown people with true level one trauma on a 30 minute flight which would have taken the ground ambo over an hour. Do you truly feel there needs to be research to prove that these things do not make a difference?

	Secondly, a good exa mple are Patients who infarct and are far from a hospital. Many ground units don't have RSI, Beta Blockers, nitro drips etc. We have been taught "time is muscle" just like with a Closed head injury "Time is brain". All of the neurosurgeons at Barrows in phoenix where I work agree flight makes the difference in stroke, hemorrhage etc. In fact most level one stroke/neuro and lvl 1 cardiac centers have "time to cath lab/ct scanner/TPA" requirements because of research proving the time issue. 

	Would prefer to have a patient with c/p 10/10 inferior infarct RV involvement new mitral regurg Hx of COPD CHF IDDM transported by ground for 1 hour with 3 s/l nitro and a little MS as opposed to a patient getting MS, nitro drip, beta blocker possibly RSI (as needed) ? Definitive treatment is cardiac cath, as we all know (interventional), therefore it is not a stretch to say confidently that I have significantly decreased mortality rates in patients by both my treatment and expedi ency.

	Lets not forget the experience and expertise that critical care RN's bring to the patient. I don't expect a rural medic who mostly sees cuts bruises and 
	tractor accidents to recognize significance of a mitral regurg in the presence of an inferior mi with RV involvement. 

	The knowledge and the extra tools that flight RN's and emt-p's bring to a sick patient may be difficult to research and qualify with statistics, but that does not make them irrelevant and unfounded.

	As far as urban center transports, I have to agree with you on that one. With the exception of high risk maternal, neonate and IABP (all interfacility transports) I do not see the need for a flight program in an area with a paramedic response time of 5 minutes. 

	Mike MacKinnon

		----- Original Message ----- 

		From: KMATTOX at aol.com 

		To: trauma-list at trauma.org 

		Sent: Tuesday, April 20, 2004 6:05 AM

		Subject: Re: Helicopter-EMS vs. ground-EMS transport in urban center -notgood

		In a message dated 4/20/2004 7:43:11 AM Central Standard Time, mmackinnon at cox.net writes:

			but a medical patient having an mi is not. air medical crews carry advanced pharmacology which can make the difference between extending a myocardial infarct or not.

		....please..... Give me one paper with evidence based Class 1, 2 or even 3 data that supports this claim. Im very sorry, but I have found NO papers where the case mix is similiar where air ambulance has shown ANY survival, or other outcome advantage over ground ambulance, except in off shore, wilderness, and high rise RESCUE (a totally different issue). ......please.....if you are going to expose persons on this list server or anywhere else with the kind of statement as you made above, support it with data. SUCH DATA SIMPLY DOES NOT EXIST. 

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Pain management in the wilderness