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PHTLS, Ground EMS, Air EMS, Chest Tubes

Mike MacKinnon mmackinnon at cox.net
Mon Apr 10 06:17:27 BST 2006

Dr Mattox
I've read your book and been to a couple of your conferences and I'm sure
your top of your field in surgery however, your response here confirms how
little you know about HEMS and capability. The advanced training and skill
set along with the various capabilities in HEMS such as RSI, chest tubes,
full ventilators, cook caths, ETCO2 monitoring, critical care RN team member
 a significantly expanded drug box etc. And not the least of which speed are
what sets HEMS apart. If you had read the research on patient outcomes in
HEMS vs ground transport you would know that. All our patients are not
cookbook trauma.
Secondly, PHTLS is not the standard for air medical, far from it. ATLS with
the ATCN side and the animal labs along with FNATC (TNATC) including animal
labs are. Repetitive cadaver labs, constant CQI, research and an environment
of furthering knowledge base are a daily part of the air medical service i
work for.
Dr M., you have probably forgotten more than i will ever know about medicine
after your first 10 years, however, you are not the expert here on air
medicine or its capabilities. I could write a dissertation on how many times
I have made a significant difference in patient outcome because of my
advanced practice role and the tools at my disposal and the research done
backs me up on that point. (the research on intubation success rates in HEMS
vs ground alone tells the story). Believe it or not, you don't have to be a
trauma surgeon to save lives.  
Here are just a few studies of the hundreds done on air medical transports
in relation to efficacy.
Prehosp Emerg Care. 2004 Jul-Sep;8(3):322-33. 

Helicopter emergency medical services transport outcomes literature:
annotated review of articles published 2000-2003.

Thomas SH.
Conn Med. 1999 Nov;63(11):677-82.Related Articles, Links 

Helicopter air medical transport: ten-year outcomes for trauma patients in a
New England program.

Jacobs LM, Gabram SG, Sztajnkrycer MD, Robinson KJ, Libby MC.
CONCLUSIONS: Rapid utilization of helicopter air medical transport can have
a dramatic impact upon patient outcome, especially within a select group of
scene transported trauma patients with Trauma Scores ranging from four to 13

Air Med J. 2002 Nov-Dec;21(6):29-31.Related Articles, Links 

Flight team management of in-place endotracheal tubes.

Frakes MA.
Ann Emerg Med. 1986 Dec;15(12):1491-5.Related Articles, Links 

Erratum in: 
Ann Emerg Med 1987 Jan;16(1):54.
J Trauma. 2002 Jan;52(1):136-45.Related Articles, Links 

Helicopter transport and blunt trauma mortality: a multicenter trial.

Thomas SH, Harrison TH, Buras WR, Ahmed W, Cheema F, Wedel SK.
CONCLUSION: The results of this study are consistent with an association
between helicopter transport mode and increased survival in blunt trauma
J Trauma. 2004 Jan;56(1):89-93.Related Articles, Links 

Effective use of the air ambulance for pediatric trauma.

Larson JT, Dietrich AM, Abdessalam SF, Werman HA.
Hospital stabilization before transfer by air ambulance may improve survival
and shorten ICU stays for patients with major trauma.
Ann Emerg Med. 2005 Aug;46(2):115-22.Related Articles, Links 

The impact of aeromedical response to patients with moderate to severe
traumatic brain injury.

Davis DP, Peay J, Serrano JA, Buono C, Vilke GM, Sise MJ, Kennedy F, Eastman
AB, Velky T, Hoyt DB.
CONCLUSION: Here we analyze a large database of patients with moderate to
severe traumatic brain injury. Aeromedical response appears to result in
improved outcomes after adjustment for multiple influential factors in
patients with moderate to severe traumatic brain injury. In addition,
out-of-hospital intubation among air-transported patients resulted in better
outcomes than ED intubation among ground-transported patients. Patients with
more severe injuries appeared to derive the greatest benefit from
aeromedical transport.
S Afr Med J. 2002 Oct;92(10):807-11.Related Articles, Links 

The effect of air medical transport on survival after trauma in Johannesburg
 South Africa.

Buntman AJ, Yeomans KA.
 CONCLUSIONS: Patients with a certain injury severity are more likely to
survive if transported by air to a trauma unit.
J Trauma. 1989 Jun;29(6):789-93; discussion 793-4.Related Articles, Links 

Emergency interhospital transport of the major trauma patient: air versus

Boyd CR, Corse KM, Campbell RC.
The benefit of HEMS transport was seen only in the patients with a
probability of survival of less than 90%. We conclude that the major trauma
patients transported by HEMS had a better outcome than those transported by
ground EMS.
Acad Emerg Med. 2002 Jul;9(7):694-8.Related Articles, Links 

Injury mortality following the loss of air medical support for rural
interhospital transport.

Mann NC, Pinkney KA, Price DD, Rowland D, Arthur M, Hedges JR, Mullins RJ.
CONCLUSIONS: Injury mortality increased with loss of air transport for
interfacility transfer in a rural area.
Br J Surg. 2004 Nov;91(11):1520-6.Related Articles, Links 

Beneficial effect of helicopter emergency medical services on survival of
severely injured patients.

Frankema SP, Ringburg AN, Steyerberg EW, Edwards MJ, Schipper IB, van Vugt

CONCLUSION: The presence of the HMT may increase chances of survival for
patients suffering multiple trauma, especially for those with blunt trauma.
Ann Surg. 1988 Dec;208(6):673-8.Related Articles, Links 

Impact of helicopters on trauma care and clinical results.

Moylan JA.
Current literature demonstrates significant reduction in trauma mortality
for those patients transported by air either from the scene of the accident
or from an outlying hospital to a trauma center. The primary factor is not
the speed of the transport but administration of life-saving care by the
helicopter medical crew at the scene of the accident or at the outlying
Helicopter Transport and Blunt Trauma Mortality: A Multicenter Trial. 
Journal of Trauma-Injury Infection & Critical Care. 52(1):136-145, January
Thomas, Stephen H. MD, MPH; Harrison, Timothy H. RN, EMTP, MPH; Buras, Wende
Reenstra MD, PhD; Ahmed, Waleed MD; Cheema, Farah MD; Wedel, Suzanne K. MD
Conclusion : The results of this study are consistent with an association
between helicopter transport mode and increased survival in blunt trauma
Mike M
-------Original Message-------
From: KMATTOX at aol.com
Date: 04/09/06 17:33:46
To: trauma-list at trauma.org
Subject: PHTLS, Ground EMS, Air EMS, Chest Tubes
Previous post:
PHTLS, does not teach you to load and go and NOT do any other
treatment. It DOES teach you to get on the road asap and treat enroute.
I have always questioned if this continued "interpretation" of load and
go is somehow connected to one's lack of confidence in skills being
performed in the back of moving ambulances...i.e..IVs, airway
management, etc?
Regardless, the point is, treat enroute to  definitive care (Trauma
Center I or II in Iowa). And as per the topic of  this thread as it
began, never have know a medic to place a chest tube, in  my state, and
certainly have not ever seen it taught in PHTLS, oh these  many, many
What I do not understand is the tremendous variations among EMS systems
despite the PHTLS.    For example, the only, ONLY advantage of  air EMS over
ground EMS is that it flys to remote, wilderness, and high rise  locations. 
ems is still EMS, and should be under the same  scrutiny as ground EMS.  
there is some urban legend that air ems  is a higher level of care than
EMS.   The opposite is probably  more correct.
In my continuing view NEITHER air or ground EMS should be putting in chest
tubes or putting needles into the chest.
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