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Mon Apr 30 15:05:48 BST 2007

On 4/29/07, Anthony caruso <medic541 at hotmail.com> wrote:
> Prêt, please tell me that crews did not wait on scene for the amount of time
> that they stated?  28 minutes?  That's outrageous!  Shame on them if they
> delayed transport with an ETA like that.  I'm not sure how close they were
> to a level 1 trauma center (or level 2 for that matter) but if you figure
> that, add 28 minutes of flight time, plus the time it takes the crew to land
> assess the patient, package and become airborne from the scene with that
> patient.  Looking at a time of possibly 36 minutes give or take?  Way too
> long for me anyway.  I do recall a statement in the protocols stating "do
> not delay transport".  What's your take?
> Anthony Caruso NREMT-P.
>
> >From: "Pret Bjorn" <p.bjorn at netzero.net>
> >Reply-To: "Trauma &amp; Critical Care mailing list"
> ><trauma-list at trauma.org>
> >To: "'Trauma &amp; Critical Care mailing list'" <trauma-list at trauma.org>
> >Subject: RE: Trauma in the air Victims wait for help
> >Date: Sun, 29 Apr 2007 08:46:16 -0400
> >
> >Well done, Forrest.  Good to be reminded that there're two sides to every
> >story.
> >
> >As I was scanning Steve's original post, it was easy to imagine the true
> >motives behind a competitive private air ambulance.  I think many states
> >have experienced similar rogue providers with varying results.
> >
> >A visit to www.monoc.org is instructive: their web site an electronic
> >monument to the Paramedical Industrial Complex.  Note the prominent
> >conservative icons: the Terror Threat barometer and the 9/11 memorial
> >(urging punishment for the terrorists and those who harbor them).
> >
> >Drilling further, it doesn't take long to find the "Save NJ Paramedics"
> >organization, whose mission it seems to declare New Jersey prehospital care
> >on the brink of a disaster, which only unrestricted private billing can
> >resolve.  Even an amateur Google detective will soon discover that their
> >ostensibly grass-roots coalition is represented by Winning Strategies, one
> >of the leading public relations firms in the northeast.
> >
> >In its proper context, the Astbury Park Press article is cynical and
> >sickening.  One can only hope that the good people of New Jersey wise up to
> >the manipulation.
> >
> >
> >Pret Bjorn, RN
> >Bangor, ME USA
> >
> >
> >-----Original Message-----
> >From: trauma-list-bounces at trauma.org
> >[mailto:trauma-list-bounces at trauma.org]
> >On Behalf Of Forrest Robleto
> >Sent: Sunday, April 29, 2007 7:12 AM
> >To: Trauma &amp, Critical Care mailing list
> >Subject: Re: Trauma in the air Victims wait for help
> >
> >But there is more to the story....
> >
> >http://www.app.com/apps/pbcs.dll/article?AID=/20070427/OPINION/704270390/103
> >0/POLITICS
> >
> >
> >On 4/29/07, S Schecter <schecters at gmail.com> wrote:
> > >
> > > Posted by the Asbury Park
> > > Press<
> > >
> >http://www.app.com/apps/pbcs.dll/misc?URL=/misc/register_zago.pbs&Category=z
> >ago&Destination=http%3A//www.app.com/
> > > >on
> > > 04/22/07
> > >
> > > BY JAMES W. PRADO ROBERTS <JWR at APP.COM>
> > > STAFF WRITER
> > >
> > > If your house is burning, the closest firefighters douse the flames.
> > >
> > > If a burglar is prowling, the closest police officer gives chase.
> > >
> > > If you are critically injured in an automobile accident and need to be
> > > airlifted to a trauma center, you'd think you would always get the
> >closest
> > > available medevac helicopter crew.
> > >
> > > Not in New Jersey.
> > >
> > > Across the state, victims of horrific auto accidents and other major
> > > trauma
> > > injuries have waited up to a half-hour longer than necessary for
> >state-run
> > > air rescue crews to reach them. Private medevac helicopters that are
> >much
> > > closer to some accident scenes are often deliberately not called by
> >state
> > > medevac dispatchers, the Asbury Park Press has found.
> > >
> > > At least 24 times since July, state medevac dispatchers sent a State
> > > Police
> > > helicopter to pick up seriously injured victims in Ocean and Burlington
> > > counties, even though a closer medevac operated by MONOC could have
> > > arrived
> > > to fly the patients to a trauma center faster, according to MONOC and a
> > > review of state medevac dispatch recordings.
> > >
> > > Patients in those cases faced delays of three to 28 minutes, according
> >to
> > > MONOC, a nonprofit regional emergency response organization, and records
> > > reviewed by the Press.
> > >
> > > "I think it's a turf battle, and they are playing it with people's
> >lives,"
> > > said Assemblyman Peter J. Biondi, R-Somerset, sponsor of a bill that
> >would
> > > require the closest-available medevac to be dispatched to a trauma
> >scene.
> > >
> > > On at least two occasions, ground-based rescue crews canceled the
> >medevac
> > > and drove to a hospital rather than wait for a state helicopter,
> >according
> > > to Jeff Behm, MONOC's vice president of operations.
> > >
> > > In February, Miguel A. Flores of Toms River waited an estimated 17
> >minutes
> > > longer than needed for an air transport. A State Police helicopter was
> > > called first, even though a MONOC medevac craft was much closer. Members
> > > of
> > > his family assumed that everything possible was done to help Flores, who
> > > later died from his injuries.
> > >
> > > "I want to know what the heck happened," said his sister, Maritza
> >Flores.
> > > "We have been in the dark."
> > >
> > > The New Jersey State Police say their two medevac units have saved
> > > thousands
> > > of patients - including Gov. Corzine, who was seriously injured in a
> >motor
> > > vehicle accident April 12 on the Garden State Parkway. They also say
> > > private
> > > medevac operators aren't as safe, while MONOC said its program is as
> >safe
> > > or
> > > safer than any in the industry.
> > >
> > > "Our record speaks for itself. In every case we've delivered our
> >patients
> > > safely," said State Police spokesman Capt. Al Della Fave.
> > >
> > > Because traumas by their nature are life-threatening, no one has said
> >for
> > > sure if transportation delays led to permanent disability or death for
> > > patients in these cases.
> > >
> > > But at least two victims, Flores in Toms River, and another in Sparta,
> > > Sussex County, later died of their injuries in hospitals.
> > >
> > > Flores, 31, was critically injured shortly before 2 a.m. Feb. 22 when
> >his
> > > Toyota severed a utility pole adjacent to Hooper Avenue in Toms River.
> > > Flores was thrown through his driver-side window and landed 42 feet
> >away.
> > >
> > > At the time, MONOC's air ambulance was available seven miles away at the
> > > Robert J. Miller Airpark in Berkeley, MONOC said.
> > >
> > > But the state's medevac dispatchers sent a New Jersey State Police
> > > helicopter dubbed SouthSTAR (Southern Shock Trauma Air Rescue). It was
> >42
> > > miles away in Voorhees.
> > >
> > > It took SouthSTAR 27 minutes to arrive, according to recordings of State
> > > Police radio transmissions.
> > >
> > > MONOC says it could have been on the scene within 10 minutes.
> > >
> > > After SouthSTAR arrived, Flores' heart rate dropped, and he eventually
> > > needed CPR, according to the dispatch recordings. As a result, he
> >couldn't
> > > be airlifted to the region's trauma center, Jersey Shore University
> > > Medical
> > > Center in Neptune. Instead, an ambulance drove Flores to Community
> >Medical
> > > Center in Toms River, where he died at 3:21 a.m.
> > >
> > > Flores was in bad shape - and he may have died even if MONOC's
> >helicopter
> > > was dispatched, said Behm of MONOC. But because he was not flown to a
> > > trauma
> > > center by the closest medevac, there is no way of knowing, Behm said.
> > >
> > > In another accident, just after 10 a.m. on Sept. 17 in Sparta, Gary J.
> > > Wasilewski's motorcycle collided with a Honda CR-V. Paramedics at the
> > > scene
> > > asked that a nearby private medevac be dispatched, according to
> > > Assemblyman
> > > Biondi and dispatch recordings. It could have arrived in 12 minutes, he
> > > said.
> > >
> > > The request was rebuffed by the dispatcher, who said, "You know what the
> > > rules are, and I'm not gonna, with the atmosphere here, I'm not gonna
> > > change
> > > anything."
> > >
> > > The State Police's helicopter NorthSTAR, which had been in Mercer
> >County,
> > > didn't arrive until 27 minutes after it was dispatched, radio recordings
> > > show.
> > >
> > > "The policy is State Police first; however, we expect dispatchers to get
> > > the
> > > most appropriate helicopter there," said David W. Gruber, a senior
> > > assistant
> > > commissioner in the state Department of Health and Senior Services.
> > >
> > > When NorthSTAR brought the 54-year-old Wasilewski to the roof of
> > > Morristown
> > > Memorial Hospital, his heart stopped, according to Biondi. Wasilewski
> >fell
> > > into a coma and was taken off life support a week later, according to
> >his
> > > fiancee, Denise Danzeisen.
> > >
> > > "Why? Why? They were sitting right there," she said of the private
> >medevac
> > > helicopter located in Netcong and operated by the Atlantic Health
> >hospital
> > > chain. "Why couldn't they do it? It makes no sense."
> > >
> > > The state health department is currently reviewing its medevac dispatch
> > > policy, and an independent consultant's report is due in June. It is
> >also
> > > reviewing whether the State Police should put a third medevac helicopter
> > > into service in central New Jersey.
> > >
> > > NorthSTAR has been dispatched since 1988 by University Hospital in
> >Newark.
> > > The hospital took over dispatch responsibilities for SouthSTAR last
> >fall.
> > >
> > > Anna Farneski, a spokeswoman for the University of Medicine and
> >Dentistry
> > > of
> > > New Jersey, which operates University Hospital, declined to comment on
> > > specific dispatches, citing patient privacy laws. The Press asked
> > > specifically about dispatch decisions, not patients' conditions.
> > >
> > > "We are unable to address misinformation disseminated by those who would
> > > turn New Jersey's medevac service into a for-profit enterprise,"
> >Farneski
> > > said.
> > > *
> > > First hour is critical*
> > >
> > > It's called the golden hour.
> > >
> > > Since the Vietnam War, emergency medical professionals have maintained
> > > that
> > > 60 minutes can mean the difference between life and death for the
> > > critically
> > > injured.
> > >
> > > Beginning in 1988, the New Jersey State Police have safely flown
> >thousands
> > > of patients to trauma centers within that time. State health department
> > > policy gives the State Police a virtual monopoly over air rescues, as
> >long
> > > as a helicopter is available.
> > >
> > > Private operators are called only if the state's medevac helicopters
> >can't
> > > respond, according to official dispatch rules and state policy letters.
> > >
> > > Most other states rely on private medevac operations to ferry the
> > > critically
> > > injured to trauma centers. But until two years ago, NorthSTAR and
> > > SouthSTAR
> > > - the State Police's two helicopter rescue units - had operated here
> > > virtually without competition.
> > >
> > > Last year, the agency's medevac helicopters responded to 1,261 accident
> > > scenes, and transported another 314 patients from one medical facility
> >to
> > > another.
> > >
> > > But to settle a lawsuit, in 2004 New Jersey decided to allow private
> > > medevac
> > > helicopters to be based in the state. There are now three private air
> > > ambulances in the state, including MONOC's, which had its first flight
> >in
> > > April 2006.
> > >
> > > By way of comparison, Maryland State Police, who pioneered nonmilitary
> > > medevac operations in 1970, also relegate private medevac helicopters to
> > > accident scenes only if the Maryland police can't respond. But Maryland
> > > State Police ferry five times the number of trauma victims that New
> >Jersey
> > > State Police do, with eight medevac helicopters on standby throughout
> >the
> > > state. Maryland has only a third more land and fewer residents - 5
> > > million,
> > > compared to 8.7 million in New Jersey.
> > >
> > > "We can have a helicopter anywhere in the state from 12 to 18 minutes,"
> > > said
> > > First Sgt. Richard Bruns, flight operations supervisor for the Maryland
> > > State Police.
> > >
> > > The Sikorsky helicopters used by the New Jersey State Police for medevac
> > > operations, originally built to fly CEOs, not patients, are larger and
> > > faster than some private air ambulances: At a cruising speed of 150
> >knots,
> > > the State Police medevac could fly from the tip of Sandy Hook to the tip
> > > of
> > > Cape May in 41 minutes - 4 minutes and 30 seconds
> > > faster than MONOC's Eurocopter, which has a cruise speed of 135 knots.
> > >
> > > But MONOC - which is owned and operated by a consortium of 20 hospitals
> > > from
> > > Hudson to Cape May counties, including Jersey Shore - says it is wrong
> >for
> > > the state health department to force trauma patients to wait longer for
> > > the
> > > State Police when another helicopter is closer.
> > >
> > > "This is a no-brainer," Behm said. "This needs to be changed now."
> > >
> > > MONOC's medevac does respond when SouthSTAR is unavailable, and Behm
> >said
> > > MONOC's helicopter has seen an increase in accident scene calls since
> > > Flores
> > > died on Feb. 22.
> > > *
> > > Assembly bill considered*
> > >
> > > In March, Assemblyman Herb Conaway Jr., a medical doctor, held a hearing
> > > on
> > > a bill similar to Biondi's that would require the state to dispatch the
> > > closest medevac helicopter to a trauma scene.
> > >
> > > Conaway, D-Burlington, asked Dr. Eric Munoz, a fellow member of the
> > > Assembly
> > > Health and Senior Services Committee, who teaches at UMDNJ and is a
> >trauma
> > > surgeon at University Hospital: "You are the trauma doc here. . . . Does
> > > 10
> > > minutes matter?"
> > >
> > > Munoz, R-Union, responded: "I don't think I've had once where I've said
> >if
> > > the helicopter got there earlier, this person would be alive. . . . I've
> > > been working in Newark 20 years, I can't remember an incident."
> > >
> > > Other agencies measure response times in seconds.
> > >
> > > In New York City last April, officials announced that a pilot program to
> > > install global positioning satellite equipment in ambulances had reduced
> > > its
> > > emergency medical response times to the most serious calls by just 33
> > > seconds. The city then spent nearly $50 million to install the equipment
> > > in
> > > 1,565 emergency response vehicles.
> > >
> > > "In an emergency," New York Mayor Michael Bloomberg said at the time,
> > > "every
> > > second counts."
> > > *
> > > Financial incentives?*
> > >
> > > The question of which helicopter is asked to respond to trauma calls is
> > > not
> > > just a question of patient care, as MONOC maintains - it's also a cash
> > > competition, some say.
> > >
> > > While the State Police itself does not charge patients for the flights,
> > > the
> > > hospitals that provide in-flight medical staff charge a flat fee of
> >$1,337
> > > for each patient. A typical private medevac fee for an auto accident
> > > victim
> > > is $8,000 or more, most of which is paid for by insurance.
> > >
> > > The State Police medevac program is suppose to be funded by an annual
> > > vehicle registration fee surcharge, which increased from $1 to $3 in
> >July.
> > >
> > > The medevac's revenue would have increased to $21.5 million, which could
> > > have been used to replace the State Police's aging Sikorsky S76-B
> > > helicopters. However, most of the money was diverted into the general
> > > treasury for other purposes. This year, the medevac unit will receive
> >the
> > > same amount of money as it did in 2006 - approximately $8.5 million.
> > >
> > > In addition to trauma rescue, the medevac helicopters perform various
> > > police
> > > and security missions. The most junior State Police trooper pilot will
> > > receive a $56,820 salary this year, according to Capt. Della Fave. There
> > > are
> > > 22 medevac pilots.
> > >
> > > Hospitals that supply medical personnel on the flights will receive a
> > > total
> > > of $2.5 million billing this year from the state, on top of the $817,000
> > > they expect from patient flights.
> > >
> > > The hospitals involved in the program are University Hospital, Virtua
> >West
> > > Jersey Hospital in Voorhees and Cooper University Hospital in Camden.
> > >
> > > >From 2001 through 2006, University Hospital and Virtua received $10.2
> > > million from the state, not including as much as $5 million more in
> > > patient
> > > billings. Last year, the hospitals won a three-year grant to continue
> >the
> > > service. Income to the hospitals was expected to be $3.3 million this
> > > year.
> > >
> > > The real reason private operators want to be called first, said Dr.
> >Steven
> > > Ross, chief of Cooper's trauma unit, is that auto accident victims in
> >New
> > > Jersey have good insurance policies that will pay for medevac services.
> > >
> > > "You want my honest answer? It's a pure and simple profit motive.
> >There's
> > > money to be made," Ross said.
> > >
> > > Stephen D. Olsen, MONOC's chief flight paramedic, disagrees.
> > >
> > > "What we think this is is a patient care issue. If there was a fire,
> >you'd
> > > want the closest fire truck," he said. "This is the same thing."
> > > --
> > > trauma-list : TRAUMA.ORG
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> > > http://www.trauma.org/index.php?/community/
> > >
> >
> >
> >
> >--
> >V/R
> >
> >Forrest Robleto
> >R House Health & Safety
> >www.RHouseTraining.com
> >FRobleto at RhouseTraining.com
> >609-792-9047
> >--
> >trauma-list : TRAUMA.ORG
> >To change your settings or unsubscribe visit:
> >http://www.trauma.org/index.php?/community/
> >
> >
> >
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>
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-- 
V/R

Forrest Robleto
R House Health & Safety
www.RHouseTraining.com
FRobleto at RhouseTraining.com
609-792-9047

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