Trauma in the air Victims wait for help

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Acutally central NJ...and don't think that NorthStar being in my backyard would ever change that opinion. 
 
-----Original Message-----
From: farcpr at gmail.com
To: trauma-list at trauma.org
Sent: Mon, 30 Apr 2007 3:43 PM
Subject: Re: Trauma in the air Victims wait for help


Where do you live, that traffic cannot make air travel look good? I know 
it's not North Jersey. 
 
On 4/30/07, rescsteve at aol.com <rescsteve at aol.com> wrote: 
> 
> Since that scenerio is almost non-existent in most areas I say my mom is a 
> load and go. Her chances of survival are better. 
> 
> Steve 
> 
> -----Original Message----- 
> From: farcpr at gmail.com 
> To: trauma-list at trauma.org 
> Sent: Mon, 30 Apr 2007 3:26 PM 
> Subject: Re: Trauma in the air Victims wait for help 
> 
> 
> If I am 30 minutes by ground from the local trauma center and I know that 
> the helo can get there in five and the helo is 10 minutes away I will try 
> to 
> get the helicopter. What would you want me to do for your mom. 
> 
> Forrest 
> 
> On 4/30/07, rescsteve at aol.com <rescsteve at aol.com> wrote: 
> > 
> > Show me the data that the use of the copter makes a difference in 
> patient 
> > outcomes. 
> > 
> > Steve 
> > 
> > -----Original Message----- 
> > From: farcpr at gmail.com 
> > To: trauma-list at trauma.org 
> > Sent: Mon, 30 Apr 2007 1:41 PM 
> > Subject: Re: Trauma in the air Victims wait for help 
> > 
> > 
> > I replied from my phone earlier, but your call that the 28 minutes was 
> > outrageous has me stumped. If you were the EMS crew on the ground and 
> you 
> > thought that it would take you 20 minutes to get to the local trauma 
> > center 
> > and the helo would take 8 minutes would you package the patient and 
> leave 
> > after 8 minutes? Would you give up after 12 minutes? If you were 
> expecting 
> > the helo in 8 minutes when would you leave without them? If the helo 
> took 
> > 15 minutes to arrive and you left after 14 how could you justify that? 
> If 
> > you have to wait you are delaying transport? I guess I will never wait 
> for 
> > a helo again. 
> > 
> > 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 & Critical Care mailing list" 
> > > ><trauma-list at trauma.org> 
> > > >To: "'Trauma & 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 
> > > > > To change your settings or unsubscribe visit: 
> > > > > 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/ 
> > > > 
> > > > 
> > > > 
> > > >-- 
> > > >trauma-list : TRAUMA.ORG 
> > > >To change your settings or unsubscribe visit: 
> > > >http://www.trauma.org/index.php?/community/ 
> > > 
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> > > trauma-list : TRAUMA.ORG 
> > > To change your settings or unsubscribe visit: 
> > > 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/ 
> > ________________________________________________________________________ 
> > AOL now offers free email to everyone. Find out more about what's free 
> > from AOL at AOL.com. 
> > -- 
> > trauma-list : TRAUMA.ORG 
> > To change your settings or unsubscribe visit: 
> > 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/ 
> ________________________________________________________________________ 
> AOL now offers free email to everyone. Find out more about what's free 
> from AOL at AOL.com. 
> -- 
> trauma-list : TRAUMA.ORG 
> To change your settings or unsubscribe visit: 
> 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/ 
________________________________________________________________________
AOL now offers free email to everyone.  Find out more about what's free from AOL at AOL.com.

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