List Archives

Mon Apr 30 21:02:38 BST 2007

Again, be careful that you distinguish among environments.  

In Maine, we occasionally see pre- and interhospital providers trying to prove that they can beat the air medical system.  One recent mid-winter midnight, a rural EMS crew drove 73 miles in 49 minutes.  

Apart from the fact that the out-of-hospital interval was STILL about twice as long, how would you justify the risk imparted on the patient and the crew?

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Andrew J Bowman
Sent: Monday, April 30, 2007 3:51 PM
To: Trauma &amp; Critical Care mailing list
Subject: Re: Trauma in the air Victims wait for help

Why tell my lawyer? Load and go with my Mom.

Many parts of the country are over-saturated with air EMS when transport by
ground would be as fast or faster when you take into account that while the
air crew is loading, spooling up, taking off, flying to, landing, managing
pt, loading up, taking off, flying to hospital, landing, etc the ground team
could have been there or almost there with their pt.

Unless you absolutely do not have ALS ground service and you routinely have
delays in ground travel then air EMS is an option. Otherwise it is a gimmick
for the evening news.

Andrew

----- Original Message ----- 
From: "Forrest Robleto" <farcpr at gmail.com>
To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
Sent: Monday, April 30, 2007 3:42 PM
Subject: Re: Trauma in the air Victims wait for help

I'll tell your lawyer you said so.

On 4/30/07, Andrew J Bowman <andrewj.bowman at gmail.com> wrote:
>
> Load and go with my mom, in the vast majority of the US air EMS is not a
> benefit. Load and go by ground.
>
> Andrew
>
> ----- Original Message -----
> From: "Forrest Robleto" <farcpr at gmail.com>
> To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
> Sent: Monday, April 30, 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
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>
> Forrest Robleto
> R House Health & Safety
> www.RHouseTraining.com
> FRobleto at RhouseTraining.com
> 609-792-9047
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> trauma-list : TRAUMA.ORG
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Forrest Robleto
R House Health & Safety
www.RHouseTraining.com
FRobleto at RhouseTraining.com
609-792-9047
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