List Archives

Mon Apr 30 21:23:35 BST 2007

No but the traffic around you is growing exponentially and that may in fact
convince you.  I used to work in Hightstown (RCA Astro Electronics) and it
was easy to get there.  Now the traffic on 33 can take all day.  I don't
think having NorthStar in your back yard will ever change your opinion but
the traffic might and sooner than you think.

There are folks that live less than 6 miles from Cooper that use helicopters
every day during rush hour.  Once 42 backs up there is no way to Cooper by
ground.

On 4/30/07, rescsteve at aol.com <rescsteve at aol.com> wrote:
>
> 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
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> > > > >
> > > > >
> > > > >
> > > > >--
> > > > >trauma-list : TRAUMA.ORG
> > > > >To change your settings or unsubscribe visit:
> > > > >http://www.trauma.org/index.php?/community/
> > > >
> > > > _________________________________________________________________
> > > > Mortgage refinance is Hot. *Terms. Get a 5.375%* fix rate. Check
> > savings
> > > >
> > > >
> > >
> >
> https://www2.nextag.com/goto.jsp?product=100000035&url=%2fst.jsp&tm=y&search=mortgage_text_links_88_h2bbb&disc=y&vers=925&s=4056&p=5117
> > > >
> > > > --
> > > > trauma-list : TRAUMA.ORG
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> > > >
> > >
> > >
> > > -- 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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> > > 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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> > 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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>

-- 
V/R

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

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