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Sun Jun 10 07:00:54 BST 2007

Phil,

I don't have any knowledge of your local area, your hospital, or the  
specialty or subspecialty services represented there. I've actually never been  to 
your state and it's probably one of the very few places where I don't have a  
professional connection. You don't present nearly enough information for me to  
comment on the actions taken by your local ground EMS providers or the flight  
crew.

Firstly, why make the helicopter come to sit on your helipad to likely  
eventually transfer the patient if they could have just as well responded to the  
scene, which they apparently did?

Secondly, what's the issue? That you mobilized a team and someone  
independent of direct physician oversight from your institution made a  decision to 
transport the patient directly to a facility other than yours? I'm  sorry you 
wasted time and money mobilizing for a patient you admit you would  likely have 
transferred anyway. 

If there was poor judgment on someone's part, or a protocol deviation, or  
some political crap at play, then I applaud any effort you address the system  
issues and do what is right by the patient - which may, in fact, be  to admit 
that someone made an appropriate decision to triage the patient  directly from 
the scene to a tertiary care facility.

>From the sounds of it, your institution is very well organized and  committed 
to the critically injured patient, and that is absolutely commendable  and 
something to be proud of - but, what intervention would you have offered  this 
or any critically injured patient, aside from airway control and assurance  of 
effective ventilation and oxygenation prior to transfer, that  may produce a 
measurable difference in outcome when your regional resource  tertiary center 
is a mere 45 minute air hop? 

I know you'll not respond with "a pangram!" but I come from a place in the  
world where critically injured patients who ought to go directly to the  trauma 
center are "stabilized" prior to transfer with a bunch of plain films and  
labs, a couple liters of cold saline for "tachycardia" and, occasionally,  
"sedation" with "vecuronium".... 

I think a stop in an ED for "evaluation and stabilization" is needless and  a 
waste of time and money when tertiary center management is indicated and a  
resource is available to expeditiously and safely move such patient directly to 
 definitive care. Exceptions? Absolutely! Lives saved by stopping in a  
non-tertiary center ED for airway control or tactical hemostasis?  Absolutely.

Regards

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