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Tue May 1 22:27:05 BST 2007

This is even worse.  You would go to the closest hospital rather than
spending extra minutes getting to a trauma hospital.  Do you know why there
are trauma hospitals??

On 5/1/07, Anthony Caruso <Medic541 at hotmail.com> wrote:
>
> Forrest, I would certainly not wait on scene with a trauma patient.  Our
> protocols dictate "do not delay transport".  If the closest hospital is a
> local one with no trauma services, then that has to be it. The helicopter
> can always go to that hospital after the patient has been evaluated by
> their
> ER doc and treated appropriately.  I'm aware that (any given) hospital has
> more equipment than I do.  More recourses than I do.
> It just makes sense to me to go to the closest hospital have the physician
> work on the patient and then wait for the critical care team, to pick up
> the
> patient and take them to where they really need to go.  Local hospitals
> have
> many more recourse then an advanced life support ambulance.
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org]
> On Behalf Of Forrest Robleto
> Sent: Monday, April 30, 2007 10:12 AM
> To: Trauma &amp, Critical Care mailing list
> Subject: Re: Trauma in the air Victims wait for help
>
>
> Expecting a helocopter to arrive after exactly how many minutes would you
> drive instead?
>
> 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/704270
> > >390/103
> > >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&Cat
> > >egory=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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> > > >
> > >
> > >
> > >
> > >--
> > >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
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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
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
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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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