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Fri Apr 25 16:30:03 BST 2008

I am just taking a stab at this , but from what I seen on the video is that the Paramedics are being blamed for the non transport of some of these pts to level one trauma centers, yet without out right scolding the actual medics. I am a Paramedic in north central TN, and we have access to three separate air transport units in this area alone, as far as level one trauma centers we only have one, which is Vanderbilt in Nashville, which is a 45 min transport by ground or roughly 15-17 min by air. Our service leaves the ultimate decision on whether a pt is flown out to the Paramedic in charge of the pt, within the guidelines of our protocols and as long as the supervisor on scene feels it is being handled appropriately. One of the issues we have been told as of late though is that the local hospitals are going to have to pick up some of the slack on these pts, and that Vanderbilt needs these local hospitals to handle what they can and send to them the rest, the problem with this is tha
t is creating just the delay that is being discussed and it is most likely due to money issues and or political issues rather than what is in the  best interest of the patient and patient  care. If we must transport pts to a local hospital that is only level 2 instead of flying the pt from the scene, or in the case of bad weather transporting by ground to Vandy you can forget the whole Golden Hour , and yes the 45 min ground tx is going to eat up the rest of the Golden Hour after adding in the actual time of the incident , extrication , if needed from what ever caused the injury, you tell me, what needs to be done, carry pt to local level two and eat up even more time with X-rays , CT's and such or getting that pt straight to a Level 1 center without the BS because there is  days that even with 3 aircraft in the area, weather and the aircraft being tied up on other incidents happens more and more that we can not get a aircraft or will have to sit on scene and wait for it, and that 
is just not acceptable! We have one of the four of Vanderbilt's BK's right here at our local hospital, and if they are on the pad we can usually either get them to a scene within 4-8 mins of calling for them, or we regularly , if there is no need for on scene time, can and do transport straight to the helipad and they are waiting for us, the problem is the aircraft that is stationed here is the busiest of the four, so it is common for them to be on other calls, the second choice we have is Air-evac , a private company, that is also very busy, and they do not have radar equipped aircraft so bad weather flights are out with them, then our third line , and is only in absolute need is Tiki mast, which is Air med from the local military base, but that some times is a nightmare because you have to jump through a lot of hoops just to get them to come, which creates long scene delays so we really don't us them much anymore, but they are there so I will count them. So maybe our situation is
 different, but I feel we should be able to transport by ground if felt it is needed on that 45 min so that the Golden Hour might be missed, but so that it does not turn into a 3hr delay because of things that have to be done once a patient is brought to a ER whether they are capable of handling it or not, but we are being told now that the local hospital who is almost ready to open a new facility here wants everything brought to them.We are a County Government service , not private, so the ultimate decision will be left to our EMS director, Medical director and county commission, but I am going to bet that politics win out over proper need and pts will be going there first instead of to a level 1 center. Now if I misunderstood the initial statement of the news story , I am sorry for the waste of all your time reading this, but what it boils down to is the politics of the area you are in , all the prehospital care providers can do is handle the calls as directed by local protocol a
nd politics, it is up to the higher beings to get this problem corrected, we can only do what we are allowed ! 
LB
-------------- Original message from Anthony Caruso <medic541 at hotmail.com>: -------------- 


> 
> An interesting segment that aired last night on a local channel here in 
> massachusetts. 
> 
> 
> http://www.thebostonchannel.com/video/15990087/index.html 
> 
> 
> 
> I'm not quite sure what would be causing this issue. Maybe more outreach to 1st 
> responders that are on scene. The indications are clearly outlined in 
> Massachusetts protocols. Would like to hear what providers on this list have to 
> say about this report. 
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