List Archives

Wed Jul 2 18:16:54 BST 2008

Ken:
>
> AGREED!
>
> Jules
>
>
> On Wed, Jul 2, 2008 at 11:53 AM, <KMATTOX at aol.com> wrote:
>
>> Jules:   Good points, but in those areas that had HEMS and GEMS  and then
>> lost HEMS and where they studied the impact of the LOSS of HEMS before
>>  and after
>> the fact,  even for relatively rural and wilderness transports,  the HEMS
>> made NO DIFFERENCE on survival and outcomes.      Many MANY of the
>> assumptions
>> and foundations to support HEMS are not based on  fact and indeed, in and
>> of
>> themselves need to be re-examed.
>>
>> k
>>
>>
>> In a message dated 7/2/2008 11:34:12 A.M. Central Daylight Time,
>> jkaymdc at aim.com writes:
>>
>> I've  watched, read, and listened to the comments about this on here and
>>  many
>> other forums. I just have a couple comments..
>>
>> Let me preface it  by saying I know things are different everywhere....
>>
>> Here in the  rural/heartland of America, as it is sometimes called, we are
>> AT
>> LEAST an  hour from any level I or II trauma center. We rely on having
>> HEMS
>> as a  option. I say "option" because over the years, it has become
>> increasingly  often they will not/can not fly to us anyway. It gets a bit
>> more stingent  each time there is an accident, which is a good thing!
>> However the problem  still remains, how do we get the patient to
>> definitive
>> care in the safest,  quickest manner?
>>
>> Here in Iowa, (NW Iowa specifically), we often  transport the patient the
>> closest hospital for stablization, because HEMS  usually cannot get to the
>> scene before we extricate the patient. In the  urban setting, I have heard
>> people comment how stupid it is to fly someone  from a hospital because
>> they
>> should be stable enough to go by  ground...well...walk in our shoes is all
>> I
>> can say. Sometimes yes,  sometimes no.
>>
>> The pilots have the choice of whether they should fly or  not...if no, and
>> that happens more often than not, especially following an  HEMS accident,
>> then the patient is put into the back of a ground ambulance,  often times
>> with a crew unqualified to monitor the chest tubes, etc....The  solution
>> for
>> a many of these very rural, often times "band-aid" station  type of
>> hospitals, is to through a nurse in the back with the medics to  cover the
>> "critical care" transport criteria....unfortunately, the nurse  often has
>> NO
>> CLUE how to do critical care. In fact, I've transported chest  tubes with
>> a
>> nurse present who was a brand new OB nurse grad and had never  seen the
>> back
>> of an ambulance.
>>
>> So..what is the answer? We like, need  and utilize our HEMS here...mostly
>> appropriately when following the  "protocol" in your service for calling
>> the
>> helo...is it appropriate they  were called to begin with? sometimes not.
>> I've
>> transported many by ground  that have been discharged to home from the ED,
>> often times beating the  ambulance back home.
>>
>> Shouldn't we be figuring out what is best for the  patient? in some areas
>> and
>> specific times that is flying them to defiinite  care (or frankly just the
>> right level of care), Sometimes not. But putting  them on the ground for a
>> 90
>> minute transport with an OB nurse who doesn't  KNOW or want to KNOW how to
>> monitor a critical care patient (chest tube,  etc puking all the
>> way),..isn't
>> helping anyone either...except the billing  department.
>>
>> Jules
>>
>>
>>
>> On Wed, Jul 2, 2008 at 10:56 AM,  Connie Potter <
>> Connie at traumafoundation.org>
>> wrote:
>>
>> > The  critical comments re: Flagstaff's tragic crash appear to come
>> mostly
>> >  from those least familiar with the rural nature of emergency care and
>> >  distances, the diminishing numbers of "volunteer EMT's" able to leave
>> >  their primary catchment area to transport a patient, AND the lack of
>> >  access to even LIV trauma care in the great mass of this US, but who
>> >  wish to second guess those who are no longer alive to rebut statements
>> >  that they flew/died for nothing.
>> >
>> > Many trauma systems review  every airmedical use. Portland OR's ATAB
>> > forbids them within 40 miles  of the scene because they delay care.
>> The
>> > rest of the  rural American often does not have the luxury of even
>> > calling for  airmed resources because there are none.  Rural hospitals
>> > are  losing specialists at an alarming rate so patients are being
>> >  transported for "routine stuff"?   Sorry, but not to an  FP.
>> >
>> > No problems with spiders?  Where do you live?  A  Brown Recluse caused
>> > one of my patients to lose her arm by the time it  necrosed to the bone.
>> > This time the unlucky patient was a college  student at U of M in
>> > Missoula, a firefighter from my home town.   We at home will think of
>> him
>> > as having died in service, thank you very  much.
>> >
>> > Except for a few of this list, the callous comments any  time one of
>> > flights goes down becomes increasingly demeaning to those  who get out
>> > daily to place their life and safety on the line.   No, we don't try to
>> > fly when it is unsafe and we do flight following  because it is.  My
>> > flight crew was in the air on the Columbia  Gorge when Mt St. Helens
>> > blew: Should we have factored that  possibility into all of our flight
>> > plans?  And if flying is so  easy, why did Scott Crossfield die after
>> his
>> > plane tore apart in a  thunderstorm?  Even the best don't always make
>> it.
>> > God Rest Them  and Give Them Peace and pray for the survivor.  And,
>> don't
>> > preach  unless you've been there.
>> >
>> > Connie  Potter
>> >
>> >
>> > -----Original Message-----
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