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Wed Jul 2 19:22:03 BST 2008

Respectfully, this is far more complicated (especially in rural climes)
than you are describing.  Just as an example, there is a vast difference
between the Total Transfer Interval (TTI) and the Time In Transit (which
we should call the Out of Hospital Interval -- or OHI -- if only for
sake of less provocative abbreviation).  

If the OHI leaves your patient prone to destabilization in the back of a
truck in the wilderness, then a nominally shorter TTI is no bargain.  

Consider too that a transport team assembled pro re nata at a Level III
or IV hospital is probably no match for the experience and training of
an active CCT program with state of the art equipment and blood and
drugs and finely-tuned protocols.  It's curiously easy for some of us to
disparage the quality of HEMS transport offhand, but there is little
argument that some of the best training and PI programs in all of EMS
are aeromedical.

Even if we graciously pretend that such is not the case, we're forced to
wonder at the practical consequences of borrowing professionals from the
local community for single-patient transport.  Take the best nurse and
respiratory therapist from the night shift at twenty per cent of rural
US hospitals, and you may want to consider closing the ED while they're
away.

Finally, lets admit that ground transfer of critically ill and injured
patients is observably unique from the routine, and worthy of separate
analysis.  I have no evidence that these trips are more crash-prone than
the nursing home transports; but I can attest to ninety-mile distances
traversed in under an hour.

Life is an endless vista of toil.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of McSwain, Norman E
Jr.
Sent: Wednesday, July 02, 2008 11:10 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: Richey and Helicopters

How about just comparing the "need" of air vs ground, based on the
patient's condition and the comparative difference in time. The time
must be measured in time from the incident to arrival at the hospital
not just the partial time of air vs ground drive/fly times from injury
site to the hospital. 

Example - waiting for the launch and arrival vs just starting out to
drive the distance is a variable that MUST be considered. Most folks
don't include this when they measure transport times.

Norman

Norman McSwain MD
Professor, Tulane School of Medicine
Trauma Director, Charity Hospital Trauma Center
norman.mcswain at tulane.edu
504 988 5111

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Robert F. Smith
Sent: Wednesday, July 02, 2008 9:39 AM
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: Richey and Helicopters

Unfortunately there is no
NTSB mandate to investigate ambulance crashes, and there is no uniform
database for these crashes.  This makes it extremely difficult to
compare the risk of air vs. ground.

Dave,

Do you think that is something that is "fixable" if pressure was applied
by
our various august governing bodies?

Rob

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Richey and Helicopters