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Wed Jul 2 19:38:13 BST 2008

Dr. Thomson,
I agree that there are a great number of issues in ground transport that
need to be addressed (limiting siren usage would be the first one), but one
has to admit that adjusted for the hours spent in transit (since you can not
look at miles traveled as a fair comparison) under both forms of transport
that helicopters far and away are the more risky of the two propositions.
That would be rather easy to compare.  In fact, the only difficult part
about the comparison would be determining how many hours the ambulances are
in operation since there is no Hobbs meter as there are in aircraft.  One
could use dispatch records to determine times, but the logistics of such a
venture would be daunting to say the least.  However, I am more than willing
to lend my support to a study to settle this matter as my schedule allows.

The other factor is that a ground motor vehicle collision is likely to
produce survivors.  A high speed controlled flight into terrain or an
uncontrolled spin after a mechanical failure is not.  Apples to oranges,
therefore you can not simply point to the frequency of MVAs involving
ambulances to argue that helicopter transport is no less risky.  If anything
one would be reasonable to assume that an aircraft which is under stringent
maintenance guidelines and operated by a well trained and qualified pilot
with over 1,000 hrs of experience would be safer than an ambulance that is
likely not as well maintained and operated by a person with no more training
than an EVOC course and the driver's ed we all get in high school.

Also I was not describing the medical treatment rendered as "Russian
roulette".  I was describing the mode of transport as being an excessively
risky option when far less hazardous means are available in most
circumstance.

> Message: 8
> Date: Wed, 2 Jul 2008 07:05:12 -0700
> From: "Thomson, Dave" <dthomson at phihelico.com>
> Subject: Richey and Helicopters
> To: <trauma-list at trauma.org>
> Message-ID:
>        <E3CAEF7CB7092D42B40CE0C3848AF8CDC1C332 at phxex2.ad.phihelico.com>
> Content-Type: text/plain;       charset="us-ascii"
>
> Helicopters have been flying billboards in the past, but very few
> systems can afford to use them that way today.  For the most part they
> have to pay their own way.
>
> The issue is really one of how best to move patients to the appropriate
> facility where they can receive care.  Both Air and Ground EMS have
> their risks and benefits.  There is no doubt that both are used
> inappropriately at times.  We have reasonably good literature describing
> the patient benefits and cost effectiveness of air ambulances, and we
> have similar literature looking at ground EMS.  We also have a body of
> knowledge regarding air ambulance crashes, which highlights the risks of
> that mode.  What we do not have is a body of literature describing the
> risk of ground ambulance transport.  We know that there are crashes and
> deaths of ground ambulances throughout the country, but only the most
> spectacular of these make the newspapers.  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.
>
> To describe any form of medical care as "Russian Roulette" is
> inflammatory, especially when published in the popular press.  Such
> comments do little to advance the science, which should be our goal.
>
> Dave Thomson
>
>
> David P. Thomson, MS, MD, FACEP, CMTE, CHC
> National Medical Advisor
> PHI Air Medical

The NTSB is already stretched thin with the general aviation crashes as it
stands now.  That is why it takes 9 months to a year or more to release a
probable cause report on a crash in most cases.

> Message: 11
> Date: Wed, 2 Jul 2008 10:39:28 -0400
> From: "Robert F. Smith" <rfsmithmd at comcast.net>
> Subject: RE: Richey and Helicopters
> To: "'Trauma &amp; Critical Care mailing list'"
>        <trauma-list at trauma.org>
> Message-ID: <004b01c8dc51$6eb9c830$4c2d5890$@net>
> Content-Type: text/plain;       charset="us-ascii"
>
> 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
>

Ma'am, all due respect, but I cut my teeth on a volunteer fire department
where the nearest hospital (a Level II trauma center) was 25 minutes away by
ground in good conditions from the "close" side of the district.  If you
were on the "far" side of the township, you were looking at closer to an
hour.  Please don't lecture me on how I don't understand the nature of rural
EMS and trauma care.

By the way, I would like to see some hard evidence that states that most
areas do not have access to aeromedical care.  I believe that to be at least
slightly overstated.  Granted, the aeromedical transport may be in the form
of a fixed wing aircraft at the nearest airport (example: Wyoming, New
Mexico and Kansas to name three states that I am aware of that does utilize
this method), but they do still have access.  The Australians have a similar
system with their RFDS and it seems to work well for them (so far as I am
aware).

Oh, and Ms. Potter, there is no antivenin for a brown recluse.  The only
American spider that an antivenin exists for is the black widow.  Even then
it is only indicated in the very young, the very elderly or the previously
ill.  I doubt a 20-something firefighter who was bitten by an indeterminate
specie of arachnid meets any of these criteria.  I lost a brother
firefighter, and consider his death a tragic loss.  However, that does not
change the fact that his death was likely completely avoidable if the facts
that have been put forth in this case are correct.  That makes it all the
more tragic and we owe it to him to do everything we possibly can to prevent
such a tragedy from occurring again.

BTW, I knew Scott Crossfield....not well enough to call him a friend, but I
met him on two occasions and had the chance to share a cup of coffee and 20
minutes of conversation with him.  A nice guy, but arrogant.  His cocky
attitude likely contributed to his death.  That being said, he was provided
with bad information upon which to base his decision. No one ever said
flying was easy.  If you don't like us speaking of things you believe we
don't know anything about, please afford us the same modicum of respect.  I
am not about to stand by and be lectured like I am a foolish child who
treads where he does not belong.

My prayers are with those who died, those they left behind and the
survivor.  However, I also choose to not simply wait for someone else to
speak up and improve the odds that our colleagues and their patients will
make it home safely- bet that through improvements in restraints or helping
to bring about reforms in the operational methods.  Continuing to propogate
falsehoods (that large swathes of the US *NEEDS* helicopters, that people
die without access to them, etc) and toe the party line is not going to
accomplish this.  Safety reforms are needed desperately and it appears the
industry refuses to act on its own.  If you have a problem with my desire to
do so, then you can quite frankly just keep it to yourself.

Message: 14
> Date: Wed, 2 Jul 2008 09:56:49 -0600
> From: "Connie Potter" <Connie at traumafoundation.org>
> Subject: Flagstaff Tragedy
> To: <trauma-list at trauma.org>
> Message-ID:
>        <E0CA484F80C47948A2A264E01B83222D27D4F7 at NFTC-SERVER.nftc.local>
> Content-Type: text/plain;       charset="US-ASCII"
>
> 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
> ------------------------------
>

Bob, if I am welcome as part of this, please count me in.

Message: 15
> Date: Wed, 2 Jul 2008 10:22:31 -0600
> From: "Bob Waddell" <bobwaddell at bresnan.net>
> Subject: Helicopter crashes
> To: "'Trauma &amp; Critical Care mailing list'"
>        <trauma-list at trauma.org>
> Message-ID: <023301c8dc5f$d478ceb0$c700a8c0 at robertrj01fejx>
> Content-Type: text/plain;       charset="us-ascii"
>
> It seems that we and the popular press jump on exactly the same bandwagon
> when a tragedy such as these occur, yet I would propose that we DETERMINE
> THE TIME IS RIGHT TO DISCUSS EMERGENCY MEDICAL TRANSPORTS versus the ground
> vs air issue in isolation.  The recent death of a Paramedic in Delaware is
> no less devastating to EMS and EM than that of the loss of life in Arizona,
> California, . . .  WE have developed a system were the patient, their
> family, the Physician, the Nurse, the Paramedic, the EMT, the cat can call
> 911 and SOMEBODY's going to the hospital in an emergency vehicle.
>
> Unsafe vehicles, vehicles NOT specifically designed for the objectives
> demanded, inadequate and inappropriate protocols, failure to decline
> services for a plethora of medically valid reasons, and lack a data are
> only
> the beginnings of why good healthcare providers and their operational Team
> members are dying unjustifiably.  Let's quit the political self
> congratulatory rhetoric and let's actually DO something to fix the problem!
>
> With NNAEMSA, EMS EXPO, and NAEMSE conferences coming up in the next few
> months I propose we start an ACTION Force (not Task Force), and bring the
> issues forth.  I can look into finding meeting space if there is any
> interest.
>
> Take care,
>
> Bob
>
> (307) 920 - 2020 cell
>
> bobwaddell at bresnan.net
>
>
>

-- 
Stephen L. Richey, CRT
Aviation Injury Research Project Leader
Saginaw Valley State University
Phone: 248-366-4452

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