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Sat Jul 19 04:20:03 BST 2008

It seems to me that there are two separate issues at work here that
dovetail into a larger issue of safety. The two issues are:

 - Medical indications for or against aeromedical transport, and
 - Logistical indications for or against flight liftoff

At least some percentage of the reported accidents boil down to "the
aircraft took off and flew under unsafe conditions because of
<FACTOR>", where <FACTOR> involves human judgement that may very well
have been unduly influenced by the pilot or controller thinking that
it is a life-or-death proposition for the patient, and choosing a
riskier flight than they would otherwise. There's a real question in
my mind as to how heavily flight decisions are influenced by overly
adrenalized scene personnel, and whether the cardinal rule of "crew
safety comes first" is being violated.

The NTSB and FAA have reviewed aeromedical accidents, and at least the
NTSB has made several recommendations in the "logistical indications"
category, which if undertaken should reduce the number of accidents
(http://www.ntsb.gov/publictn/2006/SIR0601.pdf). In my opinion, we
should leave the logistical consideration aspect (airframe safety,
aircraft certification, go/no-go weather evaluation, and so forth) to
those organizations.

In my opinion, we should be focusing our attention on the "medical
indications for or against aeromedical transport" question, because it
seems like there's a very large "seat of the pants" element to calling
for a bird: one that can be remediated with training, oversight and
QI. That way, we as a set of professionals (trauma and EMS
specialists) can stand up and say "we have a formal set of
recommendations for training and overseeing the use of air
ambulances".

Restating some of Dr. Mattox's notes:

 - Who needs air transport, and why (specific differential diagnoses
with at least two empirical confirmations, specific traumatic
injuries, estimated blood loss, etc etc)

 - When to call air transport (when transport by ground ambulance
endangers the patient or creates unacceptable, life-threatening delay,
when ground ambulance takes more than N minutes, the patient needs a
level I trauma center and there are none local, etc)

 - Who makes the final call on whether the bird lifts or not (NOT the
scene commander: FAA/NTSB have the final say, safety of bird and crew
outweighs patient urgency)

 - Mandated review/QI of ALL flights.

I would also note that apparently the FAA does not know how many
aeromedical operations exist in the US: this has to change. Maybe we
need some sort of requirement that to be licensed for medical flight,
all flights must not only meet FAA/NTSB standards but must undergo
mandated QI and/or some sort of reporting requirement.

My $0.02.

Ashton

On Fri, Jul 18, 2008 at 6:20 PM,  <KMATTOX at aol.com> wrote:
> In my SIMPLE MINDED review of papers and persons I see on the news to be
> FLOWN by Helicopter, more than 90% did not have a DISTANCE, Wilderness terrain
> or water, or clinical condition which warrented the AIR AMBULANCE  flight.
> Most of those papers and cases I have  review would have been more
> expediciously taken by ground.    so.....................
>
> 7.     Specific diagnoses and criteria warrenting  helicopter transport
> 8.    Distances below which helicopter use should NOT  be used
> 9.    Weather minimums
> 10.    Mandated review of all flights on  appropriateness by the regional
> trauma center - Level I M&M process.
>
>
>
>
> In a message dated 7/18/2008 8:17:01 P.M. Central Daylight Time,
> Marc_Matthews at medprodoctors.com writes:
>
> The  legislature can . . . and will . . .
>
> MRM
>
> ________________________________
>
> From:  trauma-list-bounces at trauma.org on behalf of Louis N. Molino, Sr.
> Sent: Fri  7/18/2008 5:13 PM
> To: Trauma &amp; Critical Care mailing  list
> Subject: Re: Aeromedical Task Force Idea
>
>
>
> Part of the  issue however is regardless of what a state feels they can't
> regulate the aero  anything industry.
>
> LNM
> Sent via BlackBerry by  AT&T
>
> -----Original Message-----
> From: "Marc Matthews - MedPro  MMC X" <Marc_Matthews at medprodoctors.com>
>
> Date: Fri, 18 Jul 2008  16:39:29
> To: Trauma &amp; Critical Care mailing  list<trauma-list at trauma.org>
> Subject: RE: Aeromedical Task Force  Idea
>
>
> And what does the data say? Are you going to use data? Who has  the data you
> are looking for? Or will this be a "feel-good
> shoot-from-the-hip-emotional-see-look-what-I-did-at-least-something-so-the-government-doesn't-do-something-fir
> st"  meeting, putting the same sort or types of policies together? I would
> think  that an independent panel of non-stakeholders that can have an objective
> view  supported by current data, will go much farther and have more meaning to
>  implement change. Any other way is suspect. Also, please consider what
> individual states have to say about new rules as each may have different laws  and
> ideas for safety.
>
> My two cents . .  .
>
> MRM
>
>
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>
> -----Original  Message-----
> From: trauma-list-bounces at trauma.org  [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of Jules
> Sent: Friday,  July 18, 2008 4:27 PM
> To: Trauma &amp, Critical Care mailing  list
> Subject: Re: Aeromedical Task Force Idea
>
> Hello,
>
> I have  heard the aeromedical folks are convening a large group of
> stakeholders and  holding a meeting this month or next. I would imagine they would be
> able to  advise about representation at that meeting...seems redundant and
> detrimental  to them and EMS to form different task forces/groups. Should be all be
> in this  together? I would imagine NAEMT would be a significant partner in
> this  group.
>
> Jules
>
> On Fri, Jul 18, 2008 at 6:22 PM, Bob Waddell  <bobwaddell at bresnan.net> wrote:
>
>> Absolutely Dr. Mattox!   Is this a discussion/forum that could be
>> requested at the 2009 Trauma  conference?  I think (personally) there
>> are a lot of "best  practices" and "best - don't do that" that needs to
>> be shared, may one  of the conferences would be the venue to allow the
>> openness to discuss  and the credibility to adapt.  I would be happy to
>> submit the  proposal, make the coffee, or whatever needs to be done.
>>  Thanks.
>>
>> Take care,
>>
>> Bob
>>
>> Robert  K. Waddell II
>> Vice President -
>> Emergency Preparedness and  Response
>> "The Sacco Triage Methodology"
>> ThinkSharp,  Inc
>>
>> Wyoming Office:
>> 1302 East 5th Avenue
>>  Cheyenne, Wyoming 82001
>> (307) 920 - 2020 cell
>>
>>  bwaddell at sharpthinkers.com
>> or bobwaddell at bresnan.net
>>  www.sharpthinkers.com
>>
>>
>> -----Original  Message-----
>> From: trauma-list-bounces at trauma.org [mailto:
>>  trauma-list-bounces at trauma.org]
>> On Behalf Of KMATTOX at aol.com
>>  Sent: Friday, July 18, 2008 5:04 PM
>> To: trauma-list at trauma.org
>>  Subject: Re: Aeromedical Task Force Idea
>>
>> I am extremely  interested.  I do believe that the local trauma centers
>> trauma  directors should be in the discussion.   We also discussed  the
>> CRITERIA for
>> using helicopters.   If we merely  address safety, we will  not have address
>> the root cause and root  problem.
>>
>> k
>>
>>
>> In a message dated  7/18/2008 11:10:19 A.M. Central Daylight Time,
>> bobwaddell at bresnan.net  writes:
>>
>> In the  immediate aftermath of the Flagstaff  crash, there was
>> discussion on the  list about forming a group,  perhaps affiliated with
>> one or more of  the national  organizations related to EMS or trauma
>> care to work  towards  improving the safety of aeromedical operations.
>> Is anyone  still  interested in pursuing this?  I am very interested in
>> it  given  both my background and current work.  Please feel free  to
>> contact me  either on- or off-list to discuss  it.
>>
>> --
>>
>>
>>
>>
>>
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