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Sat Jul 19 06:49:26 BST 2008

>
> 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.
>

Dr. Mattox, I agree.  We must address both issues- dispatch criteria and
safety measures for those operations that are deemed necessary.  Perhaps you
might use your connections in the trauma world to increase involvement in
the task force including the trauma directors and EMS medical directors?

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.
>

Bob, the Trauma conference would be an excellent setting for such a
discussion in my opinion (for what it's worth).  By then, I should have more
data available from my research regarding victims of aeromedical helicopter
crashes (as compared to non-aeromedical operations) so that could be used as
evidence one way or the other.  If it is really of interest, I could do a
side project to look at survivability in these crashes.

I have heard the aeromedical folks are convening a large group of
> stakeholders and holding a meeting this month or next. I would imagine
> theywould 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.
>

I honestly think that while we should invite the aeromedical community to
take part in this, I honestly doubt whether the more profit driven groups
would be receptive to any ideas that would reduce the number of flights
(which is mostly likely going to be a core recommendation of any proposal
since the excessive and improper use of helicopters is a key factor in the
number of crashes).  Relying upon them to regulate themselves is akin to the
idea of letting the meatpacking industry regulate themselves.  It's a shame
no one has written a popular book like "The Jungle" about the aeromedical
business.  They have proven themeselves to be- as a group- resistent to
change and only willing to implement safety measures when it appears the
government is going to crack down.

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-first"
> 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.

That is why I think it should be a round table effort- with both
stakeholders (the aeromedical camp) and the non-stakeholders (the rest of
us, assuming none of you all own a ground ambulance service).   As for the
data, it exists- aeromedical transport is only beneficial in a small set of
circumstances, most patients transported are not truly "critical", and that
these operations repeatedly engage in practices that are suspect (flying in
bad weather, landing in places that are marginal, etc).  Other than the data
(which I will do my best to find, regardless of which side it supports) for
the survivability of crashes of aeromedical helicopters and non-aeromedical
flights, I am not sure what more we could expect to yield probative value.

As someone else pointed out, the states have no say over aviation operations
(at least not directly...there are ways to make things unpleasant but I
digress), but they do have say over EMS operations in their states.  How
willing these agencies might be to enforcing restrictions on EMS operations,
I have no idea.

I might suggest that persons here suggest REALISTIC agenda items which
>  might be included in such a task force.     I have at least  4 agenda items
> to suggest, but I do believe that all who participated in this  discussion
> earlier should submit.
>

1.   Records of previoius crashes, dx of patients who died in  crashes
> 2.   Flight conditions at time of crash
> 3.   Existing guidelines regarding URBAN use
>

You might want to split #2 into a couple of separate issues: flight rules
(visual flight rules vs. instrument flight rules) under which the flight was
conducted and weather conditions

To the list I would like to add several other points:
-Phase of operation during which crash occurred (takeoff, hovering in ground
effect, hovering out of ground effect, transition to cruise flight, cruise
flight, transition to landing (approach), landing)
-Terrain over which flight occurred
-Existence (AND USE) of safety equipment onboard the accident aircraft
including, but not limited to ground proximity warning systems (GPWS), night
vision, radar altimeters,
-Whether restraints were used by the crew at the time of the crash

As much as I hate to be the one to suggest this- and I am prepared for the
flame war that is likely to ensue (both from frequent contributors and the
lurkers from the aeromedical companies that I know are on the list)- but I
have what might  be perhaps the last resort option to reign in the
operations that absolutely refuse to engage in measures to ensure the safety
of their patients and their crews.  If the major EMS, trauma, emergency
medicine and critical care organizations adopt standards defining the
appropriate use of helicopters as being circumstances X, Y, and Z then
refusal to abide by those regulations would leave the offending
organizations open to lawsuits.  Like I said, I hate to suggest it but
perhaps reminding these groups that either they lose a little profit by not
flying any patient with a pulse (and in the case of Air Evac, sometimes
those without) they can get their hands on that they stand to lose far more
when one of their birds goes down and the lawyers for the families of the
patient and crew finds out the crash happened under circumstances that are
not medically defensible.   *dons asbestos proximity suit*

If the Trauma conference does not work for everyone, please let me know.  I
believe my university would be willing to host a meeting if it is more
amenable to everyone's schedule.  We have a beatiful campus with some
wonderful conference facilities and the airport is less than 10 minutes from
campus.

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

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