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Sat Jul 19 18:29:09 BST 2008

On Sat, Jul 19, 2008 at 12:49 AM, Stephen Richey <stephen.richey at gmail.com>
wrote:

>
> 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.
> Sounds familiar for MANY groups....
>
> Stephen,

First, I am not disagreeing with you and in fact agree that the "profit
driven groups" need to not be in charge of any task force/group.  I am
simply stating that a "non-stakeholders" group should not be the sole group
making decision for an industry it does not understand.  I am familiar with
that after sitting on committees within state Public Health where they
looked at me as if I had two heads when I mentioned "EMS doesn't function
within that capacity"....or "you do know that we don't just "give rides" to
people, yes?"

 All industries must have a say in their own future, if for no other reason
than because they MUST take ownership in what is happening within their
industry.  As for NAEMT...they are the most likely voice for EMS at the
federal level..IMO they need to be sitting at this table.

Having said that: let me give you two hypothetical....first, I live in a
VERY rural area, a minimum 75 minutes from the nearest Level II Trauma
Center or approx 2+ hours from a level I by ground. We rely on "the"
helicopter" many times. Are they always warranted after the fact?   We also
have a state protocol with an algorithm for when a helicopter should be
called. But here are two incidences for consideration:

Case 1....MVC...Car vs flat-trailer (as you'd haul motocross bikes or
snowmobiles on). Trailer come loose from the ball of the pickup pulling it,
swings into oncoming traffic. The trailer literally travels down the drivers
side of the vehicle it is meeting at the time, pushing it into the ditch, as
well as caving in the drivers door and rear driver's side door, where there
are two people (obvious Driver adult) passenger  (teenager). There are two
addition passengers who are unhurt.
  >> 2 year paramedic on scene determines the helicopter needs to be
dispatched from level II trauma center 75 minutes away based on "mechanism,
extrication time and severity of injury"  i.e...major intrusion with patient
requiring extended extrication time (over 30 minutes). No breath sounds on
left side, mangled left arm and decreasing pressures 15 minutes into
extrication (I am obviously not giving you all the details, just the
"criteria" details). Second patient (peds) had full thickness avulsion of
left cheek (mandible and maxilla showing) and compliant of left shoulder
pain.
  >>Due to extended extrication time, helicopter is diverted to scene to
save time transporting to the airport (20 miles away from the scene) after
extrication is complete. Helicopter lands in a hay field near scene. Pt is
intubated, etc by flight crew once extricated and flown directly to Level II
trauma center.
   Pt 2...is taken to local hospital;  then transferred by ground an hour
later (to same level II trauma center) for surgical repair of cheek and
ortho for fractured clavical.

Case 2...ambulance service is paged out at 0200 to local hospital for
elderly pt with no decernable pulse in one leg to meet the helicopter at the
airport for transport to "specialty care" 75 minutes away. Pt has some
discomfort, readness and swelling to that leg, complains of tingling, but
otherwise is ambulatory. Transport by helicopter is requested by the
physician at the recieving hospital. Pt is "assisted" to the cot and taken
to the airport where the helicopter is waiting to do a "hot load" (doesn't
completely shut down). Pt is stable and wondering what all the fuss is
about..<G>

Which case truly warranted the helicopter?
 Did either of them?
 What risk was involved for everyone?
Who cared? (except the "old" paramedic who was paged out at 0200 and a bit
grumpy with the drama of it all..<G>)

Jules

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