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Tue Nov 25 21:56:34 GMT 2008

All good suggestions.  I strongly agree with Bryan's implication (as I  
take it) that whatever we do must benefit the patient.  Safe,  
effective, appropriate care on scene, during transport, and during the  
transfer of care is the pinnacle of proper emergency and trauma care.   
Everything must facilitate proper care.

Anything else is simply activities supporting other agenda's.

Take care,

Bob

Robert K. Waddell II, EMT-P (ret)
The Sacco Triage Method (STM)

Wyoming office
1302 East 5th Avenue
Cheyenne, Wyoming 82001

307 920 2020

bwaddell at sharpthinkers.com
www.sharpthinkers.com

On Nov 25, 2008, at 2:46 PM, Stephen Richey wrote:

> On Tue, Nov 25, 2008 at 4:34 PM, Robert Waddell II
> <bobwaddell at bresnan.net>wrote:
>
>> Stephen,
>>
>> Lou makes a valid point.  While working EMS in southern Wyoming and
>> Northern Colorado we more commonly landed aircraft in fields and on  
>> road
>> ways than a designated spot.
>
>
> Yes, and so long as the terrain is flat and there are no  
> obstructions then
> there is not a serious issue.  However, when you get over into the  
> hills
> towards Medicine Bow/Como Bluff or up towards the Wind Rivers, then  
> you
> start to encounter the sort of terrain where having predetermined  
> landing
> site would certainly be a good thing in terms of safety.
>
>
>> Cheyenne, Wyoming has a large airport, the next closest one is 50  
>> miles
>> away in two directions and ??> miles away in the other two.
>
>
>
> This is true for public airports although there are a few private  
> fields
> scattered here and there.  It is still a pretty empty expanse in  
> terms of a
> lack of airports.
>
>
>
>> There is virtually no way to designate LZ's when you're dealing  
>> with vast
>> geography.    Many safe landing have been facilitated in the  
>> frontier.
>
>
> GPS?  Or you could simply designate the landing zone as being at the
> intersection of "Middle Road" and "Nowhere Highway" or a certain  
> mile marker
> on the interstate.   I have heard of a few counties in northern  
> Indiana
> (which is pretty flat and featureless, although not as expansive  
> seeing as
> Indiana measured east to west is roughly the same size as Campbell  
> County,
> WY measured north to south) have used the latter option.
>
>
>
> Take care,
>
> Bob Waddell II
> EMT-P (ret)
> bobwaddell at bresnan.net
> 307 920 2020
>
>
> On Nov 25, 2008, at 11:04 AM, Stephen Richey wrote:
>>
>> No, it would not.  It would simply require the air ambulance  
>> operations to
>>> go out and designate appropriate landing zones in their service  
>>> areas.
>>> This
>>> is in keeping with the type of proactive approach to safety we are  
>>> trying
>>> to
>>> encourage in the industry.
>>>
>>> The simpler option is to utilize existing airports and have the  
>>> patient
>>> transported there.  There are a lot more airports around- public and
>>> private- than many people realize.
>>>
>>> On Tue, Nov 25, 2008 at 12:53 PM, LouIs N. Molino, Sr. <lnmolino at aol.com
>>>> wrote:
>>>
>>> But point 2 would eliminate the use of HEMS in rural and frontier  
>>> areas
>>>> where it MAY actually be warrented.
>>>>
>>>> Louis N. Molino, Sr. CET
>>>> FF/NREMT/FSI/EMSI
>>>> Typed by my thumbs on my iPhone.
>>>>
>>>>
>>>> On Nov 24, 2008, at 14:35, "Stephen Richey" <stephen.richey at gmail.com 
>>>> >
>>>> wrote:
>>>>
>>>> On Mon, Nov 24, 2008 at 3:22 PM, Anthony Caruso <medic541 at hotmail.com
>>>>
>>>>> wrote:
>>>>>>
>>>>>
>>>>>
>>>>> Stephen, I have been reading this thread for as long as it has  
>>>>> been on
>>>>>> here.  I think that definitely changes are to be made for  
>>>>>> criteria on
>>>>>> when,
>>>>>> and when not to call for a chopper.  As I have said before more
>>>>>> emphases
>>>>>> should be placed on educating pre hospital providers. But there's
>>>>>> enough
>>>>>> blame to go around on that.
>>>>>>
>>>>>> However, how do you suppose that you (we) can change the way  
>>>>>> Maryland
>>>>>> dose
>>>>>> its job?
>>>>>>
>>>>>>
>>>>>
>>>>> *Flight safety measures*:
>>>>> 1-Two pilots on board all flights
>>>>> 2-No landings at sites that have not previously been surveyed and
>>>>> approved
>>>>> (no more impromptu landing zones at the scenes of car accidents,  
>>>>> etc)
>>>>> 3-No flights without terrain awarness and warning systems  
>>>>> (TAWS), ground
>>>>> proximity warning system (GPWS) and night vision equipment  
>>>>> available to
>>>>> the
>>>>> pilots
>>>>> 4-No flights in deteriorating weather conditions or in  
>>>>> situations where
>>>>> the
>>>>> lowest level of clouds is within 500 feet of the top of the  
>>>>> highest
>>>>> obstruction along the planned flight routes.
>>>>>
>>>>> *EMS System Changes*
>>>>> 1-All flights are subject to audit and review to determine the  
>>>>> medical
>>>>> necessity of the flight and the data is open to anyone who wants  
>>>>> to use
>>>>> it
>>>>> for research purposes; this would allow for agencies other than  
>>>>> MIEMMS
>>>>> to
>>>>> keep tabs on the system as well as allow MIEMMS to recognize and  
>>>>> address
>>>>> problems before they become severe.  It could also allow further
>>>>> tailoring
>>>>> of the dispatch protocols for a specific area if certain issues  
>>>>> arise.
>>>>> 2-Hold ground crews accountable for their actions when they
>>>>> unnecessarily
>>>>> call for aeromedical transport in cases where it was not needed  
>>>>> (based
>>>>> upon
>>>>> careful review of the case) and allow for punishment (suspension,
>>>>> termination, etc) for repeated abuse of the system.
>>>>> 3-Term limit for the medical director to avoid development of
>>>>> complacency
>>>>> and abuse of power
>>>>> 4-Abolishment of statewide protocols in favor of a regional or  
>>>>> county
>>>>> based
>>>>> system.
>>>>>
>>>>>
>>>>> There helicopters' serve duel roles.
>>>>>
>>>>>
>>>>>> A) Obviously EMS missions.
>>>>>>
>>>>>> B) Law enforcement missions.
>>>>>>
>>>>>> Is there a big difference on civilian medavac Vs. law enforcement
>>>>>> agency
>>>>>> medavac and there standards?
>>>>>>
>>>>>>
>>>>>
>>>>> I honestly can not say because so far as I am aware there has  
>>>>> never been
>>>>> a
>>>>> good comparison of the two because there are so few dual purpose
>>>>> operations
>>>>> (off the top of my head- Maryland State Police, Los Angeles County
>>>>> Sheriff's
>>>>> Department (I think the fly rescue), the US Coast Guard)
>>>>>
>>>>>
>>>>> From: ALS79 at aol.com> Date: Mon, 24 Nov 2008 14:58:00 -0500>  
>>>>> Subject:
>>>>>>
>>>>>>> Re:
>>>>>>>
>>>>>>> Maryland Air Ambulance Review Panel> To: trauma- 
>>>>>>> list at trauma.org> >
>>>>>> Bill
>>>>>> Metcalf filled my position when I left ACEP. At the time, he  
>>>>>> was the
>>>>>> EMS
>>>>>>
>>>>>>>
>>>>>>> Director for the state of Colorado. He was originally a  
>>>>>>> firefighter
>>>>>> in >
>>>>>> Maryland, and was at one time married to an executive with the  
>>>>>> ATS. He
>>>>>> left
>>>>>> ACEP and > went to work for JEMS magazine, and the on to be EMS  
>>>>>> Chief
>>>>>> of
>>>>>> the
>>>>>> fire > protection district at Lake Tahoe. He serves on the  
>>>>>> IAFC's EMS
>>>>>> Committee and also > does some consulting on the side with Jim
>>>>>> Paturas.>
>>>>>>
>>>>>>> I
>>>>>>>
>>>>>> have known Bill for many years. While he can be objective, the  
>>>>>> two >
>>>>>> unalterable characteristics about him are that he'll vote on  
>>>>>> the side
>>>>>> of
>>>>>> the
>>>>>> majority > opinion, and he'll always defend MIEMSS because  
>>>>>> that's his
>>>>>> home
>>>>>> turf.> > It doesn't look good for our side.> > Bob Kellow> > >
>>>>>> **************> One site has it all. Your email accounts, your  
>>>>>> social >
>>>>>> networks, and the things you love. Try
>>>>>> the new AOL.com > today!(
>>>>>>
>>>>>>
>>>>>> http://pr.atwola.com/promoclk/100000075x1212962939x1200825291/aol?redir=http://www.aol.com/
>>>>>> ?op
>>>>>>
>>>>>>>
>>>>>>> tin=new-dp%26icid=aolcom40vanity%26ncid=emlcntaolcom00000001)>  
>>>>>>> -->
>>>>>> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe
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>>>>>>
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>>>>>>
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>>>>>>
>>>>>>
>>>>>>
>>>>>
>>>>> --
>>>>> Stephen L. Richey, CRT
>>>>> Aviation Injury Research Project Leader
>>>>> Saginaw Valley State University
>>>>> Work E-mail: slrichey at svsu.edu
>>>>> Home Office Phone: 248-366-4452
>>>>>
>>>>> "Hier stehe ich. Ich kann nicht anders. Gott helfe mir. Amen."-  
>>>>> Martin
>>>>> Luther, before the Diet of Worms, 16. April 1521
>>>>> --
>>>>> trauma-list : TRAUMA.ORG
>>>>> To change your settings or unsubscribe visit:
>>>>> http://www.trauma.org/index.php?/community/
>>>>>
>>>>> --
>>>>
>>>> trauma-list : TRAUMA.ORG
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>>>> http://www.trauma.org/index.php?/community/
>>>>
>>>>
>>>
>>>
>>> --
>>> Stephen L. Richey, CRT
>>> Aviation Injury Research Project Leader
>>> Saginaw Valley State University
>>> Work E-mail: slrichey at svsu.edu
>>> Home Office Phone: 248-366-4452
>>>
>>> "Hier stehe ich. Ich kann nicht anders. Gott helfe mir. Amen."-  
>>> Martin
>>> Luther, before the Diet of Worms, 16. April 1521
>>> --
>>> trauma-list : TRAUMA.ORG
>>> To change your settings or unsubscribe visit:
>>> http://www.trauma.org/index.php?/community/
>>>
>>
>> --
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>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
>
>
>
> -- 
> Stephen L. Richey, CRT
> Aviation Injury Research Project Leader
> Saginaw Valley State University
> Work E-mail: slrichey at svsu.edu
> Home Office Phone: 248-366-4452
>
> "Hier stehe ich. Ich kann nicht anders. Gott helfe mir. Amen."- Martin
> Luther, before the Diet of Worms, 16. April 1521
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/

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