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Thu Oct 2 09:32:40 BST 2008

I suspect the?'agreed upon standards' comment refers to the decision-tree in the Maryland EMS protocol that guides field providers in making a decision of where to take a trauma patient. It is virtually a verbatim copy of what is in the ATLS course manual. Recommendations for mode of transportation are also in the EMS protocol but I am not aware of any evidence beyond local consensus to support them.

Aeromedical flights are a hazardous business that is not aided by?the obsession with claims x number of missions or flight hours have been flown without a crash. These claims can go on for a long time while conditions brew that lead to?a crash. Then everyone is standing over the wreakage wondering how something so bad could happen in such a 'safe' program. Why were only a minority of the helicopters in the MSP fleet equipped with ground-proximity warning system equipment? Given the value of that equipment in preventing controlled flight into terrain mishaps, what was different about the mission of the GPWS-equipped helicopters from the others in the fleet? There's no reason to believe that the crewmembers who died didn't do everything possible to ensure a safe mission was executed. I question what did MSP Aviation do as an organization to help that aircrew.

-----Original Message-----
From: Stephen Richey <stephen.richey at gmail.com>
To: Discussion of Critical Care Medicine <ccm-l at ccm-l.org>; trauma-list at trauma.org; robert. little <Robert.Little at baltsun.com>
Sent: Wed, 1 Oct 2008 8:53 pm
Subject: Re: [CCM-L] Helicopter crashes

I love (*note: sarcasm) the comment by the Maryland state medical director
(next to last paragraph).  Since when have their been agreed upon standards
for when to call the helicopter?  It's simply an item of the laundry list
mechanism of injury list that may or may not (most likely the latter)
indicate the presence of a serious injury. Good sensitivity, lousy
specificity.

If this crash doesn't make Dr. Bass pull his head out of whereever he seems
to have it stuck (clouds, etc) , then maybe he doesn't have what it takes to
effectively lead a state EMS operation which has near totalitarian control
over its jurisdiction.   I don't believe he is stupid (I've talked to him
before and he seems reasonably intelligent) nor do I believe it's malicious
or corrupt act on his part.  However, he may have been sipping the
aeromedical Koolaid for just a little too long like so many others have
been.  Think of it as a long running selection bias.....

Source:
http://www.baltimoresun.com/news/opinion/editorial/bal-ed.chopper01oct01,0,4234849.story

A teenager survives a weekend car accident with little if any physical
injuries, only to die in the crash of the Maryland State Police helicopter
that was whisking her to a trauma center. Did the 17-year-old really need to
be flown to the hospital, especially in such bad weather that night?

The chopper transporting Ashley J. Younger and the driver of the car wasn't
equipped with an electronic warning device that helps pilots fly in low
visibility and avoid crashing into the ground. State police outfitted three
other helicopters with the "early ground proximity warning system" during
upgrades in recent years; why not the entire fleet?

These and many other troubling questions have been raised in the wake of the
fatal weekend helicopter crash that is under investigation by the National
Transportation Safety Board. NTSB reviews are routine in such cases. But the
circumstances of the accident should compel further reviews by the state
police, Charles County officials and the Maryland In
stitute for Emergency
Medical Services Systems, which operates the statewide system of trauma
care. Killed in the Sunday morning crash were Ms. Younger; pilot Stephen H.
Bunker, 59; Trooper Mickey C. Lippy, 34, a paramedic; and Tonya Mallard, 39,
a volunteer emergency medical worker from the Waldorf squad.

The driver of the car, Jordan Wells, 18, of Waldorf, also was a patient on
the helicopter and was critically injured when the chopper crashed in fog
and rain in a wooded area just a few miles from its home base at Andrews Air
Force Base.

  NTSB member Deborah A.P. Hersman, who inspected the crash site, has
already characterized the weather conditions that night as "challenging" for
the pilot, a veteran and retired state trooper. But did the paramedics on
the scene give sufficient thought to transporting the injured by ambulance
instead?

*Dr. Robert R. Bass, head of MIEMSS, says the extent of the initial car
crash - the car's interior was crushed within 12 to 18 inches of a
passenger- met one of the national standards for transporting an accident
victim by helicopter. The patients complained of chest, back and spine pain
that could indicate internal injuries. Was this the right call? The
appropriate standard? Should paramedics have consulted with a trauma center
physician in such a case before ordering a helicopter?*

This was the first fatal crash of a state police medevac helicopter in 22
years; the fleet has had an exemplary safety record. Answering some of these
distressing questions may not comfort the families of the brave men and
women who died in the accident, but it could help prevent another tragedy.

-- 
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

"It is the characteristic excellence of the strong man that he can bring
momentous issues to the fore and make a decision about them. The weak are
always forced to decide between alternatives they have not chosen
themselves."- Dietrich Bon
hoeffer
--
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[CCM-L] Helicopter crashes