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Tue Oct 7 02:11:50 BST 2008

I am concerned that the ROOT CAUSE of the underlying issue is not being  
addressed.     At issue here is just when should both ground  and air ambulances 
be dispatched and utilized.     Mechanism  of injury criteria have long been 
shown to be less reliable than other  criteria.     It is well known that "THE 
GOLDEN HOUR" is  more of a marketing ploy, than a physiological  reality.    
The kinds of odds ratios that exist for  helicopter transport would never be 
tolerated in other areas of  medicine.     The number of false negative flights 
is simply  unacceptable in that far too many patients with MINOR conditions are 
simply over  triaged and over transported.      

I challenge  any reviewer to look at the specific medical or surgical 
conditions present in  those who have DIED in air ambulance crashes during the last 
30 years and submit  these to an independent panel and ask them to determine 
just where the patient  should have been transported to and by what means.       
I project that the results would be sobering.     

Let us all take this opportunity to stand back 30 feet and reflect on the  
reality of what we are witnessing and use this as an opportunity to make a mid  
course correction, just as we have in fluid resuscitation and damage control  
surgery this last 15 years.        We own no  less to those public who trust 
us to analyze our results and do better next  time.    

I am certain that in other areas of health care within a hospital the  recent 
events in air ambulance transport would be reviewed by a Joint Commission  
mandated Sentinel Event Committee.        Let  us hope that the lucrative 
industry of air ambulance transport does not silence  or redirect the essence of 
what now is a national call for sanity in standards,  dispatch criteria, etc. 
etc. etc.  

k

In a message dated 10/6/2008 7:33:42 P.M. Central Daylight Time,  
stephen.richey at gmail.com writes:

*Panel  to Review Maryland Medevac Helicopters*
Last Edited: Monday, 06 Oct  2008, 7:06 PM EDT   Created: Monday, 06 Oct
2008, 3:53 PM  EDT
http://www.myfoxdc.com/myfox/pages/News/Detail?contentId=7588498&version=4&loc
ale=EN-US&layoutCode=TSTY&pageId=3.2.1

*BALTIMORE  (AP) -- A national panel of experts will review operations for
Maryland's  medevacs after a deadly helicopter crash, and consultations will
be  required before air transport, a top emergency response official  said
Monday.*

Unless they include Norman McSwain, Ken Mattox, and  Bryan Bledsoe, I
question whether this is going to be anything other than  another whitewash
feel good meeting that has become the standard in the  aeromedical industry.

*Robert Bass, executive director of the  Maryland Institute for Emergency
Medical Services Systems, emphasized that  the new consultations were not a
criticism of first responders, who make  tough decisions under difficult
circumstances.*

*"Rather, it is to  enable them to take a momentary pause during a chaotic
and stressful  incident to review the indications for and potential benefits
of air  transport with personnel at the trauma center," Bass said.*

*Bass said  the system is seeking a panel of experts with balanced views
about air  medical services, "middle-of-the-road folks who have an  objective
overview." The panel will make recommendations to the system's  board after
the review.*

Why do I have the feeling this is going to  turn out to be a group of one or
two objectors and the rest of the board  are card carrying members of the
AMPA and/or AAMS?

*"We want to pull  in a multidisciplinary team that has a lot of experience
and a national  perspective, because we believe that these issues really are
national-level  issues," Bass told reporters after a news conference.*

He has finally  said something I agree with.

*The announcement comes just more than a  week after a helicopter
transporting victims of a car accident crashed  while flying in foggy weather
in suburban Washington, D.C., killing four of  the five people on board.*

*It was the eighth fatal crash in the past  12 months across the country
involving medical transport helicopters,  prompting some to question the role
of the helicopters and when they should  be used.*

*Officials are working on creating a system for  consultations, and Bass
hoped they would be in effect within days. The  consultations are expected to
be very short, lasting 60 or 90 seconds, and  will be done while a helicopter
prepares to fly to the scene of an  accident.*

Unless they have a doc who does *nothing* but sit and listen  to the radio,
it's going to take a lot longer than 90 seconds to get the  doc on the line
and give them a report that really is in depth enough to  allow the doc to
make a "fly" or "drive" decisions.  Also who is going  to cover the doc if
someone decides to sue them in the event someone dies  after being told "No,
go by ground".

Also the default will remain  launching the helicopter and then deciding it's
not needed?  How is  that going to improve safety?

"*It's really a very rapid quick  assessment that gets to the salient
features of what's going on and then we  make a decision," said Dr. Thomas
Scalea, the physician in chief at the R  Adams Cowley Shock Trauma Center.*

*First-responders previously have  made the call on whether air transport was
needed. Now, they will confer  with a physician. Generally, patients who are
within a 30-minute drive of a  trauma center are taken by ambulance. However,
exceptions can be made based  on how serious injuries might be.*

*Scalea underscored that he has  enormous faith in first-responders.*

*"I have trouble overruling  somebody who's at the scene and can put their
eyes on the patient," Scalea  said*

*A thorough review of the field response and patient care in the  Sept. 28
crash also will be done to reconstruct the response and find ways  to improve
field triage, Bass said.*

The day they come out and admit  that crew died for basically nothing (which
is what happened) because their  precious system is catastrophically flawed
will be the day I buy Dr. Bass  dinner.  However, I hold out some slim hope
that minor changes will  occur but believe the system will remain largely
intact despite the claims  to the contrary until I see significant  changes
occuring.

**

*Bass, who made the announcement at  Shock Trauma, emphasized that the only
state-run emergency helicopter  system has saved thousands of lives *

Who wants to be the one to stand  up and call bullshit on this tired old
statement this time?

*and is  a model for the nation and the world. But he also said it's an
opportunity  to improve the system.*

*The sole crash survivor, 18-year-old Jordan  Wells, remained in critical but
stable condition at Shock Trauma. Her  father, Scott, told reporters that he
and his wife, Lynn, talked to their  daughter for the first time Monday since
the crash. Her recovery could take  up to 12 months.*

*"They took the tubes out, and one of her first  thoughts was 'Dad, I'm sorry
I wrecked the car,"' Wells  said.*

*Wells said Monday was the first time he had heard of questions  about the
role of medevac helicopters because he has been tending to his  daughter.*

*"Her mother and I are just extremely, extremely grateful  for the paramedics
and the pilot that night that came out to rescue my  daughter and died in
that service," Wells said.*

*Meanwhile,  helicopter service has resumed with some of the Maryland  fleet's
helicopters, and more are expected to resume service soon, said  James Brown,
a spokesman for the Maryland Institute for Emergency Medical  Services
Systems.*
*Maryland**'s helicopter program has been known for  its safety record, with
just three other fatal crashes in four decades. But  in recent weeks,
concerns had been raised about the fleet's age and  maintenance.
*

Age and maintenance are only the most obvious issues  to the non-flying
community.  The more obvious causes of crashes are  the simple mathematics of
if you fly more, the more likely a crash and the  the excessive risks of
flying into severe instrument conditions at low  altitude in a helicopter
under pressure to complete a mission.

--  
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 Bonhoeffer
--
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Panel to Review Maryland Medevac Helicopters