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Wed Oct 8 14:40:31 BST 2008

>
> WHERE IS THE DATA TO SUPPORT THIS STATEMENT.   I CANNOT FIND  IT.
>
Neither can the people who stand up and make such assinine pronouncements,
otherwise we would not be having this debate.

> Message: 4
> Date: Tue, 7 Oct 2008 10:22:40 -0500
> From: "McSwain, Norman E Jr." <nmcswai at tulane.edu>
> Subject: RE: Panel to Review Maryland Medevac Helicopters
> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID:
>        <B79C02DCC4FA074DB02381DF1C5D60BA01AB22B3 at EX07.ad.tulane.edu>
> Content-Type: text/plain;       charset="us-ascii"
>
> Unfortunately Bob is correct
>
>
>
> I would be great to be a part of a real panel changed with a productive
> outcome of realistic and patient care oriented guidelines. But my  view
> of the government directed reviews tells me it will never happen. "You
> can't gore my ox"

Especially in that state, with that system.  If the governor or anyone else
wants to effect changes, heads are going to have to roll at MIEMSS.

> Message: 7
> Date: Tue, 7 Oct 2008 10:43:21 -0500
> From: "Bryan Bledsoe, DO" <bbledsoe at earthlink.net>
> Subject: RE: Panel to Review Maryland Medevac Helicopters
> To: "'Trauma &amp; Critical Care mailing list'"
>        <trauma-list at trauma.org>
> Message-ID: <012e01c92893$6de72c20$49b58460$@net>
> Content-Type: text/plain;       charset="US-ASCII"
>
> Norman is right.  I heard a reporter asked Bob Bass (a good man) if I would
> be selected for the panel.  He said, "Maybe, but we are looking for
> somebody
> who does not have an established opinion either way."
>
> Bryan
>

As everyone said, there is no such person.  I wonder if that was code for "a
bunch of MIEMSS lackies whom we can bend to our will."  However, if you
actually think that Dr. Bass is a good person then I will try to give him
the benefit of the doubt, although his actions thus far do not seem to bode
well for his likely intentions in this process.

> Even if some did, it's a boneheaded approach, promising miserable
> failure: a system which excludes opinion would inherently exclude
> expertise.
>

On the other side, I'd look for award-winning flight programs with
> impeccable safety records.  There are a few -- one of which happens to
> be right down the hall from me.  Both the Medical Director (Norm
> Dinerman, MD, FACEP) and the Executive Director (Tom Judge, EMT-P and an
> armload of other credentials) are internationally known, highly
> respected, infinitely professional, and uncompromising in their
> dedication to safe and effective air medical operations.
>
I would prefer to see the safety experts- especially from Fort Rucker (as
Dr. Krin mentioned below) being brought in on this.    Hell hath no fury
like a military board reviewing a serious crash.   If anyone wants to
seriously pursue involving the military experts on the operations side of
this, let me know and I will talk to some of my contacts.  I am not sure how
willing they are to take part, but I would imagine they probably have
more documentation on safe operation of helicopters in adverse or hostile
conditions than anyone else on the planet.  Also, let us not forget the
Coast Guard, who have amongst their ranks some of the most qualified,
experienced and competent helo pilots on the planet.

> Message: 13
> Date: Tue, 7 Oct 2008 15:26:06 EDT
> From: Krin135 at aol.com
> Subject: Re: Panel to Review Maryland Medevac Helicopters
> To: trauma-list at trauma.org
> Message-ID: <d28.3432b590.361d11ce at aol.com>
> Content-Type: text/plain
>
> And make sure that you pull some folks in from Ft
>  Rucker/Pensacola/Wright-Patterson, as short of actual combat losses, the
>  military programs (both MAST/MEDEVAC/DUSTOFF and Combat Search and Rescue
>  (C-SAR)) have shown that using 'heavy iron' (UH-1H/N/U/V) , UH/MH-60, CH-3,
>  CH/MH-47, and CH/MH-53) with full IFR (most with RADAR altimeters and since
>  the mid 1990's all with two or more engines) birds with two qualified
>  pilots plus back seat crew have had an admirable safety record, even when
>  handling missions that no civilian outfit is able to cope with.
>
> And from the after action reviews of the only flight related incident that
>  was suffered by the DUSTOFF flight platoon at Ft. Sill, OK (4/507th Med Co)
>  during the 1980-83 time period that I spent with them, the folks out of
> Mother  Rucker (and the corresponding Navy/AF/CG types) will NOT be likely
> to accept a  whitewash....(Kudos to Instructor Pilot CW4 Lee Ross for making
> a safe landing  after a total hydraulic failure...what could have been a
> Class A incident  (destroyed aircraft and/or loss of life) was limited to a
> Class C (minimal  damage, fixable on site and flown home a couple of days
> later) situation.)
>

> Message: 14
> Date: Tue, 7 Oct 2008 15:50:29 -0400
> From: "Bjorn, Pret" <pbjorn at emh.org>
> Subject: RE: Panel to Review Maryland Medevac Helicopters
> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID:
>        <9CCE32ECAAFDEB4DA01EC771B6AD951B036A7A2E at VALIER.me.emh.org>
> Content-Type: text/plain;       charset="us-ascii"
>
> Stephen RICHARDS?  WTF?
>
> Stephen Richey, of course.  My sincere apologies.
>
No need for an apology.  I am simply honored to have been mentioned in the
same breath as Ken and others who are well regarded in this field.  As I
told Ken in an off-list e-mail, I would be happy simply being allowed to
play a small part in this, let alone being on the panel itself.

> Message: 15
> Date: Tue, 7 Oct 2008 17:09:05 -0400
> From: "Forrest Robleto" <farcpr at gmail.com>
> Subject: Re: Need help locating specific citations on Mechanism of
>        Injury, Over/Under Triage, and medical aircraft usage
> To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID:
>        <2277979f0810071409x66cdb3a9h9e5b0e10aa38b197 at mail.gmail.com>
> Content-Type: text/plain; charset=ISO-8859-1
>
> We (EMS) are not even aloud to think we might know what might be wrong with
> the patient.  We are however allowed to say holy shit that SUV rolled over
> six times so the guy inside needs a trauma center soon.
> We are also allowed to compute that the traffic will take us 1 hour to the
> trauma center and the chopper 30 minutes.
>
Then the solution is to fix the EMS educational system to the point where
medics are more than simply a glorified triage technician.   What's funny is
that for the cost of operationg Maryland's helicopter system for one year,
they probably  could have an entire legion of paramedics trained to a point
not seen outside of SF medicine.

On Tue, Oct 7, 2008 at 8:32 AM, Robert F. Smith <rfsmithmd at comcast.net
>wrote:

> I don't even understand, conceptually, how a mechanism of injury could be
> used to determine whether a patient should be transported by air or by
> ground. Wouldn't time from scene call to resus room be the relevant
factor?
> Maybe the unvented PTX pt should avoid air travel.

If you stay at low altitude, the PTX is not normally an issue, even if the
patient is mechanically ventilated.

> Message: 16
> Date: Tue, 7 Oct 2008 15:10:01 -0700
> From: "Thomson, Dave" <dthomson at phihelico.com>
> Subject: Air medical references
> To: <trauma-list at trauma.org>
> Message-ID:
>        <E3CAEF7CB7092D42B40CE0C3848AF8CDE93D6A at phxex2.ad.phihelico.com>
> Content-Type: text/plain;       charset="us-ascii"
>
> I'm not sure exactly why Mr. Richey feels the need to slander the Air
> Medical Journal or the authors who have published there.

It's not slander, I simply questioned the possibility of alterior motives
underpinning the selection of articles for publication.  It is akin to being
skeptical of a publication put out by the Bigfoot Field Researchers
Organization: they can peer review it all they like, but the evidence
to convince all but the true believers is just not there.

> I think everyone involved in the air medical industry realizes that the
> research has often been weak or poorly done.  Dr. Thomas has done a nice job
> of reviewing the research and pointing out some of the strengths and
> weaknesses.  He has also put together a group, the Critical Care Transport
> Collaborative Outcomes Research effort (www.cctcore.org), that will be
> better able to answer those questions.
>
We will see if that actually produces anything approaching the claims you
and other industry spokesmen hope it does.  That being said, we already have
sufficient evidence to warrant certain practices being taken up as standards
and others being disregarded entirely, yet a large number of your colleagues
still more or less insist that we can fly helicopters for any patient with a
temperature above ambient.

> We have the potential accomplish a lot if we can get past the name calling
> and start to address the real issues here.

I don't believing questioning what amounts to a religious zeal for
aeromedical transport is the same as name calling.  The same is true for
holding people to account for saying one thing out of one side of their
mouth and then turning around and doing the exact opposite when it costs
people their lives.  You call it name calling, I call it demanding that
professionals take their lumps along with their kudos and that they have the
decency to admit when they have screwed up.

> In all due respect, I have read the articles.    Where  comparison studies
> on injury severity, distance, time, costs and outcomes are  compared, ground
> ambulance have always been equal or superior to helicopter  transport.
>  The references are in many different journals,  including critical care,
> trauma, surgical, air industry, hospital management,  EMS, and others.
> Many, if not most of the articles are not  Class 3, 2, or 1 papers, but are
> mainly expert opinion, with NO concomitant  comparisons.     The entry
> criteria are often very interesting.      Over my lifetime, I have  probably
> read over 500 of the helicopter references.   The very first  entry in my
> own CV is a helicopter article.      Where  helicopter services have been
> known to be lost, and where data were kept pre and  post loss of the
> service, the times, and outcomes showed NO benefit to air  ambulance
> transport.

Nicely put.

> It is time we came together and established appropriate standards, use
> criteria, and outcomes analysis, with the same scrutiny that we apply to
> cases  in the OR, ICU, and other critical care

That is all I am calling for, but also to include standards for the safety
side of things too, since we can not count on the FAA and other governmental
agencies to put their boot up the backside of the helicopter companies and
force them to do anything but skirt the bare minimums of Part 91 and Part
135 and maybe comply with the polite suggestions in the NTSB report on the
subject.    As the advice drilled into my head by a flight instructor friend
(25,000+ hrs logged, flew Hueys in Viet Nam, etc)  when I told him I was
pursuing my pilot's license: "If you remember nothing else, remember this:
just because you're current, doesn't mean you're proficient and just because
you can doesn't mean you should.  It is far better to be on the ground
wishing you were in the air, than the other way around."  If some of the air
ambulance operations would have kept this in mind, perhaps I would not have
had to attend so many funerals since I became involved in EMS.

>
> Of course this group, like ALL stakeholders MUST be present to address the
> approaches to the massive overuse of helicopters and increase number of
> crashes
>  and loss of life.     HOWEVER, this kind of group must not  be the only
> one
> present, as others also have data and have the ability to  scientifically
> evaluate data.     Past attempts to do what  we all are anticipating needs
> to be
> done were stymied by the people who were  economically and emotionally
> attached
> to helicopter use.

I am more than happy to work with the helicopter companies in any way I
can.  However, if a meeting is held, I believe attendance (or at least
voting privileges on any consensus statements) should be limited in order to
prevent either side from attempting to crush the competition in the
conference version of a human wave attack.

-- 
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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