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Wed Oct 15 15:37:41 BST 2008

Guys
Can I suggest you take this discussion off-list and then present us
with a single summary statement from yourselves collectively to the
group highlighting the major issues and where you have identified
areas of agreement, controversy and further research?
many thanks
Karim

On 10/15/2008, Stephen Richey <stephen.richey at gmail.com> wrote:
> On Wed, Oct 15, 2008 at 10:01 AM, Bjorn, Pret <pbjorn at emh.org> wrote:
>
> > "Well, the problem is that they contradict themselves.  The very
> > premises of
> > 'appropriate flight requests' and increasing the number of flights are
> > antipodal given that we already fly more people than need to be flown."
> >
> > Your logic is flawed, and you're smart enough to make me believe it's
> > intentional.
>
>
> How is my logic flawed other than I expect this subset of medicine to hold
> itself and to be held by others to a standard similar to that of other
> branches.
>
>
> >  Unacceptable overtriage does not rule out unacceptable
> > undertriage.  Adhering to triage rules may as easily increase
> > appropriate uses as eliminate dangerous ones.
>
>
> But the very triage "rules" they apply to (mechanism, etc) have been proven
> to be at best, unreliable.
>
>
> >   In Maine, we still
> > encounter cases where steadfastly ignorant providers delay or deny
> > flight transport in cases which scream for it.  Unsurprisingly, most of
> > these providers are critics of air medicine generally.
>
>
> If the indications (drive time to nearest hospital >30-40 minutes, unstable
> trauma victim, etc) are there and the weather is satisfactory, then fly the
> patient.  Otherwise, keep the helicopter on the ground.  Anyone who lets
> their personal beliefs get in the way of their clinical decision making
> should find a different line of work and this goes for persons on both sides
> of the issue (those who believe helicopters have absolutely no utility and
> those who think they should be flown every time possible).
>
> >
> >
> > Further, speaking hypothetically (wink), one might even imagine systems
> > in which properly triaged patients are transported by substandard
> > competing services -- at the expense of the system, and occasionally the
> > patient.  In a free market, a superior service can (and should, without
> > delay) bury inferior, dangerous competitors.
>
>
> On this, we agree.
>
>
> >   These tools can't hurt.
>
> Tell that to the family of all the crews that AirEvac Lifeteam has lost
> because of their aggressive marketing tactics leading to unchecked growth.
>
>
> "It depends on the definitions use.  From the sound of it (both the
> 'amputated' portion and what is on the website) their definition of
> 'worthy' is that they have bribed, coddled and done everything short of
> fellating
> the local ground EMS providers.  I read nothing there that made me believe
> their definition of safe is anything more than passing the required
> inspections and being able to launch.  #2 is a wishy-washy sort of statement
> without
> any real teeth....more or less just a reminder to be polite and
> professional."
>
> There is no hope, nor dignity, in responding to this baseless, tasteless
> > bullshit.
> >
>
> How is it bull**** pointing out that buying off local EMS providers with
> free pens, shirts, coffee mugs, helicopter rides and blatantly lying or
> engage in double speak to the press (example the comment by the medical
> director for AeroMed in a recent article in the Grand Rapids Press about how
> "I know we save lives all the time" even though he has zero evidence to back
> up that claim) is unethical and should cease?  I would imagine you have no
> problem with regulations to reign in overzealous drug reps do you?
> Same issue really, except the aeromedical industry is targeting people with
> a lot less education (and ability/desire/etc to assess the literature) than
> your average physician.
>
> "It's possible, but since they give no evidence to that end, the reasonable
> judgment is that they are simply working to increase profits since every one
> of the measures is geared solely to that end.   If they were trying to
> improve things, there would be clauses for encouraging medical review of the
> calls to assure only those patients who need to be flown are flown."
>
> Let's not pretend that ThinkThroughTools is anything more or less than a
> > coaching and consulting agency.  They've found a niche in air medicine,
> > and they're trying to offer a service at a reasonable profit.
>
>
>
>
> >
> >
> > Smart hospitals dump millions of dollars into just this sort of service
> > amplification every year, without any explicit or implied clinical
> > goals.  It's up to the hospitals to do good work; they hire consultants
> > because healthcare in general is late to the competitive market mindset,
> > to its undoing.  That you're not finding evidence of distinct programs
> > in safety or triage or medical necessity is in large part a result of
> > these being beyond the scope of the service.
>
>
> Hospitals don't regularly engage and encourage activities (call them
> collectively "Y") that get sufficient numbers of their employees killed to
> warrant a federal investigation.  Having a consultant basically go in to a
> system like that and tell them "Hey you can make even more money by doing
> "X"" when X worsens the conditions that led to Y, especially when these
> companies are of the mindset that they are beyond reproach from state and
> local authorities, then some (not much, but some) of the blood is on the
> hands of the consultant.  Most of it is where it belongs- the administration
> of the air ambulance service, their medical director, the local EMS medical
> director for not restricting the circumstances under which patients can be
> flown and finally the federal government for having such a high body count
> to trigger action that we continue to lose colleagues, friends and
> patients.
>
>
> > But it's certainly also because you've already judged the company to fit
> > your paradigm.
> >
> Actually I gave them a benefit of the doubt, because at first I though it
> was something Dr. Bledsoe had written as a joke because it was so
> unabashedly a how-to manual on profiteering.
>
> >
> > References to safety and appropriateness are not hard to find throughout
> > the web site -- if you look, and indulge them a modest moral or ethical
> > benefit of the doubt.  It's strategically effective but intellectually
> > lazy to paint them as money-grubbing sleaze balls on zero evidence.
>
>
> Actually I looked and the only references to safety were contradicted by the
> other suggestions on the site.  Why is that something you refuse to
> comprehend?  Why the chip on your shoulder Pret?  You're normally a pretty
> rational person (actually one of the more level headed people on this list
> to be quite honest) and I don't understand why you're acting like you were
> just at the head of the line for Kool-Aid.
>
> >
> > There's a promising future in politics for you.
>
>
>
> > Your Honor, I have nothing else for this witness.
>
>
> Thanks...sarcasm and *ad hominem* attacks are always a great substitute for
> the inability to actually refute what the issues brought up by groups such
> as this group.
>
> >  --
> > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > 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
>
> "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
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>

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