List Archives

Wed Feb 25 16:29:24 GMT 2009

I found it rather interesting that rotor was the target of this
legislation whereas the most recent tragedies in our rural area were
both King Airs (Sierra Blanca and Chinle).  There is nothing in this
legislation to compel oversight of fixed wing airmedical transport.  

As to triage and utilization, etc., the statute does require that
helicopter regulations be integral to state (EMS) planning.  However, it
give a rather confusing "clarification" about interstate transport which
apparently will require an agreement between states in order to apply
regulations. 

Connie Potter, RN, MBA
President
National Foundation for Trauma Care

-----Original Message-----
From: Thomson, Dave [mailto:dthomson at phihelico.com] 
Sent: Wednesday, February 25, 2009 7:42 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: NTSB to Issue Helicopter EMS Safety Recommendations

The current dispatch criteria have been out since 2003.  They no doubt
need revision, but nevertheless they have been available and have been
endorsed by several groups.  I think the new trauma triage guidelines
from CDC may help decrease some unnecessary scene responses.

I agree that utilization review is the key.  Currently some programs do
a good job, while others don't do any UR.  The excuse that many
organizations use is "If we upset the referring organizations then they
won't call us when we are truly needed."  That's bunk - you can
instruct, rather than belittle, and most people will respond in a
positive manner.

The insurance carriers are the ultimate external UR in many cases - but
they also suffer from a lack of knowledge.

There are two other important questions that need to be addressed in
this discussion: What are the alternatives, and how safe are they?

In some areas there are ground ambulances with well trained crews who
can efficiently and cost-effectively transport patients. That is one
alternative to air medical transport.  The other alternative is having
the ability to manage these patients in place. The former is,
unfortunately rare, especially in rural areas.  The latter capability is
also rapidly decreasing, as hospitals close or become essentially
free-standing emergency departments.  It is also not clear exactly what
the risks are with ground ambulance transport.  We have some reasonable
data that emergency response with red lights and sirens is a high-risk
procedure.  What we don't know is what the risks are for routine-traffic
critical care transport (both patient care and vehicle risk).  We also
don't have guidelines for when those transports need to be run with red
lights and siren.

There are groups, such as CCT-CORE that are attempting to shed some
light on some of these issues.  Until we have those data the best thing
we can do is to encourage everyone to use the appropriate resources in
the safest manner possible to provide patients with the best care
available.

Dave Thomson

David P. Thomson, MS, MD, FACEP, CMTE, CHC
National Medical Advisor
PHI Air Medical

-----Original Message-----
From: Bjorn, Pret [mailto:pbjorn at emh.org] 
Sent: 24 February, 2009 10:10
To: Trauma &amp; Critical Care mailing list
Cc: HEMS at ntsb.gov
Subject: RE: NTSB to Issue Helicopter EMS Safety Recommendations

I'm not seeing any recommendation of even the most rudimentary triage
and activation (case selection) criteria.  

Preventable injuries and deaths are bad enough, I'll grant; but is no
one (beyond those who pay the bills) interested that a significant
number of these fatalities did not suffer time-sensitive or otherwise
critical medical issues?  Such is not merely a punctuation of the
tragedy; it's a conspicuous symptom of an inadequately controlled and
inefficient system.

Licensed air medical operations should be required to demonstrate
medical necessity to an external oversight process.  Such a simple
amplification of accountability -- at all levels -- would save more
lives than any on-board gizmo.  Indeed, it would refine and enhance all
aspects of the air medical system.

Pret Bjorn, RN
Bangor, ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of listasmsd
Sent: Monday, February 23, 2009 6:10 PM
To: Trauma &amp; Critical Care mailing list
Subject: NTSB to Issue Helicopter EMS Safety Recommendations

NTSB to Issue Helicopter EMS Safety Recommendations

Who Pays for Safety Measures?

Suzanne Wedel of Boston MedFlight testified that the operation's new
Sikorsky S76 C++ aircraft has $1.1 million worth of enhanced safety
features, including night vision goggles, SPIFR (single pilot instrument
flight rules) auto pilot, ground proximity warning, cockpit voice
recorder, traffic avoidance collision system, moving map, satellite
position tracking, airborne weather radar, satellite weather data,
electronic nav charts, integrated GPS (global positioning system),
emergency locator transmitter, Nightsun, and lightning strike
protection.

According to Marc Harstein, Medicare and Medicaid Services, Medicare
covers helicopter EMS transport to medical facilities at a rate of
$3,308 urban and $4,962 rural if the facility is not accessible by
ground vehicle, transport is over great distances or is complicated by
other obstacles (such as heavy traffic), or the patient's condition is
not appropriate for ground transport.

Air ambulance trips reimbursed by Medicare increased 24%, from 1.65
transports per 1,000 beneficiaries in 2001 to 2.04 transports 1,000
beneficiaries in 2004, Harstein said. 

Two nurses were among experts who testified before the National
Transportation Safety Board's four-day hearing on helicopter EMS safety,
which was prompted by a record year in helicopter EMS accident
fatalities. 

"The take-home message for nurses here is we need to be engaged," said
Kevin High, RN, president of the Air & Surface Transport Nurses
Association and trauma program manager for Vanderbilt LifeFlight,
Nashville, Tenn. "We've got skin in this game. Nurses are losing their
lives in the line of duty."

High was one of the nurses who answered questions from the board of
inquiry Feb. 3-6. in Washington, D.C.

"What I wanted them to know is this is a multi-factorial problem," High
said. "All week, what I kept hearing over and over again is, 'There's no
silver bullet and no one thing that's going to make [accidents] stop.'"

The hearing was held to learn more about helicopter EMS operations so
the NTSB can better evaluate the factors that lead to accidents and
recommend safety improvements to the Federal Aviation Administration,
which oversees the field. The issues discussed included operational
structure and models, flight operations, aircraft safety equipment,
training, and oversight.

"I don't think the solution to the problem can be found inside the
industry alone," High said. "I think whatever [the NTSB] comes up with,
not everybody is going to like it. I think it will probably be some type
of compromise. [But] I'm not worried about it. Inaction would worry me."

The NTSB added helicopter EMS safety to its Most Wanted List of
Transportation Safety Improvements in October, along with a list of
recommendations: Conduct all flights with medical personnel on board in
accordance with charter aircraft regulations. Develop and implement
flight risk evaluation programs. Require formalized dispatch and
flight-following procedures, including up-to-date weather information.
Install terrain awareness and warning systems on aircraft.

Accident Statistics

Each year about 400,000 patients and transplant organs are safely
transported via helicopter EMS, according to Robert L. Sumwalt, chairman
of the board of inquiry. "In the last six years, we have seen 85 HEMS
accidents, resulting in 77 fatalities," Sumwalt said in his opening
statement at the hearing. "In calendar year 2003, we saw 19 accidents
and seven fatalities; in 2004, there were 13 accidents with 18
fatalities; 2005 had 15 accidents and 11 fatalities. In 2006, 13
[helicopter EMS] accidents occurred with a total of five fatalities. In
2007, there were 11 accidents with a total of seven fatalities. However,
2008 was the deadliest year in HEMS on record, with 13 EMS helicopter
accidents, and 29 fatalities.

"The Safety Board is concerned that these types of accidents will
continue if a concerted effort is not made to improve the safety of
emergency medical flights,"Sumwalt said.

Ira Blumen, MD, professor of medicine, medical director and program
director, University of Chicago Aeromedical Network, testified there
were 131 fatalities in 146 helicopter EMS accidents between 1998 and
2008, 77% of which were due to human error.

There were 668 dedicated helicopter EMS units from 21 companies in
operation in 2008, Blumen said.

Kevin Hutton, MD, testifying on behalf of the Association of Air Medical
Services, said growth in helicopter EMS use is spurred by: rural level
of care requirements; increased time-dependent care; consolidation and
critical care regionalization; increased patient destination
legislation; limited or no rural ground transport capability;
malpractice lawsuits; decreased local specialty capability; growth and
consolidation of providers (economies of scale); and more consistent
reimbursement.

Hutton is CEO and chairman of Golden Hour Data Systems Inc., which
provides air medical and ground transport services, integrated
computer-aided dispatch, clinical charting, and other services.

Focusing on Solutions

Nine states require that helicopter EMS programs be credentialed by the
Commission on Accreditation of Medical Transport Services, based in
Anderson, S.C. Eileen Frazer, RN, executive director of the
organization, testified at the hearing that CAMTS added new safety
guidelines Jan. 30. "The No. 1 issue we have concerns about is fatigue
and sleep deprivation," Frazer testified. She said 49% of helicopter EMS
accidents happen at night, while only 34% of flights take place at
night. "One of our biggest concerns is sleep inertia - that period after
you wake up. What is your cognitive function? What are your psychomotor
skills and what activities must you do immediately after being
awakened?"

CAMTS is looking to secure funding for a study on sleep deprivation and
sleep inertia spefically targeting helicopter EMS crews, possibly using
simulators, Frazer said. "We see more and more medical personnel working
24- and 48-hour shifts."

Until that study can be done, educating personnel on the signs of
fatigue is important, she said.

Another hot topic is safety management systems, Frazer said. "One of the
issues we run into when we go out and review programs is that there may
not be anyone at a hospital helipad that you can directly communicate
with you are coming in," she said. "If it's a program that's based at
that hospital, usually there's sophisticated procedures and there's
somebody to meet you. That may not be the case with a hospital helipad
that's not within your own system."

Helicopter Association International president Matt Zuccaro, who is also
co-chairman of the International Helicopter Safety Team, addressed
recommendations including mandatory use of night vision goggles; an all
IFR (instrument flight rules) operating environment; elimination of
launch/response times; study of fatigue factors in helicopter EMS;
education programs; non-punitive safety reporting environments; and
implementation of safety management systems.

Zuccaro also asked for discussion on "the need to provide a sterile
operating environment for pilots and technicians, absent of undo
pressures, so that any considerations are limited to safe aeronautical
decision making."

"You need to be engaged on a national level - know what's going on, pay
attention, read, and make your voice heard," ASTNA's High said. The NTSB
invites members of the EMS community, including RNs, to make submissions
related to the safety of the industry through March 9. Materials should
be submitted to NTSB, Ms. Lorenda Ward, Hearing Officer, 490 L'Enfant
Plaza East SW, Washington, DC 20594, or they may be submitted
electronically to HEMS at ntsb.gov.

http://include.nurse.com/article/20090223/NATIONAL02/302230044/-1/frontp
age
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

List Archives

For your convenience, find the Trauma List Archive Below

NTSB to Issue Helicopter EMS Safety Recommendations