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Wed Feb 25 16:34:23 GMT 2009

Rotor is target because of over-use, saturation, hyped capability and
need and the tendency to drop like a rock when the rotors are no longer
rotors. Fixed wing does have the advantage of glide capability. Although not
always well performed.

Andrew

On Wed, Feb 25, 2009 at 11:29 AM, Connie Potter <Connie at traumafoundation.org
> wrote:

> 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
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NTSB to Issue Helicopter EMS Safety Recommendations