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Wed Feb 25 16:40:04 GMT 2009

Thank you Andrew.  Well said, as always.

On Wed, Feb 25, 2009 at 11:34 AM, Andrew J Bowman
<andrewj.bowman at gmail.com>wrote:

> 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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> >
> >
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-- 
Stephen L. Richey, CRT

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