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Mon Jun 15 20:42:51 BST 2009

Just one article where both doctors defended the status quo. A quote
from each doctor.

This is a system that has only one medical provider in the back. A
paramedic, who has taken time off from being a paramedic, just to become
a state trooper. The medic can work as a trooper for a while, when there
is an opening on the helicopter, they will put the trooper through their
14 week training program to make up for all of that time not providing
medical care. This is such a good idea, it should probably be extended
to trauma nurses and physicians.

>From "Advantages of medevac transport challenged
Some experts find helicopter no better than ground travel

By Robert Little
October 5, 2008"

page 1

http://www.baltimoresun.com/news/nation-world/bal-te.medevac05oct05,0,754514.story?page=1

page 2

http://www.baltimoresun.com/news/nation-world/bal-te.medevac05oct05,0,754514.story?page=2

The idea borders on heresy in Baltimore, a city whose pioneering trauma
center became a global model and where Dr. R Adams Cowley coined the
phrase "golden hour," defining how quickly a patient should get to a
hospital to have the best chance of survival. "Whenever someone says
they want to ratchet it back," says Dr. Thomas M. Scalea, physician in
chief at Shock Trauma, "I tell them 'OK, how many people can die next
year to make that worthwhile?'"

"If it's my family or my patients, and there's no definitive research,
then I want to have a paramedic and a helicopter available," said Dr.
Robert R. Bass, director of the Maryland Institute for Emergency Medical
Services Systems.

I did not create the system. I do not have oversight of the system. I
did not put these words in their mouths. They run this system. They
continue to resist changing its many serious flaws. They speak for
themselves.

Tim Noonan.

On Mon, 15 Jun 2009 14:44 -0400, "Gross, Ronald"
<Ronald.Gross at baystatehealth.org> wrote:
> I'm curious - exactly where is it that Drs. Bass and Scalea stated these
> views?  Please let us all know your references.  I would love to know
> where are you getting your "data" from, because while I do not know Dr.
> Bass, I DO know Dr. Scalea, and what I am hearing from you is copmpletely
> contrary to the Tom Scalea that I have known for the better part of 2
> decades.  I am saying this not knowing you from Adam, but speak to you
> with respect that you seem to have failed to accord to the other 2
> gents......... 
> Ronald I. Gross, MD, FACS
> Chief of Trauma & Emergency Surgery Services
> Baystate Medical Center
> 759 Chestnut Street
> Springfield, MA  01199
> 413-794-4022
> ronald.gross at bhs.org
> ________________________________________
> From: trauma-list-bounces at trauma.org [trauma-list-bounces at trauma.org] On
> Behalf Of htaed_rd at 123mail.org [htaed_rd at 123mail.org]
> Sent: Monday, June 15, 2009 1:40 PM
> To: Trauma-List [TRAUMA.ORG]
> Subject: RE: Alternative therapies (OT)
> 
> Since I work outside of hospitals and generally only comment on the
> truly egregious in-hospital practices, such as Reiki, I do not pay
> attention to the different severity scores among the different non-ACS
> trauma centers in Maryland. Either way, it is not relevant to the topic.
> What is relevant is the difference in outcomes of the patients flown vs.
> not flown.
> 
> Does delaying the arrival at the trauma center in order to fly the
> patient to that same trauma center make any sense? This is one of the
> practices that has only been stopped over the objections of Dr. Bass and
> Dr. Scalea.
> 
> I do pay attention to the fiasco that is MIEMSS. Until the recent crash,
> Dr. Scalea and Dr. Bass were both supporting an EMS flight policy that
> makes Reiki look scientific. They could not provide any evidence to
> support their position, since there is none. Apparently their energies
> were not strong enough to generate research on this topic.
> 
> Since they have cut flights by almost 70%, there is no sign that
> patients are worse off. When it comes to criticizing EMS charlatanism, I
> refuse to remain silent.
> 
> Perhaps you should leave discussion of this topic to those familiar with
> the research.
> 
> Tim Noonan.
> 
> 
> On Mon, 15 Jun 2009 08:59 -0400, "Gross, Ronald"
> <Ronald.Gross at baystatehealth.org> wrote:
> > I truly do lament the loss of ANY patient and/or medical crew member in
> > the crash of an aircraft.  Whether or not the use of that aircraft is
> > justified will be settled right around the same time we see agreement
> > between the NRA and the anti-gun lobbies, or peace in the Middle East.
> > So I would ask you to ask one simple question - if we forgot the fact
> > that patients arrive to Shock Trauma in an aircraft, and just for laughs
> > and giggles assume that they were to arrive by ground, how would outcomes
> > compare to other institutions that weren't "guided" by some sort of ACS
> > COT/governmental/system arrangement that specified standards and
> > scrutinized outcomes, ISS for ISS, TRISS for TRISS.
> >
> > OK, gotta go now - need to light my incense and open the door for my
> > masseuse!
> >
> > Ron
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org
> > [mailto:trauma-list-bounces at trauma.org] On Behalf Of htaed_rd at 123mail.org
> > Sent: Friday, June 12, 2009 5:11 PM
> > To: Trauma-List [TRAUMA.ORG]
> > Subject: RE: Alternative therapies (OT)
> >
> > How does good treatment inside the hospital justify flying patients with
> > minor injuries, or without any injuries?
> >
> > The comparison of outcomes between, before the HEMS crash and after the
> > crash, have not been published yet. However, nobody seems to be noticing
> > any difference after cutting flights by almost 70%. It will be
> > interesting to see how they deal with the results of an actual study of
> > EMS.
> >
> > Am I supposed to encourage the use of helicopters to fly patients with
> > body damage to their vehicles, because they usually limit themselves to
> > evidence based medicine inside the hospital? Maybe just a bit of Reiki
> > because somebody forgot their risperdal the week they set the Reiki
> > program up?
> >
> > Flying everyone is not evidence based, regardless of their record with
> > patients with serious injuries. This is also a way of preventing the
> > prehospital providers from developing an ability to assess and treat
> > trauma patients. MIEMSS acts as if the medic's only job is to prepare
> > the patient for transfer to the helicopter crew. Start an IV, run it
> > wide open, give high flow oxygen, hook up the monitor, and fully
> > imobilze the patient. The helicopter program, with just one
> > cross-trained provider in the back, is seen as a substitute for
> > insisting on good paramedics. That isn't my description. Dr. Bass (CEO
> > of MIEMSS) has repeatedly stated that having helicopters is the state
> > plan for rural EMS. that does not mean that their medics are not good,
> > but that they accomplish this in spite of MIEMSS.
> >
> > The quality of the hospital does not justify endangering HEMS crews and
> > patients on whimsical flights.
> >
> > Delaying arrival at the trauma center, just to put the patient in a
> > helicopter is one of the practices that Dr. Bass and Dr. Scalea have
> > tried to defend. It certainly isn't based on science. Maybe it is
> > something one of their Reiki Masters came up with.
> >
> > I do not know how good they are at trauma, but they have an approach to
> > EMS that is even less scientific than Reiki.
> >
> > Their treatment inside the hospital has nothing to do with their magical
> > helicopter rides.
> >
> > Tim Noonan.
> >
> >
> > On Fri, 12 Jun 2009 15:30 -0400, "Gross, Ronald"
> > <Ronald.Gross at baystatehealth.org> wrote:
> > > Tim,
> > > Have you taken any time to compare Shock Trauma's outcomes, ISS for ISS,
> > > TRISS for TRISS?  I suggest you do before making allegations about magic
> > > helicopters and the like.
> > > Ron
> > >
> > > -----Original Message-----
> > > From: htaed_rd at 123mail.org <htaed_rd at 123mail.org>
> > > Sent: Friday, June 12, 2009 12:42 PM
> > > To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
> > > Subject: RE: Alternative therapies (OT)
> > >
> > >
> > > Shock Trauma continues to encourage the belief that putting a patient in
> > > a helicopter creates a magical healing aura around the patient. If
> > > pressure were not put on them after the recent fatal crash, they would
> > > still be singing the praises of delaying transport, just to put the
> > > patient in the magic helicopter.
> > >
> > > They get away with it because they tell the voters that it is Free. As
> > > if there is any such thing. Now they are promoting Reiki as Free. The
> > > question is, are they as good at medicine as they are at selling snake
> > > oil? Do you trust real medicine from a snake oil salesman?
> > >
> > > Acupuncture has been repeatedly studied. Acupuncture does not do any
> > > better than placebo. Even fake acupuncture has done better than "real
> > > acupuncture" in studies. This is not medicine. This is snake oil.
> > >
> > > In discussing medicine that is evidence based vs everything not evidence
> > > based that is presented as medicine, why do you bring religion into the
> > > conversation?
> > >
> > > This has nothing to do with religion, unless you worship at the altar of
> > > R Adams Cowley's "Golden Hour."
> > >
> > > Maybe you believe that Dr. Scalea is divinely inspired in his direction
> > > of Shock Trauma.
> > >
> > > Bringing religion into this is nothing but misdirection. This has
> > > nothing to do with religion, although in Maryland things do take on more
> > > than a religious tone, when you suggest that an ambulance could actually
> > > drive to a trauma center. Oh, the horror!
> > >
> > > Research seems to be the one thing absent from EMS in Maryland.
> > >
> > > Not that I have an opinion on the matter.
> > >
> > > Tim Noonan.
> > >
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