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Mon Mar 2 01:18:54 GMT 2009

Ian,

You're correct of course.  Given all the variability the EMT on the scene
often has to make a tough decision.  But sometimes it's not all that tough,
if you have a shocky teenager from an MVA and traffic has you two hours from
the trauma center and it's a 12 minute flight, most of the variables go
away.

I know that helo's are inherently dangerous but so are motor vehicles.  The
ambulance is not the safest means of travel.

There are some folks who are predisposed to downplay the usefulness of the
medical helicopter out of hand.  There are times when it's right and times
when it's not but I knew that Stephen would pickup on the family arriving
first statement.

He is to helo's what Lou Dobb's was to aliens.

V/R

Forrest Robleto
R House Health & Safety
www.RHouseTraining.com
FRobleto at RhouseTraining.com
609-792-9047

Jean-Luc Godard  - "To be or not to be. That's not really a question."

On Sun, Mar 1, 2009 at 5:41 PM, Ian Seppelt <seppelt at med.usyd.edu.au> wrote:

> Of course (hence 'in general terms') but it is surprising what delays
> develop in any helicopter flight [time from request to undertake mission to
> actually being off the ground, travel time to scene, time to land, time to
> shut down, time to assess and package the patient, time to load, time to
> start up, flying time, landing and shut down time again].
>
> If I can make a different generalisation (using time rather than distance)
> then if driving time (lights and sirens) is less than 30 - 45 min then a
> helicopter will actually be slower rather than faster. It is always
> embarrassing when relatives (travelling by car) arrive at the hospital
> quicker than the patient (by helicopter).
>
> Cheers, Ian
>
> Forrest Robleto wrote:
>
>>  If all traffic and terrain were the same then you could compare ground
>> to
>> air.  They are not the same.  There are times when a ground ambulance is 2
>> hours from a trauma center at 5pm and 20 minutes from that same trauma
>> center at 5am.  This is near my home in New Jersey.  I'm sure there are
>> similar spots in New york,  Atlanta, and Los Angeles.
>>
>>
>> V/R
>>
>> Forrest Robleto
>> R House Health & Safety
>> www.RHouseTraining.com <http://www.rhousetraining.com/>
>> FRobleto at RhouseTraining.com
>> 609-792-9047
>>
>>
>>
>>
>> W. C. Fields  - "I never drink water because of the disgusting things that
>> fish do in it."
>>
>> On Sun, Mar 1, 2009 at 5:43 AM, Ian Seppelt <seppelt at med.usyd.edu.au>
>> wrote:
>>
>>
>>
>>>  In general terms 200 - 250km is the 'break even' point, where it
>>> becomes
>>> quicker to use a fixed wing despite the added time of secondary ground
>>> transfers. 50 - 200km is where helicopters tend to be quickest, less than
>>> 50km it is probably quicker just to drive by road.
>>>
>>> Ian Seppelt
>>>
>>>
>>> Greg Benton wrote:
>>>
>>>
>>>
>>>>  I am in a regional trauma service in Victoria Australia, 235km from
>>>> Melbourne. Off the top of my head we do 80 - 90% of our tertiary center
>>>> transport by fixed wing, 5 - 10% road, and 5 - 10 % rotary.
>>>>
>>>> It's a very effective means of moving people and costs way less than
>>>> rotary
>>>> wing transfers. Air Ambulance here also use King Airs I believe.
>>>>
>>>> Cheers
>>>>
>>>> Greg
>>>>
>>>> -----Original Message-----
>>>> From: trauma-list-bounces at trauma.org [mailto:
>>>> trauma-list-bounces at trauma.org]
>>>> On Behalf Of Stephen Richey
>>>> Sent: Thursday, February 26, 2009 4:13 AM
>>>> To: Trauma &amp, Critical Care mailing list
>>>> Subject: Re: NTSB to Issue Helicopter EMS Safety Recommendations
>>>>
>>>> I would look at the success (and safety record) of the Royal Flying
>>>> Doctor
>>>> Service in Australia.  They actually  have been known to land their
>>>> fixed-wing aircraft (King Airs if memory suffices) on roads to access
>>>> patients.
>>>>
>>>> My main point with there being a greater utility in the use of fixed
>>>> wing
>>>> aircraft in rural areas (and I mean REALLY rural....Wyoming, New Mexico,
>>>> northern Maine, western Kansas, North Dakota, Alaska, etc....not "Look!
>>>> There's corn!" rural) is that they are faster over exceedingly long
>>>> distances (once you get past a couple hundred miles as is the case when
>>>> your
>>>> closest trauma center may be Albuquerque, Denver, Salt Lake City,
>>>> Portland
>>>> or Anchorage.  In this way, they actually save time.  The secondary
>>>> point
>>>> to
>>>> all of this is the reduction in the number of people unnecessarily flown
>>>> from scenes.  It is this sort of cowboy tactic that gets crews and
>>>> patients
>>>> killed.
>>>>
>>>> Interhospital transfer by fixed wing aircraft- if it is taken seriously
>>>> and
>>>> implemented properly (which is currently is not in many places because
>>>> of
>>>> the reliance on helicopters)- can be an extremely effective means of
>>>> moving
>>>> the minority of patients who really need aeromedical evacuation as quick
>>>> as
>>>> possible.   Also patient care in the back of a helicopter is not easy
>>>> and
>>>> the added "comfort" of a more stable and roomy cabin offered by a fixed
>>>> wing
>>>> aircraft allows for advanced procedures to be carried out quicker and
>>>> easier.
>>>>
>>>> On Wed, Feb 25, 2009 at 12:01 PM, p.bjorn at netzero.net
>>>> <p.bjorn at netzero.net>wrote:
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>> Begs the question: how useful ARE fixed wing services in EMS?  Even in
>>>>> my
>>>>> experience (rural Maine), the circumstances which at once suggest and
>>>>> tolerate airplane transfer during the primary treatment phase are
>>>>> exceedingly rare.  You're adding at least two vehicles and maybe three
>>>>>
>>>>>
>>>>>
>>>>>
>>>> teams
>>>>
>>>>
>>>>
>>>>
>>>>> to the transfer process.  That consumes time and shatters continuity.
>>>>>
>>>>> Pret
>>>>>
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>>>>
>>>>
>>>>
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>>>>>
>>>>>
>>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
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