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Mon Mar 2 02:54:37 GMT 2009

Two hours to the trauma center versus how long to a non-trauma center?
Notifying the closest hospital (to give them time to get a surgeon, etc) and
going there was my suggestion, not a two hour trudge to a trauma center.
Granted, if I were the EMS provider and I honestly felt the patient would
not survive the trip to the nearest hospital then I would likely call for a
helicopter.   I've done exactly that on a handful of occasions and had to
disimpact my former medical director (who is as much of an anti-helicopter
person as you paint me to be) from my ass every time because if we did so it
was on us to justify taking such a drastic step as a scene response.  That
would be why I could count the number of people I've flown off scenes as a
civilian EMS provider on both hands (eight to be precise).

And the hour estimate was all inclusive, not just the preflight and
unloading.  I would wager that is a safe estimate for a majority of flights,
especially if you are talking as far out from the hospital as you are
proffering in this situation.  In many cases, just trying to find a landing
zone can be challenging, especially in less than ideal weather.

On Sun, Mar 1, 2009 at 9:36 PM, Forrest Robleto <farcpr at gmail.com> wrote:

> I gave you an example of a two hour drive or a twelve minute flight for a
> teenager in shock and you still opted to forgo the helicopter.  One hour
> preflight and unloading time?  Don't we have to unload the ambulance?  If
> you don't think you are closed minded on this subject you are fooling
> yourself.
>
> My point was there are some folks who are against the flights no matter
> what. And although they may be overused they do have a legitimate use.
>
>
> V/R
>
> Forrest Robleto
> R House Health & Safety
> www.RHouseTraining.com
> FRobleto at RhouseTraining.com
> 609-792-9047
>
>
>
>
> Groucho Marx  - "I have had a perfectly wonderful evening, but this wasn't
> it."
>
> On Sun, Mar 1, 2009 at 9:08 PM, Stephen Richey <stephen.richey at gmail.com
> >wrote:
>
> > On Sun, Mar 1, 2009 at 8:18 PM, Forrest Robleto <farcpr at gmail.com>
> wrote:
> >
> > > 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.
> >
> >
> > Let's not forget that that "12 minute flight" is going to be more like an
> > hour given the dispatch time, the preflight, the response to the scene,
> the
> > on-scene assessment and treatment by the helicopter crew, the return to
> the
> > hospital and then unloading of the victim.   Perhaps the best option is
> to
> > transport them to the closest hospital and have the helicopter meet you
> > there (assuming you really think it is necessary to transfer them out)?
> >
> > >
> > >
> > > I know that helo's are inherently dangerous but so are motor vehicles.
> >  The
> > > ambulance is not the safest means of travel.
> >
> >
> > Actually, compared to the other alternative (helicopters), ground
> > ambulances
> > are a relatively safe mode of transportation.
> >
> > >
> > >
> > > 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.
> > >
> >
> > I don't dismiss their utility out of hand.  Remember, I flew aeromedical
> > transfers while in the Air Force.   They have their place, just like any
> > other tool.  The problem is that I see them being used as a very risky
> and
> > very expensive alternative to proper triage and treatment in many areas.
> > The one thing that (for lack of a better phrase) pisses me off about the
> > 'we
> > need helicopters in our rural area because our EMTs are bad and we can't
> > afford medics" argument is that it is exactly that sort of sentiment that
> > holds EMS back.  If your EMTs are bad- retrain them and fire the ones who
> > can't or won't come up to an acceptable level of competency (even if they
> > are volunteers, you can still fire them).  The utility of medics is still
> > questionable in trauma and even in other settings, so the best thing that
> > can be done in a lot of situations is to push for top notch BLS care and
> > supplement that with a handful of medics (even if it is on an "intercept"
> > basis from a regional ALS service rather than "local" medics) based on
> the
> > call volume.
> >
> >
> > > He is to helo's what Lou Dobb's was to aliens.
> > >
> >
> > Thank you?  I think.....not really sure what you are referring to.  If
> that
> > is referring to the fact that I take the stance that until I have
> credible
> > proof that an otherwise outlandish claim- be it that exposing a lot of
> > people to a greater risk for what appears to be no benefit to most,
> minimal
> > benefit to a handful and great benefit to one in several thousand or to
> the
> > existence of aliens, Sasquatch, etc- is defensible I will be skeptical,
> > then
> > I agree and believe that you paid me a compliment.  If you are trying to
> > peg
> > me as someone who is closeminded and unwilling to see alternative
> > positions,
> > then you have taken my prior posts in completely the wrong manner.
> >
> >
> > --
> > Stephen L. Richey, CRT
> >  --
> > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> --
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>

-- 
Stephen L. Richey, CRT

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