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Mon Mar 2 03:08:58 GMT 2009

One of our squads has a definite traffic problem.  Compounded by the fact
that the traffic in the other direction is usually not heavy which leads to
higher speeds and nasty MVA's.  The chief there regularly flies trauma
patients during the 5-6PM time slot.   Other times they can make it
themselves in pretty good time.

We teach EMT's that trama patients require a trauma center.  That if you
take the severe trauma patient to a non trauma hospital that they may not
get the care they need and will likely be transferred to the trauma center.
If that isn't correct we need to change what we are teaching.

V/R

Forrest Robleto
R House Health & Safety
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 9:54 PM, Stephen Richey <stephen.richey at gmail.com>wrote:

> 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 <http://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/> <http://trauma.org/>
> > > To change your settings or unsubscribe visit:
> > > http://www.trauma.org/index.php?/community/
> > >
> > --
> > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
>
>
>
> --
>  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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