List Archives

Mon Mar 2 05:27:19 GMT 2009

pleas pleas pleas dont sent any message for me pleas

> Date: Sun, 1 Mar 2009 22:30:43 -0500
> Subject: Re: NTSB to Issue Helicopter EMS Safety Recommendations
> From: stephen.richey at gmail.com
> To: trauma-list at trauma.org
> 
> On Sun, Mar 1, 2009 at 10:08 PM, Forrest Robleto <farcpr at gmail.com> wrote:
> 
> > 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.
> 
> 
> The problem with that is (and I'm guessing you're talking suburbs or the
> edge of an urban area) the availability of landing zones. Do you have
> predesignated sites for such activities? If not, I would highly suggest
> that you and your superiors think about taking such a step. It is the least
> you owe to your patients and to our colleagues on the aeromedical side of
> things. Your primary concern seems to be the care delivered to the
> patients, while my primary concerns are that as well as the safety of
> everyone involved and whether the slight chance of improving the former is
> worth serious and obvious increases in risk with regards to the latter.
> 
> >
> >
> > 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.
> 
> 
> The problem is that such as an approach- while cautious in terms of triage-
> leads to exactly the sort of mess we had (and probably still have) in
> Maryland that led to the Trooper 2 fiasco. EMS personnel are notoriously
> bad at deciding which patients need to go to a trauma center versus which
> can be treated at a "non-trauma center" and it only seems to get worse when
> you add helicopters (and the companies promoting their use to the mix). A
> lot of people get flown for expediency's sake rather than medical necessity
> (such as the two girls on board Trooper 2). Look at the numbers of people
> flown into trauma centers and released directly from the ED or within 24
> hours?
> 
> Even in the case of "shock" as diagnosed by EMS personnel how many of those
> patients actually go on to need surgery in the first hour or even first six
> hours after hospital admission? I am guessing that the number is not as
> high as you might suspect , but I don't have any studies to cite on this at
> the moment. That is one of the reasons I stand behind my "take them to the
> closest decent hospital and if they need to be referred out if they need
> more aggressive care". This approach is exactly what is used in many combat
> settings with great results.
> 
> I am not arguing there are not occasional situations where helicopter
> transport is the obvious best course of action, but I am simply trying to
> figure out how the "He's been hurt, so he needs a trauma center but the
> traffic is bad" is a completely and incontrovertible dispatch criteria.
> It's just that you (and a lot of other people) are missing a couple of steps
> in the decision making process here.
> 
> >
> >
> >
> > 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/
> > >
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> 
> 
> 
> -- 
> Stephen L. Richey, CRT
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/

_________________________________________________________________
More than messages–check out the rest of the Windows Live™.
http://www.microsoft.com/windows/windowslive/

List Archives

For your convenience, find the Trauma List Archive Below

NTSB to Issue Helicopter EMS Safety Recommendations