List Archives

Sat Mar 21 16:35:38 GMT 2009

Indeed
The Richardson case is not clear cut
Namely we do not know how long she spent in the local hospital
When, the confirmatory cat-scan was done
Or time form onset of symptomes to herniation

This said
Quebec (largest geographical jurisdiction in North America has access to 0 (zero) Medevac Helicopters

Patient needing emergency PTCA in the regions are condemned (time is muscle)
ALL intracranial bleeds are condemned
Some Internal hemorraghes, at night and on weekend arer condemned 
(These events are not measured or re-assessed)
Some Trauma (non-urban) would benefit for a rapid transport to specialised care
AND AVOID THE ABSOLUTELY WELL MEANING BUT DEADLY SMALL HOSPITALPIT STOPS 

As the life(death) clock is set I believe we have discovered that :
Many deaths are (near) instanteneous
Even more are resistant to time (1/2 day?)
Either of wich do not beneficiate from rapid transport to specialised care

But there still exists avoidable deaths where the opportunity to intervene are calculated in 30min-1hours
For those
Intelligently applied there are ways to save lives 

and

AND

Improve on morbidity, pain and distress

Albeight, these last three depend more on cultural and financial resources
And where the personalizing "VIP" cases have a tendency to punctualy have the society ask itselvf the question

The other point is that "specialised" care is sorely absent in some peripheral hospitals and some of the time (indice of absence of system)
(Nobody answered my "emergency cranial decompression" question!?)
These hospitals could be, but are not better prepared for those emergencies
And know enough, often, to just make things worse
The hability to bring in a Emergency ICU Response Team
Is somewhat valid in large hospital but definitely more so in far away small hospitals

And that is also part of what an intelligent Medevac team provide

IIRC you are against emergency needle chest decompressions
So I am not sure you are going to be an advocate of general surgeons doing emergency cranial decompressions either

Charles
Note: Quebec have recognised Emegency Medicine as a speciality in early 2000 only and a very limited number of emergency physicans are allowed to graduate each year
They are NO advanced care Paramedics whatsoever
They are no Critical Care transfer ambulance (except for 2 neonate transfer teams based in Montreal only)
The Emergency medical speciality is a one year certificate course tagged onto the family medicine module
The roads are the worse in N-A

----- Original Message ----
From: "KMATTOX at aol.com" <KMATTOX at aol.com>
To: trauma-list at trauma.org; EMED-L at LISTSRV.UCSF.EDU; Paramedicine at yahoogroups.com; DailyBrief at yahoogroups.com; FLIGHTMED at FLIGHTWEB.COM
Sent: Saturday, March 21, 2009 11:59:32 AM
Subject: Lack of accepting ground EMS cost Richardson her life ?

THe initial headline cited something about the lack of a CHOPPER cost  
Richardson her life.    

Be Careful to pass judgment or draw conclusions, especially on VIPs until  
you have all of the data.    My information is different from  some that is in 
the press.  It is apparent that there was patient  delay at a time an 
ambulance arrived.  It is the timing of the ambulance  arrival (actually two arrivals) 
that is (are) in  dispute.    Ambulance attendants saw her setting up on one 
of the occassions and she apparently refused to be  transported.      That 
decision node if true is the  crucial one.  If that data is correct, there was 
time to get her to a  place for evaluation and observation.    

Except in military zones, I have found very few if any situations where the  
lack of a helicopter air ambulance cost a patient their  life.      I would be 
happy to debate,  discuss, etc. this subject with anyone at any  time.    

For most situations for EMS transport in the United States, ground  ambulance 
is more effective, rapid, and integrated with the existing trauma  systems 
than air ambulance.  

k

In a message dated 3/21/2009 10:49:45 A.M. Central Daylight Time,  
jimmnn at comcast.net writes:

>From  today's Globe &  Mail:

http://tinyurl.com/c9zrt7

Jim<  

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

**************Feeling the pinch at the grocery store?  Make dinner for $10 or 
less. (http://food.aol.com/frugal-feasts?ncid=emlcntusfood00000001)
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

List Archives

For your convenience, find the Trauma List Archive Below

Lack of accepting ground EMS cost Richardson her life ?