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Bjorn, Pret pbjorn at emhs.org
Tue Dec 30 13:05:12 GMT 2014

An EM doc I once worked with was killed in a copter crash in the 80's.  The news reported that he was transporting a patient from the Vineyard to the mainland for treatment of Rocky Mountain Spotted Fever.  Don't know why the ferry and some doxycycline wouldn't have sufficed, much less why a doc needed to fly along..

There clearly has always been harmful overutilization of civilian air CCT since its inception; but I think things are slowly improving.  And I know that for all the anecdotes and absolutism, there is truly a need, and there are some exemplary models to draw from.

Pret Bjorn
Bangor, ME

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Charles Krin
Sent: Monday, December 29, 2014 10:01 PM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: Medivac


by definition, Block Island and Martha's Vineyard would require air transport for all but the most routine transfers...just like most of the Islands that Gustavo works with...

Then again, both BI and MV have fixed wing landing facilities, while several of the ones in the Puerto Rico/USVI area require either helos or float planes...


On 12/29/2014 16:05, Gross, Ronald wrote:
> Unless you add Long or Staten or Manhattan or Block to the word Island!  Sorry - I just couldn't resist!!
> Happy New Year to all,
> Ronald I. Gross, MD, FACS
> Chief, Division of Trauma, Acute Care Surgery & Surgical Critical Care
> Baystate Medical Center Associate Professor of Surgery Tufts School of
> Medicine
> 759 Chestnut Street
> Springfield, MA 01199
> 413-794-4022
> ronald.gross at baystatehealth.org
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Gustavo E. Flores
> Sent: Monday, December 29, 2014 4:33 PM
> To: Trauma-List [TRAUMA.ORG]
> Subject: Re: Medivac
> I work for a fixed wing provider in San Juan. We service the Caribbean very frequently. There are many good arguments to be said about the use of ground vs. rotor wing in metro areas but they all become moot when we insert the word "island" into the equation.
> Gustavo E. Flores, MD, EMT-P
> 787.630.6301
> @gflores911
>> On Dec 29, 2014, at 14:38, William Bromberg <brombwi1 at memorialhealth.com> wrote:
>> I used to be very much more hardline in my opinion that HEMS had to make major improvements in the manner that you guys discuss. However the more I get involved with the smaller hospitals the more grey I see.
>> For example, about 20% of our transfer flights have essentially no medical justification and that used to drive me insane until I started to do RTTDC and found out that many of these small towns (1-3 hours away by ground) have only one ambulance so if they send their crew away to Savannah, their town is essentially without EMS for hours. The same is true for scene responses as the crews out there know that if the patient is significantly injured they are coming to us anyway, and coming by air (for the reason above), so why not cut out the middleman?
>> The rest of the changes can all be lumped into costs v. benefits and
>> I cannot pretend to know exactly where the line is (although I bet
>> the line would be clearer if actual individuals had to carry both the
>> costs and get the benefits but I admit that is a quasi-religious
>> belief in this particular instance). To me this debate may be like
>> the booster seats on airplanes issue -- there is no doubt that
>> requiring them with the same rules as cars would save lives in a
>> crash but it turns out that because of the increased costs (both in
>> money and time/trouble) more people would substitute driving instead
>> of flying and overall safety would be reduced (I believe the same is
>> true of the TSA BTW but "security" seems resistant to cost benefit
>> analysis). In this case the potential loss of life due to reduced EMS
>> services, increased incentives to keep inappropriate patients instead
>> of transferring them, increased incentives to NOT call HEMS from the
>> scene and the like need to be taken int
>   a
>> ccount rather than the simpler analysis of "HEMS is less safe than commercial flight" so this must be fixed. I would personally prefer a state by state methodology of regulation for two reasons: 1. this would generate data that we could review to determine best practice and 2. HEMS is going to look a lot different in S. Dakota than in Maryland and maybe the needs/requirements should be different (for example commercial aviation in Alaska has a whole bunch of different rules than anywhere else in CONUS). The FAA makes this very difficult however.
>> Bill Bromberg
>> William J. Bromberg, MD, FACS
>> Savannah Surgical Group
>> 912-350-7412

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