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ambo out of servie

William Bromberg brombwi1 at memorialhealth.com
Wed Dec 31 03:43:33 GMT 2014


If you have insurance "they" pay for it. If you have assets you pay for it. If you have neither  insurance or assets "we" pay for it, just like the rest of our kludge system. 

William J. Bromberg, MD, FACS
Sent from my iPhone

> On Dec 30, 2014, at 19:30, <daniel.gerard at comcast.net> <daniel.gerard at comcast.net> wrote:
> 
> So just to be clear, if I am following this correctly: 
> 
> the justification for HEMS, when there is no medical justification, and transport time by ground is one to two hours, is because they only have one ambulance in town? 
> 
> So who pays for poor system design? Is this something everyone shoulders, or is it just the poor guy who happened to end up in a hospital with a poorly designed out of hospital care and transport system? 
> 
> Dan 
> 
> ----- Original Message -----
> 
> From: "Charles Krin" <cskrin2 at hughes.net> 
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org> 
> Sent: Tuesday, December 30, 2014 4:00:25 PM 
> Subject: =?utf-8?B?UmU6IGFtYm8gb3V0IG9mIHNlcnZpZQ====?= 
> 
> yes, because as (relatively rarely used) regional assets, it's normally 
> *much* easier to get 'mutual aid' coverage for helos... 
> 
> where the real sticking point is, is when the weather is marginal for a 
> ground trip, but well below minimums for even IFR flight...sorting out 
> how to maintain coverage while providing expeditious transport for a 
> truly critical patient can be....interesting. 
> 
> Chuck 
> 
>> On 12/30/2014 16:43, jrhmdtraum at aol.com wrote: 
>> But is that any different than the helicopter being out of service due to the ride.? 
>> 
>> On Dec 29, 2014, at 14:38, William Bromberg &lt;brombwi1 at memorialhealth.com&gt; wrote:&gt;&gt;&gt;&gt; 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.&gt;&gt;&gt;&gt; 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?&gt;&gt;&gt;&gt; The rest of the changes can all be lumped into costs v. benefits and I cannot pretend t
> o 
>> 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 o&gt; a&gt;&gt; ccount rather than the simpler analysis of "HEMS is less safe than com
> me 
>> rcial 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.&gt;&gt;&gt;&gt; Bill Bromberg&gt;&gt;&gt;&gt;&gt;&gt; William J. Bromberg, MD, FACS&gt;&gt; Savannah Surgical Group&gt;&gt; 912-350-7412 
>> 
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