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Medivac

Stephen Richey stephen.richey at gmail.com
Wed Dec 31 23:35:40 GMT 2014


Honestly, and I have said this before during conferences both for clinical
providers and aviation safety that the the Maine model is the one that
should be emulated if we want a functional and safe HEMS system. You can
tell them I said this but in many ways, they give even the most elite
military rotorcraft aviation units a serious run for their money.

As you pointed out, part of what makes them so stellar is a solid ground
ambulance system to utilize when the helicopter cannot or should not fly or
when the needs of a patient means you can't get everything into the back of
a helo. That's what is missing in most areas due to the "dash for cash"
attitude of many operators- basically concern for what is best and most
practical for the patient is third or fourth down the list of concerns.
Really, the concept of HEMS, fixed wing aeromedical transport and ground
CCT should not be thought of as separate competing entities but as parts of
the same system preferably in a formal sense.  That's why Maine does it so
well.  It's the Kranz dictum: tough and competent.
On Dec 31, 2014 11:51 AM, "Bjorn, Pret" <pbjorn at emhs.org> wrote:

> LifeFlight of Maine.  Based here in Bangor, in equal partnership with a
> separate hospital system in Lewiston.  They'll tell you there's plenty of
> credit to go around, but most of its enduring genius and passion comes from
> two guys I'm VERY proud to hang out with: Tom Judge (Executive Director)
> and Norm Dinerman (Medical Director).
>
> You can and should Google either of them.  Rock stars.  But beware: I read
> their bios and it's like, "Wow.  I SUCK."
>
> I'll be briefish; but this is important:
>
> So I lost a colleague in the 80's, as I've mentioned.  Then about a decade
> later, a private, owner/pilot-operated "medical helicopter" (search "Sean
> Rafter Airmed Skycare") accepted a burn transfer that took it directly into
> an active, blistering nor'easter (AKA "inadvertent IFR"), in the middle of
> the night, with insufficient fuel.  The tanks ran dry over Casco Bay, and
> they ditched in heavy seas.  The pilot managed to survive on the avulsed
> pontoons while his aircraft, patient, a medic and a nurse sank into the icy
> depths.  Thus the first line-of-duty deaths in Maine EMS history were
> utterly and outrageously avoidable.
>
> It's unsurprising then, that by the mid-1990's you could fairly count me
> among the most obstreperous critics of HEMS in Maine.  When I discovered
> that Norm was making helicopter plans for greater Bangor, I was neither
> hesitant nor reticent in confronting him.
>
> "Well, then, you're a perfect fit for a vacancy on our concept team,"
> Norm said.  "You'll ask all the questions I would never think of.  If this
> is a bad idea, you'll help me understand why."
>
> [Or something like that.  This was nearly twenty years ago.  And Norm has
> a truly majestic vocabulary, even in casual conversation.]
>
> So I started going to meetings and traveling to service sites and learning
> tons.  Struggle as I did, I could not preserve my negative instincts.
>
> Maine is a PERFECT place for HEMS from every perspective, and Tom and Norm
> established an immediate and unconditional focus safety and quality before
> all else, including the flying itself (all flight personnel are
> systematically blinded to the clinical details until AFTER flights are
> accepted, and any of the crew can veto the mission without penalty for any
> reasonable concern; for backup, the air operation is seamlessly integrated
> with a robust GROUND CCT system, and defers to it easily and regularly).
> LifeFlight's training programs and PI infrastructure dwarf that of any
> others I can think of, anywhere in healthcare.  And their operating budget
> is practically independent of direct charges (make no mistake, flying is
> expensive and patients are billed; but long-term sustainability derives
> mostly from grants and other world-class fundraising).
>
> I was at the table when LifeFlight's earliest rules and methods
> materialized, and within a few months -- well before the first patient was
> transported -- I was their biggest fan.  And so I remain.
>
> My friends and their distinguished program have won every award in the
> industry, raised the bar for all aspects of emergency and critical care
> across the state, and saved many, many lives.  LifeFlight has been
> consulted around the world for its reputation in safety, clinical
> effectiveness, and organizational innovation.  When I think of HEMS, I
> think of LifeFlight.  And frankly, if they were everybody's model, we
> wouldn't be having these uncomfortable conversations.
>
> www.lifeflightofmaine.org
>
> Cheers, and a very happy new year!
>
> Pret Bjorn, RN
> Bangor, ME USA
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org] On Behalf Of Stephen Richey
> Sent: Tuesday, December 30, 2014 6:09 PM
> To: Trauma &amp, Critical Care mailing list
> Subject: RE: Medivac
>
> One of those models being those of one of the programs in Maine.  I forget
> which hospital (thanks to the headache I have at the moment) but they were
> one of the first to publicly stand up for safety and not view crashes as
> the price of doing business.
> On Dec 30, 2014 8:05 AM, "Bjorn, Pret" <pbjorn at emhs.org> wrote:
>
> > 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
> >
> > Ron:
> >
> > 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...
> >
> > ck
> >
> > 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
> >  o
> > >   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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