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ambo out of service

Charles Krin cskrin2 at hughes.net
Fri Jan 2 16:40:11 GMT 2015


Dr. McSwain:

your statement is true and only true *IF* 1) there are enough responders
available on the scene to be able to detach units for immediate
transport; and 2) if an appropriate facility is within a reasonable time
by ground.

Even accepting that an EMT Basic can often transport a critical trauma
patient as the primary attendant, if you have six or more seriously
injured (triage codes red (emergent) and yellow (urgent) patients plus
an assortment of 'walking wounded,' and only two trucks, each with one
paramedic and one basic, even if you coopt a EVOC trained firefighter as
a driver, you are *still* removing critical assets needed on scene.

(I have worked in areas of Louisiana where neither of those were always
true....with the exception of Alexandria, *how* many Level III or better
trauma centers are there between I-20 and I-10?)

ck
 
On 1/2/2015 09:47, McSwain, Norman E wrote:
> That depends on your philosophy: If you believe that the most severe are treated first in the MCI, then the most severe patients should be managed in the closest facility. The others will have time to go in a slower method of transportation (motor vehicle) or wait until the rush is over in the closest facility for their management. Helo transport will  most likely delay the management of the most severely injured patients
>
> Norman
> Professor, Tulane University of Louisiana, Surgery
> Clinical Professor, Louisiana State University,  Surgery
> Trauma Director, Spirit of Charity Trauma Center, ILH,
> Police Surgeon, New Orleans Police Department
> Medical Director, PreHospital Trauma Life Support (PHTLS)
> New Orleans, 504-988-5111 
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Stephen Richey
> Sent: Friday, January 02, 2015 12:07 AM
> To: Trauma &amp, Critical Care mailing list
> Subject: Re: ambo out of service
>
> In true full blown MCIs which are mercifully rare, yeah.  It's a valid option.
> On Jan 1, 2015 12:40 PM, "Brandon Oto" <brandon at degreesofclarity.com> wrote:
>
>> A similar version of this: In briefs from local air ambulance services 
>> I have been told a number of times that a perfectly legitimate use of 
>> the helicopter is to transport patients from an MCI (or any large 
>> incident) to more distant centers in order to avoid overwhelming the 
>> closest facilities in relatively remote areas. If anybody objects to 
>> the below indication, do you object to this too? If not both, why?
>>
>> (No real opinion here, I have little experience with flight medicine.)
>>
>> Brandon
>>
>> ***
>> http://degreesofclarity.com/ <http://degreesofclarity.com/> 
>> http://emsbasics.com/ <http://emsbasics.com/>
>>
>>
>>
>>
>>
>>
>>> On Dec 30, 2014, at 10:43 PM, William Bromberg <
>> brombwi1 at memorialhealth.com <mailto:brombwi1 at memorialhealth.com>> wrote:
>>> 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 <mailto:
>> daniel.gerard at comcast.net>> <daniel.gerard at comcast.net <mailto:
>> 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 
>>>> <mailto:cskrin2 at hughes.net>>
>>>> To: "Trauma-List [TRAUMA.ORG <http://trauma.org/>]" <
>> trauma-list at trauma.org <mailto: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 
>>>>> <mailto: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 
>> <mailto: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 co  sts 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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