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ambo out of service

Charles Krin cskrin2 at hughes.net
Sat Jan 3 02:27:29 GMT 2015


Stephen:

what is the *critical* difference between your scenario and mine?

(and yes, I've done the 'ok, load up a bunch of walking wounded and
skedaddle' routine before, at least in drills when I've been the
responsible medical control. I'm also aware of at least one airline
incident in NYC where someone commandeered a city bus, loaded it with
walking wounded, and sent it not to the nearest trauma center, but one
that was in the secondary response zone, by arrangement.)

(oh, and I *was* one of the medical control officers at a distant but
still involved hospital for KATRINA and up close and personal with RITA...)

ck

On 1/2/2015 17:54, Stephen Richey wrote:
> Theoretically, by the time the helicopters arrive twenty to thirty minutes
> into the response, the critical traumas who aren't entrapped should have
> been transported especially in an urban or suburban setting where you have
> sufficient resources to handle anything short of a flat out disaster.  In
> rural areas, you may completely drain three counties of their EMS assets
> for a multi-vehicle pileup especially if the providers aren't smart enough
> to put several walking wounded in the same ambulance (I've personally seen
> six or in one truck for minor burns and smoke inhalation following a
> fire).  Also they have to be intelligent enough and given sufficient
> freedom of action to realize that just because it has a trauma mechanism,
> if it's to be not serious, it can go to any hospital so as to unburden the
> system.  I know several systems where such leeway doesn't exist because if
> poor medical direction and poorly educated providers.
>
> If you really are straining the resources of the trauma center with
> critical patients as was supposed in Brandon's scenario, chances are you
> are probably dealing with an event most will only see once or twice in a
> long career.  Pretty much, Hurricane Katrina is the best example I can
> think of in the past couple of decades in the US.  If you simply have a
> bunch of walking wounded, buses or multiple pickup trucks will function
> quicker and cheaper to get those patients to care.  I saw it done firsthand
> with pickup trucks when I was visiting friends in Oklahoma and helped with
> the wounded from the tornado super outbreak in 1999.
>  On Jan 2, 2015 11:40 AM, "Charles Krin" <cskrin2 at hughes.net> wrote:
>
>> 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
>>>>>>



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