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ambo out of service

Stephen Richey stephen.richey at gmail.com
Sat Jan 3 02:37:39 GMT 2015


In the case where you have truly no option except between say a Level I/II
trauma center in a city some considerable distance away and the local
bandaid station hospital that is about as capable of handling a serious
complex trauma as your average veterinary clinic (no disrespect intended to
the veterinary profession), is it really ethical to not send the patient to
the trauma center?  Even if it is by the less desirable means of a
helicopter.

Mercifully, most areas with a trauma center have lots of other competent
facilities able to accept overflow in the event of anything short of a
several hundred casualties.  Thus, the proposed setting where you have
every close by facility worthy of being called a hospital overwhelmed by an
influx of critical or serious patients is exceptionally rare.
On Jan 2, 2015 7:13 PM, "Kenneth Mattox" <kmattox at aol.com> wrote:

> I do not concur w this logic.
>
> k
>
> Sent from my iPhone
>
> > On Jan 2, 2015, at 12:07 AM, Stephen Richey <stephen.richey at gmail.com>
> wrote:
> >
> > 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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