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Gut Check…

76 comments


Many of you may have heard of the EMS helicopter midair collision near Flagstaff, AZ that killed six people a couple days ago. A day before that, another EMS helicopter crashed landed hard in Phoenix, severely injuring two crew members and slightly injuring the pilot.

I have a good friend who, until just recently, was a flight medic in Phoenix. If memory serves, one of the three helicopter EMS services that crashed was a former employer.

You cannot imagine the dread that passed over me as I dialed JB’s cell phone, hoping like hell he’d answer. He didn’t, but (thank God) later checked in with his friends via e-mail.

So instead of JB getting killed, six people from the midair collision died, and a flight nurse critically injured. Six people I don’t know and had no connection to, other than by chosen profession. That includes two patients, including one who had no damned business being flown in the first place.

The wildland firefighter who was being transported in one helicopter had been treated for an anaphylactic reaction to insect bite antivenin.

There is ZERO reason to transport an anaphylactic reaction by helicopter, people.

It’s like crushing a roach with a steamroller. There’s nothing that the flight crew does that a ground crew can’t, and once that treatment is started – on scene – the transport isn’t that time sensitive. Moreover, my sources have it that the insect for which he was given antivenin was a spider.

There is no bite from a North American spider that requires antivenin, and EMS crews certainly don’t carry it. That means this poor man was given the antivenin – possibly inappropriately – in a hospital, and then put in a helicopter and flown to another hospital.

When I was working at Podunk General Hospital, Nail Salon, Tire Repair and Crawfish Hut, we were quite capable of dealing with anaphylactic reactions, and the term definitive care and PGHNSTRACH rarely met in the same sentence. We’d never even think of flying out one of those patients.

It’s just…STOOPID.

*sigh*

I tell you this now…if we in EMS dont find a cure for our Rotoriasis – and that includes ER physicians and trauma surgeons – and start utilizing medical helicopters appropriately, the .gov is going to tell us how to do it, for our own good.

And you know how that usually turns out.

For a more measured take on the subject, go check out Rogue Medic and Too Old To Work, Too Young To Retire.

They do measured responses so much better than I.

  • IceFire

    Um….you DO know what a lot of Coast Guard chopper jocks call their helos, don’t you? (as told to me by a retired said chopper jock) That would be “50 million moving parts flying in close formation”. And this from a former PILOT! If even they don’t have much faith in their bird’s ability to stay aloft, why should the rest of us? Unless the situation is really dire, and there’s no good alternative, skip the chopper ride.

  • IceFire

    Um….you DO know what a lot of Coast Guard chopper jocks call their helos, don’t you? (as told to me by a retired said chopper jock) That would be “50 million moving parts flying in close formation”. And this from a former PILOT! If even they don’t have much faith in their bird’s ability to stay aloft, why should the rest of us? Unless the situation is really dire, and there’s no good alternative, skip the chopper ride.

  • ice_gnome

    I agree. As totwtytr said, this is medicine by mechanism. EMT classes these days are too busy trying to teach people how to pass the test, and not how to be EMT’s (the same goes for lots of medic classes, especially EMT-I classes, but that’s a rant for another day). It’s much easier to teach someone that A+B=helo ride than it is to teach them to use critical thinking skills. Then again, if someone really needs the helo and doesn’t get it, you get sued…it’s a catch 22.When I started in PA 10 years ago, we had 1 helo for the entire northeast region. There were many times we took patients to hospitals an hour away by ambo cause the helo was out or something. Here in MD, the helo’s are supplied by the state police. The entire reason for the existance of the MD State Police air unit is medevac (if they are on a police call, and a medevac gets toned out, they must leave the police scene and do the medevac), so you can see why MSP push push push medevac calls. I’ve seen more helo’s called for patients that didn’t need it at all, and all because it pushes the care to a higher authority (ie, the flight medic). And the flight medic won’t refuse because A) the more calls they get, the more money they get from the state, and B) everyone is afraid of getting sued. And in the state of MD, there are 8 MSP helo’s, and 2 park police helo’s available for medevac, not to mention the private companies that fly out of hospitals in DC. I think there might be 8 medevac helos in ALL of PA.This topic is quite a button pusher for me. Flying out patients just because of mechanism is a crap way to treat.

  • ice_gnome

    I agree. As totwtytr said, this is medicine by mechanism. EMT classes these days are too busy trying to teach people how to pass the test, and not how to be EMT’s (the same goes for lots of medic classes, especially EMT-I classes, but that’s a rant for another day). It’s much easier to teach someone that A+B=helo ride than it is to teach them to use critical thinking skills. Then again, if someone really needs the helo and doesn’t get it, you get sued…it’s a catch 22.When I started in PA 10 years ago, we had 1 helo for the entire northeast region. There were many times we took patients to hospitals an hour away by ambo cause the helo was out or something. Here in MD, the helo’s are supplied by the state police. The entire reason for the existance of the MD State Police air unit is medevac (if they are on a police call, and a medevac gets toned out, they must leave the police scene and do the medevac), so you can see why MSP push push push medevac calls. I’ve seen more helo’s called for patients that didn’t need it at all, and all because it pushes the care to a higher authority (ie, the flight medic). And the flight medic won’t refuse because A) the more calls they get, the more money they get from the state, and B) everyone is afraid of getting sued. And in the state of MD, there are 8 MSP helo’s, and 2 park police helo’s available for medevac, not to mention the private companies that fly out of hospitals in DC. I think there might be 8 medevac helos in ALL of PA.This topic is quite a button pusher for me. Flying out patients just because of mechanism is a crap way to treat.

  • ice_gnome

    I agree. As totwtytr said, this is medicine by mechanism. EMT classes these days are too busy trying to teach people how to pass the test, and not how to be EMT’s (the same goes for lots of medic classes, especially EMT-I classes, but that’s a rant for another day). It’s much easier to teach someone that A+B=helo ride than it is to teach them to use critical thinking skills. Then again, if someone really needs the helo and doesn’t get it, you get sued…it’s a catch 22.When I started in PA 10 years ago, we had 1 helo for the entire northeast region. There were many times we took patients to hospitals an hour away by ambo cause the helo was out or something. Here in MD, the helo’s are supplied by the state police. The entire reason for the existance of the MD State Police air unit is medevac (if they are on a police call, and a medevac gets toned out, they must leave the police scene and do the medevac), so you can see why MSP push push push medevac calls. I’ve seen more helo’s called for patients that didn’t need it at all, and all because it pushes the care to a higher authority (ie, the flight medic). And the flight medic won’t refuse because A) the more calls they get, the more money they get from the state, and B) everyone is afraid of getting sued. And in the state of MD, there are 8 MSP helo’s, and 2 park police helo’s available for medevac, not to mention the private companies that fly out of hospitals in DC. I think there might be 8 medevac helos in ALL of PA.This topic is quite a button pusher for me. Flying out patients just because of mechanism is a crap way to treat.

  • ice_gnome

    I agree. As totwtytr said, this is medicine by mechanism. EMT classes these days are too busy trying to teach people how to pass the test, and not how to be EMT’s (the same goes for lots of medic classes, especially EMT-I classes, but that’s a rant for another day). It’s much easier to teach someone that A+B=helo ride than it is to teach them to use critical thinking skills. Then again, if someone really needs the helo and doesn’t get it, you get sued…it’s a catch 22.When I started in PA 10 years ago, we had 1 helo for the entire northeast region. There were many times we took patients to hospitals an hour away by ambo cause the helo was out or something. Here in MD, the helo’s are supplied by the state police. The entire reason for the existance of the MD State Police air unit is medevac (if they are on a police call, and a medevac gets toned out, they must leave the police scene and do the medevac), so you can see why MSP push push push medevac calls. I’ve seen more helo’s called for patients that didn’t need it at all, and all because it pushes the care to a higher authority (ie, the flight medic). And the flight medic won’t refuse because A) the more calls they get, the more money they get from the state, and B) everyone is afraid of getting sued. And in the state of MD, there are 8 MSP helo’s, and 2 park police helo’s available for medevac, not to mention the private companies that fly out of hospitals in DC. I think there might be 8 medevac helos in ALL of PA.This topic is quite a button pusher for me. Flying out patients just because of mechanism is a crap way to treat.

  • Anne

    Wow. I do have a question though…I’m sure I remember there being antivenin for black widow and brown recluse bites…sometimes the b. recluse antivenin can help prevent the necrotizing reaction around the bite. Just being a smartass.

  • Anne

    Wow. I do have a question though…I’m sure I remember there being antivenin for black widow and brown recluse bites…sometimes the b. recluse antivenin can help prevent the necrotizing reaction around the bite. Just being a smartass.

  • Anne

    Wow. I do have a question though…I’m sure I remember there being antivenin for black widow and brown recluse bites…sometimes the b. recluse antivenin can help prevent the necrotizing reaction around the bite. Just being a smartass.

  • Anne

    Wow. I do have a question though…I’m sure I remember there being antivenin for black widow and brown recluse bites…sometimes the b. recluse antivenin can help prevent the necrotizing reaction around the bite. Just being a smartass.

  • Rogue Medic

    ice_gnome,In the Philadelphia area, just a small part of PA, PENN Star has 6 helicopters (last I heard), MedEvac has a similar number, JeffStat has a few, Sky Flight Care has a few, I’m probably missing some helicopter service(s), and then there are all of the mutual aid helicopters from surrounding areas.MD is slacking compared to the Philly area, of course, some of the territory does overlap. But for the number of helicopters, it’s like the Oshkosh Air Show around here.People using mechanism as criteria to fly are just an example that stupidity does not prevent people from working in EMS and some of the dangerous stupid people are the doctors who write these thoughtless criteria.

  • Rogue Medic

    ice_gnome,In the Philadelphia area, just a small part of PA, PENN Star has 6 helicopters (last I heard), MedEvac has a similar number, JeffStat has a few, Sky Flight Care has a few, I’m probably missing some helicopter service(s), and then there are all of the mutual aid helicopters from surrounding areas.MD is slacking compared to the Philly area, of course, some of the territory does overlap. But for the number of helicopters, it’s like the Oshkosh Air Show around here.People using mechanism as criteria to fly are just an example that stupidity does not prevent people from working in EMS and some of the dangerous stupid people are the doctors who write these thoughtless criteria.

  • Rogue Medic

    ice_gnome,In the Philadelphia area, just a small part of PA, PENN Star has 6 helicopters (last I heard), MedEvac has a similar number, JeffStat has a few, Sky Flight Care has a few, I’m probably missing some helicopter service(s), and then there are all of the mutual aid helicopters from surrounding areas.MD is slacking compared to the Philly area, of course, some of the territory does overlap. But for the number of helicopters, it’s like the Oshkosh Air Show around here.People using mechanism as criteria to fly are just an example that stupidity does not prevent people from working in EMS and some of the dangerous stupid people are the doctors who write these thoughtless criteria.

  • Rogue Medic

    ice_gnome,In the Philadelphia area, just a small part of PA, PENN Star has 6 helicopters (last I heard), MedEvac has a similar number, JeffStat has a few, Sky Flight Care has a few, I’m probably missing some helicopter service(s), and then there are all of the mutual aid helicopters from surrounding areas.MD is slacking compared to the Philly area, of course, some of the territory does overlap. But for the number of helicopters, it’s like the Oshkosh Air Show around here.People using mechanism as criteria to fly are just an example that stupidity does not prevent people from working in EMS and some of the dangerous stupid people are the doctors who write these thoughtless criteria.

  • Matt G

    I watched an organ donor flown out recently. Everyone onscene agreed that the guy was dead, but they flew him out, anyway. Sigh. Waste.

  • Matt G

    I watched an organ donor flown out recently. Everyone onscene agreed that the guy was dead, but they flew him out, anyway. Sigh. Waste.

  • Matt G

    I watched an organ donor flown out recently. Everyone onscene agreed that the guy was dead, but they flew him out, anyway. Sigh. Waste.

  • Matt G

    I watched an organ donor flown out recently. Everyone onscene agreed that the guy was dead, but they flew him out, anyway. Sigh. Waste.

  • Anonymous

    Hey Anne, You may want to read up on current treatment recomendations for BWS bites. Antivenin, while available, is very seldom used. From CA poison control:Various medications are used to treat the muscle cramps, spasms and pain of a bite. Black widow spider antivenin is seldom necessary.

  • Anonymous

    Hey Anne, You may want to read up on current treatment recomendations for BWS bites. Antivenin, while available, is very seldom used. From CA poison control:Various medications are used to treat the muscle cramps, spasms and pain of a bite. Black widow spider antivenin is seldom necessary.

  • Anonymous

    Hey Anne, You may want to read up on current treatment recomendations for BWS bites. Antivenin, while available, is very seldom used. From CA poison control:Various medications are used to treat the muscle cramps, spasms and pain of a bite. Black widow spider antivenin is seldom necessary.

  • Anonymous

    Hey Anne, You may want to read up on current treatment recomendations for BWS bites. Antivenin, while available, is very seldom used. From CA poison control:Various medications are used to treat the muscle cramps, spasms and pain of a bite. Black widow spider antivenin is seldom necessary.

  • Anonymous

    I worked in the ER at two rural hospitals in Northern California and we transferred several patient’s via helicopter when they were in big trouble and needed a higher lever of care than what we could offer in our ER with our tiny ICUs. I am certain that the gentleman you are referring to had to be intubated and needed a higher lever of care. The reason for the helicopter transfer was because the drive through the mountains took several hours by ground whereas it was 45 minutes to one hour by chopper. Also, the small rural areas had one or two ACLS units and couldn’t spare them to be gone from the county for 4 hours. It was rural areas that didn’t have the luxury of having private ambulance companies for tansfers. Perhaps this was the case in Arizona on that day. This was the case at two separate hospitals in Northern California.

  • Anonymous

    I worked in the ER at two rural hospitals in Northern California and we transferred several patient’s via helicopter when they were in big trouble and needed a higher lever of care than what we could offer in our ER with our tiny ICUs. I am certain that the gentleman you are referring to had to be intubated and needed a higher lever of care. The reason for the helicopter transfer was because the drive through the mountains took several hours by ground whereas it was 45 minutes to one hour by chopper. Also, the small rural areas had one or two ACLS units and couldn’t spare them to be gone from the county for 4 hours. It was rural areas that didn’t have the luxury of having private ambulance companies for tansfers. Perhaps this was the case in Arizona on that day. This was the case at two separate hospitals in Northern California.

  • Anonymous

    I worked in the ER at two rural hospitals in Northern California and we transferred several patient’s via helicopter when they were in big trouble and needed a higher lever of care than what we could offer in our ER with our tiny ICUs. I am certain that the gentleman you are referring to had to be intubated and needed a higher lever of care. The reason for the helicopter transfer was because the drive through the mountains took several hours by ground whereas it was 45 minutes to one hour by chopper. Also, the small rural areas had one or two ACLS units and couldn’t spare them to be gone from the county for 4 hours. It was rural areas that didn’t have the luxury of having private ambulance companies for tansfers. Perhaps this was the case in Arizona on that day. This was the case at two separate hospitals in Northern California.

  • Anonymous

    I worked in the ER at two rural hospitals in Northern California and we transferred several patient’s via helicopter when they were in big trouble and needed a higher lever of care than what we could offer in our ER with our tiny ICUs. I am certain that the gentleman you are referring to had to be intubated and needed a higher lever of care. The reason for the helicopter transfer was because the drive through the mountains took several hours by ground whereas it was 45 minutes to one hour by chopper. Also, the small rural areas had one or two ACLS units and couldn’t spare them to be gone from the county for 4 hours. It was rural areas that didn’t have the luxury of having private ambulance companies for tansfers. Perhaps this was the case in Arizona on that day. This was the case at two separate hospitals in Northern California.


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