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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.

  • Fire Fox

    AD, can you give your readers your opinion on what are the appropriate circumstances for using medflight? Lot’s of folks just assume that it’s used in place of an ambulance, to get the patient to the hospital faster. In our area, it is used to transport to a city hospital better equipped to handle traumas, burns, etc. The local hospitals are good, but don’t have the staffing or equipment to handle the big n bad stuff.

  • Fire Fox

    AD, can you give your readers your opinion on what are the appropriate circumstances for using medflight? Lot’s of folks just assume that it’s used in place of an ambulance, to get the patient to the hospital faster. In our area, it is used to transport to a city hospital better equipped to handle traumas, burns, etc. The local hospitals are good, but don’t have the staffing or equipment to handle the big n bad stuff.

  • Fire Fox

    AD, can you give your readers your opinion on what are the appropriate circumstances for using medflight? Lot’s of folks just assume that it’s used in place of an ambulance, to get the patient to the hospital faster. In our area, it is used to transport to a city hospital better equipped to handle traumas, burns, etc. The local hospitals are good, but don’t have the staffing or equipment to handle the big n bad stuff.

  • Fire Fox

    AD, can you give your readers your opinion on what are the appropriate circumstances for using medflight? Lot’s of folks just assume that it’s used in place of an ambulance, to get the patient to the hospital faster. In our area, it is used to transport to a city hospital better equipped to handle traumas, burns, etc. The local hospitals are good, but don’t have the staffing or equipment to handle the big n bad stuff.

  • Rogue Medic

    “a more measured take on the subject?”I think they need to do a UDS for you at Borg Central. :-) Thanks for the pimpin’. :-) Fire Fox,In which conditions will a few minutes make a big difference? If there will be a significantly shorter transport by helicopter – more than half an hour difference in transport time, not the drive is 30 minutes and the helicopter will get them there in 25 minutes – and the patient is truly unstable, then it may be appropriate to fly the patient.

  • Rogue Medic

    “a more measured take on the subject?”I think they need to do a UDS for you at Borg Central. :-) Thanks for the pimpin’. :-) Fire Fox,In which conditions will a few minutes make a big difference? If there will be a significantly shorter transport by helicopter – more than half an hour difference in transport time, not the drive is 30 minutes and the helicopter will get them there in 25 minutes – and the patient is truly unstable, then it may be appropriate to fly the patient.

  • Rogue Medic

    “a more measured take on the subject?”I think they need to do a UDS for you at Borg Central. :-) Thanks for the pimpin’. :-) Fire Fox,In which conditions will a few minutes make a big difference? If there will be a significantly shorter transport by helicopter – more than half an hour difference in transport time, not the drive is 30 minutes and the helicopter will get them there in 25 minutes – and the patient is truly unstable, then it may be appropriate to fly the patient.

  • Rogue Medic

    “a more measured take on the subject?”I think they need to do a UDS for you at Borg Central. :-) Thanks for the pimpin’. :-) Fire Fox,In which conditions will a few minutes make a big difference? If there will be a significantly shorter transport by helicopter – more than half an hour difference in transport time, not the drive is 30 minutes and the helicopter will get them there in 25 minutes – and the patient is truly unstable, then it may be appropriate to fly the patient.

  • Beaker

    Our Medical Director has always been against helicopters unless there is going to be a large difference in time. Most of the medics I know used to complain that he was putting patients lives at risk. They’ve stopped complaining… I just wish people didn’t have to die to get his point across.

  • Beaker

    Our Medical Director has always been against helicopters unless there is going to be a large difference in time. Most of the medics I know used to complain that he was putting patients lives at risk. They’ve stopped complaining… I just wish people didn’t have to die to get his point across.

  • Beaker

    Our Medical Director has always been against helicopters unless there is going to be a large difference in time. Most of the medics I know used to complain that he was putting patients lives at risk. They’ve stopped complaining… I just wish people didn’t have to die to get his point across.

  • Beaker

    Our Medical Director has always been against helicopters unless there is going to be a large difference in time. Most of the medics I know used to complain that he was putting patients lives at risk. They’ve stopped complaining… I just wish people didn’t have to die to get his point across.

  • Billy Sparks

    ECU (I think) did a study and like 80%+ of the heloed in “traumas” were discharged from the ED. That is right they were not sick enough to get room for overnight stay. I think it is a two fold problem. Around here when aero-medical started the aero-medical folks really pushed the concept of using there service to the point that several local counties have the helo launched for certain types of calls (shootings, stabbings, pin-ins etc). Suddenly it became easier to let the chopper come on and keep your trucks in county. Slippery slope strikes again.

  • Billy Sparks

    ECU (I think) did a study and like 80%+ of the heloed in “traumas” were discharged from the ED. That is right they were not sick enough to get room for overnight stay. I think it is a two fold problem. Around here when aero-medical started the aero-medical folks really pushed the concept of using there service to the point that several local counties have the helo launched for certain types of calls (shootings, stabbings, pin-ins etc). Suddenly it became easier to let the chopper come on and keep your trucks in county. Slippery slope strikes again.

  • Billy Sparks

    ECU (I think) did a study and like 80%+ of the heloed in “traumas” were discharged from the ED. That is right they were not sick enough to get room for overnight stay. I think it is a two fold problem. Around here when aero-medical started the aero-medical folks really pushed the concept of using there service to the point that several local counties have the helo launched for certain types of calls (shootings, stabbings, pin-ins etc). Suddenly it became easier to let the chopper come on and keep your trucks in county. Slippery slope strikes again.

  • Billy Sparks

    ECU (I think) did a study and like 80%+ of the heloed in “traumas” were discharged from the ED. That is right they were not sick enough to get room for overnight stay. I think it is a two fold problem. Around here when aero-medical started the aero-medical folks really pushed the concept of using there service to the point that several local counties have the helo launched for certain types of calls (shootings, stabbings, pin-ins etc). Suddenly it became easier to let the chopper come on and keep your trucks in county. Slippery slope strikes again.

  • Jeff

    Does money have anything to do with this? I’m sure a ride in the chopper costs someone more than a ride in the bus.My cousin was in a motorcycle accident not to long ago. Left turner going into the sun couldn’t see – SO SHE WENT ANYWAY!When he found out he was going by helicopter, he told them he didn’t want to because they were too dangerous. Kinda funny considering how he was injured, but looks like he may have been right.

  • Jeff

    Does money have anything to do with this? I’m sure a ride in the chopper costs someone more than a ride in the bus.My cousin was in a motorcycle accident not to long ago. Left turner going into the sun couldn’t see – SO SHE WENT ANYWAY!When he found out he was going by helicopter, he told them he didn’t want to because they were too dangerous. Kinda funny considering how he was injured, but looks like he may have been right.

  • Jeff

    Does money have anything to do with this? I’m sure a ride in the chopper costs someone more than a ride in the bus.My cousin was in a motorcycle accident not to long ago. Left turner going into the sun couldn’t see – SO SHE WENT ANYWAY!When he found out he was going by helicopter, he told them he didn’t want to because they were too dangerous. Kinda funny considering how he was injured, but looks like he may have been right.

  • Jeff

    Does money have anything to do with this? I’m sure a ride in the chopper costs someone more than a ride in the bus.My cousin was in a motorcycle accident not to long ago. Left turner going into the sun couldn’t see – SO SHE WENT ANYWAY!When he found out he was going by helicopter, he told them he didn’t want to because they were too dangerous. Kinda funny considering how he was injured, but looks like he may have been right.

  • Anonymous

    whitecap nurse says:AD – I totally agree with you. When I worked in an urban area as a medic, people were always calling the helicopter for trauma. It probably saved 10 minutes air time vs. drive time. HOWEVER, when you factor in the report, assessment by flight team (which they do BEFORE takeoff) and transferring in and out of the helicopter, I think those 10 minutes got lost pretty quickly. I think helicopter response is most appropriate when it will take an ambulance longer to REACH the scene to assess the pt. in the first place. Now, I do know of one spectacular helicopter response in which the patient was in full arrest (with good CPR) on the edge of a lake, pretty far away from any EMS. The helo had to land on an island, they rowed the pt. out to it and flew him out. He survived, neurologically intact.

  • Anonymous

    whitecap nurse says:AD – I totally agree with you. When I worked in an urban area as a medic, people were always calling the helicopter for trauma. It probably saved 10 minutes air time vs. drive time. HOWEVER, when you factor in the report, assessment by flight team (which they do BEFORE takeoff) and transferring in and out of the helicopter, I think those 10 minutes got lost pretty quickly. I think helicopter response is most appropriate when it will take an ambulance longer to REACH the scene to assess the pt. in the first place. Now, I do know of one spectacular helicopter response in which the patient was in full arrest (with good CPR) on the edge of a lake, pretty far away from any EMS. The helo had to land on an island, they rowed the pt. out to it and flew him out. He survived, neurologically intact.

  • Anonymous

    whitecap nurse says:AD – I totally agree with you. When I worked in an urban area as a medic, people were always calling the helicopter for trauma. It probably saved 10 minutes air time vs. drive time. HOWEVER, when you factor in the report, assessment by flight team (which they do BEFORE takeoff) and transferring in and out of the helicopter, I think those 10 minutes got lost pretty quickly. I think helicopter response is most appropriate when it will take an ambulance longer to REACH the scene to assess the pt. in the first place. Now, I do know of one spectacular helicopter response in which the patient was in full arrest (with good CPR) on the edge of a lake, pretty far away from any EMS. The helo had to land on an island, they rowed the pt. out to it and flew him out. He survived, neurologically intact.

  • Anonymous

    whitecap nurse says:AD – I totally agree with you. When I worked in an urban area as a medic, people were always calling the helicopter for trauma. It probably saved 10 minutes air time vs. drive time. HOWEVER, when you factor in the report, assessment by flight team (which they do BEFORE takeoff) and transferring in and out of the helicopter, I think those 10 minutes got lost pretty quickly. I think helicopter response is most appropriate when it will take an ambulance longer to REACH the scene to assess the pt. in the first place. Now, I do know of one spectacular helicopter response in which the patient was in full arrest (with good CPR) on the edge of a lake, pretty far away from any EMS. The helo had to land on an island, they rowed the pt. out to it and flew him out. He survived, neurologically intact.

  • Dedicated_Dad

    I have some experience here from the other end.I wrecked a motorcycle and shattered my tibial plateau. Obviously at the time the report was “closed fracture of lower extremity. No loss of consciousness, no other significant injury except some road-rash. BP, Pulse, respiration, etc. all normal for circumstances.”I got a helicopter ride to the nearest major trauma center, about a 2.5-hour drive from the scene. There were several alternative hospitals much closer, one within a 15-minute drive, another about 35 minutes, several others much closer.I argued with the (volunteer) EMTs on scene. I broke my leg. I’ve done this before, in fact THE SAME LEG. I can’t see why a helicopter ride is necessary for a broken leg.Apparently the rule, as explained to me, is “motorcycle+injury=helicopter.” Period. I still objected, but gave in because (1) they harped on the possibility that my knee-pain could be a distracting injury such that I was bleeding out internally while arguing. This was ridiculous and I told them so. There was no impact. I broke my leg. All exams unremarkable, vitals stable and normal — I didn’t need a helicopter. Still, they pushed.Their other argument was that the copter was already there and that the nurse onboard would take care of my pain while they (volunteer EMTs) would instead board me up and haul me to the local “trauma center” with no pain meds.I agreed to the HC ride, got a touch of morphine (1mg!!??) and they proceeded to board me.HUH?? Again — no reason for this. Not a scratch on my helmet, but… They insisted. At this point I had no choice — since I’d taken the MS the EMTs and their ‘bolance were no longer an option and I was going to be boarded if I was getting in the HC. Period. I cooperated, by this time I just wanted to get to someone who would do something about my pain.I’m still bothered by this. I didn’t need the HC, didn’t need to be boarded, nothing about me said any of this was necessary except the fact that I was on a MC when it happened. Like the boys told me — MC+AC=HC. Period.This is NUTS.DD

  • Dedicated_Dad

    I have some experience here from the other end.I wrecked a motorcycle and shattered my tibial plateau. Obviously at the time the report was “closed fracture of lower extremity. No loss of consciousness, no other significant injury except some road-rash. BP, Pulse, respiration, etc. all normal for circumstances.”I got a helicopter ride to the nearest major trauma center, about a 2.5-hour drive from the scene. There were several alternative hospitals much closer, one within a 15-minute drive, another about 35 minutes, several others much closer.I argued with the (volunteer) EMTs on scene. I broke my leg. I’ve done this before, in fact THE SAME LEG. I can’t see why a helicopter ride is necessary for a broken leg.Apparently the rule, as explained to me, is “motorcycle+injury=helicopter.” Period. I still objected, but gave in because (1) they harped on the possibility that my knee-pain could be a distracting injury such that I was bleeding out internally while arguing. This was ridiculous and I told them so. There was no impact. I broke my leg. All exams unremarkable, vitals stable and normal — I didn’t need a helicopter. Still, they pushed.Their other argument was that the copter was already there and that the nurse onboard would take care of my pain while they (volunteer EMTs) would instead board me up and haul me to the local “trauma center” with no pain meds.I agreed to the HC ride, got a touch of morphine (1mg!!??) and they proceeded to board me.HUH?? Again — no reason for this. Not a scratch on my helmet, but… They insisted. At this point I had no choice — since I’d taken the MS the EMTs and their ‘bolance were no longer an option and I was going to be boarded if I was getting in the HC. Period. I cooperated, by this time I just wanted to get to someone who would do something about my pain.I’m still bothered by this. I didn’t need the HC, didn’t need to be boarded, nothing about me said any of this was necessary except the fact that I was on a MC when it happened. Like the boys told me — MC+AC=HC. Period.This is NUTS.DD

  • Dedicated_Dad

    I have some experience here from the other end.I wrecked a motorcycle and shattered my tibial plateau. Obviously at the time the report was “closed fracture of lower extremity. No loss of consciousness, no other significant injury except some road-rash. BP, Pulse, respiration, etc. all normal for circumstances.”I got a helicopter ride to the nearest major trauma center, about a 2.5-hour drive from the scene. There were several alternative hospitals much closer, one within a 15-minute drive, another about 35 minutes, several others much closer.I argued with the (volunteer) EMTs on scene. I broke my leg. I’ve done this before, in fact THE SAME LEG. I can’t see why a helicopter ride is necessary for a broken leg.Apparently the rule, as explained to me, is “motorcycle+injury=helicopter.” Period. I still objected, but gave in because (1) they harped on the possibility that my knee-pain could be a distracting injury such that I was bleeding out internally while arguing. This was ridiculous and I told them so. There was no impact. I broke my leg. All exams unremarkable, vitals stable and normal — I didn’t need a helicopter. Still, they pushed.Their other argument was that the copter was already there and that the nurse onboard would take care of my pain while they (volunteer EMTs) would instead board me up and haul me to the local “trauma center” with no pain meds.I agreed to the HC ride, got a touch of morphine (1mg!!??) and they proceeded to board me.HUH?? Again — no reason for this. Not a scratch on my helmet, but… They insisted. At this point I had no choice — since I’d taken the MS the EMTs and their ‘bolance were no longer an option and I was going to be boarded if I was getting in the HC. Period. I cooperated, by this time I just wanted to get to someone who would do something about my pain.I’m still bothered by this. I didn’t need the HC, didn’t need to be boarded, nothing about me said any of this was necessary except the fact that I was on a MC when it happened. Like the boys told me — MC+AC=HC. Period.This is NUTS.DD

  • Dedicated_Dad

    I have some experience here from the other end.I wrecked a motorcycle and shattered my tibial plateau. Obviously at the time the report was “closed fracture of lower extremity. No loss of consciousness, no other significant injury except some road-rash. BP, Pulse, respiration, etc. all normal for circumstances.”I got a helicopter ride to the nearest major trauma center, about a 2.5-hour drive from the scene. There were several alternative hospitals much closer, one within a 15-minute drive, another about 35 minutes, several others much closer.I argued with the (volunteer) EMTs on scene. I broke my leg. I’ve done this before, in fact THE SAME LEG. I can’t see why a helicopter ride is necessary for a broken leg.Apparently the rule, as explained to me, is “motorcycle+injury=helicopter.” Period. I still objected, but gave in because (1) they harped on the possibility that my knee-pain could be a distracting injury such that I was bleeding out internally while arguing. This was ridiculous and I told them so. There was no impact. I broke my leg. All exams unremarkable, vitals stable and normal — I didn’t need a helicopter. Still, they pushed.Their other argument was that the copter was already there and that the nurse onboard would take care of my pain while they (volunteer EMTs) would instead board me up and haul me to the local “trauma center” with no pain meds.I agreed to the HC ride, got a touch of morphine (1mg!!??) and they proceeded to board me.HUH?? Again — no reason for this. Not a scratch on my helmet, but… They insisted. At this point I had no choice — since I’d taken the MS the EMTs and their ‘bolance were no longer an option and I was going to be boarded if I was getting in the HC. Period. I cooperated, by this time I just wanted to get to someone who would do something about my pain.I’m still bothered by this. I didn’t need the HC, didn’t need to be boarded, nothing about me said any of this was necessary except the fact that I was on a MC when it happened. Like the boys told me — MC+AC=HC. Period.This is NUTS.DD

  • Rogue Medic

    DD,Yes, it is nuts.And it is all supervised by doctors.

  • Rogue Medic

    DD,Yes, it is nuts.And it is all supervised by doctors.

  • Rogue Medic

    DD,Yes, it is nuts.And it is all supervised by doctors.

  • Rogue Medic

    DD,Yes, it is nuts.And it is all supervised by doctors.

  • Dedicated_Dad

    I called 911 myself. Told them I’d dumped the bike and broke my leg. Told them no LOC, etc. Told her to make it clear to the crew that I was OK but needed a ride, didn’t want anyone getting hurt, especially local volunteers.I was sitting, smoking a cigarette and cursing my broken leg when they got there. Like I said, no impact. My passenger walked away, essentially uninjured. No impact, not a scratch on my helmet. No LOC, oriented 5×5, etc. DX:closed tibial fx and minor road rash.Later I developed compartment syndrome and needed a quad-compartment fasciotomy, plus several hours to put the little pieces of my knee back together with internal and external fixation.None of this could have been done at the local crawfish-hut, my local OS told me if he’d seen my x-ray he’d have sent me where I ended up.Still, in that case I’d have been off the board pretty quick, knocked out and wrapped up for a leisurely ride. The HC was totally unnecessary.DD

  • Dedicated_Dad

    I called 911 myself. Told them I’d dumped the bike and broke my leg. Told them no LOC, etc. Told her to make it clear to the crew that I was OK but needed a ride, didn’t want anyone getting hurt, especially local volunteers.I was sitting, smoking a cigarette and cursing my broken leg when they got there. Like I said, no impact. My passenger walked away, essentially uninjured. No impact, not a scratch on my helmet. No LOC, oriented 5×5, etc. DX:closed tibial fx and minor road rash.Later I developed compartment syndrome and needed a quad-compartment fasciotomy, plus several hours to put the little pieces of my knee back together with internal and external fixation.None of this could have been done at the local crawfish-hut, my local OS told me if he’d seen my x-ray he’d have sent me where I ended up.Still, in that case I’d have been off the board pretty quick, knocked out and wrapped up for a leisurely ride. The HC was totally unnecessary.DD

  • Dedicated_Dad

    I called 911 myself. Told them I’d dumped the bike and broke my leg. Told them no LOC, etc. Told her to make it clear to the crew that I was OK but needed a ride, didn’t want anyone getting hurt, especially local volunteers.I was sitting, smoking a cigarette and cursing my broken leg when they got there. Like I said, no impact. My passenger walked away, essentially uninjured. No impact, not a scratch on my helmet. No LOC, oriented 5×5, etc. DX:closed tibial fx and minor road rash.Later I developed compartment syndrome and needed a quad-compartment fasciotomy, plus several hours to put the little pieces of my knee back together with internal and external fixation.None of this could have been done at the local crawfish-hut, my local OS told me if he’d seen my x-ray he’d have sent me where I ended up.Still, in that case I’d have been off the board pretty quick, knocked out and wrapped up for a leisurely ride. The HC was totally unnecessary.DD

  • Dedicated_Dad

    I called 911 myself. Told them I’d dumped the bike and broke my leg. Told them no LOC, etc. Told her to make it clear to the crew that I was OK but needed a ride, didn’t want anyone getting hurt, especially local volunteers.I was sitting, smoking a cigarette and cursing my broken leg when they got there. Like I said, no impact. My passenger walked away, essentially uninjured. No impact, not a scratch on my helmet. No LOC, oriented 5×5, etc. DX:closed tibial fx and minor road rash.Later I developed compartment syndrome and needed a quad-compartment fasciotomy, plus several hours to put the little pieces of my knee back together with internal and external fixation.None of this could have been done at the local crawfish-hut, my local OS told me if he’d seen my x-ray he’d have sent me where I ended up.Still, in that case I’d have been off the board pretty quick, knocked out and wrapped up for a leisurely ride. The HC was totally unnecessary.DD

  • TOTWTYTR

    DD, This is “Medicine by Mechanism” where in discretion and thought by the EMTs and medics is replaced by blind adherence to protocol. It’s not good medicine and it’s not good for patients. It IS good for risk managers, and if you’ll excuse the purjorative term, Pussy Medical Directors who are afraid of being sued. As I note in my “more measured” post I think HEMS risks having standards imposed on them by judicial decision. Part of that process is going to be suits against EMS systems, Medical Directors, and hospitals for inappropriately using helicopters when ground transport would have been as good or better. It’s entirely likely that some of the suits won’t involve crashes, but will involve HEMS transport where the insurance carrier refused to pay and the patient was left on the hook for a very expensive ride to the hospital. Others will indeed involve crashes and not all of the litigants will be patients or their estates. This is going to become a very hot controversy in EMS as the media and .gov become interested in it. The only thing that will stop that is the disappearance of a pretty, young, blond coed! ;)

  • TOTWTYTR

    DD, This is “Medicine by Mechanism” where in discretion and thought by the EMTs and medics is replaced by blind adherence to protocol. It’s not good medicine and it’s not good for patients. It IS good for risk managers, and if you’ll excuse the purjorative term, Pussy Medical Directors who are afraid of being sued. As I note in my “more measured” post I think HEMS risks having standards imposed on them by judicial decision. Part of that process is going to be suits against EMS systems, Medical Directors, and hospitals for inappropriately using helicopters when ground transport would have been as good or better. It’s entirely likely that some of the suits won’t involve crashes, but will involve HEMS transport where the insurance carrier refused to pay and the patient was left on the hook for a very expensive ride to the hospital. Others will indeed involve crashes and not all of the litigants will be patients or their estates. This is going to become a very hot controversy in EMS as the media and .gov become interested in it. The only thing that will stop that is the disappearance of a pretty, young, blond coed! ;)

  • TOTWTYTR

    DD, This is “Medicine by Mechanism” where in discretion and thought by the EMTs and medics is replaced by blind adherence to protocol. It’s not good medicine and it’s not good for patients. It IS good for risk managers, and if you’ll excuse the purjorative term, Pussy Medical Directors who are afraid of being sued. As I note in my “more measured” post I think HEMS risks having standards imposed on them by judicial decision. Part of that process is going to be suits against EMS systems, Medical Directors, and hospitals for inappropriately using helicopters when ground transport would have been as good or better. It’s entirely likely that some of the suits won’t involve crashes, but will involve HEMS transport where the insurance carrier refused to pay and the patient was left on the hook for a very expensive ride to the hospital. Others will indeed involve crashes and not all of the litigants will be patients or their estates. This is going to become a very hot controversy in EMS as the media and .gov become interested in it. The only thing that will stop that is the disappearance of a pretty, young, blond coed! ;)

  • TOTWTYTR

    DD, This is “Medicine by Mechanism” where in discretion and thought by the EMTs and medics is replaced by blind adherence to protocol. It’s not good medicine and it’s not good for patients. It IS good for risk managers, and if you’ll excuse the purjorative term, Pussy Medical Directors who are afraid of being sued. As I note in my “more measured” post I think HEMS risks having standards imposed on them by judicial decision. Part of that process is going to be suits against EMS systems, Medical Directors, and hospitals for inappropriately using helicopters when ground transport would have been as good or better. It’s entirely likely that some of the suits won’t involve crashes, but will involve HEMS transport where the insurance carrier refused to pay and the patient was left on the hook for a very expensive ride to the hospital. Others will indeed involve crashes and not all of the litigants will be patients or their estates. This is going to become a very hot controversy in EMS as the media and .gov become interested in it. The only thing that will stop that is the disappearance of a pretty, young, blond coed! ;)

  • Rogue Medic

    DD,TOTWTYTR is absolutely right about this. If medical directors don’t start acting as if they have some medical training, the lawyers will start making the medical decisions for them. We have become a country of idiots afraid to think for ourselves, wanting only someone to take responsibility away from us. 1 mg morphine? As you know that is a completely ineffective dose for the injury you had. Even the nurse/medic on the helicopter was only interested in appearances, not actual patient care. 1 mg morphine for an adult male with a fractured ankle! Horrible incompetence. Of course, all of this is approved by the medical director – it’s not about patient care, it’s about not being sued. So, when things change they will be blowing 180 degrees in the other direction with the wind. No thinking, just imitate everyone else and ignore the incompetence.

  • Rogue Medic

    DD,TOTWTYTR is absolutely right about this. If medical directors don’t start acting as if they have some medical training, the lawyers will start making the medical decisions for them. We have become a country of idiots afraid to think for ourselves, wanting only someone to take responsibility away from us. 1 mg morphine? As you know that is a completely ineffective dose for the injury you had. Even the nurse/medic on the helicopter was only interested in appearances, not actual patient care. 1 mg morphine for an adult male with a fractured ankle! Horrible incompetence. Of course, all of this is approved by the medical director – it’s not about patient care, it’s about not being sued. So, when things change they will be blowing 180 degrees in the other direction with the wind. No thinking, just imitate everyone else and ignore the incompetence.

  • Rogue Medic

    DD,TOTWTYTR is absolutely right about this. If medical directors don’t start acting as if they have some medical training, the lawyers will start making the medical decisions for them. We have become a country of idiots afraid to think for ourselves, wanting only someone to take responsibility away from us. 1 mg morphine? As you know that is a completely ineffective dose for the injury you had. Even the nurse/medic on the helicopter was only interested in appearances, not actual patient care. 1 mg morphine for an adult male with a fractured ankle! Horrible incompetence. Of course, all of this is approved by the medical director – it’s not about patient care, it’s about not being sued. So, when things change they will be blowing 180 degrees in the other direction with the wind. No thinking, just imitate everyone else and ignore the incompetence.

  • Rogue Medic

    DD,TOTWTYTR is absolutely right about this. If medical directors don’t start acting as if they have some medical training, the lawyers will start making the medical decisions for them. We have become a country of idiots afraid to think for ourselves, wanting only someone to take responsibility away from us. 1 mg morphine? As you know that is a completely ineffective dose for the injury you had. Even the nurse/medic on the helicopter was only interested in appearances, not actual patient care. 1 mg morphine for an adult male with a fractured ankle! Horrible incompetence. Of course, all of this is approved by the medical director – it’s not about patient care, it’s about not being sued. So, when things change they will be blowing 180 degrees in the other direction with the wind. No thinking, just imitate everyone else and ignore the incompetence.

  • Shakespere

    Hi. Wonderful blog.I enjoyed your writing.

  • Shakespere

    Hi. Wonderful blog.I enjoyed your writing.

  • Shakespere

    Hi. Wonderful blog.I enjoyed your writing.

  • Shakespere

    Hi. Wonderful blog.I enjoyed your writing.

  • 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.


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