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Occupy Air Medical Transport*

19 comments

Now there's a movement I could get behind!

 

 

 

 

 

* Not an actual movement. Photo posed for humorous purposes only. Don't get excited, Dr. Bledsoe. ;)

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Posted by on October 23, 2011 • Filed under: Helicopter EMS, Humor, Raging case of rotoriasis
  • http://www.medicmadness.com Sean Eddy

    I have never understood that. The whole “better safe than sorry” mentality when it comes to air transport decisions just shows lack of confidence and / or assessment capabilities. 

  • schmoo1964

    interesting:

    THis is what I saw this morning, literally 3/8 of a mile from my home:

    http://middleoftheright.blogspot.com/2011/10/question-for-emts.html

  • http://liberalartistintheambulance.com Katie B.

    As I’m still in EMT school (and thus recognize that I don’t really know what I’m talking about) I choose not to argue with my instructors when they teach us to make transport decisions solely on mechanism of injury. However, I do agree with you that we should be treating the /patient/ and not the MOI and hopefully once I’m out there I’ll have the sense to make good decisions. You know, actually think about what’s going on with my patient and decide what’s best instead of simply, “Significant MOI = Airlift to hospital.” 

    My patients are going to owe you so much someday…

  • Anonymous

    Lawsuit paranoia… And people trying to justify their existences… AGAIN…

  • Fern the Fire-Rescue newbie

    When my instructor told my class that we automatically transport to a trauma center if there’s intrusion into the cabin, I emailed him a  link to the EMS research podcast that covered a study done on it.

    He still asserted he was right and that mechanism matters. (I on the other hand say f*** the mechanism. I let my patient’s condition denote that. But I digress. I’m not a medic who’s been working in the field for 20 years, so what do I know?)

  • Anonymous

    Some medics have 20 years of experience. Other medics have 1 year of experience, repeated 20 times.
    Mechanism of injury is a piece of the puzzle, but it’s not THE puzzle.

    Ambulance Driver

    ________________________________

  • CombatDoc

    After spending over a year in working trauma in Iraq I learned a few things about it.  It is good to expect the worse case in blunt, head, and penetrating trauma.  If the patient needs the surgeon than no one else matters after the airway is controlled.  And sometimes you have to step back and see the big picture as one of my paramedic preceptors told me, “Don’t look at the tree and miss the forest.”  Number one was I normally had around a 45 min time from take off to delivery a trauma team and I lost very few massive truama patients in flight.

    Mechanism is not alone an indication to fly and the new PHTLS criteria have made an attempt to place the emphasis back on assessment.  People need to sit down and do some serious looking at times with following up on the time to surgical intervention on their flights and unless you live in bumfuck egypt your going to be surprised that it is not that much faster or in fact not at all.

    I have seen people flown to a trauma center 25 miles away when one was down the road 12 miles.  There is no way you can justify that one at all.  I have seen patients make it by ground faster than the more critical one sitting on scene waiting for the bird.  I hate to say this but, maybe it is time to start consulting with medical control for permission to fly a patient, I despise the mother may I attitude but, in EMS tends we to bring that on ourselves.  If I could deliver that patient alive from trauma that most people would say oh shit to on a daily basis why the hell would I wait for an aircraft with even a 30 min ground transport?  People need to start doing the job they were trained for and are certified to do…

  • Anonymous

    *sigh*

    Combat Doc, will you marry me?

    I mean, I’m not gay, and it might look a little weird to others, but I’m willing to overlook all that, since you’re already inside my head and all… ;)

  • http://liberalartistintheambulance.com Katie B.

    Yes MOI matters, it’s just not the ONLY thing that matters. But my instructor pretty much has the class trained to say “high priority patient” when he says “significant MOI” which I find a little disturbing because I think there should be more to it than that. But it’s the same with a lot of other things too. We’re not trained to THINK in EMT school–just to do as we’re taught. So I let it be. I know that he will teach what he wants to teach no matter what I say anyway so I’d rather not portray myself as an arrogant know-it-all and make him hate me when neither of us will gain anything from it.

    For now, I’ll just be a good little EMT student and do what I’m told but I want to make the right decisions when it’s my turn to be out there. I got into EMS because I wanted to use my brain. And I will. 

  • Anonymous

    A lot of that is the rote memorization and parrot routine required to pass the NREMT skills stations. As long as you look at it the way you are – do it this way to pass the test, then use common sense in the field – you’ll do fine.
    And in fairness to your instructor, when you have 25 or so people in a class, and the school only allows you so many hours to conduct it, some things are reduced to lowest common denominator. Sometimes as an instructor, your hands are tied by the school and the curriculum length, and the only thing you can do is get them ready to pass the test.

    Ambulance Driver

    ________________________________

  • CombatDoc

    Sorry, my wife says she is not done with me yet

  • http://cursesfoiledagain2.wordpress.com/ Jake

    Agreed that MOI by itself should not be a criteria for flight. But you also need to know the capabilities of your local hospital. For instance, we fly (significant) head injuries frequently, because even though we’re on average less than 10 minutes from a Level 3 trauma center, they have little to no neurology support. The Level 1 center, which is about 45 minutes away by ground or 15 minutes by air, has a full Neuro ICU. That’s where the local hospital would ship the patient anyway. Burn patients get an even longer flight, because UVA has a true burn center, and even the local Level 1 center would probably ship them there.

    You also have to know your helicopters. Our local service usually lands at about the same time we get the patient to the LZ, or within 5 minutes on either side, making any delay minimal – especially when the dispatch information prompts us to put them on standby early. They don’t care about getting cancelled if they’re not needed.

    OTOH, if you regularly have to wait, it might be better to get them to even a non-trauma center hospital for stabilization, and the helicopter can pick the patient up there, instead.

  • Anonymous

    “Burn patients get an even longer flight, because UVA has a true burn center, and even the local Level 1 center would probably ship them there.”

    I don’t disagree with anything you said, but here’s my question: Presumably we fly people because they are a) in need of specialized care, and b) their condition is time-critical.

    So what’s so time-critical about a burn patient, provided their airway is secured and their fluid needs are met?

    Short answer: There’s nothing time critical about specialized burn care, once the patient’s fluid needs are met and their airway is secure. So why do we fly them? Knee-jerk reaction because the damage can be so horrific looking?

    Ambulance Driver

    ________________________________

  • CombatDoc

    Let’s look at some times.  You are dispatched on a Motorcycle vs. something immovable.  You put your aircraft up on standby on dispatch.  Now you’re on scene and make pt contact.  You have a “critical” pt and immediately start the process of getting them on the LSB and ask for the bird.  Now you have a 90-120 second delay prior to dispatch of the bird and a 2-4 min launch time if they are not sitting there running depending on the aircraft.  If you are worth your salt you have them on a board and loaded at the same time the aircraft launches or before, my record was 2 min from pt contact to pt loaded by radio times.  The bird has a 14-18 min flight time based on wind and variables.
     
    Instead of flying you start to the trauma center as soon as they are loaded and start your 45 min clock.  So it takes them the 14-18 min to get there and then a couple of min to land.  Even a hot load takes 5-10 min after they assess the pt and load them then a min or two to take off then 14-18 min to the trauma center.  Again a couple of min to land and then depending on the facility 5 min or so to get into the ER.  Added up it is around added up it is around 50 min to fly and 45 by ground, best times are 40 min and top end would upwards of an hour.  So best case scenario is they save 5 min and pay 10,000 more for what?  The air crew can do what for your pt you cannot?  I personally think the air transport is needed available and it is a benefit at times, just not all the times it is asked for.
     
    Your other statement is that a non-trauma facility is OK for stabilization and let them come there to pick them up.  If they can be stabilized at a non-trauma facility the sure as hell do not need a bird.  The sole purpose of that aircraft, besides as a billboard, is to get the FUBAR’d pt to the guy or gal who holds the knife to save his/her life.  If it can be there prior to extrication then by all means do it.  But then again even in those situations a proper assessment is needed as a lot of trapped and pinned pts do not need immediate surgical intervention with the safety features of today’s automobiles.
     
    I am a month away from being done with my Paramedic class and I am glad I get to start making these calls all the time.  Then again as an Advanced EMT I have taken plenty of pts by ground that had great outcomes that others said I should have flown.  I could go on and on and I am sorry Kelly if I hijacked this but, it is something I am very passionate about as I has seen this trend getting worse over the 16 years I have been involved in EMS.  To the newbi who said you are not supposed to think:  If you are being taught that I am sorry, Critical thinking is what separates the cookbook from the clinician and you should be doing that from day one.

  • http://cursesfoiledagain2.wordpress.com/ Jake

    Short answer: There’s nothing time critical about specialized burn care,
    once the patient’s fluid needs are met and their airway is secure. So
    why do we fly them?

    Short answer? Because our medical director tells us to.

    Longer answer: Generally, the ones we fly also have suspected airway
    involvement, whether that suspicion is due to mechanism, the location of
    the burns, or the BSA involved (I’m sure you can have serious burns over 30% or more with no airway involvement, but it’s more likely that there is). Airway burns are time-critical even if the airway is currently controlled, and our local hospital (Level 3) isn’t equipped to deal with that effectively, so they fly. Once in the helicopter, the flight crew decides where they go, which is usually UVA.

    Beyond burns: I see two issues for my squad.

    1) We get very little feedback and review on patients that are flown. Unless someone on the ambulance knows somebody on the helicopter, or the actual patient contacts us later, we don’t usually find out what happened after the helicopter leaves the ground. This makes it effectively impossible for us to examine and improve our fly/no-fly decision making. It’s also an issue we’ve been trying to fix (or at least improve) for years, with no success.

    2) Our operational policies are effectively that we don’t do ground transport to the Level 1 trauma center except in extremely rare cases, due to the distance. If the helicopter isn’t available we go to the local Level 3, and they do what they can to keep the patient alive until they can arrange a transfer by other means if necessary (or until the helicopter is available). This is an partly an operational decision due to available resources and the amount of time it takes the transporting unit and members out of service, and partly the idea that the Level 3 can at least perform some interventions we can’t that can extend the patient’s life so they can make it to the Level 1 (chest tube, RSI, etc.). I don’t necessarily agree with this – especially the resource argument – but I’m in the minority, and the people in charge don’t agree with me.

    I see #1 as our biggest problem on this topic – we have no idea how often we’re calling the helicopter when it’s not needed, or why it’s not needed in those cases, and no way to find out. Without that information, it’s difficult to assess #2 because any arguments for or against are unsubstantiated supposition.

  • http://cursesfoiledagain2.wordpress.com/ Jake

    If they can be stabilized at a non-trauma facility the sure as hell do not need a bird.

    Just to clarify, by “stabilize” I mean “patch them up enough that they’ll survive another 30-45 minutes so they can make it to the guy or gal who holds the knife to save his/her life.” Things like RSI, chest tubes, etc., that can be done at even a non-trauma facility can buy the patient extra time so they can make it to the trauma center alive. We can’t do those things, and the patient certainly isn’t going to get them sitting in a field somewhere waiting for the helicopter, or on the road to the Level 1 trauma center.

    If we can get to the Level 3 facility more than about 5 minutes before the helicopter can get to us, that’s normally what we’ll do. After that, they usually end up flying to the Level 1 anyway, but it’s the ER doc’s decision at that point.

  • 9-ECHO-1

    In the place I used to work we would call the helicopter (per protocol) from a distant trauma center, and during both legs of the flight they had to fly over a trauma center. We were supposed to leave the scene if the ‘copter was “five minutes or less away”, so whenever we called them for their ETA, it was always “four minutes. Seems they knew our protocols too. Fortunately, due to a pretty good training officer, they have gotten away from that and now make the 30 minute ground trip to the nearer trauma center (although they now have a pair of helicopters…{sigh}. Fortunately, the folks I work for now realize the folly of calling for a helicopter when you are 30 minutes by ground from one of three Level I trauma centers. See, AD, some people DO understand.

  • BH

    Talk to the folks who run the Trauma Registry at your Level 1.  Keeping that Level1 designation requires a huge amount of paperwork, data processing, number-crunching, etc, and as a result there will be a full-time staff dedicated to it, so there’s always someone to talk to.  As the saying goes, I told you that so I can tell you this- one of the other requirements is is outreach to the EMS community.  Our trauma center came to (and sponsored) our local EMS expo, and were passing out cards that said “Trauma Patient Feedback” along with an email address and what information they would need to get it.  Might be worth making contact with someone at your trauma center and find out if they’d be willing to do something similar for you. 

  • BH

    The unfortunate part is that you actually paid money to be treated like a moron.  Drives me crazy.  As an instructor I feel like I should apologize. 

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