Re: Re: Great Posts on CareFlite!

September 7, 2003

First off I dont think you need to group all EMS in your " WE " .

So what you are saying is that you have a 7/f in resp distress spo2 @ 83% BR

67 Lips cyn. closest hosp. is 25 min. by ground pound just to have the hosp.

fly the f out to children's when you get there. You are saying it is not a good

idea to spend the extra 10 min ( time for bird to get there b/c you got your

report from the first responders and you launched enrout) to start IV drop

some epi onboard bag her and try to stable her b4 you get to the LZ.

What you are saying is that she should have been ground pounded first right.

B/C we abuse the use of the bird right?????

September 7, 2003

How about we look at it from this stand point: What is in the best interest

of the patient? If you can get the patient to the appropriate hospital by

ground faster than by air, then the patient should go by ground. If the bird

can do the round trip faster than a ground unit can get to the appropriate

hospital, then the patient should fly. The key is getting the patient to the

most appropriate hospital in the shortest amount of time. In a urban

setting, there is very little need for air transport. In the rural setting,

there is a large demand. It all depends on what services are available at

the closest hospital vs. what the needs of the patient are.

RE: Great Posts on CareFlite!

> >

> > > Sarcasm doesn't win many debates.

> > >

> > > You folks continuing to ride the air-medical bandwagon need to

> do the same

> > > thing the CISM folks are doing right now - stop and critically

> assess your

> > > beliefs. In situations like this it is always best to be on solid

> > foundation

> > > and not try to insert anecdote in place of evidence.

> > >

> > > I've often posted to these forums of the need for evidence-based

> > protocols,

> > > and air-medical is no different than anything else in medicine.

> There have

> > > been studies with results contrary to the obvious common belief

> regarding

> > > helicopter transport. More research is needed before we attempt

> to draw

> > > lines.

> > >

> > > There is an excellent article on EMS research in the just-

> published

> > > September issue of Prehospital Perspective. The article is

> titled " Islands

> > > of Truth " , written by M. Dudte. It would do each of us well

> to read

> > it

> > > and try to understand the author's perspective. The magazine is

> > > subscription, but for the time being it is a free subscription.

> Please

> > sign

> > > up and read the article.

> > >

> > > The URL for the mag's front page is:

> > > http://www.prehospitalperspective.net/

> > >

> > > The URL for the article is:

> > >

> http://www.prehospitalperspective.net/subscribers/sept03/general.pdf

> > >

> > > Regards,

> > > Donn , LP

> > >

September 7, 2003

K P I can certainly agree that putting a bird on STANDBY as a precautionary

measure ALL O THE TIME is totally wrong and a waste of resources. Your

partner should at least make an assessment of the patient first and only

then request a bird if she can't get the patient to an appropriate hospital

(Level 1 or 2) prior to death or marked decress in LOC or severity of

condition. I know that in Houston the citizens infrequently make way for

any emergency vehicle unless it is a police officer pulling them over. So I

can see that due to traffic on I-10 and I-45 being what it is, sometimes

after patient evaluation and the case warranted it I would order a bird.

otherwise I would opt for ground transport.

Chet

RE: Great Posts on CareFlite!

> >

> > > Sarcasm doesn't win many debates.

> > >

> > > You folks continuing to ride the air-medical bandwagon need to

> do the same

> > > thing the CISM folks are doing right now - stop and critically

> assess your

> > > beliefs. In situations like this it is always best to be on solid

> > foundation

> > > and not try to insert anecdote in place of evidence.

> > >

> > > I've often posted to these forums of the need for evidence-based

> > protocols,

> > > and air-medical is no different than anything else in medicine.

> There have

> > > been studies with results contrary to the obvious common belief

> regarding

> > > helicopter transport. More research is needed before we attempt

> to draw

> > > lines.

> > >

> > > There is an excellent article on EMS research in the just-

> published

> > > September issue of Prehospital Perspective. The article is

> titled " Islands

> > > of Truth " , written by M. Dudte. It would do each of us well

> to read

> > it

> > > and try to understand the author's perspective. The magazine is

> > > subscription, but for the time being it is a free subscription.

> Please

> > sign

> > > up and read the article.

> > >

> > > The URL for the mag's front page is:

> > > http://www.prehospitalperspective.net/

> > >

> > > The URL for the article is:

> > >

> http://www.prehospitalperspective.net/subscribers/sept03/general.pdf

> > >

> > > Regards,

> > > Donn , LP

> > >

September 7, 2003

" The time flying to rural areas cancells all posible benefits " . Our Trauma

center is approxiamtely 65 miles away which means an average of lets say for

round numbers a 60 minute flight time is every light is green, traffic is

light and we are lucky. Flight time to our county is 20 minutes plus lets

say 5 minutes to left off and 5 minutes to load the patient. Savings to the

patient at a minimum is 10 minutes (and within the golden hour). Is saving

at least 10 minutes worth the flight, depends on what is best for the

patient.

RE: Great Posts on CareFlite!

> > > >

> > > > > Sarcasm doesn't win many debates.

> > > > >

> > > > > You folks continuing to ride the air-medical bandwagon need

> to

> > > do the same

> > > > > thing the CISM folks are doing right now - stop and

> critically

> > > assess your

> > > > > beliefs. In situations like this it is always best to be on

> solid

> > > > foundation

> > > > > and not try to insert anecdote in place of evidence.

> > > > >

> > > > > I've often posted to these forums of the need for evidence-

> based

> > > > protocols,

> > > > > and air-medical is no different than anything else in

> medicine.

> > > There have

> > > > > been studies with results contrary to the obvious common

> belief

> > > regarding

> > > > > helicopter transport. More research is needed before we

> attempt

> > > to draw

> > > > > lines.

> > > > >

> > > > > There is an excellent article on EMS research in the just-

> > > published

> > > > > September issue of Prehospital Perspective. The article is

> > > titled " Islands

> > > > > of Truth " , written by M. Dudte. It would do each of us

> well

> > > to read

> > > > it

> > > > > and try to understand the author's perspective. The magazine

> is

> > > > > subscription, but for the time being it is a free

> subscription.

> > > Please

> > > > sign

> > > > > up and read the article.

> > > > >

> > > > > The URL for the mag's front page is:

> > > > > http://www.prehospitalperspective.net/

> > > > >

> > > > > The URL for the article is:

> > > > >

> > >

> http://www.prehospitalperspective.net/subscribers/sept03/general.pdf

> > > > >

> > > > > Regards,

> > > > > Donn , LP

> > > > >

September 7, 2003

K P,

What area are you referring to?

RE: Great Posts on CareFlite!

> > > >

> > > > > Sarcasm doesn't win many debates.

> > > > >

> > > > > You folks continuing to ride the air-medical bandwagon need

> to

> > > do the same

> > > > > thing the CISM folks are doing right now - stop and

> critically

> > > assess your

> > > > > beliefs. In situations like this it is always best to be on

> solid

> > > > foundation

> > > > > and not try to insert anecdote in place of evidence.

> > > > >

> > > > > I've often posted to these forums of the need for evidence-

> based

> > > > protocols,

> > > > > and air-medical is no different than anything else in

> medicine.

> > > There have

> > > > > been studies with results contrary to the obvious common

> belief

> > > regarding

> > > > > helicopter transport. More research is needed before we

> attempt

> > > to draw

> > > > > lines.

> > > > >

> > > > > There is an excellent article on EMS research in the just-

> > > published

> > > > > September issue of Prehospital Perspective. The article is

> > > titled " Islands

> > > > > of Truth " , written by M. Dudte. It would do each of us

> well

> > > to read

> > > > it

> > > > > and try to understand the author's perspective. The magazine

> is

> > > > > subscription, but for the time being it is a free

> subscription.

> > > Please

> > > > sign

> > > > > up and read the article.

> > > > >

> > > > > The URL for the mag's front page is:

> > > > > http://www.prehospitalperspective.net/

> > > > >

> > > > > The URL for the article is:

> > > > >

> > >

> http://www.prehospitalperspective.net/subscribers/sept03/general.pdf

> > > > >

> > > > > Regards,

> > > > > Donn , LP

> > > > >

September 7, 2003

KP,

I find it amazing that someone who has no idea what they are talking about,

would have the initiative to post with such a firm stand and opinion to this

professional group. I respect your stand and you are free to whatever

opinion you might have, however I must correct the issues that you have

commented on that are completely inaccurate.

At the present time, there is only one flight program that services the

Houston area and as you mentioned it is Memorial Hermann Life Flight.

1. Life Flight does not base its 3 aircraft inside the city at the local

hospital as you alleged. Life Flight recognizes the importance of quick

responses and respects the Golden Hour therefore they have 3 remote

satellite bases in the rural area. Base #1 is at Wayne Hooks airport

in Tomball (North), Base #2 is located at the SugarLand airport (West), and

Base #3 is located at Clover Field in Friendswood (South). Time does make a

difference.

As several professionals posted previously, there are specific circumstances

when a helicopter is needed as well as circumstances where it is not.

Traffic in the Houston area is very challenging and it is likely that

critical patients (MI, Hemorrhagic CVA's, or any other surgical candidates,

trauma or medical) outside the loop area can greatly benefit by the use of

air transport. I have been on both sides, both ground and air. I too

agree with the guys from Beaumont that posted and there are very few

circumstances where it is best to fly a patient vs. ground transporting them

to the local Level 3 Trauma Center.

#2 When you place an aircraft on standby in the Houston area, they began

preparing for a flight, locate the exact location, whether it be coordinates

or keymap and they are readily available to be launched. Life Flight DOES

NOT take it upon themselves to launch without a request from an agency.

#3 Money issues, There are only 2 Level 1 Trauma Centers in the Houston

area. It is set through the hospitals as well as the RAC that critical

trauma patients inside the Loop are taken to Ben Taub and patients outside

the Loop go to Memorial Hermann Hospital. I fail to see where money is an

issue, the patients would be going to there facilities anyway. Not to

mention the fact that Memorial Hermann Life Flight is Not For Profit.

As several others have posted, it comes down to being able to do a thorough

job assessing your patient. A good clinician doesn't worry about ego's or

trying to look good. A good assessment can answer the question of which

facility is most appropriate for each patient and ultimately can help you to

make your transport decision. If you can get to that appropriate facility

faster, then that is what is best for the patient and that is what you

should do.

Thanks for the Time,

, LP

---- Original Message -----

To: < >

Sent: Sunday, September 07, 2003 9:09 PM

Subject: Re: Great Posts on CareFlite!

> houston is where i am now, but it was the same in atlanta and i know

> about baltimore too. i don't know about the whole country but i know

> we are too free and easy with helicopters and we are killing our own

> because of it.

>

> why do we do it when the records show it doesn't help? look at the

> hermann hospital study.

>

> --kp-emt--

> --h & k--

>

> > > > > > I have been reading all of the posts on Medical Transport

> by

> > > Air

> > > > > with a lot

> > > > > > of concerns. Having been on both sides of the coin during

> > > combat

> > > > > and in

> > > > > > trhe ED in combat zones as well as civilian hospitals, I

> find

> > > it

> > > > > amusing to

> > > > > > read the various view points.

> > > > > > In VietNam was a flight medic with DUSTOFF, we always felt

> and

> > > > > believed that

> > > > > > we were not the medic on the ground and could not make an

> > > accurate

> > > > > > assessment of the patients condition. Therefore we flew

> the

> > > > > mission,

> > > > > > oftentimes picking up DOA's which we were not supposed to

> do.

> > > The

> > > > > medic on

> > > > > > the ground made the decision to transport by air so as a

> flight

> > > > > medic I

> > > > > > never questioned his abilities or knowledge base.

> Conversely,

> > > in

> > > > > the ED of

> > > > > > civilian hospitals as a RN I never questioned the request

> for

> > > air

> > > > > evacution

> > > > > > of patients.

> > > > > > In a nutshell I cannot be critical of the medic on the

> ground

> > > > > requesting

> > > > > > air evacution Sure you receive the requests for

> unnecessary

> > > air

> > > > > transport

> > > > > > but, are you the one on the ground at the scene?

> > > > > > Last but not least, in VietNam we transported Head Injuries

> > > all of

> > > > > the time,

> > > > > > but we flew at a much lower altitude than the birds fly

> here in

> > > > > the states.

> > > > > >

> > > > > > Peace,

> > > > > > Chet

> > > > > > RE: Great Posts on CareFlite!

> > > > > >

> > > > > > > Sarcasm doesn't win many debates.

> > > > > > >

> > > > > > > You folks continuing to ride the air-medical bandwagon

> need

> > > to

> > > > > do the same

> > > > > > > thing the CISM folks are doing right now - stop and

> > > critically

> > > > > assess your

> > > > > > > beliefs. In situations like this it is always best to be

> on

> > > solid

> > > > > > foundation

> > > > > > > and not try to insert anecdote in place of evidence.

> > > > > > >

> > > > > > > I've often posted to these forums of the need for

> evidence-

> > > based

> > > > > > protocols,

> > > > > > > and air-medical is no different than anything else in

> > > medicine.

> > > > > There have

> > > > > > > been studies with results contrary to the obvious common

> > > belief

> > > > > regarding

> > > > > > > helicopter transport. More research is needed before we

> > > attempt

> > > > > to draw

> > > > > > > lines.

> > > > > > >

> > > > > > > There is an excellent article on EMS research in the

> just-

> > > > > published

> > > > > > > September issue of Prehospital Perspective. The article

> is

> > > > > titled " Islands

> > > > > > > of Truth " , written by M. Dudte. It would do each of

> us

> > > well

> > > > > to read

> > > > > > it

> > > > > > > and try to understand the author's perspective. The

> magazine

> > > is

> > > > > > > subscription, but for the time being it is a free

> > > subscription.

> > > > > Please

> > > > > > sign

> > > > > > > up and read the article.

> > > > > > >

> > > > > > > The URL for the mag's front page is:

> > > > > > > http://www.prehospitalperspective.net/

> > > > > > >

> > > > > > > The URL for the article is:

> > > > > > >

> > > > >

> > >

> http://www.prehospitalperspective.net/subscribers/sept03/general.pdf

> > > > > > >

> > > > > > > Regards,

> > > > > > > Donn , LP

> > > > > > >

September 7, 2003

what's the difference between a professional amd a magpie?

There's no such thing as the golden hour? So you mean getting to

someone to a trauma center in 60 minutes or less is bull? well neat.

no more ambulances or pretty birds for the medics anymore. ride a bike!

On Sunday, 7 Sep, 2003, at 22:07 US/Central, compoundfx wrote:

> very interesting, but you did not aswer my question. what is the

> golden hour? what do helicopters add to the equation? do you read

> the literature, study the research, or ar you just defending turf?

> are you a professional or a magpie?

>

> --kp-emt--

> --h & k--

>

>>>>>>>> I have been reading all of the posts on Medical

> Transport

>>> by

>>>>> Air

>>>>>>> with a lot

>>>>>>>> of concerns. Having been on both sides of the coin

> during

>>>>> combat

>>>>>>> and in

>>>>>>>> trhe ED in combat zones as well as civilian hospitals,

> I

>>> find

>>>>> it

>>>>>>> amusing to

>>>>>>>> read the various view points.

>>>>>>>> In VietNam was a flight medic with DUSTOFF, we always

> felt

>>> and

>>>>>>> believed that

>>>>>>>> we were not the medic on the ground and could not make

> an

>>>>> accurate

>>>>>>>> assessment of the patients condition. Therefore we

> flew

>>> the

>>>>>>> mission,

>>>>>>>> oftentimes picking up DOA's which we were not supposed

> to

>>> do.

>>>>> The

>>>>>>> medic on

>>>>>>>> the ground made the decision to transport by air so as

> a

>>> flight

>>>>>>> medic I

>>>>>>>> never questioned his abilities or knowledge base.

>>> Conversely,

>>>>> in

>>>>>>> the ED of

>>>>>>>> civilian hospitals as a RN I never questioned the

> request

>>> for

>>>>> air

>>>>>>> evacution

>>>>>>>> of patients.

>>>>>>>> In a nutshell I cannot be critical of the medic on the

>>> ground

>>>>>>> requesting

>>>>>>>> air evacution Sure you receive the requests for

>>> unnecessary

>>>>> air

>>>>>>> transport

>>>>>>>> but, are you the one on the ground at the scene?

>>>>>>>> Last but not least, in VietNam we transported Head

> Injuries

>>>>> all of

>>>>>>> the time,

>>>>>>>> but we flew at a much lower altitude than the birds fly

>>> here in

>>>>>>> the states.

>>>>>>>>

>>>>>>>> Peace,

>>>>>>>> Chet

>>>>>>>> RE: Great Posts on CareFlite!

>>>>>>>>

>>>>>>>>> Sarcasm doesn't win many debates.

>>>>>>>>>

>>>>>>>>> You folks continuing to ride the air-medical

> bandwagon

>>> need

>>>>> to

>>>>>>> do the same

>>>>>>>>> thing the CISM folks are doing right now - stop and

>>>>> critically

>>>>>>> assess your

>>>>>>>>> beliefs. In situations like this it is always best

> to be

>>> on

>>>>> solid

>>>>>>>> foundation

>>>>>>>>> and not try to insert anecdote in place of evidence.

>>>>>>>>>

>>>>>>>>> I've often posted to these forums of the need for

>>> evidence-

>>>>> based

>>>>>>>> protocols,

>>>>>>>>> and air-medical is no different than anything else in

>>>>> medicine.

>>>>>>> There have

>>>>>>>>> been studies with results contrary to the obvious

> common

>>>>> belief

>>>>>>> regarding

>>>>>>>>> helicopter transport. More research is needed before

> we

>>>>> attempt

>>>>>>> to draw

>>>>>>>>> lines.

>>>>>>>>>

>>>>>>>>> There is an excellent article on EMS research in the

>>> just-

>>>>>>> published

>>>>>>>>> September issue of Prehospital Perspective. The

> article

>>> is

>>>>>>> titled " Islands

>>>>>>>>> of Truth " , written by M. Dudte. It would do

> each of

>>> us

>>>>> well

>>>>>>> to read

>>>>>>>> it

>>>>>>>>> and try to understand the author's perspective. The

>>> magazine

>>>>> is

>>>>>>>>> subscription, but for the time being it is a free

>>>>> subscription.

>>>>>>> Please

>>>>>>>> sign

>>>>>>>>> up and read the article.

>>>>>>>>>

>>>>>>>>> The URL for the mag's front page is:

>>>>>>>>> http://www.prehospitalperspective.net/

>>>>>>>>>

>>>>>>>>> The URL for the article is:

>>>>>>>>>

>>>>>>>

>>>>>

>>>

> http://www.prehospitalperspective.net/subscribers/sept03/general.pdf

>>>>>>>>>

>>>>>>>>> Regards,

>>>>>>>>> Donn , LP

>>>>>>>>>

September 8, 2003

Yes, to both. Still here, still short, and still crazy after all these

years. You seem to know me, how about telling us who you are.

Ed

September 8, 2003

Please tell us where in the SETTRAC protocols, by-laws, policies, or anything

else this is found. I rarely miss any of the SETTRAC Board meeting or any of

the pre-hospital committee meetings, and this is the first I have heard of this

inside/outside of the loop criteria.

Maxine Pate

hire-Pattison EMS

----- Original Message -----

From:

There are only 2 Level 1 Trauma Centers in the Houston

area. It is set through the hospitals as well as the RAC that critical

trauma patients inside the Loop are taken to Ben Taub and patients outside

the Loop go to Memorial Hermann Hospital.

September 8, 2003

It should be the Golden 10,15 or 20 minutes. I doubt that anyone who has been in

this business any length of time

really believes that you have an hour before your patient starts falling apart.

I don't remember where the Golden Hour

mark came from. I do think that it gave everyone a target time to get to. I made

think about where our scene time fit

into the picture. I feel that it made us hurry up. So whats the big deal about

where the research is on the Golden

Hour. The end result is it made us hurry up on scene. Sometimes you can research

yourself to death when common sense

is all you need. Are helicopters necessary? Yes they are. Are we putting the

crew at risk when we do a standby? No

more than when we send them to a scene call. I don't understand this standby

discussion. When we had a flight service

in our area, we lifted them off if the dispatch information sounded as if they

were needed. Very few times did we have

to cancel the flight. Most of the time the bird was on the ground by the time we

had the patient packaged. They did

very little additional assesment or treatment on the ground. We had a good

relationship with the crews. Many times

members of our department were on the crew. The flight crew and our crew worked

together as a team while the bird was

on the ground. Any protocol that we did not offer, the flight crew did. The

flight crews in our area did not have an

attitude. Speaking of attitude, it sure seems to be a lot of it being posted

lately

again................................

Henry Barber ----- my real name, not my screen name, flight name, animal name,

game boy name, chat room name ect.....

" D.E. (Donn) " wrote:

> Although this person is yet to identify him/her/itself, it seems to me

> that the question regarding the golden hour is a good one. I've

> researched the literature and cannot find a good answer. Can anybody

> define " the golden hour " ? Where did the reference originate? Is there

> any validity to this assumption, or was it just some kind of sales

> pitch?

>

> Donn

>

> Re: Great Posts on CareFlite!

>

> that is your best answer? man, you need to find better work.

>

> you opened your mouth, at least try to answer the question. what is

> the golden hour?

>

> --kp-emt--

> --h & k--

>

> > >>>>>>>>>> I have been reading all of the posts on Medical

> > >>> Transport

> > >>>>> by

> > >>>>>>> Air

> > >>>>>>>>> with a lot

> > >>>>>>>>>> of concerns. Having been on both sides of the coin

> > >>> during

> > >>>>>>> combat

> > >>>>>>>>> and in

> > >>>>>>>>>> trhe ED in combat zones as well as civilian hospitals,

> > >>> I

> > >>>>> find

> > >>>>>>> it

> > >>>>>>>>> amusing to

> > >>>>>>>>>> read the various view points.

> > >>>>>>>>>> In VietNam was a flight medic with DUSTOFF, we always

> > >>> felt

> > >>>>> and

> > >>>>>>>>> believed that

> > >>>>>>>>>> we were not the medic on the ground and could not make

> > >>> an

> > >>>>>>> accurate

> > >>>>>>>>>> assessment of the patients condition. Therefore we

> > >>> flew

> > >>>>> the

> > >>>>>>>>> mission,

> > >>>>>>>>>> oftentimes picking up DOA's which we were not supposed

> > >>> to

> > >>>>> do.

> > >>>>>>> The

> > >>>>>>>>> medic on

> > >>>>>>>>>> the ground made the decision to transport by air so as

> > >>> a

> > >>>>> flight

> > >>>>>>>>> medic I

> > >>>>>>>>>> never questioned his abilities or knowledge base.

> > >>>>> Conversely,

> > >>>>>>> in

> > >>>>>>>>> the ED of

> > >>>>>>>>>> civilian hospitals as a RN I never questioned the

> > >>> request

> > >>>>> for

> > >>>>>>> air

> > >>>>>>>>> evacution

> > >>>>>>>>>> of patients.

> > >>>>>>>>>> In a nutshell I cannot be critical of the medic on the

> > >>>>> ground

> > >>>>>>>>> requesting

> > >>>>>>>>>> air evacution Sure you receive the requests for

> > >>>>> unnecessary

> > >>>>>>> air

> > >>>>>>>>> transport

> > >>>>>>>>>> but, are you the one on the ground at the scene?

> > >>>>>>>>>> Last but not least, in VietNam we transported Head

> > >>> Injuries

> > >>>>>>> all of

> > >>>>>>>>> the time,

> > >>>>>>>>>> but we flew at a much lower altitude than the birds fly

> > >>>>> here in

> > >>>>>>>>> the states.

> > >>>>>>>>>>

> > >>>>>>>>>> Peace,

> > >>>>>>>>>> Chet

> > >>>>>>>>>> RE: Great Posts on CareFlite!

> > >>>>>>>>>>

> > >>>>>>>>>>> Sarcasm doesn't win many debates.

> > >>>>>>>>>>>

> > >>>>>>>>>>> You folks continuing to ride the air-medical

> > >>> bandwagon

> > >>>>> need

> > >>>>>>> to

> > >>>>>>>>> do the same

> > >>>>>>>>>>> thing the CISM folks are doing right now - stop and

> > >>>>>>> critically

> > >>>>>>>>> assess your

> > >>>>>>>>>>> beliefs. In situations like this it is always best

> > >>> to be

> > >>>>> on

> > >>>>>>> solid

> > >>>>>>>>>> foundation

> > >>>>>>>>>>> and not try to insert anecdote in place of evidence.

> > >>>>>>>>>>>

> > >>>>>>>>>>> I've often posted to these forums of the need for

> > >>>>> evidence-

> > >>>>>>> based

> > >>>>>>>>>> protocols,

> > >>>>>>>>>>> and air-medical is no different than anything else in

> > >>>>>>> medicine.

> > >>>>>>>>> There have

> > >>>>>>>>>>> been studies with results contrary to the obvious

> > >>> common

> > >>>>>>> belief

> > >>>>>>>>> regarding

> > >>>>>>>>>>> helicopter transport. More research is needed before

> > >>> we

> > >>>>>>> attempt

> > >>>>>>>>> to draw

> > >>>>>>>>>>> lines.

> > >>>>>>>>>>>

> > >>>>>>>>>>> There is an excellent article on EMS research in the

> > >>>>> just-

> > >>>>>>>>> published

> > >>>>>>>>>>> September issue of Prehospital Perspective. The

> > >>> article

> > >>>>> is

> > >>>>>>>>> titled " Islands

> > >>>>>>>>>>> of Truth " , written by M. Dudte. It would do

> > >>> each of

> > >>>>> us

> > >>>>>>> well

> > >>>>>>>>> to read

> > >>>>>>>>>> it

> > >>>>>>>>>>> and try to understand the author's perspective. The

> > >>>>> magazine

> > >>>>>>> is

> > >>>>>>>>>>> subscription, but for the time being it is a free

> > >>>>>>> subscription.

> > >>>>>>>>> Please

> > >>>>>>>>>> sign

> > >>>>>>>>>>> up and read the article.

> > >>>>>>>>>>>

> > >>>>>>>>>>> The URL for the mag's front page is:

> > >>>>>>>>>>> http://www.prehospitalperspective.net/

> > >>>>>>>>>>>

> > >>>>>>>>>>> The URL for the article is:

> > >>>>>>>>>>>

> > >>>>>>>>>

> > >>>>>>>

> > >>>>>

> > >>>

> > >

> http://www.prehospitalperspective.net/subscribers/sept03/general.pdf

> > >>>>>>>>>>>

> > >>>>>>>>>>> Regards,

> > >>>>>>>>>>> Donn , LP

> > >>>>>>>>>>>

September 8, 2003

Perhaps the lesson of this debate has nothing at all to do with the

topic. Instead of defending practices and turf using adage and anecdote

perhaps we should play the skeptic's game. Certainly there is sound

science justifying much of what we do, but not everything. Some of our

practice is just because we've always done it that way.

But who in our ranks is going to do the questioning? We seem to be awash

with folks taking pride in our technician status. We need more

scientists within our ranks, and fewer technicians. If that is ever

going to happen it will be because the dinosaurs teach the newbies to

not blindly accept what we tell them, or what they read, or what they

see. We need to teach them the why's as well as the how's. The new breed

of medic needs to ask questions. They need to be skeptical.

At this time in our history perhaps the topics of these little debates

are really meaningless. It is the fact that we debate at all that is

important. It would be better if we were more polite, but at least we

debate.

Donn , LP

My real name too, but then you knew that, didn't you?

Re: Great Posts on CareFlite!

>

> that is your best answer? man, you need to find better work.

>

> you opened your mouth, at least try to answer the question. what is

> the golden hour?

>

> --kp-emt--

> --h & k--

>

> > >>>>>>>>>> I have been reading all of the posts on Medical

> > >>> Transport

> > >>>>> by

> > >>>>>>> Air

> > >>>>>>>>> with a lot

> > >>>>>>>>>> of concerns. Having been on both sides of the coin

> > >>> during

> > >>>>>>> combat

> > >>>>>>>>> and in

> > >>>>>>>>>> trhe ED in combat zones as well as civilian hospitals,

> > >>> I

> > >>>>> find

> > >>>>>>> it

> > >>>>>>>>> amusing to

> > >>>>>>>>>> read the various view points.

> > >>>>>>>>>> In VietNam was a flight medic with DUSTOFF, we always

> > >>> felt

> > >>>>> and

> > >>>>>>>>> believed that

> > >>>>>>>>>> we were not the medic on the ground and could not make

> > >>> an

> > >>>>>>> accurate

> > >>>>>>>>>> assessment of the patients condition. Therefore we

> > >>> flew

> > >>>>> the

> > >>>>>>>>> mission,

> > >>>>>>>>>> oftentimes picking up DOA's which we were not supposed

> > >>> to

> > >>>>> do.

> > >>>>>>> The

> > >>>>>>>>> medic on

> > >>>>>>>>>> the ground made the decision to transport by air so as

> > >>> a

> > >>>>> flight

> > >>>>>>>>> medic I

> > >>>>>>>>>> never questioned his abilities or knowledge base.

> > >>>>> Conversely,

> > >>>>>>> in

> > >>>>>>>>> the ED of

> > >>>>>>>>>> civilian hospitals as a RN I never questioned the

> > >>> request

> > >>>>> for

> > >>>>>>> air

> > >>>>>>>>> evacution

> > >>>>>>>>>> of patients.

> > >>>>>>>>>> In a nutshell I cannot be critical of the medic on the

> > >>>>> ground

> > >>>>>>>>> requesting

> > >>>>>>>>>> air evacution Sure you receive the requests for

> > >>>>> unnecessary

> > >>>>>>> air

> > >>>>>>>>> transport

> > >>>>>>>>>> but, are you the one on the ground at the scene?

> > >>>>>>>>>> Last but not least, in VietNam we transported Head

> > >>> Injuries

> > >>>>>>> all of

> > >>>>>>>>> the time,

> > >>>>>>>>>> but we flew at a much lower altitude than the birds fly

> > >>>>> here in

> > >>>>>>>>> the states.

> > >>>>>>>>>>

> > >>>>>>>>>> Peace,

> > >>>>>>>>>> Chet

> > >>>>>>>>>> RE: Great Posts on CareFlite!

> > >>>>>>>>>>

> > >>>>>>>>>>> Sarcasm doesn't win many debates.

> > >>>>>>>>>>>

> > >>>>>>>>>>> You folks continuing to ride the air-medical

> > >>> bandwagon

> > >>>>> need

> > >>>>>>> to

> > >>>>>>>>> do the same

> > >>>>>>>>>>> thing the CISM folks are doing right now - stop and

> > >>>>>>> critically

> > >>>>>>>>> assess your

> > >>>>>>>>>>> beliefs. In situations like this it is always best

> > >>> to be

> > >>>>> on

> > >>>>>>> solid

> > >>>>>>>>>> foundation

> > >>>>>>>>>>> and not try to insert anecdote in place of evidence.

> > >>>>>>>>>>>

> > >>>>>>>>>>> I've often posted to these forums of the need for

> > >>>>> evidence-

> > >>>>>>> based

> > >>>>>>>>>> protocols,

> > >>>>>>>>>>> and air-medical is no different than anything else in

> > >>>>>>> medicine.

> > >>>>>>>>> There have

> > >>>>>>>>>>> been studies with results contrary to the obvious

> > >>> common

> > >>>>>>> belief

> > >>>>>>>>> regarding

> > >>>>>>>>>>> helicopter transport. More research is needed before

> > >>> we

> > >>>>>>> attempt

> > >>>>>>>>> to draw

> > >>>>>>>>>>> lines.

> > >>>>>>>>>>>

> > >>>>>>>>>>> There is an excellent article on EMS research in the

> > >>>>> just-

> > >>>>>>>>> published

> > >>>>>>>>>>> September issue of Prehospital Perspective. The

> > >>> article

> > >>>>> is

> > >>>>>>>>> titled " Islands

> > >>>>>>>>>>> of Truth " , written by M. Dudte. It would do

> > >>> each of

> > >>>>> us

> > >>>>>>> well

> > >>>>>>>>> to read

> > >>>>>>>>>> it

> > >>>>>>>>>>> and try to understand the author's perspective. The

> > >>>>> magazine

> > >>>>>>> is

> > >>>>>>>>>>> subscription, but for the time being it is a free

> > >>>>>>> subscription.

> > >>>>>>>>> Please

> > >>>>>>>>>> sign

> > >>>>>>>>>>> up and read the article.

> > >>>>>>>>>>>

> > >>>>>>>>>>> The URL for the mag's front page is:

> > >>>>>>>>>>> http://www.prehospitalperspective.net/

> > >>>>>>>>>>>

> > >>>>>>>>>>> The URL for the article is:

> > >>>>>>>>>>>

> > >>>>>>>>>

> > >>>>>>>

> > >>>>>

> > >>>

> > >

> http://www.prehospitalperspective.net/subscribers/sept03/general.pdf

> > >>>>>>>>>>>

> > >>>>>>>>>>> Regards,

> > >>>>>>>>>>> Donn , LP

> > >>>>>>>>>>>

September 8, 2003

I have watched this thread and said I was not going to comment but I just

have to say this about that.

I have been evolved in emergency service since the 60s military and the

gradual steps up to present day I am an EMT-P I work rural ems I have and

are affiliated with fire service. I have worked with many different flight

services the Houston group included air rescue and med link in Beaumont and

now the Gold Star service that is so new I don't even know the name of the

service yet. All I know is that when they are called they respond to the

incident and give what ever assistance is needed and transport to the proper

facility for the patients needs I have never been turned down for a

transport except for bird on another flight or weathered in or down for

repairs. The wonderful people that have worked all these services have never

ever had any thing negative to say to me or any one I have worked with They

have always been supportive and have responded to my needs what ever they

were.

The Golden Hour was a filed study done in a land Hospital finding that

trauma patients who reached the trauma center with in one hour of the time

of injury had a higher success rate. I have to agree with Dr. Bledsoe in

seeing that the ones that are going to live do in fact live and the ones

that are going to die do indeed die, but some where in the middle we have

those that are on the thin line leaning to the right or the left and our

efforts in some way hopefully sway the out come for those.

I fully support those flight services and there efforts and if those people

were not here to help us render care I fell that many patients would not be

doing as well and the death rate would be higher than it is inside or out

side the golden hour the cost of treating those patients far out way the

income gained form treating them that is why flight services don't stay very

long, so lets cut them a little slack.

Every time a bird lifts off the crew is in danger but I don't think they

would want you to not call them when you were in doubt of whither a patient

needs them or not if in doubt call them they would rather respond to a

patient that does not need there care then miss even one that did need them.

I hope this has not angered any one but I think this thread has reached a

productive end and need to be ended here . I wish to say in closing thanks

Life Flight, Herman flight crews, Air Rescue, Medlink, and Gold Star for

every thing you have ever done for my patients and crew members a job well

done.

Thank You

EMT-P

Re: Great Posts on CareFlite!

snip

> >

snip to the end

September 8, 2003

AMEN Donn. We all need to adopt the skeptic's role. " Question authority "

ought to be our motto. Why, for example, are we all still collaring and

boarding people who obviously don't need it and get pressure injuries from it?

Why,

for example, do we persist in transporting people Code 3 who have no life

threatening conditions? Why, for example, do we continue to sit on scene doing

stuff that we can do enroute? And on and on and on. As Donn says, " because

we've always done it that way. "

One of the recent posts mentioned that when calculating helo time vs. load

and go time you plug in 15-20 minutes for helo crew on scene patient assessment.

WHAT? Why should it take any helo crew 15-20 minutes to assess a patient

we've already assessed? It shouldn't. And most of the time it doesn't except

when the help crew has so little confidence in the abilities of the ground crew

that they feel the need to do it all over again. But even then, why should

it take them any longer to assess and plan than it does the ground crew? It

shouldn't and I suggest that it doesn't in most cases.

Best,

GG

Gene Gandy, JD, LP

EMS Educator and Consultant

HillGandy Associates

POB 1651

Albany, TX 76430

cell:

wegandy@...

wegandy1938@...

In a message dated 9/8/2003 10:55:30 AM Central Daylight Time,

donn@... writes:

(snip)

But who in our ranks is going to do the questioning? We seem to be awash

with folks taking pride in our technician status. We need more

scientists within our ranks, and fewer technicians. If that is ever

going to happen it will be because the dinosaurs teach the newbies to

not blindly accept what we tell them, or what they read, or what they

see. We need to teach them the why's as well as the how's. The new breed

of medic needs to ask questions. They need to be skeptical.

(snip)

Donn , LP

My real name too, but then you knew that, didn't you?

September 8, 2003

To All the Brothers and Sisters:

It is not wrong to use a helo to fly a patient to definitive care. The

thing we need to address is not whether the helo or the ambulance crashed.

Not who said what about whom after each call or how bad we can bad mouth

each other on the group.

The real issues are two in my opinion:

1) The proper Guidelines for Air medical transport: for example

- If the patient requires prolonged extraction. If the patient is

still trapped and the helo is 5 min away for instance.

- If the distance to the facility and the time required to travel

this distance is going to be more then what it would be by an areomedical

crew; to include their round trip, 5 min for landing and lift off (

approx.), 15-20 min on the scene to assess the patient.

- If traffic on the way to the trauma facility is going to be heavy

due to rush hour, construction, road closure for various reasons. we should

know all of these factors going to the call by asking for them. Part of your

scene size up, in a big picture your exit route.

- Over whelmed system and there is just no other alternative, the

most serious should fly.

- I bet there could be several others that could be added to the

list.

2) Proper QA/QI on the behalf of the agency requesting the helo and

education on when to utilize a helo. Sometimes a helo isn't always necessary

and the areomedical company has to eat the cost of powering the helos up and

flying them. Some are just on stand by and others are cancelled because

there was no real need for them to come out in the first place. Those

companies could take that money and donate it to the paychecks of their

employees as pay raises, or add it to the education budget for extra CE and

training.

It is really bad to see how quickly tempers heat up over something so

trivial and the finger pointing starts. Some of the flight medics I guess

have forgotten they used to be field medics. Instead of bickering and

arguing we should be teaching those that need the guidance and help them to

the light and not look down on them.

The book " Shocktrauma " that you spoke of Mr. Brando is a very good book

and education. Dr. Bledsoe did make a good point and their is research that

backs what he says, but there are studies that show that the golden hour is

truly important to maintain.

There are some inexperience medics out on the streets that need

guidance. For those of us that have been out there for a while help them out

and point them in the right direction. That is one of the other reasons so

many people burn out so quickly is that others still have the paragod

syndrome and think everyone is inferior to them.

In closing, my apologize for the following : if anyone wants to complain

and sniffle over what I just wrote. Do it privately and save everyone else

on the group the head ache.

" De Oppresso Liber "

Jelal Babaa,

CCEMTP/NREMTP

Arlington, TX

RE: Great Posts on CareFlite!

> > > >>>>>>>>>>

> > > >>>>>>>>>>> Sarcasm doesn't win many debates.

> > > >>>>>>>>>>>

> > > >>>>>>>>>>> You folks continuing to ride the air-medical

> > > >>> bandwagon

> > > >>>>> need

> > > >>>>>>> to

> > > >>>>>>>>> do the same

> > > >>>>>>>>>>> thing the CISM folks are doing right now - stop and

> > > >>>>>>> critically

> > > >>>>>>>>> assess your

> > > >>>>>>>>>>> beliefs. In situations like this it is always best

> > > >>> to be

> > > >>>>> on

> > > >>>>>>> solid

> > > >>>>>>>>>> foundation

> > > >>>>>>>>>>> and not try to insert anecdote in place of evidence.

> > > >>>>>>>>>>>

> > > >>>>>>>>>>> I've often posted to these forums of the need for

> > > >>>>> evidence-

> > > >>>>>>> based

> > > >>>>>>>>>> protocols,

> > > >>>>>>>>>>> and air-medical is no different than anything else in

> > > >>>>>>> medicine.

> > > >>>>>>>>> There have

> > > >>>>>>>>>>> been studies with results contrary to the obvious

> > > >>> common

> > > >>>>>>> belief

> > > >>>>>>>>> regarding

> > > >>>>>>>>>>> helicopter transport. More research is needed before

> > > >>> we

> > > >>>>>>> attempt

> > > >>>>>>>>> to draw

> > > >>>>>>>>>>> lines.

> > > >>>>>>>>>>>

> > > >>>>>>>>>>> There is an excellent article on EMS research in the

> > > >>>>> just-

> > > >>>>>>>>> published

> > > >>>>>>>>>>> September issue of Prehospital Perspective. The

> > > >>> article

> > > >>>>> is

> > > >>>>>>>>> titled " Islands

> > > >>>>>>>>>>> of Truth " , written by M. Dudte. It would do

> > > >>> each of

> > > >>>>> us

> > > >>>>>>> well

> > > >>>>>>>>> to read

> > > >>>>>>>>>> it

> > > >>>>>>>>>>> and try to understand the author's perspective. The

> > > >>>>> magazine

> > > >>>>>>> is

> > > >>>>>>>>>>> subscription, but for the time being it is a free

> > > >>>>>>> subscription.

> > > >>>>>>>>> Please

> > > >>>>>>>>>> sign

> > > >>>>>>>>>>> up and read the article.

> > > >>>>>>>>>>>

> > > >>>>>>>>>>> The URL for the mag's front page is:

> > > >>>>>>>>>>> http://www.prehospitalperspective.net/

> > > >>>>>>>>>>>

> > > >>>>>>>>>>> The URL for the article is:

> > > >>>>>>>>>>>

> > > >>>>>>>>>

> > > >>>>>>>

> > > >>>>>

> > > >>>

> > > >

> > http://www.prehospitalperspective.net/subscribers/sept03/general.pdf

> > > >>>>>>>>>>>

> > > >>>>>>>>>>> Regards,

> > > >>>>>>>>>>> Donn , LP

> > > >>>>>>>>>>>

September 8, 2003

The " Golden Hour " concept was an invention of R A.

Cowley, MD FACS who founded the Shock Trauma Center

and land Institute for Emergency Medical Services

Systems(MIEMSS) in Baltimore.

But where did the concept of hospitals' widespread use

of medical helicopters (to increase their in-house

census) first appear in the business literature? The

Harvard Business Review, 1980, " Healthcare In

the '80's: Can Hospitals Survive " by Jeff

Goldsmith,PhD, who was then at the University of

Chicago. His article described how hospitals could

establish " captive systems of distribution " through

the use of medical helicopters, which could escape the

geographic limitations of local markets, and " pluck "

patients from the markets of competing hospitals.

Since then, we've seen the " development " of emergency

air medical services in much the same way that we've

witnessed the " development " of other market

opportunity, money-driven commercial

strategies/enterprises (i.e., PHTLS, CISM, BTLS, AHLS,

etc., etc., etc., etc., etc.). I know... I'm a

heretic, but at least I'm honest.

Bob Kellow

September 9, 2003

I have two answers the cod3 is because the management wants you back in

service faster and the sitting on scene is so the medic in the back has help

from the emt that drives and so the medic in the back does not have to stand

and move around during transportation.

These are just opinions.

Re: Re: Great Posts on CareFlite!

> AMEN Donn. We all need to adopt the skeptic's role. " Question authority "

> ought to be our motto. Why, for example, are we all still collaring and

> boarding people who obviously don't need it and get pressure injuries from

it? Why,

> for example, do we persist in transporting people Code 3 who have no life

> threatening conditions? Why, for example, do we continue to sit on scene

doing

> stuff that we can do enroute? And on and on and on. As Donn says,

" because

> we've always done it that way. "

>

> One of the recent posts mentioned that when calculating helo time vs. load

> and go time you plug in 15-20 minutes for helo crew on scene patient

assessment.

> WHAT? Why should it take any helo crew 15-20 minutes to assess a patient

> we've already assessed? It shouldn't. And most of the time it doesn't

except

> when the help crew has so little confidence in the abilities of the ground

crew

> that they feel the need to do it all over again. But even then, why

should

> it take them any longer to assess and plan than it does the ground crew?

It

> shouldn't and I suggest that it doesn't in most cases.

>

> Best,

>

> GG

> Gene Gandy, JD, LP

> EMS Educator and Consultant

> HillGandy Associates

> POB 1651

> Albany, TX 76430

> cell:

> wegandy@...

> wegandy1938@...

>

> In a message dated 9/8/2003 10:55:30 AM Central Daylight Time,

> donn@... writes:

> (snip)

> But who in our ranks is going to do the questioning? We seem to be awash

> with folks taking pride in our technician status. We need more

> scientists within our ranks, and fewer technicians. If that is ever

> going to happen it will be because the dinosaurs teach the newbies to

> not blindly accept what we tell them, or what they read, or what they

> see. We need to teach them the why's as well as the how's. The new breed

> of medic needs to ask questions. They need to be skeptical.

>

> (snip)

> Donn , LP

>

> My real name too, but then you knew that, didn't you?

>

September 9, 2003

Gene-

On Code Three driving...

I do not allow my drivers to drive Code Three from the scene to the

hospital. I cannot do anything while being tossed about in the back of the

unit, nor do the patients appreciate it.

On Scene Time...

I only perform the most necessary procedures on the scene, to allow me to

continue care enroute: IV on scene, Rx enroute.... RSI/ET on scene, PPV

enroute....etc. Generally, the only patient who sees all of the tricks on

scene is the cardiac arrest.....

On Helicopter Crews assessments....

Our Life Flight crews have come to expect a thoroughly assessed and trended

pt who has had all the necessary procedures performed and functional prior

to landing. I mean, me do have at least 20 min to work with prior to

landing, after all. A handoff here in Dogpatch is short, sweet and to the

point. We even give a written report when we have sufficient hands.......

On use of air transport at ALL.....

If the patient needs some specialty that is not locally available to save

life or limb or materially improve morbidity / mortality, they fly to

Houston or Galveston. You have to know local resources intimately to make

an informed decision.

Regards-

TD

Re: Re: Great Posts on CareFlite!

>I have two answers the cod3 is because the management wants you back in

>service faster and the sitting on scene is so the medic in the back has

help

>from the emt that drives and so the medic in the back does not have to

stand

>and move around during transportation.

>These are just opinions.

>

> Re: Re: Great Posts on CareFlite!

>

>> AMEN Donn. We all need to adopt the skeptic's role. " Question

authority "

>> ought to be our motto. Why, for example, are we all still collaring and

>> boarding people who obviously don't need it and get pressure injuries

from

>it? Why,

>> for example, do we persist in transporting people Code 3 who have no life

>> threatening conditions? Why, for example, do we continue to sit on scene

>doing

>> stuff that we can do enroute? And on and on and on. As Donn says,

> " because

>> we've always done it that way. "

>>

>> One of the recent posts mentioned that when calculating helo time vs.

load

>> and go time you plug in 15-20 minutes for helo crew on scene patient

>assessment.

>> WHAT? Why should it take any helo crew 15-20 minutes to assess a

patient

>> we've already assessed? It shouldn't. And most of the time it doesn't

>except

>> when the help crew has so little confidence in the abilities of the

ground

>crew

>> that they feel the need to do it all over again. But even then, why

>should

>> it take them any longer to assess and plan than it does the ground crew?

>It

>> shouldn't and I suggest that it doesn't in most cases.

>>

>> Best,

>>

>> GG

>> Gene Gandy, JD, LP

>> EMS Educator and Consultant

>> HillGandy Associates

>> POB 1651

>> Albany, TX 76430

>> cell:

>> wegandy@...

>> wegandy1938@...

>>

>> In a message dated 9/8/2003 10:55:30 AM Central Daylight Time,

>> donn@... writes:

>> (snip)

>> But who in our ranks is going to do the questioning? We seem to be awash

>> with folks taking pride in our technician status. We need more

>> scientists within our ranks, and fewer technicians. If that is ever

>> going to happen it will be because the dinosaurs teach the newbies to

>> not blindly accept what we tell them, or what they read, or what they

>> see. We need to teach them the why's as well as the how's. The new breed

>> of medic needs to ask questions. They need to be skeptical.

>>

>> (snip)

>> Donn , LP

>>

>> My real name too, but then you knew that, didn't you?

>>

September 9, 2003

Thanks Bob.

Re: Re: Great Posts on CareFlite!

> The " Golden Hour " concept was an invention of R A.

> Cowley, MD FACS who founded the Shock Trauma Center

> and land Institute for Emergency Medical Services

> Systems(MIEMSS) in Baltimore.

>

> But where did the concept of hospitals' widespread use

> of medical helicopters (to increase their in-house

> census) first appear in the business literature? The

> Harvard Business Review, 1980, " Healthcare In

> the '80's: Can Hospitals Survive " by Jeff

> Goldsmith,PhD, who was then at the University of

> Chicago. His article described how hospitals could

> establish " captive systems of distribution " through

> the use of medical helicopters, which could escape the

> geographic limitations of local markets, and " pluck "

> patients from the markets of competing hospitals.

>

> Since then, we've seen the " development " of emergency

> air medical services in much the same way that we've

> witnessed the " development " of other market

> opportunity, money-driven commercial

> strategies/enterprises (i.e., PHTLS, CISM, BTLS, AHLS,

> etc., etc., etc., etc., etc.). I know... I'm a

> heretic, but at least I'm honest.

>

> Bob Kellow

>

September 9, 2003

I guess age generates loss of memory lol. I just remembered seeing the story

on 60 minutes several years ago and that it was in land I did the assume

thing in that I assumed it was a study.

Thanks much

Re: Great Posts on CareFlite!

> Sorry , but your information is incorrect. The Golden Hour study by

> " a land Hospital " is a myth, although it has many elements of truth.

> Dr. R. Cowley did indeed work in land at the University of

> land Health Center and the famous Baltimore Shock Trauma Center is

> named for the good doctor. He is credited with saving and salvaging many

> hundreds of lives. The Golden Hour may indeed be real and tangible and

> there are many references in the literature that attribute the term to

> Dr. Cowley. However, no such study as you suggest may be found in any

> literature search. The term appears to be coined from thin air.

>

> Another instance of " we've always done it that way " ??????

>

> Donn

>

> > snip to the end

>

September 9, 2003

Don,

Do you not put your socks on the same way each morning. Do you not put your

underware on with a specific leg first (if

you wear said item), Do you not eat with your utensil in the same hand, do you

not put your electrodes on your patient

in a specific order, do you not adjust the mirrors on the truck the same way

each time you drive, do you not start an

IV the same way each time, All of the above mentioned are its always done

that way issues. Sometimes the right

answer is: I have always done it that way.

Henry