Guest guest Posted July 6, 2002 Report Share Posted July 6, 2002 Is there anyway to see the entire study so that the number of patients examined, the statistical methods, and a more in depth look into why 17% fewer serious trauma patients were admitted without a helicopter than before can be taken. My first question is why was there a 12% decrease in trauma patient admissions? Secondly, why a 17% decrease in admissions of severely injured trauma patients? Does this mean that those patients went to other " less qualified (i.e. level 3 and 4 facilities) " than they would have with a helicopter? How were patients that would have been previously flown evaluated after the helicopter went away? If, looking from a trauma center perspective, there was no change in patient transport time or mortality...this may be an over simplistic conclusion because there are bound to be trauma patients that would have been flown with helicopter availability that went somewhere else (at least 17%). So, I would conclude from this abstract that trauma centers continue to save lives as regularly after discontinuing a hospital based helicopter service as they did before...but this doesn't tell us what happens to those outlying patients who no longer get transported to the trauma center. Let me know where the whole article is. AOL gave me fits in trying to locate it. Thanks. Dudley Wait Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 6, 2002 Report Share Posted July 6, 2002 Dudley, You can order the entire study from the National Library of Medicine (NLM), or I'm sure that you can contact the American College of Surgeons in Chicago and order a reprint, or you can call the authors at UTMB-Galveston. Bob THEDUDMAN@... wrote: > Is there anyway to see the entire study so that the number of > patients > examined, the statistical methods, and a more in depth look into why > 17% > fewer serious trauma patients were admitted without a helicopter than > before > can be taken. > > My first question is why was there a 12% decrease in trauma patient > admissions? Secondly, why a 17% decrease in admissions of severely > injured > trauma patients? Does this mean that those patients went to other > " less > qualified (i.e. level 3 and 4 facilities) " than they would have with a > > helicopter? How were patients that would have been previously flown > evaluated after the helicopter went away? If, looking from a trauma > center > perspective, there was no change in patient transport time or > mortality...this may be an over simplistic conclusion because there > are bound > to be trauma patients that would have been flown with helicopter > availability > that went somewhere else (at least 17%). > > So, I would conclude from this abstract that trauma centers continue > to save > lives as regularly after discontinuing a hospital based helicopter > service as > they did before...but this doesn't tell us what happens to those > outlying > patients who no longer get transported to the trauma center. > > Let me know where the whole article is. AOL gave me fits in trying to > locate > it. Thanks. > > Dudley Wait > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 6, 2002 Report Share Posted July 6, 2002 Dudley, I'll send you the study in zipped PDF format if you want it. I can't send attachments to the list so reply to me privately if you want it. Donn Re: Interesting Is there anyway to see the entire study so that the number of patients examined, the statistical methods, and a more in depth look into why 17% fewer serious trauma patients were admitted without a helicopter than before can be taken. My first question is why was there a 12% decrease in trauma patient admissions? Secondly, why a 17% decrease in admissions of severely injured trauma patients? Does this mean that those patients went to other " less qualified (i.e. level 3 and 4 facilities) " than they would have with a helicopter? How were patients that would have been previously flown evaluated after the helicopter went away? If, looking from a trauma center perspective, there was no change in patient transport time or mortality...this may be an over simplistic conclusion because there are bound to be trauma patients that would have been flown with helicopter availability that went somewhere else (at least 17%). So, I would conclude from this abstract that trauma centers continue to save lives as regularly after discontinuing a hospital based helicopter service as they did before...but this doesn't tell us what happens to those outlying patients who no longer get transported to the trauma center. Let me know where the whole article is. AOL gave me fits in trying to locate it. Thanks. Dudley Wait Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 6, 2002 Report Share Posted July 6, 2002 I feel that this study is severely flawed, much like any research it will provide you the net results that supports your political views what ever they may be. The study fails to mention that UTMB chose to discontinue the air service but yet Hermann Hospital continued the service but from a different location, Friendswood, Texas. And since UTMB was not willing to play well with others the majority of those trauma and other patients are flown into Hermann Hospital....... And since I am on my soapbox, how much of our TAX DOLLARS did the rocket scientist have to spend to find this out. Re: Interesting > > > Is there anyway to see the entire study so that the number of patients > examined, the statistical methods, and a more in depth look into why 17% > fewer serious trauma patients were admitted without a helicopter than before > can be taken. > > My first question is why was there a 12% decrease in trauma patient > admissions? Secondly, why a 17% decrease in admissions of severely injured > trauma patients? Does this mean that those patients went to other " less > qualified (i.e. level 3 and 4 facilities) " than they would have with a > helicopter? How were patients that would have been previously flown > evaluated after the helicopter went away? If, looking from a trauma center > perspective, there was no change in patient transport time or > mortality...this may be an over simplistic conclusion because there are > bound > to be trauma patients that would have been flown with helicopter > availability > that went somewhere else (at least 17%). > > So, I would conclude from this abstract that trauma centers continue to save > lives as regularly after discontinuing a hospital based helicopter service > as > they did before...but this doesn't tell us what happens to those outlying > patients who no longer get transported to the trauma center. > > Let me know where the whole article is. AOL gave me fits in trying to > locate > it. Thanks. > > Dudley Wait > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 6, 2002 Report Share Posted July 6, 2002 The answer is probably simpler than that. UTMD and Sealy are state-run institutions ( Sealy is only state " acute care " hospital in Texas--thus that is why all the prisoners go there). Helicopters are a loss leader. They do not make money in and of themselves--but potentially through bringing insured trauma patients whose medical insurance will pay potentially large bills. Thus, when UTMB was not breaking even on the helicopter (and God knows they already have enough patients in their system), the decision was made to shut down the operation. Hermann, on the other hand, can operate Life Flight as a loss leader as they do not report to the voters. BEB Re: Interesting > > > > > > Is there anyway to see the entire study so that the number of patients > > examined, the statistical methods, and a more in depth look into why 17% > > fewer serious trauma patients were admitted without a helicopter than > before > > can be taken. > > > > My first question is why was there a 12% decrease in trauma patient > > admissions? Secondly, why a 17% decrease in admissions of severely > injured > > trauma patients? Does this mean that those patients went to other " less > > qualified (i.e. level 3 and 4 facilities) " than they would have with a > > helicopter? How were patients that would have been previously flown > > evaluated after the helicopter went away? If, looking from a trauma > center > > perspective, there was no change in patient transport time or > > mortality...this may be an over simplistic conclusion because there are > > bound > > to be trauma patients that would have been flown with helicopter > > availability > > that went somewhere else (at least 17%). > > > > So, I would conclude from this abstract that trauma centers continue to > save > > lives as regularly after discontinuing a hospital based helicopter service > > as > > they did before...but this doesn't tell us what happens to those outlying > > patients who no longer get transported to the trauma center. > > > > Let me know where the whole article is. AOL gave me fits in trying to > > locate > > it. Thanks. > > > > Dudley Wait > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 6, 2002 Report Share Posted July 6, 2002 Kenny, The fault in your statement lies in the fact that the researchers were attempting to prove that the loss of the helicopter service was detrimental. Their findings were the opposite of what they had intended to prove. Please read the complete report. Regards, Donn Re: Interesting I feel that this study is severely flawed, much like any research it will provide you the net results that supports your political views what ever they may be. The study fails to mention that UTMB chose to discontinue the air service but yet Hermann Hospital continued the service but from a different location, Friendswood, Texas. And since UTMB was not willing to play well with others the majority of those trauma and other patients are flown into Hermann Hospital....... And since I am on my soapbox, how much of our TAX DOLLARS did the rocket scientist have to spend to find this out. Re: Interesting > > > Is there anyway to see the entire study so that the number of patients > examined, the statistical methods, and a more in depth look into why 17% > fewer serious trauma patients were admitted without a helicopter than before > can be taken. > > My first question is why was there a 12% decrease in trauma patient > admissions? Secondly, why a 17% decrease in admissions of severely injured > trauma patients? Does this mean that those patients went to other " less > qualified (i.e. level 3 and 4 facilities) " than they would have with a > helicopter? How were patients that would have been previously flown > evaluated after the helicopter went away? If, looking from a trauma center > perspective, there was no change in patient transport time or > mortality...this may be an over simplistic conclusion because there are > bound > to be trauma patients that would have been flown with helicopter > availability > that went somewhere else (at least 17%). > > So, I would conclude from this abstract that trauma centers continue to save > lives as regularly after discontinuing a hospital based helicopter service > as > they did before...but this doesn't tell us what happens to those outlying > patients who no longer get transported to the trauma center. > > Let me know where the whole article is. AOL gave me fits in trying to > locate > it. Thanks. > > Dudley Wait > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 7, 2002 Report Share Posted July 7, 2002 Donn, Thanks for sending me the complete article. It was very interesting. Although it really didn't prove any points about the viability of helicopter ambulance services, it did prove that when you are a Level 1 trauma center situated on an island well over 50 miles away from any other trauma center, and you decide to discontinue your helicopter service, it will not have a negative impact upon the patients that you see in your Level 1 trauma center. It did prove that paramedics may need to be better trained when to wait on scene vs. when to load and go...because scene times and transport times decreased after stopping the helicopter...and no negative impact was had on patient outcome...so maybe some education is necessary on when and how to use aeromedical resources. But the study does not indicate (again) what happened to these " patients " who no longer arrived at UTMB...so we don't know what caused the scene times to change. For example, in Galveston County, the number of air flights from scenes back to UTMB dropped dramatically but not to zero (from 142 to an average of 50)and their ground transports increased by 10 year two and by 150 year 3...thereby leading one to make an assumption that we were no longer flying patients on the island to UTMB but potentially we still were out on the mainland side...but again I would bet that only the most serious of the mainland side still went to UTMB and the remainder went back to the helicopter's main hospital. Looking at Brazoria County, their scene flights also dropped (from 103 to an average of 9.5)and ground transports from scene increased from 7 to 10 year two and 18 year three...(where did these patients go?) I do agree with the authors and the research shows it that stopping a hospital based helicopter service does not affect the outcomes of patients you continue to see in that remotely located hospital. Unfortunately, from a health-care system approach (or even a RAC approach if there was a way to get regional data), we do not know the overall outcome of stopping this level of transport service. The authors stated themselves that " we cannot determine whether more patients are being transported to other trauma centers or if there is simply a decrease in severe trauma injuries in our area " . I also would like to quote the author's final statement in this article: " In conclusion, the termination of this service had no measurable negative impact on trauma patient outcomes in our institution. " Unfortunately we will never know the impact it had on those patients not lucky enough to be ground transported into UTMB. Dudley Wait Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 7, 2002 Report Share Posted July 7, 2002 Dudley, You are quite welcome, and I can't argue with much of what you say. In fact, I agree wholeheartedly that we all need to be educated better as to which patient really needs chopper transport and which one will do just as well, or at least will fare no worse with ground transport. The statistic in this study I found most revealing was... >> before termination of the air ambulance service, the majority of patients who were air transported to our hospital were not severely injured; 256 of 366 air transport patients had ISS =15. Finally, of those patients transported with ISS >15, our total mortality remains similar to that of other institutions. In other words, we continue to fly patients for whom air transport does no good. This ties up the aircraft and puts pilots, medics and nurses at undue risk when compared to the potential for benefit. This is the point I was trying to make a couple weeks ago. I agree that air transport has a place, I just feel we ground medics misuse the resource and it is costing instead of saving lives. I think the study does prove that much. Regards, Donn Re: Interesting Best regards, Donn, Thanks for sending me the complete article. It was very interesting. Although it really didn't prove any points about the viability of helicopter ambulance services, it did prove that when you are a Level 1 trauma center situated on an island well over 50 miles away from any other trauma center, and you decide to discontinue your helicopter service, it will not have a negative impact upon the patients that you see in your Level 1 trauma center. It did prove that paramedics may need to be better trained when to wait on scene vs. when to load and go...because scene times and transport times decreased after stopping the helicopter...and no negative impact was had on patient outcome...so maybe some education is necessary on when and how to use aeromedical resources. But the study does not indicate (again) what happened to these " patients " who no longer arrived at UTMB...so we don't know what caused the scene times to change. For example, in Galveston County, the number of air flights from scenes back to UTMB dropped dramatically but not to zero (from 142 to an average of 50)and their ground transports increased by 10 year two and by 150 year 3...thereby leading one to make an assumption that we were no longer flying patients on the island to UTMB but potentially we still were out on the mainland side...but again I would bet that only the most serious of the mainland side still went to UTMB and the remainder went back to the helicopter's main hospital. Looking at Brazoria County, their scene flights also dropped (from 103 to an average of 9.5)and ground transports from scene increased from 7 to 10 year two and 18 year three...(where did these patients go?) I do agree with the authors and the research shows it that stopping a hospital based helicopter service does not affect the outcomes of patients you continue to see in that remotely located hospital. Unfortunately, from a health-care system approach (or even a RAC approach if there was a way to get regional data), we do not know the overall outcome of stopping this level of transport service. The authors stated themselves that " we cannot determine whether more patients are being transported to other trauma centers or if there is simply a decrease in severe trauma injuries in our area " . I also would like to quote the author's final statement in this article: " In conclusion, the termination of this service had no measurable negative impact on trauma patient outcomes in our institution. " Unfortunately we will never know the impact it had on those patients not lucky enough to be ground transported into UTMB. Dudley Wait Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 8, 2002 Report Share Posted July 8, 2002 I don't know if this applies specifically to Galveston, but in Austin/ County STARFlight (the Austin/ Co EMS helicopter) is dispatched on the initial dispatch on some incidents, as opposed to locales in which a ground medic must assess the patient in person and request a helicopter. The reason I bring this factoid up is that STARFlight used to (when I worked at AEMS, anyway) fly patients who weren't necessarily Cat I patients simply because " they want to go to Brack and we're headed that way anyway, so why not? " As the attending ground medic who suddenly had the opportunity to NOT do the paperwork on this patient, I saw that as a Good Thing. Obviously, on the occasions when we were dispatched to a " multiple amputation with blood running in the gutters " and arrived to find a fella with toe pain for three weeks, the helicopter crew was understandably less charitable. Also, I know my scene times were sometimes longer when I knew a helicopter was coming because I knew that my additional 5 minutes on scene followed by a hand-off to the helicopter would result in a quicker transport than if I loaded and goded for 45 minutes from the sticks to the hospital. I'm positive that that thought process occurred in Galveston as well. Anyway, at least in Austin, that convenience flight statistic might explain why the numbers don't add up. stay safe - phil __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 9, 2002 Report Share Posted July 9, 2002 I would like to have this study zipped and sent to our service please. Silsbee EMS 114 hwy 96 south Silsbee, Tx 77656 Re: Interesting Is there anyway to see the entire study so that the number of patients examined, the statistical methods, and a more in depth look into why 17% fewer serious trauma patients were admitted without a helicopter than before can be taken. My first question is why was there a 12% decrease in trauma patient admissions? Secondly, why a 17% decrease in admissions of severely injured trauma patients? Does this mean that those patients went to other " less qualified (i.e. level 3 and 4 facilities) " than they would have with a helicopter? How were patients that would have been previously flown evaluated after the helicopter went away? If, looking from a trauma center perspective, there was no change in patient transport time or mortality...this may be an over simplistic conclusion because there are bound to be trauma patients that would have been flown with helicopter availability that went somewhere else (at least 17%). So, I would conclude from this abstract that trauma centers continue to save lives as regularly after discontinuing a hospital based helicopter service as they did before...but this doesn't tell us what happens to those outlying patients who no longer get transported to the trauma center. Let me know where the whole article is. AOL gave me fits in trying to locate it. Thanks. Dudley Wait Quote Link to comment Share on other sites More sharing options...
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