Re: Questionable IV & RUDE flight crew

[Guest guest]

,

Ground transport to a level 2 facility would have taken about 45. The pt was

stable and talking when the air craft arrived, and it only took about 15 for

them to get there from the time that they were called. No IV was attempted by

us, as we were still assessing the pt, who was again by now alert and talking.

At that point, I saw no need to attempt the IV. Now, had this pt been unstable

and needed IV access for meds, then YES an IV would have been started, if not

to.

The medic think about starting one IV above the other one, and then decided that

he would start it right next to the first one.

Wayne

lisawhir@... wrote:

Wayne and all,

Most of what I want to say has been said already by others on the list, but

I somehow feel the need to echo it anyway for this kind of thing is near and

dear to me.

From the ground crew stand point, was the helicopter needed? It sounds like

it was in the beginning providing that transporting by ground to an

appropriate trauma center would have taken more than 30-45 minutes. How long

did the

ground crew wait for the aircraft? Did the ground crew attempt an IV, but

was unsuccessful prior to the arrival of the air crew? Once the patient

became alert and stable, how far out was the helicopter? It is acceptable to

cancel a helicopter if it's no longer needed.

Once the air crew was there, from what you have described, there would have

been no reason to start an IV on-scene. IV's can be initiated in the

aircraft and should be if there is not an emergent need such as medications to

facilitate intubation, immediate fluid resuscitation, etc.

Starting two IV's on the same side ... as long as there is two different

vein paths, I haven't heard of this being a problem. Starting it in the same

vein, maybe not a good idea. Sometimes the air crew has better access to one

arm over the other depending on how their aircraft is configured. But, again,

it sounds like they didn't need to start the IV on-scene.

The rudeness is completely unacceptable. There is NO excuse for that! Our

jobs, both ground and air come with stresses. The EMS crew, the patient, the

family and any other personnel on-scene (fire and police) should be treated

with kindness and respect by the air crew regardless of what kind of pressure

or stress they're under. You absolutely should call their

supervisor/director and report the bad behavior. And, as someone else has

mentioned, it would

be beneficial to QI the call with the air crew as well to try and understand

what their rational was for what they did clinically. It would surprise me

if their protocols and or Medical Director supports starting an IV or two

on-scene when they could have done it in the aircraft. After all, the

helicopter is supposed to save time, right?

If this particular provider displays this behavior on a regular basis and/or

makes bad decisions clinically, don't use them! How would that be

benefiting the patient? If you have more than one helicopter service in your

area,

call the one that does the best job and does it safely.

Good luck,

In a message dated 10/18/2005 1:14:27 PM Central Standard Time,

rxmd911@... writes:

A couple of weeks ago I was working a motorcycle race at a dirt track, in

whcih we had two riders hit each other. On arrival to the first person, who

was unresponsive and had snoring respirations, I asked that an air medical

serivce be called. The second person was also unresponsive, but no snoring

respirations. The first one was out for at least 2-3 minutes.

All the necessary precautions were taken and he was placed in the unit. The

local EMS arrived and took care of the second person. I ask the local EMS

to call an air medical provider, and ask for either provider X or Y, and

thought that was who they called.

The air medical provider arrived and it was provider F, seems they have a

base close to this area, so they were called. The crew comes to my unit and I

give report to " kojack & Mr. Clean " . After this, they were trying to decide

if they wanted to start a line there or in the air. By this time the pt was

alert and talking. His family member was in the unit talking with him also.

They kick him out, and start barking orders (the flight crew) they were

almost tossed out on their ears they were so rude. Finally Mr. Clean decides

to

start a line in the unit before carrying the pt across the track. He starts

one IV in the left hand, and then wants to start another one in the same

location. Correct me if I'm wrong, but in BTLS it states that a bi-lateral IV

is just that, BI-LATERAL, meaning that one goes in one hand or arm and the

other one goes in the other.

It was suggested that we drive around to the other side of the track to the

awaiting helicopter. By EMT goes to drive around to the bird, and the family

member is still talking to the pt, and wanting to know where he was being

taken, as they were from out of town. The " flight medic " yells again, and

tells him to step back out of the door so we can go.

I was never use this provider again, if this is the way that their crews

are, I'll call the provider that I want and ask for.

So, my question is, was the IV's placed in a strang position or is this

acceptable? The guy was stable, and only one IV would have been enough, but I

think that this guy wanted to show off.

Thanks,

Wayne

---------------------------------

Yahoo! Music Unlimited - Access over 1 million songs. Try it free.

[Non-text portions of this message have been removed]

[Guest guest]

,

Ground transport to a level 2 facility would have taken about 45. The pt was

stable and talking when the air craft arrived, and it only took about 15 for

them to get there from the time that they were called. No IV was attempted by

us, as we were still assessing the pt, who was again by now alert and talking.

At that point, I saw no need to attempt the IV. Now, had this pt been unstable

and needed IV access for meds, then YES an IV would have been started, if not

to.

The medic think about starting one IV above the other one, and then decided that

he would start it right next to the first one.

Wayne

lisawhir@... wrote:

Wayne and all,

Most of what I want to say has been said already by others on the list, but

I somehow feel the need to echo it anyway for this kind of thing is near and

dear to me.

From the ground crew stand point, was the helicopter needed? It sounds like

it was in the beginning providing that transporting by ground to an

appropriate trauma center would have taken more than 30-45 minutes. How long

did the

ground crew wait for the aircraft? Did the ground crew attempt an IV, but

was unsuccessful prior to the arrival of the air crew? Once the patient

became alert and stable, how far out was the helicopter? It is acceptable to

cancel a helicopter if it's no longer needed.

Once the air crew was there, from what you have described, there would have

been no reason to start an IV on-scene. IV's can be initiated in the

aircraft and should be if there is not an emergent need such as medications to

facilitate intubation, immediate fluid resuscitation, etc.

Starting two IV's on the same side ... as long as there is two different

vein paths, I haven't heard of this being a problem. Starting it in the same

vein, maybe not a good idea. Sometimes the air crew has better access to one

arm over the other depending on how their aircraft is configured. But, again,

it sounds like they didn't need to start the IV on-scene.

The rudeness is completely unacceptable. There is NO excuse for that! Our

jobs, both ground and air come with stresses. The EMS crew, the patient, the

family and any other personnel on-scene (fire and police) should be treated

with kindness and respect by the air crew regardless of what kind of pressure

or stress they're under. You absolutely should call their

supervisor/director and report the bad behavior. And, as someone else has

mentioned, it would

be beneficial to QI the call with the air crew as well to try and understand

what their rational was for what they did clinically. It would surprise me

if their protocols and or Medical Director supports starting an IV or two

on-scene when they could have done it in the aircraft. After all, the

helicopter is supposed to save time, right?

If this particular provider displays this behavior on a regular basis and/or

makes bad decisions clinically, don't use them! How would that be

benefiting the patient? If you have more than one helicopter service in your

area,

call the one that does the best job and does it safely.

Good luck,

In a message dated 10/18/2005 1:14:27 PM Central Standard Time,

rxmd911@... writes:

A couple of weeks ago I was working a motorcycle race at a dirt track, in

whcih we had two riders hit each other. On arrival to the first person, who

was unresponsive and had snoring respirations, I asked that an air medical

serivce be called. The second person was also unresponsive, but no snoring

respirations. The first one was out for at least 2-3 minutes.

All the necessary precautions were taken and he was placed in the unit. The

local EMS arrived and took care of the second person. I ask the local EMS

to call an air medical provider, and ask for either provider X or Y, and

thought that was who they called.

The air medical provider arrived and it was provider F, seems they have a

base close to this area, so they were called. The crew comes to my unit and I

give report to " kojack & Mr. Clean " . After this, they were trying to decide

if they wanted to start a line there or in the air. By this time the pt was

alert and talking. His family member was in the unit talking with him also.

They kick him out, and start barking orders (the flight crew) they were

almost tossed out on their ears they were so rude. Finally Mr. Clean decides

to

start a line in the unit before carrying the pt across the track. He starts

one IV in the left hand, and then wants to start another one in the same

location. Correct me if I'm wrong, but in BTLS it states that a bi-lateral IV

is just that, BI-LATERAL, meaning that one goes in one hand or arm and the

other one goes in the other.

It was suggested that we drive around to the other side of the track to the

awaiting helicopter. By EMT goes to drive around to the bird, and the family

member is still talking to the pt, and wanting to know where he was being

taken, as they were from out of town. The " flight medic " yells again, and

tells him to step back out of the door so we can go.

I was never use this provider again, if this is the way that their crews

are, I'll call the provider that I want and ask for.

So, my question is, was the IV's placed in a strang position or is this

acceptable? The guy was stable, and only one IV would have been enough, but I

think that this guy wanted to show off.

Thanks,

Wayne

---------------------------------

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[Non-text portions of this message have been removed]

[Guest guest]

Larry,

The second IV could have been started in the other hand or arm, as we had taken

the guys leather jacket off, so it's not like the other hand/arm was not

available. But, yes side by side in the left hand. As I have stated, he was

going to start 1 on top of another, but did not.

Wayne

Larry wrote:

I believe in distal to proximal whenever possible, but not two in the same

circulation feeder. Opposite limbs, not the same IF the second line is REALLY

necessary. I wonder how the air crew would react if someone stuck two angios in

the back of their hand?

There is no call for rudeness. The airmed business is becoming more competitive

and arriving like a paragod is NOT good for business. More people are going to

see this behaviour and make them vote with their feet. Contact the district

manager, or someone higher than the local level manager, and complain.

Life can be simple: Fly (drive) safe, give good care, and be nice. Can't get

simpler than that.

" Service is love made visible. Friendship is love made personal. Kindness is

love made tangible. Giving is love made believable " - Anonymous

Larry RN, (former) CFRN, LP

Houston Texas

[Guest guest]

Larry,

The second IV could have been started in the other hand or arm, as we had taken

the guys leather jacket off, so it's not like the other hand/arm was not

available. But, yes side by side in the left hand. As I have stated, he was

going to start 1 on top of another, but did not.

Wayne

Larry wrote:

I believe in distal to proximal whenever possible, but not two in the same

circulation feeder. Opposite limbs, not the same IF the second line is REALLY

necessary. I wonder how the air crew would react if someone stuck two angios in

the back of their hand?

There is no call for rudeness. The airmed business is becoming more competitive

and arriving like a paragod is NOT good for business. More people are going to

see this behaviour and make them vote with their feet. Contact the district

manager, or someone higher than the local level manager, and complain.

Life can be simple: Fly (drive) safe, give good care, and be nice. Can't get

simpler than that.

" Service is love made visible. Friendship is love made personal. Kindness is

love made tangible. Giving is love made believable " - Anonymous

Larry RN, (former) CFRN, LP

Houston Texas

[Guest guest]

I know that I have posted this before, but let me add a little more to the

entire situation. The pts leather jacket had been removed, so the right arm was

free and could have been used to start the second IV, but was not. They were

started side-by-side in the left hand. Both were 18g and not 16g. This was not

a mulit-trauma pt, but could have been if not for the helmet. It did have some

track marks on the back, but no major damage or in pieces.

The pt was stable, and as many have pointed out, one would have probably been

OK, as the pts v/s were not elevated, and were within normal limits. No SOB, no

CP, just mild pain to the neck, with no step-offs, but tender to palpation.

I've used many air medical providers in my time, and this was the first time

that I've ever had any problems with rude crews.

Wayne

" Kistner, T " wrote:

Based on your description, one was probably enough. I have seen two

large bore IV's started in the same arm, usually the AC and bicep or

back of the forearm. This was done in a major trauma center and at that

time acceptable practice. Care must be used so that a proximal site from

the same vein is not infiltrated, causing both to become useless.

Questionable IV & RUDE flight crew

A couple of weeks ago I was working a motorcycle race at a dirt track,

in whcih we had two riders hit each other. On arrival to the first

person, who was unresponsive and had snoring respirations, I asked that

an air medical serivce be called. The second person was also

unresponsive, but no snoring respirations. The first one was out for at

least 2-3 minutes.

All the necessary precautions were taken and he was placed in the unit.

The local EMS arrived and took care of the second person. I ask the

local EMS to call an air medical provider, and ask for either provider X

or Y, and thought that was who they called.

The air medical provider arrived and it was provider F, seems they have

a base close to this area, so they were called. The crew comes to my

unit and I give report to " kojack & Mr. Clean " . After this, they were

trying to decide if they wanted to start a line there or in the air. By

this time the pt was alert and talking. His family member was in the

unit talking with him also. They kick him out, and start barking orders

(the flight crew) they were almost tossed out on their ears they were so

rude. Finally Mr. Clean decides to start a line in the unit before

carrying the pt across the track. He starts one IV in the left hand,

and then wants to start another one in the same location. Correct me if

I'm wrong, but in BTLS it states that a bi-lateral IV is just that,

BI-LATERAL, meaning that one goes in one hand or arm and the other one

goes in the other.

It was suggested that we drive around to the other side of the track to

the awaiting helicopter. By EMT goes to drive around to the bird, and

the family member is still talking to the pt, and wanting to know where

he was being taken, as they were from out of town. The " flight medic "

yells again, and tells him to step back out of the door so we can go.

I was never use this provider again, if this is the way that their crews

are, I'll call the provider that I want and ask for.

So, my question is, was the IV's placed in a strang position or is this

acceptable? The guy was stable, and only one IV would have been enough,

but I think that this guy wanted to show off.

Thanks,

Wayne

---------------------------------

Yahoo! Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

I know that I have posted this before, but let me add a little more to the

entire situation. The pts leather jacket had been removed, so the right arm was

free and could have been used to start the second IV, but was not. They were

started side-by-side in the left hand. Both were 18g and not 16g. This was not

a mulit-trauma pt, but could have been if not for the helmet. It did have some

track marks on the back, but no major damage or in pieces.

The pt was stable, and as many have pointed out, one would have probably been

OK, as the pts v/s were not elevated, and were within normal limits. No SOB, no

CP, just mild pain to the neck, with no step-offs, but tender to palpation.

I've used many air medical providers in my time, and this was the first time

that I've ever had any problems with rude crews.

Wayne

" Kistner, T " wrote:

Based on your description, one was probably enough. I have seen two

large bore IV's started in the same arm, usually the AC and bicep or

back of the forearm. This was done in a major trauma center and at that

time acceptable practice. Care must be used so that a proximal site from

the same vein is not infiltrated, causing both to become useless.

Questionable IV & RUDE flight crew

A couple of weeks ago I was working a motorcycle race at a dirt track,

in whcih we had two riders hit each other. On arrival to the first

person, who was unresponsive and had snoring respirations, I asked that

an air medical serivce be called. The second person was also

unresponsive, but no snoring respirations. The first one was out for at

least 2-3 minutes.

All the necessary precautions were taken and he was placed in the unit.

The local EMS arrived and took care of the second person. I ask the

local EMS to call an air medical provider, and ask for either provider X

or Y, and thought that was who they called.

The air medical provider arrived and it was provider F, seems they have

a base close to this area, so they were called. The crew comes to my

unit and I give report to " kojack & Mr. Clean " . After this, they were

trying to decide if they wanted to start a line there or in the air. By

this time the pt was alert and talking. His family member was in the

unit talking with him also. They kick him out, and start barking orders

(the flight crew) they were almost tossed out on their ears they were so

rude. Finally Mr. Clean decides to start a line in the unit before

carrying the pt across the track. He starts one IV in the left hand,

and then wants to start another one in the same location. Correct me if

I'm wrong, but in BTLS it states that a bi-lateral IV is just that,

BI-LATERAL, meaning that one goes in one hand or arm and the other one

goes in the other.

It was suggested that we drive around to the other side of the track to

the awaiting helicopter. By EMT goes to drive around to the bird, and

the family member is still talking to the pt, and wanting to know where

he was being taken, as they were from out of town. The " flight medic "

yells again, and tells him to step back out of the door so we can go.

I was never use this provider again, if this is the way that their crews

are, I'll call the provider that I want and ask for.

So, my question is, was the IV's placed in a strang position or is this

acceptable? The guy was stable, and only one IV would have been enough,

but I think that this guy wanted to show off.

Thanks,

Wayne

---------------------------------

Yahoo! Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

Not trying to create problems here but if the patient had stable v/s and you

" saw no need to attempt the IV " , then how can you justify a helicopter

rather than ground transport with the difference in time being 30 minutes?

Just curious,

Sam, LP

Re: Questionable IV & RUDE flight crew

> ,

>

> Ground transport to a level 2 facility would have taken about 45. The pt

> was stable and talking when the air craft arrived, and it only took about

> 15 for them to get there from the time that they were called. No IV was

> attempted by us, as we were still assessing the pt, who was again by now

> alert and talking. At that point, I saw no need to attempt the IV. Now,

> had this pt been unstable and needed IV access for meds, then YES an IV

> would have been started, if not to.

>

> The medic think about starting one IV above the other one, and then

> decided that he would start it right next to the first one.

>

> Wayne

>

> lisawhir@... wrote:

>

> Wayne and all,

>

> Most of what I want to say has been said already by others on the list,

> but

> I somehow feel the need to echo it anyway for this kind of thing is near

> and

> dear to me.

>

> From the ground crew stand point, was the helicopter needed? It sounds

> like

> it was in the beginning providing that transporting by ground to an

> appropriate trauma center would have taken more than 30-45 minutes. How

> long did the

> ground crew wait for the aircraft? Did the ground crew attempt an IV,

> but

> was unsuccessful prior to the arrival of the air crew? Once the patient

> became alert and stable, how far out was the helicopter? It is

> acceptable to

> cancel a helicopter if it's no longer needed.

>

> Once the air crew was there, from what you have described, there would

> have

> been no reason to start an IV on-scene. IV's can be initiated in the

> aircraft and should be if there is not an emergent need such as

> medications to

> facilitate intubation, immediate fluid resuscitation, etc.

>

> Starting two IV's on the same side ... as long as there is two different

> vein paths, I haven't heard of this being a problem. Starting it in the

> same

> vein, maybe not a good idea. Sometimes the air crew has better access to

> one

> arm over the other depending on how their aircraft is configured. But,

> again,

> it sounds like they didn't need to start the IV on-scene.

>

> The rudeness is completely unacceptable. There is NO excuse for that!

> Our

> jobs, both ground and air come with stresses. The EMS crew, the patient,

> the

> family and any other personnel on-scene (fire and police) should be

> treated

> with kindness and respect by the air crew regardless of what kind of

> pressure

> or stress they're under. You absolutely should call their

> supervisor/director and report the bad behavior. And, as someone else

> has mentioned, it would

> be beneficial to QI the call with the air crew as well to try and

> understand

> what their rational was for what they did clinically. It would surprise

> me

> if their protocols and or Medical Director supports starting an IV or two

> on-scene when they could have done it in the aircraft. After all, the

> helicopter is supposed to save time, right?

>

> If this particular provider displays this behavior on a regular basis

> and/or

> makes bad decisions clinically, don't use them! How would that be

> benefiting the patient? If you have more than one helicopter service in

> your area,

> call the one that does the best job and does it safely.

>

> Good luck,

>

>

>

>

>

> In a message dated 10/18/2005 1:14:27 PM Central Standard Time,

> rxmd911@... writes:

>

> A couple of weeks ago I was working a motorcycle race at a dirt track, in

> whcih we had two riders hit each other. On arrival to the first person,

> who

> was unresponsive and had snoring respirations, I asked that an air

> medical

> serivce be called. The second person was also unresponsive, but no

> snoring

> respirations. The first one was out for at least 2-3 minutes.

>

> All the necessary precautions were taken and he was placed in the unit.

> The

> local EMS arrived and took care of the second person. I ask the local

> EMS

> to call an air medical provider, and ask for either provider X or Y, and

> thought that was who they called.

>

> The air medical provider arrived and it was provider F, seems they have a

> base close to this area, so they were called. The crew comes to my unit

> and I

> give report to " kojack & Mr. Clean " . After this, they were trying to

> decide

> if they wanted to start a line there or in the air. By this time the pt

> was

> alert and talking. His family member was in the unit talking with him

> also.

> They kick him out, and start barking orders (the flight crew) they were

> almost tossed out on their ears they were so rude. Finally Mr. Clean

> decides to

> start a line in the unit before carrying the pt across the track. He

> starts

> one IV in the left hand, and then wants to start another one in the same

> location. Correct me if I'm wrong, but in BTLS it states that a

> bi-lateral IV

> is just that, BI-LATERAL, meaning that one goes in one hand or arm and

> the

> other one goes in the other.

>

> It was suggested that we drive around to the other side of the track to

> the

> awaiting helicopter. By EMT goes to drive around to the bird, and the

> family

> member is still talking to the pt, and wanting to know where he was being

> taken, as they were from out of town. The " flight medic " yells again,

> and

> tells him to step back out of the door so we can go.

>

> I was never use this provider again, if this is the way that their crews

> are, I'll call the provider that I want and ask for.

>

> So, my question is, was the IV's placed in a strang position or is this

> acceptable? The guy was stable, and only one IV would have been enough,

> but I

> think that this guy wanted to show off.

>

> Thanks,

> Wayne

>

>

> ---------------------------------

> Yahoo! Music Unlimited - Access over 1 million songs. Try it free.

>

> [Non-text portions of this message have been removed]

>

>

>

>

>

>

>

>

[Guest guest]

Not trying to create problems here but if the patient had stable v/s and you

" saw no need to attempt the IV " , then how can you justify a helicopter

rather than ground transport with the difference in time being 30 minutes?

Just curious,

Sam, LP

Re: Questionable IV & RUDE flight crew

> ,

>

> Ground transport to a level 2 facility would have taken about 45. The pt

> was stable and talking when the air craft arrived, and it only took about

> 15 for them to get there from the time that they were called. No IV was

> attempted by us, as we were still assessing the pt, who was again by now

> alert and talking. At that point, I saw no need to attempt the IV. Now,

> had this pt been unstable and needed IV access for meds, then YES an IV

> would have been started, if not to.

>

> The medic think about starting one IV above the other one, and then

> decided that he would start it right next to the first one.

>

> Wayne

>

> lisawhir@... wrote:

>

> Wayne and all,

>

> Most of what I want to say has been said already by others on the list,

> but

> I somehow feel the need to echo it anyway for this kind of thing is near

> and

> dear to me.

>

> From the ground crew stand point, was the helicopter needed? It sounds

> like

> it was in the beginning providing that transporting by ground to an

> appropriate trauma center would have taken more than 30-45 minutes. How

> long did the

> ground crew wait for the aircraft? Did the ground crew attempt an IV,

> but

> was unsuccessful prior to the arrival of the air crew? Once the patient

> became alert and stable, how far out was the helicopter? It is

> acceptable to

> cancel a helicopter if it's no longer needed.

>

> Once the air crew was there, from what you have described, there would

> have

> been no reason to start an IV on-scene. IV's can be initiated in the

> aircraft and should be if there is not an emergent need such as

> medications to

> facilitate intubation, immediate fluid resuscitation, etc.

>

> Starting two IV's on the same side ... as long as there is two different

> vein paths, I haven't heard of this being a problem. Starting it in the

> same

> vein, maybe not a good idea. Sometimes the air crew has better access to

> one

> arm over the other depending on how their aircraft is configured. But,

> again,

> it sounds like they didn't need to start the IV on-scene.

>

> The rudeness is completely unacceptable. There is NO excuse for that!

> Our

> jobs, both ground and air come with stresses. The EMS crew, the patient,

> the

> family and any other personnel on-scene (fire and police) should be

> treated

> with kindness and respect by the air crew regardless of what kind of

> pressure

> or stress they're under. You absolutely should call their

> supervisor/director and report the bad behavior. And, as someone else

> has mentioned, it would

> be beneficial to QI the call with the air crew as well to try and

> understand

> what their rational was for what they did clinically. It would surprise

> me

> if their protocols and or Medical Director supports starting an IV or two

> on-scene when they could have done it in the aircraft. After all, the

> helicopter is supposed to save time, right?

>

> If this particular provider displays this behavior on a regular basis

> and/or

> makes bad decisions clinically, don't use them! How would that be

> benefiting the patient? If you have more than one helicopter service in

> your area,

> call the one that does the best job and does it safely.

>

> Good luck,

>

>

>

>

>

> In a message dated 10/18/2005 1:14:27 PM Central Standard Time,

> rxmd911@... writes:

>

> A couple of weeks ago I was working a motorcycle race at a dirt track, in

> whcih we had two riders hit each other. On arrival to the first person,

> who

> was unresponsive and had snoring respirations, I asked that an air

> medical

> serivce be called. The second person was also unresponsive, but no

> snoring

> respirations. The first one was out for at least 2-3 minutes.

>

> All the necessary precautions were taken and he was placed in the unit.

> The

> local EMS arrived and took care of the second person. I ask the local

> EMS

> to call an air medical provider, and ask for either provider X or Y, and

> thought that was who they called.

>

> The air medical provider arrived and it was provider F, seems they have a

> base close to this area, so they were called. The crew comes to my unit

> and I

> give report to " kojack & Mr. Clean " . After this, they were trying to

> decide

> if they wanted to start a line there or in the air. By this time the pt

> was

> alert and talking. His family member was in the unit talking with him

> also.

> They kick him out, and start barking orders (the flight crew) they were

> almost tossed out on their ears they were so rude. Finally Mr. Clean

> decides to

> start a line in the unit before carrying the pt across the track. He

> starts

> one IV in the left hand, and then wants to start another one in the same

> location. Correct me if I'm wrong, but in BTLS it states that a

> bi-lateral IV

> is just that, BI-LATERAL, meaning that one goes in one hand or arm and

> the

> other one goes in the other.

>

> It was suggested that we drive around to the other side of the track to

> the

> awaiting helicopter. By EMT goes to drive around to the bird, and the

> family

> member is still talking to the pt, and wanting to know where he was being

> taken, as they were from out of town. The " flight medic " yells again,

> and

> tells him to step back out of the door so we can go.

>

> I was never use this provider again, if this is the way that their crews

> are, I'll call the provider that I want and ask for.

>

> So, my question is, was the IV's placed in a strang position or is this

> acceptable? The guy was stable, and only one IV would have been enough,

> but I

> think that this guy wanted to show off.

>

> Thanks,

> Wayne

>

>

> ---------------------------------

> Yahoo! Music Unlimited - Access over 1 million songs. Try it free.

>

> [Non-text portions of this message have been removed]

>

>

>

>

>

>

>

>

[Guest guest]

Well....let me take a stab at this.

I have no connection to flight services however I believe they are valid things

to have when you either A) need to move with great speed to a definitive care

facility or the patient needs a treatment that the air provider has that the

ground crew cannot provide and the patient outcome would be detrimental without

this treatment (i.e. airway/ventilation options not carried by the ground crew).

I think it is a shame that the crew was rude...as I am sure that no one else in

EMS has ever been rude or made comments that in hind-sight they wish hadn't been

made or had a bad day...I mean...the onslaught of out of work EMS supervisors

testifies to this...

Next, why was the helicopter not canceled and the patient ground transported to

the hospital of choice. Having trouble seeing why the helicopter was

needed...and actually why the patient needed to be transported to a Level II or

Level I trauma center. How far away was the closest hospital with a CT scanner?

Lastly, we have determined that the ground agency wouldn't have started an IV if

they had completed the transport...then why are we complaining about the process

and procedures used by the flight crew to do a treatment they felt was necessary

after the ground crew felt it was not a necessary treatment? Again...if the

patient didn't warrant a prophylactic IV (even a saline lock)...why did they

need to be FLOWN to a trauma center?

I believe that not only is the proliferation of flight services in Texas a

problem...the proliferation of flying totally non-appropriate patients to a

trauma center (taking up a helicopter and trauma bed unnecessarily when it could

be needed by someone else) is another BIG growing problem.

Wayne, before you hit reply and start getting upset...I am not really doubting

what you did (I wasn't there) as much as using your circumstances as a

springboard to discussion about why local hospitals cannot care and treat

non-trauma alert patients and that ground transport agencies can no longer

" handle " or " care for " trauma patients...

Let me ask one other question...how long was this patient in the hospital and

what was their discharge diagnosis? 45 minute transport time? What's wrong

with that?

Questionable IV & RUDE flight crew

A couple of weeks ago I was working a motorcycle race at a dirt track,

in whcih we had two riders hit each other. On arrival to the first

person, who was unresponsive and had snoring respirations, I asked that

an air medical serivce be called. The second person was also

unresponsive, but no snoring respirations. The first one was out for at

least 2-3 minutes.

All the necessary precautions were taken and he was placed in the unit.

The local EMS arrived and took care of the second person. I ask the

local EMS to call an air medical provider, and ask for either provider X

or Y, and thought that was who they called.

The air medical provider arrived and it was provider F, seems they have

a base close to this area, so they were called. The crew comes to my

unit and I give report to " kojack & Mr. Clean " . After this, they were

trying to decide if they wanted to start a line there or in the air. By

this time the pt was alert and talking. His family member was in the

unit talking with him also. They kick him out, and start barking orders

(the flight crew) they were almost tossed out on their ears they were so

rude. Finally Mr. Clean decides to start a line in the unit before

carrying the pt across the track. He starts one IV in the left hand,

and then wants to start another one in the same location. Correct me if

I'm wrong, but in BTLS it states that a bi-lateral IV is just that,

BI-LATERAL, meaning that one goes in one hand or arm and the other one

goes in the other.

It was suggested that we drive around to the other side of the track to

the awaiting helicopter. By EMT goes to drive around to the bird, and

the family member is still talking to the pt, and wanting to know where

he was being taken, as they were from out of town. The " flight medic "

yells again, and tells him to step back out of the door so we can go.

I was never use this provider again, if this is the way that their crews

are, I'll call the provider that I want and ask for.

So, my question is, was the IV's placed in a strang position or is this

acceptable? The guy was stable, and only one IV would have been enough,

but I think that this guy wanted to show off.

Thanks,

Wayne

---------------------------------

Yahoo! Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

Well....let me take a stab at this.

I have no connection to flight services however I believe they are valid things

to have when you either A) need to move with great speed to a definitive care

facility or the patient needs a treatment that the air provider has that the

ground crew cannot provide and the patient outcome would be detrimental without

this treatment (i.e. airway/ventilation options not carried by the ground crew).

I think it is a shame that the crew was rude...as I am sure that no one else in

EMS has ever been rude or made comments that in hind-sight they wish hadn't been

made or had a bad day...I mean...the onslaught of out of work EMS supervisors

testifies to this...

Next, why was the helicopter not canceled and the patient ground transported to

the hospital of choice. Having trouble seeing why the helicopter was

needed...and actually why the patient needed to be transported to a Level II or

Level I trauma center. How far away was the closest hospital with a CT scanner?

Lastly, we have determined that the ground agency wouldn't have started an IV if

they had completed the transport...then why are we complaining about the process

and procedures used by the flight crew to do a treatment they felt was necessary

after the ground crew felt it was not a necessary treatment? Again...if the

patient didn't warrant a prophylactic IV (even a saline lock)...why did they

need to be FLOWN to a trauma center?

I believe that not only is the proliferation of flight services in Texas a

problem...the proliferation of flying totally non-appropriate patients to a

trauma center (taking up a helicopter and trauma bed unnecessarily when it could

be needed by someone else) is another BIG growing problem.

Wayne, before you hit reply and start getting upset...I am not really doubting

what you did (I wasn't there) as much as using your circumstances as a

springboard to discussion about why local hospitals cannot care and treat

non-trauma alert patients and that ground transport agencies can no longer

" handle " or " care for " trauma patients...

Let me ask one other question...how long was this patient in the hospital and

what was their discharge diagnosis? 45 minute transport time? What's wrong

with that?

Questionable IV & RUDE flight crew

A couple of weeks ago I was working a motorcycle race at a dirt track,

in whcih we had two riders hit each other. On arrival to the first

person, who was unresponsive and had snoring respirations, I asked that

an air medical serivce be called. The second person was also

unresponsive, but no snoring respirations. The first one was out for at

least 2-3 minutes.

All the necessary precautions were taken and he was placed in the unit.

The local EMS arrived and took care of the second person. I ask the

local EMS to call an air medical provider, and ask for either provider X

or Y, and thought that was who they called.

The air medical provider arrived and it was provider F, seems they have

a base close to this area, so they were called. The crew comes to my

unit and I give report to " kojack & Mr. Clean " . After this, they were

trying to decide if they wanted to start a line there or in the air. By

this time the pt was alert and talking. His family member was in the

unit talking with him also. They kick him out, and start barking orders

(the flight crew) they were almost tossed out on their ears they were so

rude. Finally Mr. Clean decides to start a line in the unit before

carrying the pt across the track. He starts one IV in the left hand,

and then wants to start another one in the same location. Correct me if

I'm wrong, but in BTLS it states that a bi-lateral IV is just that,

BI-LATERAL, meaning that one goes in one hand or arm and the other one

goes in the other.

It was suggested that we drive around to the other side of the track to

the awaiting helicopter. By EMT goes to drive around to the bird, and

the family member is still talking to the pt, and wanting to know where

he was being taken, as they were from out of town. The " flight medic "

yells again, and tells him to step back out of the door so we can go.

I was never use this provider again, if this is the way that their crews

are, I'll call the provider that I want and ask for.

So, my question is, was the IV's placed in a strang position or is this

acceptable? The guy was stable, and only one IV would have been enough,

but I think that this guy wanted to show off.

Thanks,

Wayne

---------------------------------

Yahoo! Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

Short of an expanding epidural hematoma, what neurosurgical lesion would be

better off with the minimal difference in speed between a helicopter and

ground ambulance? If the helicopter were at the scene at the time of injury,

then maybe. But to sit and wait for a helicopter with an operational ground

ambulance borders on negligence (and don't give me the argument that they

would have to stop the rodeo/race/polo match/rugby game/ballet recital until

another ambulance arrives--that is defined as lunacy). Second, the

literature is showing that prehospital airway interventions increase

mortality in neurological trauma. Thus, holding somebody for a helicopter

crew to perform a non-indicated procedure is a non-sequiter and probably

negligent.

It is a sad day in Texas when patient transport decisions are based upon who

bought pizza at the last meeting, who hands out colorful hats and pins,

whose coffee mug is the neatest--or who offers the best kickback.

I just attended a meeting in Oz yesterday where the flight paramedics were

looking at ways to decrease unnecessary and non-beneficial use of their

helicopter (which is primarily a rescue device as there is no Coast Guard in

Australia). They don' want to assume the risk of making a transport unless

the patient clearly might benefit. Of course, their service is

not-for-profit. In the United States, the struggle for the legal tender

justifies all behavior. I'll send them some beanies with rotors on top and a

gross of helicopter transport pins.

BEB

PS: Watch the video from this USC EM professor--he throws more hand grenades

at this madness than I do (

<http://emedhome.com/cme/lecture/Lecture36/player.html>

http://emedhome.com/cme/lecture/Lecture36/player.html)

_____

From: [mailto: ] On

Behalf Of THEDUDMAN@...

Sent: Wednesday, October 19, 2005 10:00 PM

To:

Subject: Re: Questionable IV & RUDE flight crew

Well....let me take a stab at this.

I have no connection to flight services however I believe they are valid

things to have when you either A) need to move with great speed to a

definitive care facility or the patient needs a treatment that the air

provider has that the ground crew cannot provide and the patient outcome

would be detrimental without this treatment (i.e. airway/ventilation options

not carried by the ground crew).

I think it is a shame that the crew was rude...as I am sure that no one else

in EMS has ever been rude or made comments that in hind-sight they wish

hadn't been made or had a bad day...I mean...the onslaught of out of work

EMS supervisors testifies to this...

Next, why was the helicopter not canceled and the patient ground transported

to the hospital of choice. Having trouble seeing why the helicopter was

needed...and actually why the patient needed to be transported to a Level II

or Level I trauma center. How far away was the closest hospital with a CT

scanner?

Lastly, we have determined that the ground agency wouldn't have started an

IV if they had completed the transport...then why are we complaining about

the process and procedures used by the flight crew to do a treatment they

felt was necessary after the ground crew felt it was not a necessary

treatment? Again...if the patient didn't warrant a prophylactic IV (even a

saline lock)...why did they need to be FLOWN to a trauma center?

I believe that not only is the proliferation of flight services in Texas a

problem...the proliferation of flying totally non-appropriate patients to a

trauma center (taking up a helicopter and trauma bed unnecessarily when it

could be needed by someone else) is another BIG growing problem.

Wayne, before you hit reply and start getting upset...I am not really

doubting what you did (I wasn't there) as much as using your circumstances

as a springboard to discussion about why local hospitals cannot care and

treat non-trauma alert patients and that ground transport agencies can no

longer " handle " or " care for " trauma patients...

Let me ask one other question...how long was this patient in the hospital

and what was their discharge diagnosis? 45 minute transport time? What's

wrong with that?

Questionable IV & RUDE flight crew

A couple of weeks ago I was working a motorcycle race at a dirt track,

in whcih we had two riders hit each other. On arrival to the first

person, who was unresponsive and had snoring respirations, I asked that

an air medical serivce be called. The second person was also

unresponsive, but no snoring respirations. The first one was out for at

least 2-3 minutes.

All the necessary precautions were taken and he was placed in the unit.

The local EMS arrived and took care of the second person. I ask the

local EMS to call an air medical provider, and ask for either provider X

or Y, and thought that was who they called.

The air medical provider arrived and it was provider F, seems they have

a base close to this area, so they were called. The crew comes to my

unit and I give report to " kojack & Mr. Clean " . After this, they were

trying to decide if they wanted to start a line there or in the air. By

this time the pt was alert and talking. His family member was in the

unit talking with him also. They kick him out, and start barking orders

(the flight crew) they were almost tossed out on their ears they were so

rude. Finally Mr. Clean decides to start a line in the unit before

carrying the pt across the track. He starts one IV in the left hand,

and then wants to start another one in the same location. Correct me if

I'm wrong, but in BTLS it states that a bi-lateral IV is just that,

BI-LATERAL, meaning that one goes in one hand or arm and the other one

goes in the other.

It was suggested that we drive around to the other side of the track to

the awaiting helicopter. By EMT goes to drive around to the bird, and

the family member is still talking to the pt, and wanting to know where

he was being taken, as they were from out of town. The " flight medic "

yells again, and tells him to step back out of the door so we can go.

I was never use this provider again, if this is the way that their crews

are, I'll call the provider that I want and ask for.

So, my question is, was the IV's placed in a strang position or is this

acceptable? The guy was stable, and only one IV would have been enough,

but I think that this guy wanted to show off.

Thanks,

Wayne

---------------------------------

Yahoo! Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

Short of an expanding epidural hematoma, what neurosurgical lesion would be

better off with the minimal difference in speed between a helicopter and

ground ambulance? If the helicopter were at the scene at the time of injury,

then maybe. But to sit and wait for a helicopter with an operational ground

ambulance borders on negligence (and don't give me the argument that they

would have to stop the rodeo/race/polo match/rugby game/ballet recital until

another ambulance arrives--that is defined as lunacy). Second, the

literature is showing that prehospital airway interventions increase

mortality in neurological trauma. Thus, holding somebody for a helicopter

crew to perform a non-indicated procedure is a non-sequiter and probably

negligent.

It is a sad day in Texas when patient transport decisions are based upon who

bought pizza at the last meeting, who hands out colorful hats and pins,

whose coffee mug is the neatest--or who offers the best kickback.

I just attended a meeting in Oz yesterday where the flight paramedics were

looking at ways to decrease unnecessary and non-beneficial use of their

helicopter (which is primarily a rescue device as there is no Coast Guard in

Australia). They don' want to assume the risk of making a transport unless

the patient clearly might benefit. Of course, their service is

not-for-profit. In the United States, the struggle for the legal tender

justifies all behavior. I'll send them some beanies with rotors on top and a

gross of helicopter transport pins.

BEB

PS: Watch the video from this USC EM professor--he throws more hand grenades

at this madness than I do (

<http://emedhome.com/cme/lecture/Lecture36/player.html>

http://emedhome.com/cme/lecture/Lecture36/player.html)

_____

From: [mailto: ] On

Behalf Of THEDUDMAN@...

Sent: Wednesday, October 19, 2005 10:00 PM

To:

Subject: Re: Questionable IV & RUDE flight crew

Well....let me take a stab at this.

I have no connection to flight services however I believe they are valid

things to have when you either A) need to move with great speed to a

definitive care facility or the patient needs a treatment that the air

provider has that the ground crew cannot provide and the patient outcome

would be detrimental without this treatment (i.e. airway/ventilation options

not carried by the ground crew).

I think it is a shame that the crew was rude...as I am sure that no one else

in EMS has ever been rude or made comments that in hind-sight they wish

hadn't been made or had a bad day...I mean...the onslaught of out of work

EMS supervisors testifies to this...

Next, why was the helicopter not canceled and the patient ground transported

to the hospital of choice. Having trouble seeing why the helicopter was

needed...and actually why the patient needed to be transported to a Level II

or Level I trauma center. How far away was the closest hospital with a CT

scanner?

Lastly, we have determined that the ground agency wouldn't have started an

IV if they had completed the transport...then why are we complaining about

the process and procedures used by the flight crew to do a treatment they

felt was necessary after the ground crew felt it was not a necessary

treatment? Again...if the patient didn't warrant a prophylactic IV (even a

saline lock)...why did they need to be FLOWN to a trauma center?

I believe that not only is the proliferation of flight services in Texas a

problem...the proliferation of flying totally non-appropriate patients to a

trauma center (taking up a helicopter and trauma bed unnecessarily when it

could be needed by someone else) is another BIG growing problem.

Wayne, before you hit reply and start getting upset...I am not really

doubting what you did (I wasn't there) as much as using your circumstances

as a springboard to discussion about why local hospitals cannot care and

treat non-trauma alert patients and that ground transport agencies can no

longer " handle " or " care for " trauma patients...

Let me ask one other question...how long was this patient in the hospital

and what was their discharge diagnosis? 45 minute transport time? What's

wrong with that?

Questionable IV & RUDE flight crew

A couple of weeks ago I was working a motorcycle race at a dirt track,

in whcih we had two riders hit each other. On arrival to the first

person, who was unresponsive and had snoring respirations, I asked that

an air medical serivce be called. The second person was also

unresponsive, but no snoring respirations. The first one was out for at

least 2-3 minutes.

All the necessary precautions were taken and he was placed in the unit.

The local EMS arrived and took care of the second person. I ask the

local EMS to call an air medical provider, and ask for either provider X

or Y, and thought that was who they called.

The air medical provider arrived and it was provider F, seems they have

a base close to this area, so they were called. The crew comes to my

unit and I give report to " kojack & Mr. Clean " . After this, they were

trying to decide if they wanted to start a line there or in the air. By

this time the pt was alert and talking. His family member was in the

unit talking with him also. They kick him out, and start barking orders

(the flight crew) they were almost tossed out on their ears they were so

rude. Finally Mr. Clean decides to start a line in the unit before

carrying the pt across the track. He starts one IV in the left hand,

and then wants to start another one in the same location. Correct me if

I'm wrong, but in BTLS it states that a bi-lateral IV is just that,

BI-LATERAL, meaning that one goes in one hand or arm and the other one

goes in the other.

It was suggested that we drive around to the other side of the track to

the awaiting helicopter. By EMT goes to drive around to the bird, and

the family member is still talking to the pt, and wanting to know where

he was being taken, as they were from out of town. The " flight medic "

yells again, and tells him to step back out of the door so we can go.

I was never use this provider again, if this is the way that their crews

are, I'll call the provider that I want and ask for.

So, my question is, was the IV's placed in a strang position or is this

acceptable? The guy was stable, and only one IV would have been enough,

but I think that this guy wanted to show off.

Thanks,

Wayne

---------------------------------

Yahoo! Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

Dudley,

I appreciate your comments. Actually, I wasn't asking if it was acceptable,

I was stating that it is indeed acceptable to cancel a helicopter if it's no

longer needed. Unfortunately, I didn't make my statement clear. Sorry for

the confusion.

As a flight medic/nurse, I have landed on a scene (or two or more over the

years) where the patient is still trapped. After 30 minutes of extrication,

the patient was stable enough to go by ground to a Level 3 or even 4 with the

prediction that the patient would be released after evaluation by a

physician. We simply assisted the ground crew (if requested to do so) and then

left

after being on scene for a considerable amount of time. Not a big deal. I

don't know of any flight services that have any issue with that either.

Again, sorry for the confusion with my statement, but thanks for pointing

that out.

PS - This email is being sent at 10:10 in the morning. This yahoo group

isn't very fast. The post I sent yesterday before 08:00 didn't arrive in my

inbox until 23:36 last night. What's up with that???

In a message dated 10/20/2005 9:57:42 AM Central Standard Time,

THEDUDMAN@... writes:

LIsa,

You asked: " It is acceptable to cancel a helicopter if it's no longer

needed. "

My opinion and our operating protocol is YES absolutely...not only is it

acceptable, it is expected. We have had helicopters on final approach and sent

them back home...we even had one we called them for because we had difficulty

accessing the patient. His pickup was hit by a train and we had a lot of

work to do to get him out of the truck...the helicopter was on the ground and

shut off when we got him out of the truck finally.

After evaluation and a long conversation to convince the patient that he at

least needed to go to the ED for evaluation (as he was really trying to

refuse and was competant to do so) the helicopter crew went back to base and we

transported him to a local ER non-emergency....

The point of no return, in my opinion, is after the helicopter is off the

ground with the patient on board...up until then, they can still be cancelled.

Dudley

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

From: lisawhir@...

To:

Sent: Wed, 19 Oct 2005 08:59:52 EDT

Subject: Re: Questionable IV & RUDE flight crew

Wayne and all,

Most of what I want to say has been said already by others on the list, but

I somehow feel the need to echo it anyway for this kind of thing is near and

dear to me.

From the ground crew stand point, was the helicopter needed? It sounds

like

it was in the beginning providing that transporting by ground to an

appropriate trauma center would have taken more than 30-45 minutes. How

long

did the

ground crew wait for the aircraft? Did the ground crew attempt an IV, but

was unsuccessful prior to the arrival of the air crew? Once the patient

became alert and stable, how far out was the helicopter? It is acceptable

to

cancel a helicopter if it's no longer needed.

Once the air crew was there, from what you have described, there would have

been no reason to start an IV on-scene. IV's can be initiated in the

aircraft and should be if there is not an emergent need such as medications

to

facilitate intubation, immediate fluid resuscitation, etc.

Starting two IV's on the same side ... as long as there is two different

vein paths, I haven't heard of this being a problem. Starting it in the

same

vein, maybe not a good idea. Sometimes the air crew has better access to

one

arm over the other depending on how their aircraft is configured. But,

again,

it sounds like they didn't need to start the IV on-scene.

The rudeness is completely unacceptable. There is NO excuse for that! Our

jobs, both ground and air come with stresses. The EMS crew, the patient,

the

family and any other personnel on-scene (fire and police) should be treated

with kindness and respect by the air crew regardless of what kind of

pressure

or stress they're under. You absolutely should call their

supervisor/director and report the bad behavior. And, as someone else has

mentioned, it would

be beneficial to QI the call with the air crew as well to try and

understand

what their rational was for what they did clinically. It would surprise me

if their protocols and or Medical Director supports starting an IV or two

on-scene when they could have done it in the aircraft. After all, the

helicopter is supposed to save time, right?

If this particular provider displays this behavior on a regular basis

and/or

makes bad decisions clinically, don't use them! How would that be

benefiting the patient? If you have more than one helicopter service in

your

area,

call the one that does the best job and does it safely.

Good luck,

In a message dated 10/18/2005 1:14:27 PM Central Standard Time,

rxmd911@... writes:

A couple of weeks ago I was working a motorcycle race at a dirt track, in

whcih we had two riders hit each other. On arrival to the first person,

who

was unresponsive and had snoring respirations, I asked that an air medical

serivce be called. The second person was also unresponsive, but no snoring

respirations. The first one was out for at least 2-3 minutes.

All the necessary precautions were taken and he was placed in the unit.

The

local EMS arrived and took care of the second person. I ask the local EMS

to call an air medical provider, and ask for either provider X or Y, and

thought that was who they called.

The air medical provider arrived and it was provider F, seems they have a

base close to this area, so they were called. The crew comes to my unit

and I

give report to " kojack & Mr. Clean " . After this, they were trying to

decide

if they wanted to start a line there or in the air. By this time the pt

was

alert and talking. His family member was in the unit talking with him

also.

They kick him out, and start barking orders (the flight crew) they were

almost tossed out on their ears they were so rude. Finally Mr. Clean

decides

to

start a line in the unit before carrying the pt across the track. He

starts

one IV in the left hand, and then wants to start another one in the same

location. Correct me if I'm wrong, but in BTLS it states that a bi-lateral

IV

is just that, BI-LATERAL, meaning that one goes in one hand or arm and the

other one goes in the other.

It was suggested that we drive around to the other side of the track to the

awaiting helicopter. By EMT goes to drive around to the bird, and the

family

member is still talking to the pt, and wanting to know where he was being

taken, as they were from out of town. The " flight medic " yells again, and

tells him to step back out of the door so we can go.

I was never use this provider again, if this is the way that their crews

are, I'll call the provider that I want and ask for.

So, my question is, was the IV's placed in a strang position or is this

acceptable? The guy was stable, and only one IV would have been enough,

but I

think that this guy wanted to show off.

Thanks,

Wayne

---------------------------------

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[Non-text portions of this message have been removed]

[Guest guest]

LIsa,

You asked: " It is acceptable to cancel a helicopter if it's no longer needed. "

My opinion and our operating protocol is YES absolutely...not only is it

acceptable, it is expected. We have had helicopters on final approach and sent

them back home...we even had one we called them for because we had difficulty

accessing the patient. His pickup was hit by a train and we had a lot of work to

do to get him out of the truck...the helicopter was on the ground and shut off

when we got him out of the truck finally.

After evaluation and a long conversation to convince the patient that he at

least needed to go to the ED for evaluation (as he was really trying to refuse

and was competant to do so) the helicopter crew went back to base and we

transported him to a local ER non-emergency....

The point of no return, in my opinion, is after the helicopter is off the ground

with the patient on board...up until then, they can still be cancelled.

Dudley

Re: Questionable IV & RUDE flight crew

Wayne and all,

Most of what I want to say has been said already by others on the list, but

I somehow feel the need to echo it anyway for this kind of thing is near and

dear to me.

From the ground crew stand point, was the helicopter needed? It sounds like

it was in the beginning providing that transporting by ground to an

appropriate trauma center would have taken more than 30-45 minutes. How long

did the

ground crew wait for the aircraft? Did the ground crew attempt an IV, but

was unsuccessful prior to the arrival of the air crew? Once the patient

became alert and stable, how far out was the helicopter? It is acceptable to

cancel a helicopter if it's no longer needed.

Once the air crew was there, from what you have described, there would have

been no reason to start an IV on-scene. IV's can be initiated in the

aircraft and should be if there is not an emergent need such as medications to

facilitate intubation, immediate fluid resuscitation, etc.

Starting two IV's on the same side ... as long as there is two different

vein paths, I haven't heard of this being a problem. Starting it in the same

vein, maybe not a good idea. Sometimes the air crew has better access to one

arm over the other depending on how their aircraft is configured. But, again,

it sounds like they didn't need to start the IV on-scene.

The rudeness is completely unacceptable. There is NO excuse for that! Our

jobs, both ground and air come with stresses. The EMS crew, the patient, the

family and any other personnel on-scene (fire and police) should be treated

with kindness and respect by the air crew regardless of what kind of pressure

or stress they're under. You absolutely should call their

supervisor/director and report the bad behavior. And, as someone else has

mentioned, it would

be beneficial to QI the call with the air crew as well to try and understand

what their rational was for what they did clinically. It would surprise me

if their protocols and or Medical Director supports starting an IV or two

on-scene when they could have done it in the aircraft. After all, the

helicopter is supposed to save time, right?

If this particular provider displays this behavior on a regular basis and/or

makes bad decisions clinically, don't use them! How would that be

benefiting the patient? If you have more than one helicopter service in your

area,

call the one that does the best job and does it safely.

Good luck,

In a message dated 10/18/2005 1:14:27 PM Central Standard Time,

rxmd911@... writes:

A couple of weeks ago I was working a motorcycle race at a dirt track, in

whcih we had two riders hit each other. On arrival to the first person, who

was unresponsive and had snoring respirations, I asked that an air medical

serivce be called. The second person was also unresponsive, but no snoring

respirations. The first one was out for at least 2-3 minutes.

All the necessary precautions were taken and he was placed in the unit. The

local EMS arrived and took care of the second person. I ask the local EMS

to call an air medical provider, and ask for either provider X or Y, and

thought that was who they called.

The air medical provider arrived and it was provider F, seems they have a

base close to this area, so they were called. The crew comes to my unit and I

give report to " kojack & Mr. Clean " . After this, they were trying to decide

if they wanted to start a line there or in the air. By this time the pt was

alert and talking. His family member was in the unit talking with him also.

They kick him out, and start barking orders (the flight crew) they were

almost tossed out on their ears they were so rude. Finally Mr. Clean decides

to

start a line in the unit before carrying the pt across the track. He starts

one IV in the left hand, and then wants to start another one in the same

location. Correct me if I'm wrong, but in BTLS it states that a bi-lateral IV

is just that, BI-LATERAL, meaning that one goes in one hand or arm and the

other one goes in the other.

It was suggested that we drive around to the other side of the track to the

awaiting helicopter. By EMT goes to drive around to the bird, and the family

member is still talking to the pt, and wanting to know where he was being

taken, as they were from out of town. The " flight medic " yells again, and

tells him to step back out of the door so we can go.

I was never use this provider again, if this is the way that their crews

are, I'll call the provider that I want and ask for.

So, my question is, was the IV's placed in a strang position or is this

acceptable? The guy was stable, and only one IV would have been enough, but I

think that this guy wanted to show off.

Thanks,

Wayne

---------------------------------

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[Non-text portions of this message have been removed]

[Guest guest]

LIsa,

You asked: " It is acceptable to cancel a helicopter if it's no longer needed. "

My opinion and our operating protocol is YES absolutely...not only is it

acceptable, it is expected. We have had helicopters on final approach and sent

them back home...we even had one we called them for because we had difficulty

accessing the patient. His pickup was hit by a train and we had a lot of work to

do to get him out of the truck...the helicopter was on the ground and shut off

when we got him out of the truck finally.

After evaluation and a long conversation to convince the patient that he at

least needed to go to the ED for evaluation (as he was really trying to refuse

and was competant to do so) the helicopter crew went back to base and we

transported him to a local ER non-emergency....

The point of no return, in my opinion, is after the helicopter is off the ground

with the patient on board...up until then, they can still be cancelled.

Dudley

Re: Questionable IV & RUDE flight crew

Wayne and all,

Most of what I want to say has been said already by others on the list, but

I somehow feel the need to echo it anyway for this kind of thing is near and

dear to me.

From the ground crew stand point, was the helicopter needed? It sounds like

it was in the beginning providing that transporting by ground to an

appropriate trauma center would have taken more than 30-45 minutes. How long

did the

ground crew wait for the aircraft? Did the ground crew attempt an IV, but

was unsuccessful prior to the arrival of the air crew? Once the patient

became alert and stable, how far out was the helicopter? It is acceptable to

cancel a helicopter if it's no longer needed.

Once the air crew was there, from what you have described, there would have

been no reason to start an IV on-scene. IV's can be initiated in the

aircraft and should be if there is not an emergent need such as medications to

facilitate intubation, immediate fluid resuscitation, etc.

Starting two IV's on the same side ... as long as there is two different

vein paths, I haven't heard of this being a problem. Starting it in the same

vein, maybe not a good idea. Sometimes the air crew has better access to one

arm over the other depending on how their aircraft is configured. But, again,

it sounds like they didn't need to start the IV on-scene.

The rudeness is completely unacceptable. There is NO excuse for that! Our

jobs, both ground and air come with stresses. The EMS crew, the patient, the

family and any other personnel on-scene (fire and police) should be treated

with kindness and respect by the air crew regardless of what kind of pressure

or stress they're under. You absolutely should call their

supervisor/director and report the bad behavior. And, as someone else has

mentioned, it would

be beneficial to QI the call with the air crew as well to try and understand

what their rational was for what they did clinically. It would surprise me

if their protocols and or Medical Director supports starting an IV or two

on-scene when they could have done it in the aircraft. After all, the

helicopter is supposed to save time, right?

If this particular provider displays this behavior on a regular basis and/or

makes bad decisions clinically, don't use them! How would that be

benefiting the patient? If you have more than one helicopter service in your

area,

call the one that does the best job and does it safely.

Good luck,

In a message dated 10/18/2005 1:14:27 PM Central Standard Time,

rxmd911@... writes:

A couple of weeks ago I was working a motorcycle race at a dirt track, in

whcih we had two riders hit each other. On arrival to the first person, who

was unresponsive and had snoring respirations, I asked that an air medical

serivce be called. The second person was also unresponsive, but no snoring

respirations. The first one was out for at least 2-3 minutes.

All the necessary precautions were taken and he was placed in the unit. The

local EMS arrived and took care of the second person. I ask the local EMS

to call an air medical provider, and ask for either provider X or Y, and

thought that was who they called.

The air medical provider arrived and it was provider F, seems they have a

base close to this area, so they were called. The crew comes to my unit and I

give report to " kojack & Mr. Clean " . After this, they were trying to decide

if they wanted to start a line there or in the air. By this time the pt was

alert and talking. His family member was in the unit talking with him also.

They kick him out, and start barking orders (the flight crew) they were

almost tossed out on their ears they were so rude. Finally Mr. Clean decides

to

start a line in the unit before carrying the pt across the track. He starts

one IV in the left hand, and then wants to start another one in the same

location. Correct me if I'm wrong, but in BTLS it states that a bi-lateral IV

is just that, BI-LATERAL, meaning that one goes in one hand or arm and the

other one goes in the other.

It was suggested that we drive around to the other side of the track to the

awaiting helicopter. By EMT goes to drive around to the bird, and the family

member is still talking to the pt, and wanting to know where he was being

taken, as they were from out of town. The " flight medic " yells again, and

tells him to step back out of the door so we can go.

I was never use this provider again, if this is the way that their crews

are, I'll call the provider that I want and ask for.

So, my question is, was the IV's placed in a strang position or is this

acceptable? The guy was stable, and only one IV would have been enough, but I

think that this guy wanted to show off.

Thanks,

Wayne

---------------------------------

Yahoo! Music Unlimited - Access over 1 million songs. Try it free.

[Non-text portions of this message have been removed]