Re: Closest Chopper

[Guest guest]

Jim,

Interesting article. I wish they had facts from LifeFlight and the ambulance

company...and not just the one provider who wasn't called...

I truly believe each ground transport agency needs to make decisions regarding

who best can service them when the need for air transport arises. Not getting

caught up in the hoopla and vitriole that the increasing competition brings with

it.

We have a protocol determining who and in what order we request air medical

providers if we need them. We run approximately 5000 calls per year, are from

15 to 30 minutes from an adult Level 1 Trauma Center (depending upon where in

our district you are) and we utilize air medical transport approximately 30 to

40 times a year. The majority of these are really hurt kids (as we are 40+

minutes from a Trauma Center that takes kids) or prolonged extrication where we

have a really hurt person and the helicopter can be sitting on scene awaiting

the patients exit from the vehicle. In addition to utilizing them this few

times, we also request and cancel them an additional 20 to 30 times a year as

well...

All this to say, each agency needs to get this set for their agency so that they

do what their Medical Director and administration desires to see. One of the

factors in this is who is closest but it is not the only factor.

We have three services to choose from. One is a no-brainer for being closer.

The second one we request by protocol is farther away (distance wise) than the

third but they fly a faster helicopter and they are reliable on initial

dispatch. Both Choice 1 and Choice 2 fly fast aircraft and tell us up front if

their helicopters are available and where they are coming from. Agency Number

3, which is closer, does not have this same track record and in fact have not

told us in the past that their aircraft was out and the one they were sending

was a VERY long distance away...

This all being said, the choice needs to be made prior to arriving on scene and

in writing with criteria that can be measured so that you truly are making the

best decision possible within the guidelines you are given to work.

It is not above some programs to " misrepresent' things like ETA and closest

helicopter in an effort to try and get flights by default instead of it being a

requesting agency decision.

I do agree with your point however, that this is a growing issue and will

probably come to areas near us in the very near future...especially if this case

is successful in getting protocol changed....

Dudley

Closest Chopper

This is becoming an issue nationwide. It will be interesting

to watch what the result is in PA. Food for thought...

http://kdka.com/local/local_story_356173820.html

Jim<

[Guest guest]

Jim,

Interesting article. I wish they had facts from LifeFlight and the ambulance

company...and not just the one provider who wasn't called...

I truly believe each ground transport agency needs to make decisions regarding

who best can service them when the need for air transport arises. Not getting

caught up in the hoopla and vitriole that the increasing competition brings with

it.

We have a protocol determining who and in what order we request air medical

providers if we need them. We run approximately 5000 calls per year, are from

15 to 30 minutes from an adult Level 1 Trauma Center (depending upon where in

our district you are) and we utilize air medical transport approximately 30 to

40 times a year. The majority of these are really hurt kids (as we are 40+

minutes from a Trauma Center that takes kids) or prolonged extrication where we

have a really hurt person and the helicopter can be sitting on scene awaiting

the patients exit from the vehicle. In addition to utilizing them this few

times, we also request and cancel them an additional 20 to 30 times a year as

well...

All this to say, each agency needs to get this set for their agency so that they

do what their Medical Director and administration desires to see. One of the

factors in this is who is closest but it is not the only factor.

We have three services to choose from. One is a no-brainer for being closer.

The second one we request by protocol is farther away (distance wise) than the

third but they fly a faster helicopter and they are reliable on initial

dispatch. Both Choice 1 and Choice 2 fly fast aircraft and tell us up front if

their helicopters are available and where they are coming from. Agency Number

3, which is closer, does not have this same track record and in fact have not

told us in the past that their aircraft was out and the one they were sending

was a VERY long distance away...

This all being said, the choice needs to be made prior to arriving on scene and

in writing with criteria that can be measured so that you truly are making the

best decision possible within the guidelines you are given to work.

It is not above some programs to " misrepresent' things like ETA and closest

helicopter in an effort to try and get flights by default instead of it being a

requesting agency decision.

I do agree with your point however, that this is a growing issue and will

probably come to areas near us in the very near future...especially if this case

is successful in getting protocol changed....

Dudley

Closest Chopper

This is becoming an issue nationwide. It will be interesting

to watch what the result is in PA. Food for thought...

http://kdka.com/local/local_story_356173820.html

Jim<

[Guest guest]

This can happen when the patient stops being the primary concern for those

on the call. One word that sums things up for EVERY provider, not just Air

Ambulances, is ETHICS. Those who don’t know what the word means, might

wanna google it :-)

Mike

Closest Chopper

This is becoming an issue nationwide. It will be interesting

to watch what the result is in PA. Food for thought...

http://kdka.com/local/local_story_356173820.html

Jim<

[Guest guest]

" " <manemtp@y...> wrote:

>

> This can happen when the patient stops being the primary concern for

those

> on the call.

According to the story, the patients weren't even extricated yet when

the chopper arrived. Obviously, ETA was not a primary concern in this

instance. I hear medics all the time saying they would not call so-

and-so flight service for a dead dog. This is a prevalent thing. So

if there was no threat to the patient, and there was no policy

superceding the medic's actions, what exactly is the problem here?

I agree. I would like to hear the story from the medics and the other

service, not just whining from the losers.

Rob

[Guest guest]

> >

> > This can happen when the patient stops being the primary concern

for

> those

> > on the call.

>

> According to the story, the patients weren't even extricated yet

when

> the chopper arrived. Obviously, ETA was not a primary concern in

this

> instance. I hear medics all the time saying they would not call

so-

> and-so flight service for a dead dog. This is a prevalent thing.

So

> if there was no threat to the patient, and there was no policy

> superceding the medic's actions, what exactly is the problem here?

>

> I agree. I would like to hear the story from the medics and the

other

> service, not just whining from the losers.

>

> Rob

>

Perhaps your right about this case...but then again you could also

be very wrong. There are so many different dynamics involved in

some of these decisions. The level of care offered by the personnel

on scene is variable depending on where you go. If there was an

immanent patient care issue that was beyond their capabilities but

within the capabilities of the closest air service then that changes

things the other direction...toward them being wrong to wait.

The problem here is not whether or not someone should catch some

grief from their boss based on being outside of some protocol. The

question is did they do the right thing. The patient doesn't have

to have been harmed for their actions to have been wrong. You can

have a good outcome despite poor care in lots of situations…most of

us have thanked god for that at one time or another.

I believe personal preference often plays a roll in the choice of

the services utilized...despite what maybe ethically correct. Is

this right? This isn't anymore right than dialing 911 in one city

and demanding the EMS from another city because you believe that

they are better for whatever reason. This is also no different than

choosing to go to a hospital that is farther away than a closer

appropriate one. We have a system based on ethical choices and we

must stay within it. If you don't like the closest provider to you

then you should address the issues with that provider rather than

circumventing the system. This would also apply to those creating

protocols based upon personal preferences. A protocol from your

Medical Director doesn't make it any more legally or ethically

defensible if it's not the most appropriate choice in a given

situation.

Jon

[Guest guest]

> >

> > This can happen when the patient stops being the primary concern

for

> those

> > on the call.

>

> According to the story, the patients weren't even extricated yet

when

> the chopper arrived. Obviously, ETA was not a primary concern in

this

> instance. I hear medics all the time saying they would not call

so-

> and-so flight service for a dead dog. This is a prevalent thing.

So

> if there was no threat to the patient, and there was no policy

> superceding the medic's actions, what exactly is the problem here?

>

> I agree. I would like to hear the story from the medics and the

other

> service, not just whining from the losers.

>

> Rob

>

Perhaps your right about this case...but then again you could also

be very wrong. There are so many different dynamics involved in

some of these decisions. The level of care offered by the personnel

on scene is variable depending on where you go. If there was an

immanent patient care issue that was beyond their capabilities but

within the capabilities of the closest air service then that changes

things the other direction...toward them being wrong to wait.

The problem here is not whether or not someone should catch some

grief from their boss based on being outside of some protocol. The

question is did they do the right thing. The patient doesn't have

to have been harmed for their actions to have been wrong. You can

have a good outcome despite poor care in lots of situations…most of

us have thanked god for that at one time or another.

I believe personal preference often plays a roll in the choice of

the services utilized...despite what maybe ethically correct. Is

this right? This isn't anymore right than dialing 911 in one city

and demanding the EMS from another city because you believe that

they are better for whatever reason. This is also no different than

choosing to go to a hospital that is farther away than a closer

appropriate one. We have a system based on ethical choices and we

must stay within it. If you don't like the closest provider to you

then you should address the issues with that provider rather than

circumventing the system. This would also apply to those creating

protocols based upon personal preferences. A protocol from your

Medical Director doesn't make it any more legally or ethically

defensible if it's not the most appropriate choice in a given

situation.

Jon

[Guest guest]

Jon,

Since I was the one mentioning protocols, let me express to you why our protocol

was developed. It was for multiple reasons. First, not only is it who can get

to your scene quickest...but for our agency it is also who can get them to the

trauma center the fastest...and when an agency can get to a scene 2 or 3 minutes

faster but has to remain on scene for say 10 minutes to perform some skill and

then their slower/smaller helicopter takes 14 minutes to get to the trauma

center...compared to the other agency that can get to the trauma center in 9

minutes...the patient still arrives faster using the farther away

helicopter...and since we only call helicopters for speed...the fastest

helicopters are the ones we call.

Secondly, we did when we adopted this protocol, discuss our concerns with the 3

agencies we have to choose from. When two of them would tell us " we don't have

a helicopter available " or " they are coming from an extended distance " and the

third would merely say " we will have them enroute " and not tell us they were

coming from 30 to 40 minutes away until 20 minutes into the call when we get a

20 minute eta...we felt we needed to step in because the risk was too great to

our patients...

Third, we utilize air transport for speed and some advanced airway control.

Although there could be some things that air medical providers could do that

would potentially benefit patients...in trauma I am not aware of what an EMT can

do that would be detrimental if a paramedic didn't arrive quickly. EMT's can

ventilate and control bleeding. RSI, fluid resuscitation and other " paramedic "

life savers are all debatable as to their efficacy in survival...and when we sit

on scene with a trauma patient and wait 20 + minutes so that we can RSI a

patient before flying them to the trauma center...then I truly fail to see where

it is a benefit...

And lastly, as the agency being called to the scene via 911, it is not the

helicopter agency that will be sued if we don't make the best decision. That

patient is our responsibility up and through their trip to the hospital. It is

our agencies responsibility to get that patient to the Trauma Center ASAP...and

we will protocol and mandate how our personnel utilize air transport, not based

upon who brings pizza or has the coolest freebies...but what is the best for our

patients taking into consideration all the factors we can reasonably

predict...so that it doesn't become a personal decision based upon what ever

factors may or may not be in that individual paramedics mind at that particular

time.

Would like to know your views on how you would recommend EMS agencies contact

flight services....yours or any others...so that the decision is the most

responsible decision at the time with the information available.

Thanks,

Dudley

Re: Closest Chopper

> >

> > This can happen when the patient stops being the primary concern

for

> those

> > on the call.

>

> According to the story, the patients weren't even extricated yet

when

> the chopper arrived. Obviously, ETA was not a primary concern in

this

> instance. I hear medics all the time saying they would not call

so-

> and-so flight service for a dead dog. This is a prevalent thing.

So

> if there was no threat to the patient, and there was no policy

> superceding the medic's actions, what exactly is the problem here?

>

> I agree. I would like to hear the story from the medics and the

other

> service, not just whining from the losers.

>

> Rob

>

Perhaps your right about this case...but then again you could also

be very wrong. There are so many different dynamics involved in

some of these decisions. The level of care offered by the personnel

on scene is variable depending on where you go. If there was an

immanent patient care issue that was beyond their capabilities but

within the capabilities of the closest air service then that changes

things the other direction...toward them being wrong to wait.

The problem here is not whether or not someone should catch some

grief from their boss based on being outside of some protocol. The

question is did they do the right thing. The patient doesn't have

to have been harmed for their actions to have been wrong. You can

have a good outcome despite poor care in lots of situations?most of

us have thanked god for that at one time or another.

I believe personal preference often plays a roll in the choice of

the services utilized...despite what maybe ethically correct. Is

this right? This isn't anymore right than dialing 911 in one city

and demanding the EMS from another city because you believe that

they are better for whatever reason. This is also no different than

choosing to go to a hospital that is farther away than a closer

appropriate one. We have a system based on ethical choices and we

must stay within it. If you don't like the closest provider to you

then you should address the issues with that provider rather than

circumventing the system. This would also apply to those creating

protocols based upon personal preferences. A protocol from your

Medical Director doesn't make it any more legally or ethically

defensible if it's not the most appropriate choice in a given

situation.

Jon

[Guest guest]

One of the things that amazed me and still does about Texas is the shear

size of the state. When I was in NJ and I went to work at McGuire AFB I was

amazed we'd have a 45 minute average transport time to a Level II Trauma Center.

The Level I was a good 90 minute drive in moderate traffic and safe operations

speeds, etc.

I had practiced to that point only either in the County that hosted not only

the Level I Trauma Center but a grand total of 12 level II's (All ER's in NJ

are Level II's by state mandate) or in a contiguous County. In any case if I

had a 10 minute scene time and a 10 minute transport it was a LONG trauma

call.

When I rode out for my EMT-I in Navasota we took one call where the to the

patient time was 40 minutes and the back to the " nearest " ER was also in that

time frame. I was astounded that I actually got to see patients both improve

and decline in the back of the bus so I can see how the statement could be

made that if you are close to a Trauma Center your perspectives are different I

know mine was!

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

LNMolino@...

(Office)

(Office Fax)

" A Texan with a Jersey Attitude "

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

[Guest guest]

In a message dated 12/28/2005 11:32:44 A.M. Central Standard Time,

flynmedic@... writes:

I shouldnt quote those fractions above as I dont know if they are

accurate...the general principle is what matters there.

But is the underlying problem not the fact that we have to make such

anecdotal based " educated " guess? In some cases we have the research to back up

the

figures we quote but in the vast majority of the arguments we have are based

only on the " gut feel " and so fourth? I am not speaking of the Myth Busting

that Dr. B has done or anyone else for that fact if it's based on true

evidence. Is this (SWAG approach) not what has brought us to the point we are

at

today in terms of the need for the " myth busting " ?

What we need is more research done on broader scales and over larger areas

of the country let alone Texas.

Oh and if you don't know what a SWAG is don't ask me I'm not telling anyone.

LNM

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

LNMolino@...

(Office)

(Office Fax)

" A Texan with a Jersey Attitude "

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

[Guest guest]

In a message dated 12/28/2005 11:32:44 A.M. Central Standard Time,

flynmedic@... writes:

I shouldnt quote those fractions above as I dont know if they are

accurate...the general principle is what matters there.

But is the underlying problem not the fact that we have to make such

anecdotal based " educated " guess? In some cases we have the research to back up

the

figures we quote but in the vast majority of the arguments we have are based

only on the " gut feel " and so fourth? I am not speaking of the Myth Busting

that Dr. B has done or anyone else for that fact if it's based on true

evidence. Is this (SWAG approach) not what has brought us to the point we are

at

today in terms of the need for the " myth busting " ?

What we need is more research done on broader scales and over larger areas

of the country let alone Texas.

Oh and if you don't know what a SWAG is don't ask me I'm not telling anyone.

LNM

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

LNMolino@...

(Office)

(Office Fax)

" A Texan with a Jersey Attitude "

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

[Guest guest]

In a message dated 12/28/2005 11:32:44 A.M. Central Standard Time,

flynmedic@... writes:

I shouldnt quote those fractions above as I dont know if they are

accurate...the general principle is what matters there.

But is the underlying problem not the fact that we have to make such

anecdotal based " educated " guess? In some cases we have the research to back up

the

figures we quote but in the vast majority of the arguments we have are based

only on the " gut feel " and so fourth? I am not speaking of the Myth Busting

that Dr. B has done or anyone else for that fact if it's based on true

evidence. Is this (SWAG approach) not what has brought us to the point we are

at

today in terms of the need for the " myth busting " ?

What we need is more research done on broader scales and over larger areas

of the country let alone Texas.

Oh and if you don't know what a SWAG is don't ask me I'm not telling anyone.

LNM

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

LNMolino@...

(Office)

(Office Fax)

" A Texan with a Jersey Attitude "

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

[Guest guest]

Dudley,

Your agency is very close to trauma services which changes your

perspective greatly. There are times when you need Air…obviously.

You also have a service that is greatly closer than the other two.

Outside of a mass casualty or their being unavailable at the time

there isn't much reason for you to consider the other two. That, I

think should be your justification for their service…not some

misinformed quote about helicopter speeds. Of the three helicopters

in your region…there is a minimal difference in speed when you get

accurate figures and its nowhere close to the 40% difference that

you quoted. Dynamics vary greatly and on any given day…any given

service can possibly outrun the other but the difference will be of

no consequence from your already close proximity.

On your second point…all services I've ever heard of give you an ETA

on whatever aircraft they are sending you. You have to make up your

mind on what is feasible for you in you're given situation. If you

are getting any less than that from any of those services I'm sure

they would like to know. I believe that any services out there

would do their best to correct that problem.

On your third point, If you wait 20 minutes for a helicopter with

that situation… It's not very fair to attribute that to a problem

with helicopter services. They just come out when they are called.

Again your situation is a bit different due to your proximity.

Change your location to somewhere outside of middle of nowhere Texas

and your perspective changes.

Lastly…That is mostly what I was trying to say also. I would only

add - to make sure the information that you use for this is accurate

and not biased by personnel opinion.

Thankfully, we have a RAC where these things can be discussed and

problems addressed. Our agency, and I'm sure the others also,

always welcome any input on ways to better our services. We have

systems in place to address any problems that arise. Problems will

occur in any multi-service interaction. It's how we handle them

that will make the difference to our future patients.

Jon

> > >

> > > This can happen when the patient stops being the primary

concern

> for

> > those

> > > on the call.

> >

> > According to the story, the patients weren't even extricated yet

> when

> > the chopper arrived. Obviously, ETA was not a primary concern

in

> this

> > instance. I hear medics all the time saying they would not call

> so-

> > and-so flight service for a dead dog. This is a prevalent

thing.

> So

> > if there was no threat to the patient, and there was no policy

> > superceding the medic's actions, what exactly is the problem

here?

> >

> > I agree. I would like to hear the story from the medics and the

> other

> > service, not just whining from the losers.

> >

> > Rob

> >

>

>

> Perhaps your right about this case...but then again you could also

> be very wrong. There are so many different dynamics involved in

> some of these decisions. The level of care offered by the

personnel

> on scene is variable depending on where you go. If there was an

> immanent patient care issue that was beyond their capabilities but

> within the capabilities of the closest air service then that

changes

> things the other direction...toward them being wrong to wait.

>

> The problem here is not whether or not someone should catch some

> grief from their boss based on being outside of some protocol.

The

> question is did they do the right thing. The patient doesn't have

> to have been harmed for their actions to have been wrong. You can

> have a good outcome despite poor care in lots of situations?most

of

> us have thanked god for that at one time or another.

>

> I believe personal preference often plays a roll in the choice of

> the services utilized...despite what maybe ethically correct. Is

> this right? This isn't anymore right than dialing 911 in one city

> and demanding the EMS from another city because you believe that

> they are better for whatever reason. This is also no different

than

> choosing to go to a hospital that is farther away than a closer

> appropriate one. We have a system based on ethical choices and we

> must stay within it. If you don't like the closest provider to

you

> then you should address the issues with that provider rather than

> circumventing the system. This would also apply to those creating

> protocols based upon personal preferences. A protocol from your

> Medical Director doesn't make it any more legally or ethically

> defensible if it's not the most appropriate choice in a given

> situation.

>

> Jon

>

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

Where is the scientific evidence that air transport makes a difference? Most

physicians can count on one hand the number of cases they have seen that

benefited from air transport. The vast majority of air transports (2/3 to

3/4) are unnecessary.

E. Bledsoe, DO, FACEP

Midlothian, Texas

Don't miss the Western States EMS Cruise!

http://proemseducators.com/index.html

_____

From: [mailto: ] On

Behalf Of Jon

Sent: Wednesday, December 28, 2005 10:42 AM

To:

Subject: Re: Closest Chopper

Dudley,

Your agency is very close to trauma services which changes your

perspective greatly. There are times when you need Air.obviously.

You also have a service that is greatly closer than the other two.

Outside of a mass casualty or their being unavailable at the time

there isn't much reason for you to consider the other two. That, I

think should be your justification for their service.not some

misinformed quote about helicopter speeds. Of the three helicopters

in your region.there is a minimal difference in speed when you get

accurate figures and its nowhere close to the 40% difference that

you quoted. Dynamics vary greatly and on any given day.any given

service can possibly outrun the other but the difference will be of

no consequence from your already close proximity.

On your second point.all services I've ever heard of give you an ETA

on whatever aircraft they are sending you. You have to make up your

mind on what is feasible for you in you're given situation. If you

are getting any less than that from any of those services I'm sure

they would like to know. I believe that any services out there

would do their best to correct that problem.

On your third point, If you wait 20 minutes for a helicopter with

that situation. It's not very fair to attribute that to a problem

with helicopter services. They just come out when they are called.

Again your situation is a bit different due to your proximity.

Change your location to somewhere outside of middle of nowhere Texas

and your perspective changes.

Lastly.That is mostly what I was trying to say also. I would only

add - to make sure the information that you use for this is accurate

and not biased by personnel opinion.

Thankfully, we have a RAC where these things can be discussed and

problems addressed. Our agency, and I'm sure the others also,

always welcome any input on ways to better our services. We have

systems in place to address any problems that arise. Problems will

occur in any multi-service interaction. It's how we handle them

that will make the difference to our future patients.

Jon

> > >

> > > This can happen when the patient stops being the primary

concern

> for

> > those

> > > on the call.

> >

> > According to the story, the patients weren't even extricated yet

> when

> > the chopper arrived. Obviously, ETA was not a primary concern

in

> this

> > instance. I hear medics all the time saying they would not call

> so-

> > and-so flight service for a dead dog. This is a prevalent

thing.

> So

> > if there was no threat to the patient, and there was no policy

> > superceding the medic's actions, what exactly is the problem

here?

> >

> > I agree. I would like to hear the story from the medics and the

> other

> > service, not just whining from the losers.

> >

> > Rob

> >

>

>

> Perhaps your right about this case...but then again you could also

> be very wrong. There are so many different dynamics involved in

> some of these decisions. The level of care offered by the

personnel

> on scene is variable depending on where you go. If there was an

> immanent patient care issue that was beyond their capabilities but

> within the capabilities of the closest air service then that

changes

> things the other direction...toward them being wrong to wait.

>

> The problem here is not whether or not someone should catch some

> grief from their boss based on being outside of some protocol.

The

> question is did they do the right thing. The patient doesn't have

> to have been harmed for their actions to have been wrong. You can

> have a good outcome despite poor care in lots of situations?most

of

> us have thanked god for that at one time or another.

>

> I believe personal preference often plays a roll in the choice of

> the services utilized...despite what maybe ethically correct. Is

> this right? This isn't anymore right than dialing 911 in one city

> and demanding the EMS from another city because you believe that

> they are better for whatever reason. This is also no different

than

> choosing to go to a hospital that is farther away than a closer

> appropriate one. We have a system based on ethical choices and we

> must stay within it. If you don't like the closest provider to

you

> then you should address the issues with that provider rather than

> circumventing the system. This would also apply to those creating

> protocols based upon personal preferences. A protocol from your

> Medical Director doesn't make it any more legally or ethically

> defensible if it's not the most appropriate choice in a given

> situation.

>

> Jon

>

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

One thing that I have really enjoyed about flying is that I get to

interact with lots of different agencies in lots of different

settings. The vastness of Texas and the challenges that brings are

awesome. Everyone should get to see all the different situations

that exist.

Jon

>

> One of the things that amazed me and still does about Texas is the

shear

> size of the state. When I was in NJ and I went to work at McGuire

AFB I was

> amazed we'd have a 45 minute average transport time to a Level II

Trauma Center.

> The Level I was a good 90 minute drive in moderate traffic and

safe operations

> speeds, etc.

>

> I had practiced to that point only either in the County that

hosted not only

> the Level I Trauma Center but a grand total of 12 level II's (All

ER's in NJ

> are Level II's by state mandate) or in a contiguous County. In any

case if I

> had a 10 minute scene time and a 10 minute transport it was a LONG

trauma

> call.

>

> When I rode out for my EMT-I in Navasota we took one call where

the to the

> patient time was 40 minutes and the back to the " nearest " ER was

also in that

> time frame. I was astounded that I actually got to see patients

both improve

> and decline in the back of the bus so I can see how the statement

could be

> made that if you are close to a Trauma Center your perspectives

are different I

> know mine was!

>

> Louis N. Molino, Sr., CET

> FF/NREMT-B/FSI/EMSI

> LNMolino@a...

> (Office)

> (Office Fax)

>

> " A Texan with a Jersey Attitude "

>

> The comments contained in this E-mail are the opinions of the

author and the

> author alone. I in no way ever intend to speak for any person or

> organization that I am in any way whatsoever involved or

associated with unless I

> specifically state that I am doing so. Further this E-mail is

intended only for its

> stated recipient and may contain private and or confidential

materials

> retransmission is strictly prohibited unless placed in the public

domain by the

> original author.

>

>

>

[Guest guest]

You could argue that 2/3 to 3/4 of the patients that are taken to a

trauma center are taken there unnecessarily in hind site. We still

take them there due to the fact we don't want the other 1/3 taken to

a lower facility that can't handle their injuries. Same argument

about the number of patients that really needed that CT in hind

site. We have to do the best thing for them at the time with the

information at hand at that time.

I shouldnt quote those fractions above as I dont know if they are

accurate...the general principle is what matters there.

Jon

> > > >

> > > > This can happen when the patient stops being the primary

> concern

> > for

> > > those

> > > > on the call.

> > >

> > > According to the story, the patients weren't even extricated

yet

> > when

> > > the chopper arrived. Obviously, ETA was not a primary concern

> in

> > this

> > > instance. I hear medics all the time saying they would not

call

> > so-

> > > and-so flight service for a dead dog. This is a prevalent

> thing.

> > So

> > > if there was no threat to the patient, and there was no policy

> > > superceding the medic's actions, what exactly is the problem

> here?

> > >

> > > I agree. I would like to hear the story from the medics and

the

> > other

> > > service, not just whining from the losers.

> > >

> > > Rob

> > >

> >

> >

> > Perhaps your right about this case...but then again you could

also

> > be very wrong. There are so many different dynamics involved in

> > some of these decisions. The level of care offered by the

> personnel

> > on scene is variable depending on where you go. If there was an

> > immanent patient care issue that was beyond their capabilities

but

> > within the capabilities of the closest air service then that

> changes

> > things the other direction...toward them being wrong to wait.

> >

> > The problem here is not whether or not someone should catch some

> > grief from their boss based on being outside of some protocol.

> The

> > question is did they do the right thing. The patient doesn't

have

> > to have been harmed for their actions to have been wrong. You

can

> > have a good outcome despite poor care in lots of situations?most

> of

> > us have thanked god for that at one time or another.

> >

> > I believe personal preference often plays a roll in the choice

of

> > the services utilized...despite what maybe ethically correct. Is

> > this right? This isn't anymore right than dialing 911 in one

city

> > and demanding the EMS from another city because you believe that

> > they are better for whatever reason. This is also no different

> than

> > choosing to go to a hospital that is farther away than a closer

> > appropriate one. We have a system based on ethical choices and

we

> > must stay within it. If you don't like the closest provider to

> you

> > then you should address the issues with that provider rather

than

> > circumventing the system. This would also apply to those

creating

> > protocols based upon personal preferences. A protocol from your

> > Medical Director doesn't make it any more legally or ethically

> > defensible if it's not the most appropriate choice in a given

> > situation.

> >

> > Jon

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

There is some literature that shows that trauma outcomes are better when

patients are first taken to lower level trauma centers. Trauma centers and

helicopters are different. Alot of the care provided in a trauma center is

not overly time sensitive. Thus, you can get a spiral CT, have a

neurosurgeon look at you, get an angiogram, have your fractures irrigated,

etc. But, for the helicopter the only advantage over ground transport is

speed (and many studies are showing ground transport is actually

faster--anybody see Kenny Navarro's abstract at the Texas conference?) and

speed makes a difference in only a small fraction of patients. Any

helicopter paramedic or nurse working today who is being honest will tell

you that the vast majority of their patients could just as safely gone by

ground (at a fraction of a cost and in a safer vehicle). What Texas needs is

more fixed-wing air ambulances and fewer helicopters. These would serve the

rural and frontier areas better and are safer, more cost effective, and more

comfortable.

FYI:

Based on estimates of the numbers of crewmembers and crew deaths during 1995

to 2001,2 the death rate of helicopter EMS crew members was 75 per 100,000

person-years, 16 times the occupational injury death rate of 4.6 for all US

workers during this period. The occupational death rate for ground EMS

personnel is around 12 per 100,000 person-years.

E. Bledsoe, DO, FACEP

Midlothian, Texas

Don't miss the Western States EMS Cruise!

http://proemseducators.com/index.html

_____

From: [mailto: ] On

Behalf Of Jon

Sent: Wednesday, December 28, 2005 11:28 AM

To:

Subject: Re: Closest Chopper

You could argue that 2/3 to 3/4 of the patients that are taken to a

trauma center are taken there unnecessarily in hind site. We still

take them there due to the fact we don't want the other 1/3 taken to

a lower facility that can't handle their injuries. Same argument

about the number of patients that really needed that CT in hind

site. We have to do the best thing for them at the time with the

information at hand at that time.

I shouldnt quote those fractions above as I dont know if they are

accurate...the general principle is what matters there.

Jon

> > > >

> > > > This can happen when the patient stops being the primary

> concern

> > for

> > > those

> > > > on the call.

> > >

> > > According to the story, the patients weren't even extricated

yet

> > when

> > > the chopper arrived. Obviously, ETA was not a primary concern

> in

> > this

> > > instance. I hear medics all the time saying they would not

call

> > so-

> > > and-so flight service for a dead dog. This is a prevalent

> thing.

> > So

> > > if there was no threat to the patient, and there was no policy

> > > superceding the medic's actions, what exactly is the problem

> here?

> > >

> > > I agree. I would like to hear the story from the medics and

the

> > other

> > > service, not just whining from the losers.

> > >

> > > Rob

> > >

> >

> >

> > Perhaps your right about this case...but then again you could

also

> > be very wrong. There are so many different dynamics involved in

> > some of these decisions. The level of care offered by the

> personnel

> > on scene is variable depending on where you go. If there was an

> > immanent patient care issue that was beyond their capabilities

but

> > within the capabilities of the closest air service then that

> changes

> > things the other direction...toward them being wrong to wait.

> >

> > The problem here is not whether or not someone should catch some

> > grief from their boss based on being outside of some protocol.

> The

> > question is did they do the right thing. The patient doesn't

have

> > to have been harmed for their actions to have been wrong. You

can

> > have a good outcome despite poor care in lots of situations?most

> of

> > us have thanked god for that at one time or another.

> >

> > I believe personal preference often plays a roll in the choice

of

> > the services utilized...despite what maybe ethically correct. Is

> > this right? This isn't anymore right than dialing 911 in one

city

> > and demanding the EMS from another city because you believe that

> > they are better for whatever reason. This is also no different

> than

> > choosing to go to a hospital that is farther away than a closer

> > appropriate one. We have a system based on ethical choices and

we

> > must stay within it. If you don't like the closest provider to

> you

> > then you should address the issues with that provider rather

than

> > circumventing the system. This would also apply to those

creating

> > protocols based upon personal preferences. A protocol from your

> > Medical Director doesn't make it any more legally or ethically

> > defensible if it's not the most appropriate choice in a given

> > situation.

> >

> > Jon

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

There is some literature that shows that trauma outcomes are better when

patients are first taken to lower level trauma centers. Trauma centers and

helicopters are different. Alot of the care provided in a trauma center is

not overly time sensitive. Thus, you can get a spiral CT, have a

neurosurgeon look at you, get an angiogram, have your fractures irrigated,

etc. But, for the helicopter the only advantage over ground transport is

speed (and many studies are showing ground transport is actually

faster--anybody see Kenny Navarro's abstract at the Texas conference?) and

speed makes a difference in only a small fraction of patients. Any

helicopter paramedic or nurse working today who is being honest will tell

you that the vast majority of their patients could just as safely gone by

ground (at a fraction of a cost and in a safer vehicle). What Texas needs is

more fixed-wing air ambulances and fewer helicopters. These would serve the

rural and frontier areas better and are safer, more cost effective, and more

comfortable.

FYI:

Based on estimates of the numbers of crewmembers and crew deaths during 1995

to 2001,2 the death rate of helicopter EMS crew members was 75 per 100,000

person-years, 16 times the occupational injury death rate of 4.6 for all US

workers during this period. The occupational death rate for ground EMS

personnel is around 12 per 100,000 person-years.

E. Bledsoe, DO, FACEP

Midlothian, Texas

Don't miss the Western States EMS Cruise!

http://proemseducators.com/index.html

_____

From: [mailto: ] On

Behalf Of Jon

Sent: Wednesday, December 28, 2005 11:28 AM

To:

Subject: Re: Closest Chopper

You could argue that 2/3 to 3/4 of the patients that are taken to a

trauma center are taken there unnecessarily in hind site. We still

take them there due to the fact we don't want the other 1/3 taken to

a lower facility that can't handle their injuries. Same argument

about the number of patients that really needed that CT in hind

site. We have to do the best thing for them at the time with the

information at hand at that time.

I shouldnt quote those fractions above as I dont know if they are

accurate...the general principle is what matters there.

Jon

> > > >

> > > > This can happen when the patient stops being the primary

> concern

> > for

> > > those

> > > > on the call.

> > >

> > > According to the story, the patients weren't even extricated

yet

> > when

> > > the chopper arrived. Obviously, ETA was not a primary concern

> in

> > this

> > > instance. I hear medics all the time saying they would not

call

> > so-

> > > and-so flight service for a dead dog. This is a prevalent

> thing.

> > So

> > > if there was no threat to the patient, and there was no policy

> > > superceding the medic's actions, what exactly is the problem

> here?

> > >

> > > I agree. I would like to hear the story from the medics and

the

> > other

> > > service, not just whining from the losers.

> > >

> > > Rob

> > >

> >

> >

> > Perhaps your right about this case...but then again you could

also

> > be very wrong. There are so many different dynamics involved in

> > some of these decisions. The level of care offered by the

> personnel

> > on scene is variable depending on where you go. If there was an

> > immanent patient care issue that was beyond their capabilities

but

> > within the capabilities of the closest air service then that

> changes

> > things the other direction...toward them being wrong to wait.

> >

> > The problem here is not whether or not someone should catch some

> > grief from their boss based on being outside of some protocol.

> The

> > question is did they do the right thing. The patient doesn't

have

> > to have been harmed for their actions to have been wrong. You

can

> > have a good outcome despite poor care in lots of situations?most

> of

> > us have thanked god for that at one time or another.

> >

> > I believe personal preference often plays a roll in the choice

of

> > the services utilized...despite what maybe ethically correct. Is

> > this right? This isn't anymore right than dialing 911 in one

city

> > and demanding the EMS from another city because you believe that

> > they are better for whatever reason. This is also no different

> than

> > choosing to go to a hospital that is farther away than a closer

> > appropriate one. We have a system based on ethical choices and

we

> > must stay within it. If you don't like the closest provider to

> you

> > then you should address the issues with that provider rather

than

> > circumventing the system. This would also apply to those

creating

> > protocols based upon personal preferences. A protocol from your

> > Medical Director doesn't make it any more legally or ethically

> > defensible if it's not the most appropriate choice in a given

> > situation.

> >

> > Jon

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

There is some literature that shows that trauma outcomes are better when

patients are first taken to lower level trauma centers. Trauma centers and

helicopters are different. Alot of the care provided in a trauma center is

not overly time sensitive. Thus, you can get a spiral CT, have a

neurosurgeon look at you, get an angiogram, have your fractures irrigated,

etc. But, for the helicopter the only advantage over ground transport is

speed (and many studies are showing ground transport is actually

faster--anybody see Kenny Navarro's abstract at the Texas conference?) and

speed makes a difference in only a small fraction of patients. Any

helicopter paramedic or nurse working today who is being honest will tell

you that the vast majority of their patients could just as safely gone by

ground (at a fraction of a cost and in a safer vehicle). What Texas needs is

more fixed-wing air ambulances and fewer helicopters. These would serve the

rural and frontier areas better and are safer, more cost effective, and more

comfortable.

FYI:

Based on estimates of the numbers of crewmembers and crew deaths during 1995

to 2001,2 the death rate of helicopter EMS crew members was 75 per 100,000

person-years, 16 times the occupational injury death rate of 4.6 for all US

workers during this period. The occupational death rate for ground EMS

personnel is around 12 per 100,000 person-years.

E. Bledsoe, DO, FACEP

Midlothian, Texas

Don't miss the Western States EMS Cruise!

http://proemseducators.com/index.html

_____

From: [mailto: ] On

Behalf Of Jon

Sent: Wednesday, December 28, 2005 11:28 AM

To:

Subject: Re: Closest Chopper

You could argue that 2/3 to 3/4 of the patients that are taken to a

trauma center are taken there unnecessarily in hind site. We still

take them there due to the fact we don't want the other 1/3 taken to

a lower facility that can't handle their injuries. Same argument

about the number of patients that really needed that CT in hind

site. We have to do the best thing for them at the time with the

information at hand at that time.

I shouldnt quote those fractions above as I dont know if they are

accurate...the general principle is what matters there.

Jon

> > > >

> > > > This can happen when the patient stops being the primary

> concern

> > for

> > > those

> > > > on the call.

> > >

> > > According to the story, the patients weren't even extricated

yet

> > when

> > > the chopper arrived. Obviously, ETA was not a primary concern

> in

> > this

> > > instance. I hear medics all the time saying they would not

call

> > so-

> > > and-so flight service for a dead dog. This is a prevalent

> thing.

> > So

> > > if there was no threat to the patient, and there was no policy

> > > superceding the medic's actions, what exactly is the problem

> here?

> > >

> > > I agree. I would like to hear the story from the medics and

the

> > other

> > > service, not just whining from the losers.

> > >

> > > Rob

> > >

> >

> >

> > Perhaps your right about this case...but then again you could

also

> > be very wrong. There are so many different dynamics involved in

> > some of these decisions. The level of care offered by the

> personnel

> > on scene is variable depending on where you go. If there was an

> > immanent patient care issue that was beyond their capabilities

but

> > within the capabilities of the closest air service then that

> changes

> > things the other direction...toward them being wrong to wait.

> >

> > The problem here is not whether or not someone should catch some

> > grief from their boss based on being outside of some protocol.

> The

> > question is did they do the right thing. The patient doesn't

have

> > to have been harmed for their actions to have been wrong. You

can

> > have a good outcome despite poor care in lots of situations?most

> of

> > us have thanked god for that at one time or another.

> >

> > I believe personal preference often plays a roll in the choice

of

> > the services utilized...despite what maybe ethically correct. Is

> > this right? This isn't anymore right than dialing 911 in one

city

> > and demanding the EMS from another city because you believe that

> > they are better for whatever reason. This is also no different

> than

> > choosing to go to a hospital that is farther away than a closer

> > appropriate one. We have a system based on ethical choices and

we

> > must stay within it. If you don't like the closest provider to

> you

> > then you should address the issues with that provider rather

than

> > circumventing the system. This would also apply to those

creating

> > protocols based upon personal preferences. A protocol from your

> > Medical Director doesn't make it any more legally or ethically

> > defensible if it's not the most appropriate choice in a given

> > situation.

> >

> > Jon

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

Those are very interesting statistics. They seem counterintuitive.

I disagree that speed is the ONLY advantage of a helicopter. It is

in my opinion the biggest advantage. I won't argue that a lot of

our patients can go by ground just as well in hind site. Can you

tell me how to definitively tell beforehand which ones it will make

a difference on…that is beyond the assessment criteria we already

use?

The statistics you quoted at the end makes me want to run screaming

from the helicopter. :-)

Jon

> > > > >

> > > > > This can happen when the patient stops being the primary

> > concern

> > > for

> > > > those

> > > > > on the call.

> > > >

> > > > According to the story, the patients weren't even extricated

> yet

> > > when

> > > > the chopper arrived. Obviously, ETA was not a primary

concern

> > in

> > > this

> > > > instance. I hear medics all the time saying they would not

> call

> > > so-

> > > > and-so flight service for a dead dog. This is a prevalent

> > thing.

> > > So

> > > > if there was no threat to the patient, and there was no

policy

> > > > superceding the medic's actions, what exactly is the problem

> > here?

> > > >

> > > > I agree. I would like to hear the story from the medics and

> the

> > > other

> > > > service, not just whining from the losers.

> > > >

> > > > Rob

> > > >

> > >

> > >

> > > Perhaps your right about this case...but then again you could

> also

> > > be very wrong. There are so many different dynamics involved

in

> > > some of these decisions. The level of care offered by the

> > personnel

> > > on scene is variable depending on where you go. If there was

an

> > > immanent patient care issue that was beyond their capabilities

> but

> > > within the capabilities of the closest air service then that

> > changes

> > > things the other direction...toward them being wrong to wait.

> > >

> > > The problem here is not whether or not someone should catch

some

> > > grief from their boss based on being outside of some

protocol.

> > The

> > > question is did they do the right thing. The patient doesn't

> have

> > > to have been harmed for their actions to have been wrong. You

> can

> > > have a good outcome despite poor care in lots of situations?

most

> > of

> > > us have thanked god for that at one time or another.

> > >

> > > I believe personal preference often plays a roll in the choice

> of

> > > the services utilized...despite what maybe ethically correct.

Is

> > > this right? This isn't anymore right than dialing 911 in one

> city

> > > and demanding the EMS from another city because you believe

that

> > > they are better for whatever reason. This is also no

different

> > than

> > > choosing to go to a hospital that is farther away than a

closer

> > > appropriate one. We have a system based on ethical choices

and

> we

> > > must stay within it. If you don't like the closest provider

to

> > you

> > > then you should address the issues with that provider rather

> than

> > > circumventing the system. This would also apply to those

> creating

> > > protocols based upon personal preferences. A protocol from

your

> > > Medical Director doesn't make it any more legally or ethically

> > > defensible if it's not the most appropriate choice in a given

> > > situation.

> > >

> > > Jon

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

Those are very interesting statistics. They seem counterintuitive.

I disagree that speed is the ONLY advantage of a helicopter. It is

in my opinion the biggest advantage. I won't argue that a lot of

our patients can go by ground just as well in hind site. Can you

tell me how to definitively tell beforehand which ones it will make

a difference on…that is beyond the assessment criteria we already

use?

The statistics you quoted at the end makes me want to run screaming

from the helicopter. :-)

Jon

> > > > >

> > > > > This can happen when the patient stops being the primary

> > concern

> > > for

> > > > those

> > > > > on the call.

> > > >

> > > > According to the story, the patients weren't even extricated

> yet

> > > when

> > > > the chopper arrived. Obviously, ETA was not a primary

concern

> > in

> > > this

> > > > instance. I hear medics all the time saying they would not

> call

> > > so-

> > > > and-so flight service for a dead dog. This is a prevalent

> > thing.

> > > So

> > > > if there was no threat to the patient, and there was no

policy

> > > > superceding the medic's actions, what exactly is the problem

> > here?

> > > >

> > > > I agree. I would like to hear the story from the medics and

> the

> > > other

> > > > service, not just whining from the losers.

> > > >

> > > > Rob

> > > >

> > >

> > >

> > > Perhaps your right about this case...but then again you could

> also

> > > be very wrong. There are so many different dynamics involved

in

> > > some of these decisions. The level of care offered by the

> > personnel

> > > on scene is variable depending on where you go. If there was

an

> > > immanent patient care issue that was beyond their capabilities

> but

> > > within the capabilities of the closest air service then that

> > changes

> > > things the other direction...toward them being wrong to wait.

> > >

> > > The problem here is not whether or not someone should catch

some

> > > grief from their boss based on being outside of some

protocol.

> > The

> > > question is did they do the right thing. The patient doesn't

> have

> > > to have been harmed for their actions to have been wrong. You

> can

> > > have a good outcome despite poor care in lots of situations?

most

> > of

> > > us have thanked god for that at one time or another.

> > >

> > > I believe personal preference often plays a roll in the choice

> of

> > > the services utilized...despite what maybe ethically correct.

Is

> > > this right? This isn't anymore right than dialing 911 in one

> city

> > > and demanding the EMS from another city because you believe

that

> > > they are better for whatever reason. This is also no

different

> > than

> > > choosing to go to a hospital that is farther away than a

closer

> > > appropriate one. We have a system based on ethical choices

and

> we

> > > must stay within it. If you don't like the closest provider

to

> > you

> > > then you should address the issues with that provider rather

> than

> > > circumventing the system. This would also apply to those

> creating

> > > protocols based upon personal preferences. A protocol from

your

> > > Medical Director doesn't make it any more legally or ethically

> > > defensible if it's not the most appropriate choice in a given

> > > situation.

> > >

> > > Jon

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

Those are very interesting statistics. They seem counterintuitive.

I disagree that speed is the ONLY advantage of a helicopter. It is

in my opinion the biggest advantage. I won't argue that a lot of

our patients can go by ground just as well in hind site. Can you

tell me how to definitively tell beforehand which ones it will make

a difference on…that is beyond the assessment criteria we already

use?

The statistics you quoted at the end makes me want to run screaming

from the helicopter. :-)

Jon

> > > > >

> > > > > This can happen when the patient stops being the primary

> > concern

> > > for

> > > > those

> > > > > on the call.

> > > >

> > > > According to the story, the patients weren't even extricated

> yet

> > > when

> > > > the chopper arrived. Obviously, ETA was not a primary

concern

> > in

> > > this

> > > > instance. I hear medics all the time saying they would not

> call

> > > so-

> > > > and-so flight service for a dead dog. This is a prevalent

> > thing.

> > > So

> > > > if there was no threat to the patient, and there was no

policy

> > > > superceding the medic's actions, what exactly is the problem

> > here?

> > > >

> > > > I agree. I would like to hear the story from the medics and

> the

> > > other

> > > > service, not just whining from the losers.

> > > >

> > > > Rob

> > > >

> > >

> > >

> > > Perhaps your right about this case...but then again you could

> also

> > > be very wrong. There are so many different dynamics involved

in

> > > some of these decisions. The level of care offered by the

> > personnel

> > > on scene is variable depending on where you go. If there was

an

> > > immanent patient care issue that was beyond their capabilities

> but

> > > within the capabilities of the closest air service then that

> > changes

> > > things the other direction...toward them being wrong to wait.

> > >

> > > The problem here is not whether or not someone should catch

some

> > > grief from their boss based on being outside of some

protocol.

> > The

> > > question is did they do the right thing. The patient doesn't

> have

> > > to have been harmed for their actions to have been wrong. You

> can

> > > have a good outcome despite poor care in lots of situations?

most

> > of

> > > us have thanked god for that at one time or another.

> > >

> > > I believe personal preference often plays a roll in the choice

> of

> > > the services utilized...despite what maybe ethically correct.

Is

> > > this right? This isn't anymore right than dialing 911 in one

> city

> > > and demanding the EMS from another city because you believe

that

> > > they are better for whatever reason. This is also no

different

> > than

> > > choosing to go to a hospital that is farther away than a

closer

> > > appropriate one. We have a system based on ethical choices

and

> we

> > > must stay within it. If you don't like the closest provider

to

> > you

> > > then you should address the issues with that provider rather

> than

> > > circumventing the system. This would also apply to those

> creating

> > > protocols based upon personal preferences. A protocol from

your

> > > Medical Director doesn't make it any more legally or ethically

> > > defensible if it's not the most appropriate choice in a given

> > > situation.

> > >

> > > Jon

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

At the risk of getting myself in more trouble with this list than I already am,

what prevents ground paramedics from doing the " special skills " (RSI, chest

tube, etc) that many flight medics are credentialed to do? I can't see any

reason that these skills can only be performed in a neat looking chopper. In

other words, we as ground medics need to work with our medical directors to

ensure that we have the right tools (equipment, drugs, and skills) to maximize

patient outcomes.

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

Re: Closest Chopper

Those are very interesting statistics. They seem counterintuitive.

I disagree that speed is the ONLY advantage of a helicopter. It is

in my opinion the biggest advantage. I won't argue that a lot of

our patients can go by ground just as well in hind site. Can you

tell me how to definitively tell beforehand which ones it will make

a difference on?that is beyond the assessment criteria we already

use?

The statistics you quoted at the end makes me want to run screaming

from the helicopter. :-)

Jon

> > > > >

> > > > > This can happen when the patient stops being the primary

> > concern

> > > for

> > > > those

> > > > > on the call.

> > > >

> > > > According to the story, the patients weren't even extricated

> yet

> > > when

> > > > the chopper arrived. Obviously, ETA was not a primary

concern

> > in

> > > this

> > > > instance. I hear medics all the time saying they would not

> call

> > > so-

> > > > and-so flight service for a dead dog. This is a prevalent

> > thing.

> > > So

> > > > if there was no threat to the patient, and there was no

policy

> > > > superceding the medic's actions, what exactly is the problem

> > here?

> > > >

> > > > I agree. I would like to hear the story from the medics and

> the

> > > other

> > > > service, not just whining from the losers.

> > > >

> > > > Rob

> > > >

> > >

> > >

> > > Perhaps your right about this case...but then again you could

> also

> > > be very wrong. There are so many different dynamics involved

in

> > > some of these decisions. The level of care offered by the

> > personnel

> > > on scene is variable depending on where you go. If there was

an

> > > immanent patient care issue that was beyond their capabilities

> but

> > > within the capabilities of the closest air service then that

> > changes

> > > things the other direction...toward them being wrong to wait.

> > >

> > > The problem here is not whether or not someone should catch

some

> > > grief from their boss based on being outside of some

protocol.

> > The

> > > question is did they do the right thing. The patient doesn't

> have

> > > to have been harmed for their actions to have been wrong. You

> can

> > > have a good outcome despite poor care in lots of situations?

most

> > of

> > > us have thanked god for that at one time or another.

> > >

> > > I believe personal preference often plays a roll in the choice

> of

> > > the services utilized...despite what maybe ethically correct.

Is

> > > this right? This isn't anymore right than dialing 911 in one

> city

> > > and demanding the EMS from another city because you believe

that

> > > they are better for whatever reason. This is also no

different

> > than

> > > choosing to go to a hospital that is farther away than a

closer

> > > appropriate one. We have a system based on ethical choices

and

> we

> > > must stay within it. If you don't like the closest provider

to

> > you

> > > then you should address the issues with that provider rather

> than

> > > circumventing the system. This would also apply to those

> creating

> > > protocols based upon personal preferences. A protocol from

your

> > > Medical Director doesn't make it any more legally or ethically

> > > defensible if it's not the most appropriate choice in a given

> > > situation.

> > >

> > > Jon

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

At the risk of getting myself in more trouble with this list than I already am,

what prevents ground paramedics from doing the " special skills " (RSI, chest

tube, etc) that many flight medics are credentialed to do? I can't see any

reason that these skills can only be performed in a neat looking chopper. In

other words, we as ground medics need to work with our medical directors to

ensure that we have the right tools (equipment, drugs, and skills) to maximize

patient outcomes.

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

Re: Closest Chopper

Those are very interesting statistics. They seem counterintuitive.

I disagree that speed is the ONLY advantage of a helicopter. It is

in my opinion the biggest advantage. I won't argue that a lot of

our patients can go by ground just as well in hind site. Can you

tell me how to definitively tell beforehand which ones it will make

a difference on?that is beyond the assessment criteria we already

use?

The statistics you quoted at the end makes me want to run screaming

from the helicopter. :-)

Jon

> > > > >

> > > > > This can happen when the patient stops being the primary

> > concern

> > > for

> > > > those

> > > > > on the call.

> > > >

> > > > According to the story, the patients weren't even extricated

> yet

> > > when

> > > > the chopper arrived. Obviously, ETA was not a primary

concern

> > in

> > > this

> > > > instance. I hear medics all the time saying they would not

> call

> > > so-

> > > > and-so flight service for a dead dog. This is a prevalent

> > thing.

> > > So

> > > > if there was no threat to the patient, and there was no

policy

> > > > superceding the medic's actions, what exactly is the problem

> > here?

> > > >

> > > > I agree. I would like to hear the story from the medics and

> the

> > > other

> > > > service, not just whining from the losers.

> > > >

> > > > Rob

> > > >

> > >

> > >

> > > Perhaps your right about this case...but then again you could

> also

> > > be very wrong. There are so many different dynamics involved

in

> > > some of these decisions. The level of care offered by the

> > personnel

> > > on scene is variable depending on where you go. If there was

an

> > > immanent patient care issue that was beyond their capabilities

> but

> > > within the capabilities of the closest air service then that

> > changes

> > > things the other direction...toward them being wrong to wait.

> > >

> > > The problem here is not whether or not someone should catch

some

> > > grief from their boss based on being outside of some

protocol.

> > The

> > > question is did they do the right thing. The patient doesn't

> have

> > > to have been harmed for their actions to have been wrong. You

> can

> > > have a good outcome despite poor care in lots of situations?

most

> > of

> > > us have thanked god for that at one time or another.

> > >

> > > I believe personal preference often plays a roll in the choice

> of

> > > the services utilized...despite what maybe ethically correct.

Is

> > > this right? This isn't anymore right than dialing 911 in one

> city

> > > and demanding the EMS from another city because you believe

that

> > > they are better for whatever reason. This is also no

different

> > than

> > > choosing to go to a hospital that is farther away than a

closer

> > > appropriate one. We have a system based on ethical choices

and

> we

> > > must stay within it. If you don't like the closest provider

to

> > you

> > > then you should address the issues with that provider rather

> than

> > > circumventing the system. This would also apply to those

> creating

> > > protocols based upon personal preferences. A protocol from

your

> > > Medical Director doesn't make it any more legally or ethically

> > > defensible if it's not the most appropriate choice in a given

> > > situation.

> > >

> > > Jon

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

At the risk of getting myself in more trouble with this list than I already am,

what prevents ground paramedics from doing the " special skills " (RSI, chest

tube, etc) that many flight medics are credentialed to do? I can't see any

reason that these skills can only be performed in a neat looking chopper. In

other words, we as ground medics need to work with our medical directors to

ensure that we have the right tools (equipment, drugs, and skills) to maximize

patient outcomes.

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

Re: Closest Chopper

Those are very interesting statistics. They seem counterintuitive.

I disagree that speed is the ONLY advantage of a helicopter. It is

in my opinion the biggest advantage. I won't argue that a lot of

our patients can go by ground just as well in hind site. Can you

tell me how to definitively tell beforehand which ones it will make

a difference on?that is beyond the assessment criteria we already

use?

The statistics you quoted at the end makes me want to run screaming

from the helicopter. :-)

Jon

> > > > >

> > > > > This can happen when the patient stops being the primary

> > concern

> > > for

> > > > those

> > > > > on the call.

> > > >

> > > > According to the story, the patients weren't even extricated

> yet

> > > when

> > > > the chopper arrived. Obviously, ETA was not a primary

concern

> > in

> > > this

> > > > instance. I hear medics all the time saying they would not

> call

> > > so-

> > > > and-so flight service for a dead dog. This is a prevalent

> > thing.

> > > So

> > > > if there was no threat to the patient, and there was no

policy

> > > > superceding the medic's actions, what exactly is the problem

> > here?

> > > >

> > > > I agree. I would like to hear the story from the medics and

> the

> > > other

> > > > service, not just whining from the losers.

> > > >

> > > > Rob

> > > >

> > >

> > >

> > > Perhaps your right about this case...but then again you could

> also

> > > be very wrong. There are so many different dynamics involved

in

> > > some of these decisions. The level of care offered by the

> > personnel

> > > on scene is variable depending on where you go. If there was

an

> > > immanent patient care issue that was beyond their capabilities

> but

> > > within the capabilities of the closest air service then that

> > changes

> > > things the other direction...toward them being wrong to wait.

> > >

> > > The problem here is not whether or not someone should catch

some

> > > grief from their boss based on being outside of some

protocol.

> > The

> > > question is did they do the right thing. The patient doesn't

> have

> > > to have been harmed for their actions to have been wrong. You

> can

> > > have a good outcome despite poor care in lots of situations?

most

> > of

> > > us have thanked god for that at one time or another.

> > >

> > > I believe personal preference often plays a roll in the choice

> of

> > > the services utilized...despite what maybe ethically correct.

Is

> > > this right? This isn't anymore right than dialing 911 in one

> city

> > > and demanding the EMS from another city because you believe

that

> > > they are better for whatever reason. This is also no

different

> > than

> > > choosing to go to a hospital that is farther away than a

closer

> > > appropriate one. We have a system based on ethical choices

and

> we

> > > must stay within it. If you don't like the closest provider

to

> > you

> > > then you should address the issues with that provider rather

> than

> > > circumventing the system. This would also apply to those

> creating

> > > protocols based upon personal preferences. A protocol from

your

> > > Medical Director doesn't make it any more legally or ethically

> > > defensible if it's not the most appropriate choice in a given

> > > situation.

> > >

> > > Jon

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

What other advantage is there? Noise, vibration? Are you saying you provide

better care than your ground-based counterparts?

BEB

E. Bledsoe, DO, FACEP

Midlothian, Texas

Don't miss the Western States EMS Cruise!

http://proemseducators.com/index.html

_____

From: [mailto: ] On

Behalf Of Jon

Sent: Wednesday, December 28, 2005 12:36 PM

To:

Subject: Re: Closest Chopper

Those are very interesting statistics. They seem counterintuitive.

I disagree that speed is the ONLY advantage of a helicopter. It is

in my opinion the biggest advantage. I won't argue that a lot of

our patients can go by ground just as well in hind site. Can you

tell me how to definitively tell beforehand which ones it will make

a difference on.that is beyond the assessment criteria we already

use?

The statistics you quoted at the end makes me want to run screaming

from the helicopter. :-)

Jon

> > > > >

> > > > > This can happen when the patient stops being the primary

> > concern

> > > for

> > > > those

> > > > > on the call.

> > > >

> > > > According to the story, the patients weren't even extricated

> yet

> > > when

> > > > the chopper arrived. Obviously, ETA was not a primary

concern

> > in

> > > this

> > > > instance. I hear medics all the time saying they would not

> call

> > > so-

> > > > and-so flight service for a dead dog. This is a prevalent

> > thing.

> > > So

> > > > if there was no threat to the patient, and there was no

policy

> > > > superceding the medic's actions, what exactly is the problem

> > here?

> > > >

> > > > I agree. I would like to hear the story from the medics and

> the

> > > other

> > > > service, not just whining from the losers.

> > > >

> > > > Rob

> > > >

> > >

> > >

> > > Perhaps your right about this case...but then again you could

> also

> > > be very wrong. There are so many different dynamics involved

in

> > > some of these decisions. The level of care offered by the

> > personnel

> > > on scene is variable depending on where you go. If there was

an

> > > immanent patient care issue that was beyond their capabilities

> but

> > > within the capabilities of the closest air service then that

> > changes

> > > things the other direction...toward them being wrong to wait.

> > >

> > > The problem here is not whether or not someone should catch

some

> > > grief from their boss based on being outside of some

protocol.

> > The

> > > question is did they do the right thing. The patient doesn't

> have

> > > to have been harmed for their actions to have been wrong. You

> can

> > > have a good outcome despite poor care in lots of situations?

most

> > of

> > > us have thanked god for that at one time or another.

> > >

> > > I believe personal preference often plays a roll in the choice

> of

> > > the services utilized...despite what maybe ethically correct.

Is

> > > this right? This isn't anymore right than dialing 911 in one

> city

> > > and demanding the EMS from another city because you believe

that

> > > they are better for whatever reason. This is also no

different

> > than

> > > choosing to go to a hospital that is farther away than a

closer

> > > appropriate one. We have a system based on ethical choices

and

> we

> > > must stay within it. If you don't like the closest provider

to

> > you

> > > then you should address the issues with that provider rather

> than

> > > circumventing the system. This would also apply to those

> creating

> > > protocols based upon personal preferences. A protocol from

your

> > > Medical Director doesn't make it any more legally or ethically

> > > defensible if it's not the most appropriate choice in a given

> > > situation.

> > >

> > > Jon

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >