Guest guest Posted December 27, 2005 Report Share Posted December 27, 2005 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< Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 27, 2005 Report Share Posted December 27, 2005 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< Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 27, 2005 Report Share Posted December 27, 2005 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< Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 27, 2005 Report Share Posted December 27, 2005 " " <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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 27, 2005 Report Share Posted December 27, 2005 > > > > 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 27, 2005 Report Share Posted December 27, 2005 > > > > 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 27, 2005 Report Share Posted December 27, 2005 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 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 > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 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 > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 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. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 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 > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 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 > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 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 > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 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 > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 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 > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 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 > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 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 > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 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 > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 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 > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 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 > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 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 > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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