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...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 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? Glasgow Coma Scale, Revised Trauma Score, physiologic parameters--nothing else Mechanism of injury criteria (except ejection from vehicle) are not based upon any science and poor predictors of who needs a helicopter. 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...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 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? Glasgow Coma Scale, Revised Trauma Score, physiologic parameters--nothing else Mechanism of injury criteria (except ejection from vehicle) are not based upon any science and poor predictors of who needs a helicopter. 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...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 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? Glasgow Coma Scale, Revised Trauma Score, physiologic parameters--nothing else Mechanism of injury criteria (except ejection from vehicle) are not based upon any science and poor predictors of who needs a helicopter. 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...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 There are lots of different situations out there and levels of care. Not all EMS run 100% MICU units. Not all are metropolitan based and have 10 minutes to the Trauma Center. You know this stuff...what are you getting at? How accurate are those statistics used outside of the metropolitan hubs? > > > > > > > > > > > > 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 Wes, These things are performed by most Critical Care trained Paramedics. You will see more and more of it in the future. The only difference is the mode of transport. Depending on the mode (i.e. ground vs. air) there are sometimes other considerations/adjustments that must be made for stuff like altitude issues, space limitations, crew make-up etc. Lee 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 Wes, These things are performed by most Critical Care trained Paramedics. You will see more and more of it in the future. The only difference is the mode of transport. Depending on the mode (i.e. ground vs. air) there are sometimes other considerations/adjustments that must be made for stuff like altitude issues, space limitations, crew make-up etc. Lee 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 Wes, These things are performed by most Critical Care trained Paramedics. You will see more and more of it in the future. The only difference is the mode of transport. Depending on the mode (i.e. ground vs. air) there are sometimes other considerations/adjustments that must be made for stuff like altitude issues, space limitations, crew make-up etc. Lee 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 Of course, there's nothing mandating that only a critical care paramedic can do these skills. Quite, simply, the ultimate level of prehospital care in Texas is the EMT-P/LP. In other words, if the EMS system and medical director want to train and allow their providers to perform these interventions, that's the only requirement. In my humble opinion, we need fewer additional certifications and fewer helos, and better trained ground providers (from ECA to to EMT-P/LP) and the medical directors to back them. -Wes Ogilvie, MPA, JD, EMT 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 Of course, there's nothing mandating that only a critical care paramedic can do these skills. Quite, simply, the ultimate level of prehospital care in Texas is the EMT-P/LP. In other words, if the EMS system and medical director want to train and allow their providers to perform these interventions, that's the only requirement. In my humble opinion, we need fewer additional certifications and fewer helos, and better trained ground providers (from ECA to to EMT-P/LP) and the medical directors to back them. -Wes Ogilvie, MPA, JD, EMT 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 Of course, there's nothing mandating that only a critical care paramedic can do these skills. Quite, simply, the ultimate level of prehospital care in Texas is the EMT-P/LP. In other words, if the EMS system and medical director want to train and allow their providers to perform these interventions, that's the only requirement. In my humble opinion, we need fewer additional certifications and fewer helos, and better trained ground providers (from ECA to to EMT-P/LP) and the medical directors to back them. -Wes Ogilvie, MPA, JD, EMT 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 Wes is right on the money here. We need better trained and equipped ground crews and fewer choppers. You chronically see services sit and wait for a chopper for a longer period of time than it would take for them to transport the patient to the ER. ExLngHrn@... wrote: Of course, there's nothing mandating that only a critical care paramedic can do these skills. Quite, simply, the ultimate level of prehospital care in Texas is the EMT-P/LP. In other words, if the EMS system and medical director want to train and allow their providers to perform these interventions, that's the only requirement. In my humble opinion, we need fewer additional certifications and fewer helos, and better trained ground providers (from ECA to to EMT-P/LP) and the medical directors to back them. -Wes Ogilvie, MPA, JD, EMT 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 Wes is right on the money here. We need better trained and equipped ground crews and fewer choppers. You chronically see services sit and wait for a chopper for a longer period of time than it would take for them to transport the patient to the ER. ExLngHrn@... wrote: Of course, there's nothing mandating that only a critical care paramedic can do these skills. Quite, simply, the ultimate level of prehospital care in Texas is the EMT-P/LP. In other words, if the EMS system and medical director want to train and allow their providers to perform these interventions, that's the only requirement. In my humble opinion, we need fewer additional certifications and fewer helos, and better trained ground providers (from ECA to to EMT-P/LP) and the medical directors to back them. -Wes Ogilvie, MPA, JD, EMT 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 Wes is right on the money here. We need better trained and equipped ground crews and fewer choppers. You chronically see services sit and wait for a chopper for a longer period of time than it would take for them to transport the patient to the ER. ExLngHrn@... wrote: Of course, there's nothing mandating that only a critical care paramedic can do these skills. Quite, simply, the ultimate level of prehospital care in Texas is the EMT-P/LP. In other words, if the EMS system and medical director want to train and allow their providers to perform these interventions, that's the only requirement. In my humble opinion, we need fewer additional certifications and fewer helos, and better trained ground providers (from ECA to to EMT-P/LP) and the medical directors to back them. -Wes Ogilvie, MPA, JD, EMT 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 There's some mental arithmetic on requesting a helo, in my opinion. The question which I think bears asking is " How quickly can I get this patient loaded into an ambulance and get going towards a hospital? " The corresponding question is " How quickly can the helo launch and be on scene and how quickly can they get to their destination? " Good judgment on the part of the initial medic (or better yet, the first responder) will answer the question the right way. -Wes 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 There's some mental arithmetic on requesting a helo, in my opinion. The question which I think bears asking is " How quickly can I get this patient loaded into an ambulance and get going towards a hospital? " The corresponding question is " How quickly can the helo launch and be on scene and how quickly can they get to their destination? " Good judgment on the part of the initial medic (or better yet, the first responder) will answer the question the right way. -Wes 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 There's some mental arithmetic on requesting a helo, in my opinion. The question which I think bears asking is " How quickly can I get this patient loaded into an ambulance and get going towards a hospital? " The corresponding question is " How quickly can the helo launch and be on scene and how quickly can they get to their destination? " Good judgment on the part of the initial medic (or better yet, the first responder) will answer the question the right way. -Wes 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 " Good judgment on the part of the initial medic (or better yet, the first responder) will answer the question the right way. " Absolutely. Nothing replaces a good thought process and rational judgement. In , ExLngHrn@a... wrote: > > There's some mental arithmetic on requesting a helo, in my opinion. The question which I think bears asking is " How quickly can I get this patient loaded into an ambulance and get going towards a hospital? " The corresponding question is " How quickly can the helo launch and be on scene and how quickly can they get to their destination? " > > Good judgment on the part of the initial medic (or better yet, the first responder) will answer the question the right way. > > -Wes > > 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 " Good judgment on the part of the initial medic (or better yet, the first responder) will answer the question the right way. " Absolutely. Nothing replaces a good thought process and rational judgement. In , ExLngHrn@a... wrote: > > There's some mental arithmetic on requesting a helo, in my opinion. The question which I think bears asking is " How quickly can I get this patient loaded into an ambulance and get going towards a hospital? " The corresponding question is " How quickly can the helo launch and be on scene and how quickly can they get to their destination? " > > Good judgment on the part of the initial medic (or better yet, the first responder) will answer the question the right way. > > -Wes > > 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 " Good judgment on the part of the initial medic (or better yet, the first responder) will answer the question the right way. " Absolutely. Nothing replaces a good thought process and rational judgement. In , ExLngHrn@a... wrote: > > There's some mental arithmetic on requesting a helo, in my opinion. The question which I think bears asking is " How quickly can I get this patient loaded into an ambulance and get going towards a hospital? " The corresponding question is " How quickly can the helo launch and be on scene and how quickly can they get to their destination? " > > Good judgment on the part of the initial medic (or better yet, the first responder) will answer the question the right way. > > -Wes > > 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 Now I am really dating myself here but way back when, before every Tom, Dick and Harry had an available helicopter, guess who did all of those things in the back of the ambulance. The paramedic with no special cert card, just extensive training on how to manage critical patients during that long 60 minute trip to the big city. So yes Wes, I agree with you. It takes time to train but here I make sure we take the time to train so we can handle those type of transfers. stephen stephens > > Of course, there's nothing mandating that only a critical care paramedic can do these skills. Quite, simply, the ultimate level of prehospital care in Texas is the EMT-P/LP. In other words, if the EMS system and medical director want to train and allow their providers to perform these interventions, that's the only requirement. > > In my humble opinion, we need fewer additional certifications and fewer helos, and better trained ground providers (from ECA to to EMT- P/LP) and the medical directors to back them. > > -Wes Ogilvie, MPA, JD, EMT > Austin, Texas > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 Now I am really dating myself here but way back when, before every Tom, Dick and Harry had an available helicopter, guess who did all of those things in the back of the ambulance. The paramedic with no special cert card, just extensive training on how to manage critical patients during that long 60 minute trip to the big city. So yes Wes, I agree with you. It takes time to train but here I make sure we take the time to train so we can handle those type of transfers. stephen stephens > > Of course, there's nothing mandating that only a critical care paramedic can do these skills. Quite, simply, the ultimate level of prehospital care in Texas is the EMT-P/LP. In other words, if the EMS system and medical director want to train and allow their providers to perform these interventions, that's the only requirement. > > In my humble opinion, we need fewer additional certifications and fewer helos, and better trained ground providers (from ECA to to EMT- P/LP) and the medical directors to back them. > > -Wes Ogilvie, MPA, JD, EMT > Austin, Texas > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 Now I am really dating myself here but way back when, before every Tom, Dick and Harry had an available helicopter, guess who did all of those things in the back of the ambulance. The paramedic with no special cert card, just extensive training on how to manage critical patients during that long 60 minute trip to the big city. So yes Wes, I agree with you. It takes time to train but here I make sure we take the time to train so we can handle those type of transfers. stephen stephens > > Of course, there's nothing mandating that only a critical care paramedic can do these skills. Quite, simply, the ultimate level of prehospital care in Texas is the EMT-P/LP. In other words, if the EMS system and medical director want to train and allow their providers to perform these interventions, that's the only requirement. > > In my humble opinion, we need fewer additional certifications and fewer helos, and better trained ground providers (from ECA to to EMT- P/LP) and the medical directors to back them. > > -Wes Ogilvie, MPA, JD, EMT > Austin, Texas > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 Wes, You answered your own question. The only thing keeping us from performing those skills, is our own Medical Directors. The advantage to us doing them, in some instances, is less noise, less vibration and a little more room. Mike 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 Wes, You answered your own question. The only thing keeping us from performing those skills, is our own Medical Directors. The advantage to us doing them, in some instances, is less noise, less vibration and a little more room. Mike 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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