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 I'd go with the first option as Critical Air (now merged into AirEvac Lifeteam, I think) has made its bread and butter operating as a rural interfacility transfer service with occasional scene responses. -Wes In a message dated 12/28/2005 10:13:39 PM Central Standard Time, mparker@... writes: Gold Star Angel Flight had helicopters placed strategically in rural areas and they are no longer around. Perhaps because of the mismanagement of the company or was it they couldn't make ends meet serving just the rural area? > > > > > > > > > > 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 I'd go with the first option as Critical Air (now merged into AirEvac Lifeteam, I think) has made its bread and butter operating as a rural interfacility transfer service with occasional scene responses. -Wes In a message dated 12/28/2005 10:13:39 PM Central Standard Time, mparker@... writes: Gold Star Angel Flight had helicopters placed strategically in rural areas and they are no longer around. Perhaps because of the mismanagement of the company or was it they couldn't make ends meet serving just the rural area? > > > > > > > > > > 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 I'd go with the first option as Critical Air (now merged into AirEvac Lifeteam, I think) has made its bread and butter operating as a rural interfacility transfer service with occasional scene responses. -Wes In a message dated 12/28/2005 10:13:39 PM Central Standard Time, mparker@... writes: Gold Star Angel Flight had helicopters placed strategically in rural areas and they are no longer around. Perhaps because of the mismanagement of the company or was it they couldn't make ends meet serving just the rural area? > > > > > > > > > > This can happen when the patient stops being the primary > > concern > > > for > > > > those > > > > > on the call. > > > > > > > > According to the story, the patients weren't even extricated > yet > > > when > > > > the chopper arrived. Obviously, ETA was not a primary concern > > in > > > this > > > > instance. I hear medics all the time saying they would not > call > > > so- > > > > and-so flight service for a dead dog. This is a prevalent > > thing. > > > So > > > > if there was no threat to the patient, and there was no policy > > > > superceding the medic's actions, what exactly is the problem > > here? > > > > > > > > I agree. I would like to hear the story from the medics and > the > > > other > > > > service, not just whining from the losers. > > > > > > > > Rob > > > > > > > > > > > > > Perhaps your right about this case...but then again you could > also > > > be very wrong. There are so many different dynamics involved in > > > some of these decisions. The level of care offered by the > > personnel > > > on scene is variable depending on where you go. If there was an > > > immanent patient care issue that was beyond their capabilities > but > > > within the capabilities of the closest air service then that > > changes > > > things the other direction...toward them being wrong to wait. > > > > > > The problem here is not whether or not someone should catch some > > > grief from their boss based on being outside of some protocol. > > The > > > question is did they do the right thing. The patient doesn't > have > > > to have been harmed for their actions to have been wrong. You > can > > > have a good outcome despite poor care in lots of situations? most > > of > > > us have thanked god for that at one time or another. > > > > > > I believe personal preference often plays a roll in the choice > of > > > the services utilized...despite what maybe ethically correct. Is > > > this right? This isn't anymore right than dialing 911 in one > city > > > and demanding the EMS from another city because you believe that > > > they are better for whatever reason. This is also no different > > than > > > choosing to go to a hospital that is farther away than a closer > > > appropriate one. We have a system based on ethical choices and > we > > > must stay within it. If you don't like the closest provider to > > you > > > then you should address the issues with that provider rather > than > > > circumventing the system. This would also apply to those > creating > > > protocols based upon personal preferences. A protocol from your > > > Medical Director doesn't make it any more legally or ethically > > > defensible if it's not the most appropriate choice in a given > > > situation. > > > > > > Jon > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 " What Texas needs is more fixed-wing air ambulances and fewer helicopters. These would serve the rural and frontier areas better and are safer, more cost effective, and more comfortable. " Or, another alternative is to take all these helicopters that seem to congregate around Houston, Dallas, Austin, and the areas inside this triangle...and move them to outlying rural areas where there would truly be a difference in flight time vs. drive time. It has often seemed odd to me that helicopters are based at or near trauma centers...which puts them farther away from the patients that actually need them...if they were 60 to 90 minutes ground time from the trauma center seems they could reach their patients faster and get them to a trauma facility faster... Just my thoughts. Dudley Re: Closest Chopper You could argue that 2/3 to 3/4 of the patients that are taken to a trauma center are taken there unnecessarily in hind site. We still take them there due to the fact we don't want the other 1/3 taken to a lower facility that can't handle their injuries. Same argument about the number of patients that really needed that CT in hind site. We have to do the best thing for them at the time with the information at hand at that time. I shouldnt quote those fractions above as I dont know if they are accurate...the general principle is what matters there. Jon > > > > > > > > This can happen when the patient stops being the primary > concern > > for > > > those > > > > on the call. > > > > > > According to the story, the patients weren't even extricated yet > > when > > > the chopper arrived. Obviously, ETA was not a primary concern > in > > this > > > instance. I hear medics all the time saying they would not call > > so- > > > and-so flight service for a dead dog. This is a prevalent > thing. > > So > > > if there was no threat to the patient, and there was no policy > > > superceding the medic's actions, what exactly is the problem > here? > > > > > > I agree. I would like to hear the story from the medics and the > > other > > > service, not just whining from the losers. > > > > > > Rob > > > > > > > > > Perhaps your right about this case...but then again you could also > > be very wrong. There are so many different dynamics involved in > > some of these decisions. The level of care offered by the > personnel > > on scene is variable depending on where you go. If there was an > > immanent patient care issue that was beyond their capabilities but > > within the capabilities of the closest air service then that > changes > > things the other direction...toward them being wrong to wait. > > > > The problem here is not whether or not someone should catch some > > grief from their boss based on being outside of some protocol. > The > > question is did they do the right thing. The patient doesn't have > > to have been harmed for their actions to have been wrong. You can > > have a good outcome despite poor care in lots of situations?most > of > > us have thanked god for that at one time or another. > > > > I believe personal preference often plays a roll in the choice of > > the services utilized...despite what maybe ethically correct. Is > > this right? This isn't anymore right than dialing 911 in one city > > and demanding the EMS from another city because you believe that > > they are better for whatever reason. This is also no different > than > > choosing to go to a hospital that is farther away than a closer > > appropriate one. We have a system based on ethical choices and we > > must stay within it. If you don't like the closest provider to > you > > then you should address the issues with that provider rather than > > circumventing the system. This would also apply to those creating > > protocols based upon personal preferences. A protocol from your > > Medical Director doesn't make it any more legally or ethically > > defensible if it's not the most appropriate choice in a given > > situation. > > > > Jon > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 " What Texas needs is more fixed-wing air ambulances and fewer helicopters. These would serve the rural and frontier areas better and are safer, more cost effective, and more comfortable. " Or, another alternative is to take all these helicopters that seem to congregate around Houston, Dallas, Austin, and the areas inside this triangle...and move them to outlying rural areas where there would truly be a difference in flight time vs. drive time. It has often seemed odd to me that helicopters are based at or near trauma centers...which puts them farther away from the patients that actually need them...if they were 60 to 90 minutes ground time from the trauma center seems they could reach their patients faster and get them to a trauma facility faster... Just my thoughts. Dudley Re: Closest Chopper You could argue that 2/3 to 3/4 of the patients that are taken to a trauma center are taken there unnecessarily in hind site. We still take them there due to the fact we don't want the other 1/3 taken to a lower facility that can't handle their injuries. Same argument about the number of patients that really needed that CT in hind site. We have to do the best thing for them at the time with the information at hand at that time. I shouldnt quote those fractions above as I dont know if they are accurate...the general principle is what matters there. Jon > > > > > > > > This can happen when the patient stops being the primary > concern > > for > > > those > > > > on the call. > > > > > > According to the story, the patients weren't even extricated yet > > when > > > the chopper arrived. Obviously, ETA was not a primary concern > in > > this > > > instance. I hear medics all the time saying they would not call > > so- > > > and-so flight service for a dead dog. This is a prevalent > thing. > > So > > > if there was no threat to the patient, and there was no policy > > > superceding the medic's actions, what exactly is the problem > here? > > > > > > I agree. I would like to hear the story from the medics and the > > other > > > service, not just whining from the losers. > > > > > > Rob > > > > > > > > > Perhaps your right about this case...but then again you could also > > be very wrong. There are so many different dynamics involved in > > some of these decisions. The level of care offered by the > personnel > > on scene is variable depending on where you go. If there was an > > immanent patient care issue that was beyond their capabilities but > > within the capabilities of the closest air service then that > changes > > things the other direction...toward them being wrong to wait. > > > > The problem here is not whether or not someone should catch some > > grief from their boss based on being outside of some protocol. > The > > question is did they do the right thing. The patient doesn't have > > to have been harmed for their actions to have been wrong. You can > > have a good outcome despite poor care in lots of situations?most > of > > us have thanked god for that at one time or another. > > > > I believe personal preference often plays a roll in the choice of > > the services utilized...despite what maybe ethically correct. Is > > this right? This isn't anymore right than dialing 911 in one city > > and demanding the EMS from another city because you believe that > > they are better for whatever reason. This is also no different > than > > choosing to go to a hospital that is farther away than a closer > > appropriate one. We have a system based on ethical choices and we > > must stay within it. If you don't like the closest provider to > you > > then you should address the issues with that provider rather than > > circumventing the system. This would also apply to those creating > > protocols based upon personal preferences. A protocol from your > > Medical Director doesn't make it any more legally or ethically > > defensible if it's not the most appropriate choice in a given > > situation. > > > > Jon > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 As of Jan 1,2007 only medstar communications is allowed to launch a helicopter to a scene in the medstar response area. Coverage is Careflite south of 30 and PHI north of 30. 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 I agree with you 100% Wes. I was about to post the same suggestion. 2 rural services I have worked for had the same complaint. The chopper gets there to the scene fast, but then sits for about 10-20 minutes evaluating the patient and performing needed interventions. If those interventions were done on the ground ambulance you could perhaps get the patient to the hospital that much faster. Salvador Capuchino Jr EMT-Paramedic --- ExLngHrn@... wrote: > At the risk of getting myself in more trouble with > this list than I already am, what prevents ground > paramedics from doing the " special skills " (RSI, > chest tube, etc) that many flight medics are > credentialed to do? I can't see any reason that > these skills can only be performed in a neat looking > chopper. In other words, we as ground medics need > to work with our medical directors to ensure that we > have the right tools (equipment, drugs, and skills) > to maximize patient outcomes. > > -Wes Ogilvie, MPA, JD, EMT-B > Austin, Texas > > Re: Closest Chopper > > > > > > > > > Dudley, > > > > > > Your agency is very close to trauma services > which changes your > > > perspective greatly. There are times when you > need > > Air.obviously. > > > You also have a service that is greatly closer > than the other > > two. > > > Outside of a mass casualty or their being > unavailable at the > time > > > there isn't much reason for you to consider the > other two. > That, > > I > > > think should be your justification for their > service.not some > > > misinformed quote about helicopter speeds. Of > the three > > helicopters > > > in your region.there is a minimal difference in > speed when you > get > === message truncated === __________________________________ Yahoo! for Good - Make a difference this year. http://brand.yahoo.com/cybergivingweek2005/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 I agree with you 100% Wes. I was about to post the same suggestion. 2 rural services I have worked for had the same complaint. The chopper gets there to the scene fast, but then sits for about 10-20 minutes evaluating the patient and performing needed interventions. If those interventions were done on the ground ambulance you could perhaps get the patient to the hospital that much faster. Salvador Capuchino Jr EMT-Paramedic --- ExLngHrn@... wrote: > At the risk of getting myself in more trouble with > this list than I already am, what prevents ground > paramedics from doing the " special skills " (RSI, > chest tube, etc) that many flight medics are > credentialed to do? I can't see any reason that > these skills can only be performed in a neat looking > chopper. In other words, we as ground medics need > to work with our medical directors to ensure that we > have the right tools (equipment, drugs, and skills) > to maximize patient outcomes. > > -Wes Ogilvie, MPA, JD, EMT-B > Austin, Texas > > Re: Closest Chopper > > > > > > > > > Dudley, > > > > > > Your agency is very close to trauma services > which changes your > > > perspective greatly. There are times when you > need > > Air.obviously. > > > You also have a service that is greatly closer > than the other > > two. > > > Outside of a mass casualty or their being > unavailable at the > time > > > there isn't much reason for you to consider the > other two. > That, > > I > > > think should be your justification for their > service.not some > > > misinformed quote about helicopter speeds. Of > the three > > helicopters > > > in your region.there is a minimal difference in > speed when you > get > === message truncated === __________________________________ Yahoo! for Good - Make a difference this year. http://brand.yahoo.com/cybergivingweek2005/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 Gold Star Angel Flight had helicopters placed strategically in rural areas and they are no longer around. Perhaps because of the mismanagement of the company or was it they couldn't make ends meet serving just the rural area? > > > > > > > > > > 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 Gold Star Angel Flight had helicopters placed strategically in rural areas and they are no longer around. Perhaps because of the mismanagement of the company or was it they couldn't make ends meet serving just the rural area? > > > > > > > > > > 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 Gold Star Angel Flight had helicopters placed strategically in rural areas and they are no longer around. Perhaps because of the mismanagement of the company or was it they couldn't make ends meet serving just the rural area? > > > > > > > > > > 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 Dudley, I don't see how the response time and time to the hospital would help any research on the subject. The average scene time is something that would be relevant. I can get that data but as for right now I can only speak for my personal experience. My scene times are truly between 5-10 minutes with a rare exception going up to 13 to 15. Something has to be very involved for us to be over the 10 minute mark. The only mandatory intervention prior to flight is an airway if needed. You are absolutely correct in most of your cases that you shouldn't wait. This is due to your proximity. The rational and thought process is different when you are farther away. I see you commented that all the helicopters should be relocated to the rural settings. That is indeed where they shine for prehospital usage. Don't forget though that scene work is just half of the mission profile. The programs have to stay economically viable or they won't exist long. I agree that there is a need for fixed wing but not in prehospital care. 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 Dudley, I don't see how the response time and time to the hospital would help any research on the subject. The average scene time is something that would be relevant. I can get that data but as for right now I can only speak for my personal experience. My scene times are truly between 5-10 minutes with a rare exception going up to 13 to 15. Something has to be very involved for us to be over the 10 minute mark. The only mandatory intervention prior to flight is an airway if needed. You are absolutely correct in most of your cases that you shouldn't wait. This is due to your proximity. The rational and thought process is different when you are farther away. I see you commented that all the helicopters should be relocated to the rural settings. That is indeed where they shine for prehospital usage. Don't forget though that scene work is just half of the mission profile. The programs have to stay economically viable or they won't exist long. I agree that there is a need for fixed wing but not in prehospital care. 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 Wait a second Mike...I thought this was about what was best for the patient and increasing people's chances of survival by utilizing helicopters in areas where they were needed... Funding??? What is this word of which you speak? Is this the F word that people were upset about just a couple of days ago on this list? Dudley Re: Re: Closest Chopper sounds good...but will 6-7 trauma patients per month fund a rotor wing aircraft in rural Texas? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 Wait a second Mike...I thought this was about what was best for the patient and increasing people's chances of survival by utilizing helicopters in areas where they were needed... Funding??? What is this word of which you speak? Is this the F word that people were upset about just a couple of days ago on this list? Dudley Re: Re: Closest Chopper sounds good...but will 6-7 trauma patients per month fund a rotor wing aircraft in rural Texas? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 Wait a second Mike...I thought this was about what was best for the patient and increasing people's chances of survival by utilizing helicopters in areas where they were needed... Funding??? What is this word of which you speak? Is this the F word that people were upset about just a couple of days ago on this list? Dudley Re: Re: Closest Chopper sounds good...but will 6-7 trauma patients per month fund a rotor wing aircraft in rural Texas? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 Wait a minute here....here is that F word again...funding...revenue streams...I thought all these helicopter programs were in place to help the poor defenseless trauma patients lying along the highways and biways of these major metropolitan areas...and flight medic after flight medic tell me they are needed in the rural area because you can't guarantee paramedic coverage and these advanced skills are needed...but only the rural areas surrounding metropolitan areas??? Only if there are enough rural calls to keep funding rolling.... Again, why is it taboo for ground EMS organizations to talk about funding and making money...but in air medical we are just stupid to think that it would never work to put them where they are needed most because they couldn't be funded. Maybe if all these agencies stopped working against each other for the flights in the metro area, stopped encouraging medics to call them with pizza, hats, and " thank you for the patient with the hangnail letters " and started working towards getting funding for these agencies where they were truly needed....we wouldn't have all the problems we are having....because unless I am mistaken...the pressure to make a certain number of revenue generating flights a month is one of the factors leading to these whirlybirds falling out of the sky... Dudley RE: Re: Closest Chopper Or, another alternative is to take all these helicopters that seem to congregate around Houston, Dallas, Austin, and the areas inside this triangle...and move them to outlying rural areas where there would truly be a difference in flight time vs. drive time. It has often seemed odd to me that helicopters are based at or near trauma centers...which puts them farther away from the patients that actually need them...if they were 60 to 90 minutes ground time from the trauma center seems they could reach their patients faster and get them to a trauma facility faster... Just my thoughts. Dudley Dudley I would recommend College level economics 101, while that plan might look wonderful on paper how would any of those programs survive without a revenue stream? It's not just the major Texas cities check Phoenix and Tucson next time you get a chance often there are more helicopters available in those cities than ground ambulances! Jim< _____ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 Wait a minute here....here is that F word again...funding...revenue streams...I thought all these helicopter programs were in place to help the poor defenseless trauma patients lying along the highways and biways of these major metropolitan areas...and flight medic after flight medic tell me they are needed in the rural area because you can't guarantee paramedic coverage and these advanced skills are needed...but only the rural areas surrounding metropolitan areas??? Only if there are enough rural calls to keep funding rolling.... Again, why is it taboo for ground EMS organizations to talk about funding and making money...but in air medical we are just stupid to think that it would never work to put them where they are needed most because they couldn't be funded. Maybe if all these agencies stopped working against each other for the flights in the metro area, stopped encouraging medics to call them with pizza, hats, and " thank you for the patient with the hangnail letters " and started working towards getting funding for these agencies where they were truly needed....we wouldn't have all the problems we are having....because unless I am mistaken...the pressure to make a certain number of revenue generating flights a month is one of the factors leading to these whirlybirds falling out of the sky... Dudley RE: Re: Closest Chopper Or, another alternative is to take all these helicopters that seem to congregate around Houston, Dallas, Austin, and the areas inside this triangle...and move them to outlying rural areas where there would truly be a difference in flight time vs. drive time. It has often seemed odd to me that helicopters are based at or near trauma centers...which puts them farther away from the patients that actually need them...if they were 60 to 90 minutes ground time from the trauma center seems they could reach their patients faster and get them to a trauma facility faster... Just my thoughts. Dudley Dudley I would recommend College level economics 101, while that plan might look wonderful on paper how would any of those programs survive without a revenue stream? It's not just the major Texas cities check Phoenix and Tucson next time you get a chance often there are more helicopters available in those cities than ground ambulances! Jim< _____ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 Wait a minute here....here is that F word again...funding...revenue streams...I thought all these helicopter programs were in place to help the poor defenseless trauma patients lying along the highways and biways of these major metropolitan areas...and flight medic after flight medic tell me they are needed in the rural area because you can't guarantee paramedic coverage and these advanced skills are needed...but only the rural areas surrounding metropolitan areas??? Only if there are enough rural calls to keep funding rolling.... Again, why is it taboo for ground EMS organizations to talk about funding and making money...but in air medical we are just stupid to think that it would never work to put them where they are needed most because they couldn't be funded. Maybe if all these agencies stopped working against each other for the flights in the metro area, stopped encouraging medics to call them with pizza, hats, and " thank you for the patient with the hangnail letters " and started working towards getting funding for these agencies where they were truly needed....we wouldn't have all the problems we are having....because unless I am mistaken...the pressure to make a certain number of revenue generating flights a month is one of the factors leading to these whirlybirds falling out of the sky... Dudley RE: Re: Closest Chopper Or, another alternative is to take all these helicopters that seem to congregate around Houston, Dallas, Austin, and the areas inside this triangle...and move them to outlying rural areas where there would truly be a difference in flight time vs. drive time. It has often seemed odd to me that helicopters are based at or near trauma centers...which puts them farther away from the patients that actually need them...if they were 60 to 90 minutes ground time from the trauma center seems they could reach their patients faster and get them to a trauma facility faster... Just my thoughts. Dudley Dudley I would recommend College level economics 101, while that plan might look wonderful on paper how would any of those programs survive without a revenue stream? It's not just the major Texas cities check Phoenix and Tucson next time you get a chance often there are more helicopters available in those cities than ground ambulances! Jim< _____ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2005 Report Share Posted December 28, 2005 I don't know about your last statement....fixed wing is widely used in rural areas of alaska...for pre-hospital care....definately an interesting concept... Dudley Re: Closest Chopper Dudley, I don't see how the response time and time to the hospital would help any research on the subject. The average scene time is something that would be relevant. I can get that data but as for right now I can only speak for my personal experience. My scene times are truly between 5-10 minutes with a rare exception going up to 13 to 15. Something has to be very involved for us to be over the 10 minute mark. The only mandatory intervention prior to flight is an airway if needed. You are absolutely correct in most of your cases that you shouldn't wait. This is due to your proximity. The rational and thought process is different when you are farther away. I see you commented that all the helicopters should be relocated to the rural settings. That is indeed where they shine for prehospital usage. Don't forget though that scene work is just half of the mission profile. The programs have to stay economically viable or they won't exist long. I agree that there is a need for fixed wing but not in prehospital care. 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 I don't know about your last statement....fixed wing is widely used in rural areas of alaska...for pre-hospital care....definately an interesting concept... Dudley Re: Closest Chopper Dudley, I don't see how the response time and time to the hospital would help any research on the subject. The average scene time is something that would be relevant. I can get that data but as for right now I can only speak for my personal experience. My scene times are truly between 5-10 minutes with a rare exception going up to 13 to 15. Something has to be very involved for us to be over the 10 minute mark. The only mandatory intervention prior to flight is an airway if needed. You are absolutely correct in most of your cases that you shouldn't wait. This is due to your proximity. The rational and thought process is different when you are farther away. I see you commented that all the helicopters should be relocated to the rural settings. That is indeed where they shine for prehospital usage. Don't forget though that scene work is just half of the mission profile. The programs have to stay economically viable or they won't exist long. I agree that there is a need for fixed wing but not in prehospital care. 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 29, 2005 Report Share Posted December 29, 2005 In a message dated 28-Dec-05 18:19:05 Central Standard Time, THEDUDMAN@... writes: Or, another alternative is to take all these helicopters that seem to congregate around Houston, Dallas, Austin, and the areas inside this triangle...and move them to outlying rural areas where there would truly be a difference in flight time vs. drive time. It has often seemed odd to me that helicopters are based at or near trauma centers...which puts them farther away from the patients that actually need them...if they were 60 to 90 minutes ground time from the trauma center seems they could reach their patients faster and get them to a trauma facility faster... Interestingly enough, back during the heyday of the MAST program (Military Assistance to Safety and Traffic, where military MEDEVAC helos, primarily US Army DUSTOFF, were available for civilian support missions) from about 1979-1985, that is exactly what happened. The US Army's 507th Medical Company (Air Ambulance) was broken up between San /Fort Sam Houston (Headquarters Detachment and 1st Platoon), El Paso/Ft Bliss (2nd Platoon), Kileen/Fort Hood) (3rd Platoon), and Lawton OK/Ft Sill (4th Platoon). Between those four, and the Coast Guard units on the Gulf coast, 75% of Texas and half of Oklahoma was provided with rapidly responding, inexpensive and SAFE emergency aeromedical transportation. Our costs were covered out of the training budget, based on the idea that the best way to keep up the critical care skills of military medics was to provide them with a variety of live patients. And that the best way to keep up the critical skills of the pilots was to keep them flying into odd ball areas. Our platoon at Ft Sill responded to primary coverage in a 150 nautical mile circle from Ft Sill, covering roughly the southwest half of OK and the north central 36 counties of Texas, with primary receiving hospitals in OKC, Dallas and Tulsa, with occasional trips to Ft , AR and Amarillo, TX. If you remember the old " Rescue 911 " show with Shatner, you might remember the shot of the DUSTOFF Huey involved in flood rescue- that was filmed during the 1982 floods in Central Texas, and involved the Ft Hood bunch. The Military MEDEVAC system had (and has) a major advantage over most civilian systems, in that we normally flew with a crew of 4, were fully IFR qualified and the military birds tend to be more heavily redundant on systems as well. In the time I was following the NTSB statistics, (roughly 1980-1995) there were IIRC *3* non combat MEDEVAC losses, all of them under major adverse conditions. This was at a time when the folks flying JetRangers found out the hard way that single pilot IFR could be difficult when the pilot had to look down at just the right angle to induce vertigo to change radio frequencies on short final... All of the Army MEDEVAC could be traced to our greatest failing in DUSTOFF, which was also our greatest claim...one that dated back to the establishment of the program.... " When I have your wounded... " ck S. Krin, DO FAAFP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2005 Report Share Posted December 29, 2005 In a message dated 28-Dec-05 18:19:05 Central Standard Time, THEDUDMAN@... writes: Or, another alternative is to take all these helicopters that seem to congregate around Houston, Dallas, Austin, and the areas inside this triangle...and move them to outlying rural areas where there would truly be a difference in flight time vs. drive time. It has often seemed odd to me that helicopters are based at or near trauma centers...which puts them farther away from the patients that actually need them...if they were 60 to 90 minutes ground time from the trauma center seems they could reach their patients faster and get them to a trauma facility faster... Interestingly enough, back during the heyday of the MAST program (Military Assistance to Safety and Traffic, where military MEDEVAC helos, primarily US Army DUSTOFF, were available for civilian support missions) from about 1979-1985, that is exactly what happened. The US Army's 507th Medical Company (Air Ambulance) was broken up between San /Fort Sam Houston (Headquarters Detachment and 1st Platoon), El Paso/Ft Bliss (2nd Platoon), Kileen/Fort Hood) (3rd Platoon), and Lawton OK/Ft Sill (4th Platoon). Between those four, and the Coast Guard units on the Gulf coast, 75% of Texas and half of Oklahoma was provided with rapidly responding, inexpensive and SAFE emergency aeromedical transportation. Our costs were covered out of the training budget, based on the idea that the best way to keep up the critical care skills of military medics was to provide them with a variety of live patients. And that the best way to keep up the critical skills of the pilots was to keep them flying into odd ball areas. Our platoon at Ft Sill responded to primary coverage in a 150 nautical mile circle from Ft Sill, covering roughly the southwest half of OK and the north central 36 counties of Texas, with primary receiving hospitals in OKC, Dallas and Tulsa, with occasional trips to Ft , AR and Amarillo, TX. If you remember the old " Rescue 911 " show with Shatner, you might remember the shot of the DUSTOFF Huey involved in flood rescue- that was filmed during the 1982 floods in Central Texas, and involved the Ft Hood bunch. The Military MEDEVAC system had (and has) a major advantage over most civilian systems, in that we normally flew with a crew of 4, were fully IFR qualified and the military birds tend to be more heavily redundant on systems as well. In the time I was following the NTSB statistics, (roughly 1980-1995) there were IIRC *3* non combat MEDEVAC losses, all of them under major adverse conditions. This was at a time when the folks flying JetRangers found out the hard way that single pilot IFR could be difficult when the pilot had to look down at just the right angle to induce vertigo to change radio frequencies on short final... All of the Army MEDEVAC could be traced to our greatest failing in DUSTOFF, which was also our greatest claim...one that dated back to the establishment of the program.... " When I have your wounded... " ck S. Krin, DO FAAFP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2005 Report Share Posted December 29, 2005 In a message dated 28-Dec-05 18:19:05 Central Standard Time, THEDUDMAN@... writes: Or, another alternative is to take all these helicopters that seem to congregate around Houston, Dallas, Austin, and the areas inside this triangle...and move them to outlying rural areas where there would truly be a difference in flight time vs. drive time. It has often seemed odd to me that helicopters are based at or near trauma centers...which puts them farther away from the patients that actually need them...if they were 60 to 90 minutes ground time from the trauma center seems they could reach their patients faster and get them to a trauma facility faster... Interestingly enough, back during the heyday of the MAST program (Military Assistance to Safety and Traffic, where military MEDEVAC helos, primarily US Army DUSTOFF, were available for civilian support missions) from about 1979-1985, that is exactly what happened. The US Army's 507th Medical Company (Air Ambulance) was broken up between San /Fort Sam Houston (Headquarters Detachment and 1st Platoon), El Paso/Ft Bliss (2nd Platoon), Kileen/Fort Hood) (3rd Platoon), and Lawton OK/Ft Sill (4th Platoon). Between those four, and the Coast Guard units on the Gulf coast, 75% of Texas and half of Oklahoma was provided with rapidly responding, inexpensive and SAFE emergency aeromedical transportation. Our costs were covered out of the training budget, based on the idea that the best way to keep up the critical care skills of military medics was to provide them with a variety of live patients. And that the best way to keep up the critical skills of the pilots was to keep them flying into odd ball areas. Our platoon at Ft Sill responded to primary coverage in a 150 nautical mile circle from Ft Sill, covering roughly the southwest half of OK and the north central 36 counties of Texas, with primary receiving hospitals in OKC, Dallas and Tulsa, with occasional trips to Ft , AR and Amarillo, TX. If you remember the old " Rescue 911 " show with Shatner, you might remember the shot of the DUSTOFF Huey involved in flood rescue- that was filmed during the 1982 floods in Central Texas, and involved the Ft Hood bunch. The Military MEDEVAC system had (and has) a major advantage over most civilian systems, in that we normally flew with a crew of 4, were fully IFR qualified and the military birds tend to be more heavily redundant on systems as well. In the time I was following the NTSB statistics, (roughly 1980-1995) there were IIRC *3* non combat MEDEVAC losses, all of them under major adverse conditions. This was at a time when the folks flying JetRangers found out the hard way that single pilot IFR could be difficult when the pilot had to look down at just the right angle to induce vertigo to change radio frequencies on short final... All of the Army MEDEVAC could be traced to our greatest failing in DUSTOFF, which was also our greatest claim...one that dated back to the establishment of the program.... " When I have your wounded... " ck S. Krin, DO FAAFP Quote Link to comment Share on other sites More sharing options...
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