Re: Closest Chopper

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

> > >

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

> > >

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

> > >

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

> > >

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

> > > >

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

> > >

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

> > >

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

> > >

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

> > >

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

> > >

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

> > >

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

> > >

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

> > >

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

> > >

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

> > >

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

> > >

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

> > >

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

> > > >

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

> > > >

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

> > > >

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

>

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

>

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

>

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

> > >

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

> > >

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