Re: Closest Chopper

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

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

> > >

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

> > >

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

> > >

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

> >

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

> >

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

> > >

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.

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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.

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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

> > >

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

> > >

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

> > >

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

> > > >

December 28, 2005