Re: Closest Chopper

December 29, 2005

In a message dated 12/29/2005 11:37:12 A.M. Central Standard Time,

bbledsoe@... writes:

Don't give up so easy. I am wrong all the time--just ask my wife,

He's not kidding! I've heard her tell him on several occasions he was wrong

and she was right.

He agreed in every case (smart man that he is)

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

LNMolino@...

(Office)

(Office Fax)

" A Texan with a Jersey Attitude "

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

December 29, 2005

In a message dated 12/29/2005 11:37:12 A.M. Central Standard Time,

bbledsoe@... writes:

Don't give up so easy. I am wrong all the time--just ask my wife,

He's not kidding! I've heard her tell him on several occasions he was wrong

and she was right.

He agreed in every case (smart man that he is)

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

LNMolino@...

(Office)

(Office Fax)

" A Texan with a Jersey Attitude "

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

December 29, 2005

Again, I'm not afraid to say this Dudley....EMS is a business.

December 29, 2005

Again, I'm not afraid to say this Dudley....EMS is a business.

December 29, 2005

Again, I'm not afraid to say this Dudley....EMS is a business.

December 29, 2005

I thought we were talking about Texas here. You can twist and turn

to try to make your thought processes fit everyone else from here to

Alaska if you want to, but I really think it would benefit you to

walk a mile in another mans shoes as it appears your opinions are

derived from a single perspective. I wish you could come do the job

for a while so you could see first hand. You're obviously an

intelligent and thoughtful man so I am sure you would readily see

that there are many applications and needs out there.

> > > > > > >

> > > > > > > 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 29, 2005

I thought we were talking about Texas here. You can twist and turn

to try to make your thought processes fit everyone else from here to

Alaska if you want to, but I really think it would benefit you to

walk a mile in another mans shoes as it appears your opinions are

derived from a single perspective. I wish you could come do the job

for a while so you could see first hand. You're obviously an

intelligent and thoughtful man so I am sure you would readily see

that there are many applications and needs out there.

> > > > > > >

> > > > > > > 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 29, 2005

I thought we were talking about Texas here. You can twist and turn

to try to make your thought processes fit everyone else from here to

Alaska if you want to, but I really think it would benefit you to

walk a mile in another mans shoes as it appears your opinions are

derived from a single perspective. I wish you could come do the job

for a while so you could see first hand. You're obviously an

intelligent and thoughtful man so I am sure you would readily see

that there are many applications and needs out there.

> > > > > > >

> > > > > > > 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 29, 2005

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: Thursday, December 29, 2005 8:52 AM

To:

Subject: Re: Closest Chopper

I thought we were talking about Texas here. You can twist and turn

to try to make your thought processes fit everyone else from here to

Alaska if you want to, but I really think it would benefit you to

walk a mile in another mans shoes as it appears your opinions are

derived from a single perspective. I wish you could come do the job

for a while so you could see first hand. You're obviously an

intelligent and thoughtful man so I am sure you would readily see

that there are many applications and needs out there.

> > > > > > >

> > > > > > > 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 29, 2005

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: Thursday, December 29, 2005 8:52 AM

To:

Subject: Re: Closest Chopper

I thought we were talking about Texas here. You can twist and turn

to try to make your thought processes fit everyone else from here to

Alaska if you want to, but I really think it would benefit you to

walk a mile in another mans shoes as it appears your opinions are

derived from a single perspective. I wish you could come do the job

for a while so you could see first hand. You're obviously an

intelligent and thoughtful man so I am sure you would readily see

that there are many applications and needs out there.

> > > > > > >

> > > > > > > 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 29, 2005

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: Thursday, December 29, 2005 8:52 AM

To:

Subject: Re: Closest Chopper

I thought we were talking about Texas here. You can twist and turn

to try to make your thought processes fit everyone else from here to

Alaska if you want to, but I really think it would benefit you to

walk a mile in another mans shoes as it appears your opinions are

derived from a single perspective. I wish you could come do the job

for a while so you could see first hand. You're obviously an

intelligent and thoughtful man so I am sure you would readily see

that there are many applications and needs out there.

> > > > > > >

> > > > > > > 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 29, 2005

One of the biggest reasons I hear that helicopters are used in Texas and

similar rural states is that it allows the ambulance to return to service.

That is akin to admitting everybody to surgery or the ICU so that the ED can

stay open. I have ridden with fixed-wing aircraft (Super King Airs)

throughout NSW and . The fleet is a part of the ambulance service.

On any given day 6-8 aircraft leave Sydney with patients and return them

home (where they are met at the rural airports by the local ambulance) and,

at the same time, critical patients are picked up and returned to Sydney or

other larger hospitals throughout the state. We picked up a merchant marine

of the coast of the Tasman Sea that had horrible pancreatitis and

electrolyte problems--he was low sick. The trip was not in range for a

helicopter and besides there are only 10 or so medical helicopters in

Australia and they are only used for rescue. The added room and the

pressurized aircraft was a good environment to work in. In Kansas Wyoming,

South Dakota and similar rural states fixed-wing ambulances are the norm.

People forget that much of West Texas is not within range for helicopters

without refueling. So, you have to figure in the slower speed of the

helicopter (versus a fixed-wing ambulance), the time to refuel, the noise

and vibration, the increased cost and danger and weigh that against any

perceived benefits. Literature from Pennsylvania and North Carolina show

that interhospital transport of patients by helicopter DO NOT improve

survival. More than 10 studies now show that scene transport by helicopter

improves survival in a very small fraction of the patients. The criteria

being used for helicopter use was developed by the medical helicopter

industry. That is like Krispy Kreme setting nutrition standards. The whole

thing is a house of cards that will soon fall--especially if the NTSB cuts

out night flights and mandates IFR. BTW--I worked as a flight paramedic for

year.

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: Thursday, December 29, 2005 8:52 AM

To:

Subject: Re: Closest Chopper

I thought we were talking about Texas here. You can twist and turn

to try to make your thought processes fit everyone else from here to

Alaska if you want to, but I really think it would benefit you to

walk a mile in another mans shoes as it appears your opinions are

derived from a single perspective. I wish you could come do the job

for a while so you could see first hand. You're obviously an

intelligent and thoughtful man so I am sure you would readily see

that there are many applications and needs out there.

December 29, 2005