Re: Corpus Christi newspaper reports on EMS response to Cheney ...

February 17, 2006

Louis

I did not say that they indicate that helicopter have no place. I said

that some may interpret that they or saying that because the discussion

focus on why not to use them instead of some of both. When to and when

not to. I think and Gene are big boys and know me well enough to

know I am not dogging them.

Henry

lnmolino@... wrote:

>

> In a message dated 2/17/2006 8:30:18 A.M. Central Standard Time,

> hbarber@... writes:

>

> Dr. B, Gene and others that people look up to, if

> we keep going down this path younger medics that read your post may

> interpret that helicopters have no place in EMS and should not be

> used.

>

> I'll let them defend or not their own comments but I've never once

> heard

> anyone on this list that is among those you mention advocate that

> there is NO

> PLACE just mis-use and or really over use of same.

>

> Louis N. Molino, Sr., CET

> FF/NREMT-B/FSI/EMSI

> LNMolino@...

> (Office)

> (Office Fax)

> (Cell Phone)

>

> " A Texan with a Jersey Attitude "

> " Great minds discuss ideas; Average minds discuss events; Small minds

>

> discuss people. "

> Eleanor Roosevelt

>

> 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.

>

February 17, 2006

Louis

I did not say that they indicate that helicopter have no place. I said

that some may interpret that they or saying that because the discussion

focus on why not to use them instead of some of both. When to and when

not to. I think and Gene are big boys and know me well enough to

know I am not dogging them.

Henry

lnmolino@... wrote:

>

> In a message dated 2/17/2006 8:30:18 A.M. Central Standard Time,

> hbarber@... writes:

>

> Dr. B, Gene and others that people look up to, if

> we keep going down this path younger medics that read your post may

> interpret that helicopters have no place in EMS and should not be

> used.

>

> I'll let them defend or not their own comments but I've never once

> heard

> anyone on this list that is among those you mention advocate that

> there is NO

> PLACE just mis-use and or really over use of same.

>

> Louis N. Molino, Sr., CET

> FF/NREMT-B/FSI/EMSI

> LNMolino@...

> (Office)

> (Office Fax)

> (Cell Phone)

>

> " A Texan with a Jersey Attitude "

> " Great minds discuss ideas; Average minds discuss events; Small minds

>

> discuss people. "

> Eleanor Roosevelt

>

> 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.

>

February 17, 2006

Louis

I did not say that they indicate that helicopter have no place. I said

that some may interpret that they or saying that because the discussion

focus on why not to use them instead of some of both. When to and when

not to. I think and Gene are big boys and know me well enough to

know I am not dogging them.

Henry

lnmolino@... wrote:

>

> In a message dated 2/17/2006 8:30:18 A.M. Central Standard Time,

> hbarber@... writes:

>

> Dr. B, Gene and others that people look up to, if

> we keep going down this path younger medics that read your post may

> interpret that helicopters have no place in EMS and should not be

> used.

>

> I'll let them defend or not their own comments but I've never once

> heard

> anyone on this list that is among those you mention advocate that

> there is NO

> PLACE just mis-use and or really over use of same.

>

> Louis N. Molino, Sr., CET

> FF/NREMT-B/FSI/EMSI

> LNMolino@...

> (Office)

> (Office Fax)

> (Cell Phone)

>

> " A Texan with a Jersey Attitude "

> " Great minds discuss ideas; Average minds discuss events; Small minds

>

> discuss people. "

> Eleanor Roosevelt

>

> 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.

>

February 17, 2006

No I do not believe all trauma should be flown. I do believe that this

patient should have because of the number of pellets and the fact that

so many may have penetrated the chest and neck.

Henry

lnmolino@... wrote:

>

> In a message dated 2/17/2006 8:30:18 A.M. Central Standard Time,

> hbarber@... writes:

>

> A littler closer or a few more shot hitting vital

> organs and this would have been a different story.

>

> every trauma has that potential outcome should we fly everyone all

> the time

> just cause we can or what might be?

>

> Louis N. Molino, Sr., CET

> FF/NREMT-B/FSI/EMSI

> LNMolino@...

> (Office)

> (Office Fax)

> (Cell Phone)

>

> " A Texan with a Jersey Attitude "

> " Great minds discuss ideas; Average minds discuss events; Small minds

>

> discuss people. "

> Eleanor Roosevelt

>

> 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.

>

February 17, 2006

No I do not believe all trauma should be flown. I do believe that this

patient should have because of the number of pellets and the fact that

so many may have penetrated the chest and neck.

Henry

lnmolino@... wrote:

>

> In a message dated 2/17/2006 8:30:18 A.M. Central Standard Time,

> hbarber@... writes:

>

> A littler closer or a few more shot hitting vital

> organs and this would have been a different story.

>

> every trauma has that potential outcome should we fly everyone all

> the time

> just cause we can or what might be?

>

> Louis N. Molino, Sr., CET

> FF/NREMT-B/FSI/EMSI

> LNMolino@...

> (Office)

> (Office Fax)

> (Cell Phone)

>

> " A Texan with a Jersey Attitude "

> " Great minds discuss ideas; Average minds discuss events; Small minds

>

> discuss people. "

> Eleanor Roosevelt

>

> 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.

>

February 17, 2006

I still see no clinical evidence that supports all of the assumptions made

in these posts. Mechanism of injury alone is not enough. What may have

happened, in absence of clinical findings, does not lead to sound clinical

judgment. " The fact that so many (pellets) may have penetrated the chest

and neck " is only one piece of the puzzle. Far too often in EMS, providers

are taking one piece of the puzzle and making a decision based on it.

Mechanism of injury does not operate in a vacuum.

Re: Corpus Christi newspaper reports on EMS response

to Cheney ...

> No I do not believe all trauma should be flown. I do believe that this

> patient should have because of the number of pellets and the fact that

> so many may have penetrated the chest and neck.

>

> Henry

>

> lnmolino@... wrote:

>

>>

>> In a message dated 2/17/2006 8:30:18 A.M. Central Standard Time,

>> hbarber@... writes:

>>

>> A littler closer or a few more shot hitting vital

>> organs and this would have been a different story.

>>

>> every trauma has that potential outcome should we fly everyone all

>> the time

>> just cause we can or what might be?

>>

>> Louis N. Molino, Sr., CET

>> FF/NREMT-B/FSI/EMSI

>> LNMolino@...

>> (Office)

>> (Office Fax)

>> (Cell Phone)

>>

>> " A Texan with a Jersey Attitude "

>> " Great minds discuss ideas; Average minds discuss events; Small minds

>>

>> discuss people. "

>> Eleanor Roosevelt

>>

>> 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.

>>

February 17, 2006

If it is in the best interest of the patient, yes.

You all are now asking that we consider lawsuits, bird

accidents, etc before patient care. Is that what we

were taught in school? I understand what the research

says, but the research has not been made a rule yet.

IOW, I do not think any RAC protocols, etc have

changed as a result of this research. If patient

outcome will benefit from the bird, then fly them out.

Accidents occur everyday. The patient could very

well die in an accident going by ground as well. For

all we know he could die in an accident in his own

vehicle the day he is discharged from the hospital.

Salvador Capuchino Jr

EMT-P

--- lnmolino@... wrote:

>

> In a message dated 2/17/2006 8:30:18 A.M. Central

> Standard Time,

> hbarber@... writes:

>

> A littler closer or a few more shot hitting vital

> organs and this would have been a different story.

>

> every trauma has that potential outcome should we

> fly everyone all the time

> just cause we can or what might be?

>

> Louis N. Molino, Sr., CET

> FF/NREMT-B/FSI/EMSI

> LNMolino@...

> (Office)

> (Office Fax)

> (Cell Phone)

>

> " A Texan with a Jersey Attitude "

> " Great minds discuss ideas; Average minds discuss

> events; Small minds

> discuss people. "

> Eleanor Roosevelt

>

> 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.

>

> [Non-text portions of this message have been

> removed]

>

February 17, 2006

I am not talking mech alone. This type of patient can go down hill very

fast. If he does go down I would prefer in to be closer to a trauma

center than to a level 4. I am talking rural EMS here of which we are.

If a trauma center is in your backyard then that is a different story.

Henry

Mike wrote:

> Henry -

>

> I see where you're coming from, but it would seem that his condition

> was

> stable enough on scene that those medics elected not to fly him.

> Mechanism

> alone isn't a determinant factor... surely we both agree on that.

>

> Mike

>

> >

> > No I do not believe all trauma should be flown. I do believe that

> this

> > patient should have because of the number of pellets and the fact

> that

> > so many may have penetrated the chest and neck.

> >

> > Henry

> >

> > lnmolino@... wrote:

> >

> > >

> > > In a message dated 2/17/2006 8:30:18 A.M. Central Standard Time,

> > > hbarber@... writes:

> > >

> > > A littler closer or a few more shot hitting vital

> > > organs and this would have been a different story.

> > >

> > > every trauma has that potential outcome should we fly everyone all

>

> > > the time

> > > just cause we can or what might be?

> > >

> > > Louis N. Molino, Sr., CET

> > > FF/NREMT-B/FSI/EMSI

> > > LNMolino@...

> > > (Office)

> > > (Office Fax)

> > > (Cell Phone)

> > >

> > > " A Texan with a Jersey Attitude "

> > > " Great minds discuss ideas; Average minds discuss events; Small

> minds

> > >

> > > discuss people. "

> > > Eleanor Roosevelt

> > >

> > > 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.

> > >

February 17, 2006

I am not talking mech alone. This type of patient can go down hill very

fast. If he does go down I would prefer in to be closer to a trauma

center than to a level 4. I am talking rural EMS here of which we are.

If a trauma center is in your backyard then that is a different story.

Henry

Mike wrote:

> Henry -

>

> I see where you're coming from, but it would seem that his condition

> was

> stable enough on scene that those medics elected not to fly him.

> Mechanism

> alone isn't a determinant factor... surely we both agree on that.

>

> Mike

>

> >

> > No I do not believe all trauma should be flown. I do believe that

> this

> > patient should have because of the number of pellets and the fact

> that

> > so many may have penetrated the chest and neck.

> >

> > Henry

> >

> > lnmolino@... wrote:

> >

> > >

> > > In a message dated 2/17/2006 8:30:18 A.M. Central Standard Time,

> > > hbarber@... writes:

> > >

> > > A littler closer or a few more shot hitting vital

> > > organs and this would have been a different story.

> > >

> > > every trauma has that potential outcome should we fly everyone all

>

> > > the time

> > > just cause we can or what might be?

> > >

> > > Louis N. Molino, Sr., CET

> > > FF/NREMT-B/FSI/EMSI

> > > LNMolino@...

> > > (Office)

> > > (Office Fax)

> > > (Cell Phone)

> > >

> > > " A Texan with a Jersey Attitude "

> > > " Great minds discuss ideas; Average minds discuss events; Small

> minds

> > >

> > > discuss people. "

> > > Eleanor Roosevelt

> > >

> > > 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.

> > >

February 17, 2006

Red,

Please do not misunderstand. I was not second guessing the crew on the

ground. I will not even do that with one of my own crews. I was

postulating what I would do here in Calhoun county.

Henry

Red wrote:

> If I lay aside all fun..... I truly believe the professionals at the

> scene, who more than likely are the best of the best.. had all the

> facts, and did exactly the right thing. Now if it happened in Alpine

> Texas... or some such western part of the state..... I want the whirly

> thing... I don't care if I just got a thorn in my toe.....

>

> " Bledsoe, DO " wrote: Henry is always a

> voice of reason. In a passionate discussion such as this,

> CISM or private ambulances in Beaumont, the truth is always somewhere

> between what the proponents and the opponents write. That is all Henry

> is

> saying.

>

> BEB

>

> _____

>

> From: [mailto: ]

> On

> Behalf Of Henry

> Sent: Friday, February 17, 2006 8:44 AM

> To:

> Subject: Re: Corpus Christi newspaper reports on EMS

> response

> to Cheney ...

>

> No I do not believe all trauma should be flown. I do believe that this

>

> patient should have because of the number of pellets and the fact that

>

> so many may have penetrated the chest and neck.

>

> Henry

>

> lnmolino@... wrote:

>

> >

> > In a message dated 2/17/2006 8:30:18 A.M. Central Standard Time,

> > hbarber@... writes:

> >

> > A littler closer or a few more shot hitting vital

> > organs and this would have been a different story.

> >

> > every trauma has that potential outcome should we fly everyone all

> > the time

> > just cause we can or what might be?

> >

> > Louis N. Molino, Sr., CET

> > FF/NREMT-B/FSI/EMSI

> > LNMolino@...

> > (Office)

> > (Office Fax)

> > (Cell Phone)

> >

> > " A Texan with a Jersey Attitude "

> > " Great minds discuss ideas; Average minds discuss events; Small

> minds

> >

> > discuss people. "

> > Eleanor Roosevelt

> >

> > 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.

> >

February 17, 2006

Red,

Please do not misunderstand. I was not second guessing the crew on the

ground. I will not even do that with one of my own crews. I was

postulating what I would do here in Calhoun county.

Henry

Red wrote:

> If I lay aside all fun..... I truly believe the professionals at the

> scene, who more than likely are the best of the best.. had all the

> facts, and did exactly the right thing. Now if it happened in Alpine

> Texas... or some such western part of the state..... I want the whirly

> thing... I don't care if I just got a thorn in my toe.....

>

> " Bledsoe, DO " wrote: Henry is always a

> voice of reason. In a passionate discussion such as this,

> CISM or private ambulances in Beaumont, the truth is always somewhere

> between what the proponents and the opponents write. That is all Henry

> is

> saying.

>

> BEB

>

> _____

>

> From: [mailto: ]

> On

> Behalf Of Henry

> Sent: Friday, February 17, 2006 8:44 AM

> To:

> Subject: Re: Corpus Christi newspaper reports on EMS

> response

> to Cheney ...

>

> No I do not believe all trauma should be flown. I do believe that this

>

> patient should have because of the number of pellets and the fact that

>

> so many may have penetrated the chest and neck.

>

> Henry

>

> lnmolino@... wrote:

>

> >

> > In a message dated 2/17/2006 8:30:18 A.M. Central Standard Time,

> > hbarber@... writes:

> >

> > A littler closer or a few more shot hitting vital

> > organs and this would have been a different story.

> >

> > every trauma has that potential outcome should we fly everyone all

> > the time

> > just cause we can or what might be?

> >

> > Louis N. Molino, Sr., CET

> > FF/NREMT-B/FSI/EMSI

> > LNMolino@...

> > (Office)

> > (Office Fax)

> > (Cell Phone)

> >

> > " A Texan with a Jersey Attitude "

> > " Great minds discuss ideas; Average minds discuss events; Small

> minds

> >

> > discuss people. "

> > Eleanor Roosevelt

> >

> > 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.

> >

February 17, 2006

I sure hope you are kidding!

Tater

Red wrote:

Now if it happened in Alpine Texas... or some such western part of the

state..... I want the whirly thing... I don't care if I just got a thorn in my

toe.....

E. Tate, LP

Whitehouse, Texas

What’s stopping you from joining EMSAT? http://www.TexasEMSAT.org

---------------------------------

Yahoo! Mail

Use Photomail to share photos without annoying attachments.

February 17, 2006

I sure hope you are kidding!

Tater

Red wrote:

Now if it happened in Alpine Texas... or some such western part of the

state..... I want the whirly thing... I don't care if I just got a thorn in my

toe.....

E. Tate, LP

Whitehouse, Texas

What’s stopping you from joining EMSAT? http://www.TexasEMSAT.org

---------------------------------

Yahoo! Mail

Use Photomail to share photos without annoying attachments.

February 18, 2006

That is a good point and I think the one we are all trying to make despite

the bluster. The DOT did EMS a disservice in 1985 by " dumbing down " the EMT

curriculum. Now, 20 years later we are getting the EMTs and paramedics (and

the sometimes antiquated medical directors) to realize that EMTs and

paramedics can think and make educated decisions without rote protocols and

" mother may I " on-line medical direction. Ben, do no more than what you

said, " Think a little harder. " That is all anybody asks and you will be a

better paramedic for it. Those of us who bluster are passionate-but it all

comes from a love and respect for the people in the field.

BEB

_____

From: [mailto: ] On

Behalf Of ben thacker

Sent: Saturday, February 18, 2006 9:09 PM

To:

Subject: RE: Corpus Christi newspaper reports on EMS response

to Cheney ...

Well one thing that I have learned in my limited experience as a paramedic

is that everyone has a opinion and for every study that promotes a

particular way to treat there is another study that directs you toward a

different path. Is one hospital as good as another? who knows but I always

call ahead to see who is working if I need medical care for myself or love

one. But many of the ideals presented on this site has made me think a

little harder each time I have a decision to make including when to fly and

when not to.

" Bledsoe, DO " wrote: Ben wrote, " Time is

precious and does not need to be wasted at a facility

that can not provide proper care. My local hospital is a level four and can

provide very little care for Pt's who require advanced surgical

intervention. "

First, how much time is precious? The Golden hour is a myth.

Second, what is " advanced surgical intervention? "

Third, what " advanced surgical intervention " is time-sensitive?

Sometimes, what seems intuitive does not prove to be so:

------------------------------------

Med Care. 2001 Jul;39(7):643-53.

Mortality among seriously injured patients treated in remote rural trauma

centers before and after implementation of a statewide trauma system.

Clay Mann N, Mullins RJ, Hedges JR, Rowland D, Arthur M, Zechnich AD.

Department of Emergency Medicine, Univeristy of Utah, School of Medicine,

Salt Lake City 84108-9161, USA. clay.mann@...

BACKGROUND: Injury mortality in rural regions remains high with little

evidence that trauma system implementation has benefited rural populations.

OBJECTIVE: To evaluate risk-adjusted mortality in remote regions of Oregon

before and after implementation of a statewide trauma system. RESEARCH

DESIGN: A retrospective cohort study assessing injury mortality through 30

days after hospital discharge. SETTING: Nine rural Oregon hospitals serving

counties with populations <18 persons per square mile. SUBJECTS: Severely

injured patients presenting to four level-3 and five level-4 trauma

hospitals 3 years before and 3 years after trauma system implementation.

MEASURES: Interhospital transfer, hospital death, and demise within 30 days

following hospital discharge. RESULTS: A total of 940 patients were

analyzed. After trauma system implementation, patients presenting to level-4

hospitals were more likely transferred to level-2 facilities (P <0.001).

Interhospital transfer times from level-3 hospitals lengthened significantly

after system implementation (P <0.001). Overall mortality rates were higher

in the postsystem period (8.3%) than the presystem period (6.7%), but not

significantly. Controlling for covariates, no additional benefit to

risk-adjusted mortality was associated with trauma system implementation.

Additional deaths, occurring after trauma system implementation, included

head-injured patients transferred from rural hospitals to nonlevel-1 trauma

center hospitals. CONCLUSIONS: Increased injury survival after Oregon trauma

system implementation, demonstrated in urban and statewide analyses, was not

confirmed in remote regions of the state. Efforts to improve trauma systems

in rural areas should focus on the processes of care for head-injured

patients transferred to higher designation trauma centers

----------------------------------------------

J Trauma. 2003 Sep;55(3):444-9.

The effect of interfacility transfer on outcome in an urban trauma system.

Nathens AB, Maier RV, Brundage SI, Jurkovich GJ, Grossman DC.

Division of General and Trauma Surgery, Harborview Medical Center, and

Department of Surgery, University of Washington, Seattle, 98104-2499, USA.

anathens@...

BACKGROUND: Transporting all trauma patients to regional trauma centers is

inefficient; however, the bypass of nearer, nondesignated hospitals in

deference to regional trauma centers decreases mortality in the severely

injured. One approach to improving efficiency is to allow the initial

assessment of selected patients at lower level (Level III/IV) designated

centers. We set out to evaluate whether patients initially assessed at these

centers and then transferred to a Level I facility were adversely affected

by delays to definitive care. METHODS: This is a retrospective cohort study

in which the primary exposure being evaluated is initial assessment at a

Level III or IV trauma center before transport to a Level I center in an

urban setting. The outcomes in this transfer cohort were compared with

outcomes in patients transported directly from the scene to a Level I center

(direct cohort). The outcomes of interest were mortality, length of stay,

and hospital charges. Multivariate analyses were used to adjust for

differences in baseline characteristics across these two cohorts. RESULTS:

Crude length of stay was comparable, whereas mortality was lower and charges

were 40% higher in the transfer cohort (n = 281) compared with the direct

cohort (n = 4,439). After adjusting for confounders, mortality and length of

stay were similar and total charges were significantly greater in the

transferred patients. CONCLUSION: Interfacility transfers in a mature urban

trauma system do not appear to impact on clinical outcome. However, transfer

patients use significantly greater resources as measured by hospital

charges. This effect is likely because of the nature of their injuries or,

alternatively, delays in reaching definitive care.

------------------------------------

J Trauma. 2004 Jan;56(1):89-93.

Effective use of the air ambulance for pediatric trauma.

Larson JT, Dietrich AM, Abdessalam SF, Werman HA.

Department of Pediatrics, College of Medicine and Public Health, Ohio State

University, Columbus, 43205, USA. larsonj@...

BACKGROUND: The purpose of this study was to compare outcomes of pediatric

trauma patients transported by helicopter from the injury scene (IS group)

to a trauma center and those transported by air after hospital stabilization

(HS group). METHODS: A retrospective analysis of pediatric trauma patients

(<19 years of age) transported by air ambulance and admitted to a pediatric

trauma center was conducted. Outcomes compared were mortality and length of

stay. Patients were subdivided into minor (Injury Severity Score [iSS] < 15)

and major (ISS > 15) trauma. TRISS analysis was performed to verify the

overall quality of the care. RESULTS: Eight hundred forty-two HS and 379 IS

patients were included. The mean age, median ISS, and distribution of

penetrating and blunt injuries did not differ significantly between the

groups. The overall death rate was significantly lower for the interfacility

transfer patients (HS group, 5.5%; IS group, 8.7%; p < 0.05). Mean intensive

care unit (ICU) and hospital length of stay did not differ significantly. HS

patients with major trauma had significantly less mortality (HS group,

15.5%; IS group, 26.7%; p < 0.05) and shorter mean ICU stays (HS group,

118.3 hours; IS group, 149.1 hours; p < 0.05) than IS major trauma patients.

No differences were seen in patients with minor trauma. TRISS analysis

showed improved survival for all patients compared with Major Trauma Outcome

Study norms. CONCLUSION: Retrospective analysis was not able to demonstrate

any benefit to direct transport from the scene to a trauma center. Hospital

stabilization before transfer by air ambulance may improve survival and

shorten ICU stays for patients with major trauma.

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Granted, trauma centers improve outcomes. The jury is out on whether one

should go to Level III or IV first and then transferred or to a Level I or

II first. It is not as cut and dried as everybody thinks.

February 18, 2006