Guest guest Posted April 30, 2005 Report Share Posted April 30, 2005 Why would you fly a burn patient? Will it make their burn better? E. Bledsoe, DO, FACEP Midlothian, TX Don't miss EMStock 2005 (http://www.EMStock.com) Re: Closest vs. Most Appropriate Facility What does the law say about this? I got into an argument with my LP partner about this subject.He said he would take an adult code to children's medical center if it was the closest facility. (in the scenario, I said that children's and parkland weren't next door, that children's was the closest facility but a regular adult ER was another 5mins down the road). He also said that if we had a burn pt, I said if they had second degree burns to 36% (both legs) if he would go to medical center at Lancaster (our closest facility), or Parkland. I said that the weather was bad or something, no bird available so we would trans. by ground, and he said that he would go to MCAL. We run an MICU, I am a basic and my partner is an LP. I think he is in the wrong, but what does the LAW say? Red Closest vs. Most Appropriate Facility Does any one have any research on Closest vs. Most appropriate facility? Should patients be transported to the facility more capable of addressing their illness \ injury even though there is a much closer facility that will only begin treatment, many times available on the ambulance, then transfer out to the other facility hours later? If so what criteria should they meet to justify the bypass? I have my own opinion but have not seen any studies, thanks in advance. Drew Bohn NREMT-P Operations Training Officer Orange County Ambulance Service inc. Orange, Texas drewbohn@... dbohn@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2005 Report Share Posted May 1, 2005 I didn't tell the whole story, but the 10 yo had 2nd & 3rd degree circumferential burns to both legs, my protocol says fly to the nearest BURN center. Which is Galveston. Lee > Why would you fly a burn patient? Will it make their burn better? > > > E. Bledsoe, DO, FACEP > Midlothian, TX > > Don't miss EMStock 2005 (http://www.EMStock.com) > > Re: Closest vs. Most Appropriate Facility > > What does the law say about this? I got into an argument with my LP partner > about this subject.He said he would take an adult code to children's medical > center if it was the closest facility. (in the scenario, I said that > children's and parkland weren't next door, that children's was the closest > facility but a regular adult ER was another 5mins down the road). > > He also said that if we had a burn pt, I said if they had second degree > burns to 36% (both legs) if he would go to medical center at Lancaster (our > closest facility), or Parkland. I said that the weather was bad or > something, no bird available so we would trans. by ground, and he said that > he would go to MCAL. > > We run an MICU, I am a basic and my partner is an LP. > > I think he is in the wrong, but what does the LAW say? > > Red > Closest vs. Most Appropriate Facility > > > Does any one have any research on Closest vs. Most appropriate facility? > Should patients be transported to the facility more capable of > addressing their illness \ injury even though there is a much closer > facility that will only begin treatment, many times available on the > ambulance, then transfer out to the other facility hours later? If so > what criteria should they meet to justify the bypass? I have my own > opinion but have not seen any studies, thanks in advance. > > Drew Bohn NREMT-P > Operations Training Officer > Orange County Ambulance Service inc. > Orange, Texas > <mailto:drewbohn@o...> drewbohn@o... > <mailto:dbohn@g...> dbohn@g... > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2005 Report Share Posted May 1, 2005 I didn't tell the whole story, but the 10 yo had 2nd & 3rd degree circumferential burns to both legs, my protocol says fly to the nearest BURN center. Which is Galveston. Lee > Why would you fly a burn patient? Will it make their burn better? > > > E. Bledsoe, DO, FACEP > Midlothian, TX > > Don't miss EMStock 2005 (http://www.EMStock.com) > > Re: Closest vs. Most Appropriate Facility > > What does the law say about this? I got into an argument with my LP partner > about this subject.He said he would take an adult code to children's medical > center if it was the closest facility. (in the scenario, I said that > children's and parkland weren't next door, that children's was the closest > facility but a regular adult ER was another 5mins down the road). > > He also said that if we had a burn pt, I said if they had second degree > burns to 36% (both legs) if he would go to medical center at Lancaster (our > closest facility), or Parkland. I said that the weather was bad or > something, no bird available so we would trans. by ground, and he said that > he would go to MCAL. > > We run an MICU, I am a basic and my partner is an LP. > > I think he is in the wrong, but what does the LAW say? > > Red > Closest vs. Most Appropriate Facility > > > Does any one have any research on Closest vs. Most appropriate facility? > Should patients be transported to the facility more capable of > addressing their illness \ injury even though there is a much closer > facility that will only begin treatment, many times available on the > ambulance, then transfer out to the other facility hours later? If so > what criteria should they meet to justify the bypass? I have my own > opinion but have not seen any studies, thanks in advance. > > Drew Bohn NREMT-P > Operations Training Officer > Orange County Ambulance Service inc. > Orange, Texas > <mailto:drewbohn@o...> drewbohn@o... > <mailto:dbohn@g...> dbohn@g... > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2005 Report Share Posted May 1, 2005 If you can take a severe trauma patient to a trauma center --- then you should do that. If you can take an extensively burned patient to a burn center --- then you should do that. If you can take a suspect cardiac patient to a cardiac center -- then you should do that. If these facilities are not available to you within a reasonable time and distance -- then take them to the closest ER. That decision (what is reasonable time and distance) may take some thought and consultation with your medical director and operations. Decisions about destination hospitals should all be worked out in advance, not at the time you desperately need to transport. One thing for sure. No court of law would convict you of taking patients to the right hospital, even if you bypassed a dozen closer (inappropriate) hospitals in route. Always do what is in the best interest of the patient. Our history of doing exactly that with code III trauma patients has set the standard and has never been seriously challenged. Best regards, Larry MD > What about the burn pt. situation? > > My partner stands his ground about if he was in a court of law, that a lawyer > would hang him out to dry for " passing by one ER to go to another ER that I > think is better. I'm not a DR and I cant make that decision! " I hate to say > it, as it makes all medics who have many years experience look bad, but he's > old school....big time. I can go on & on about other things, but this subject > and the 12-lead are the ones that most concern me. > > > Closest vs. Most Appropriate Facility >> >> >> Does any one have any research on Closest vs. Most appropriate facility? >> Should patients be transported to the facility more capable of >> addressing their illness \ injury even though there is a much closer >> facility that will only begin treatment, many times available on the >> ambulance, then transfer out to the other facility hours later? If so >> what criteria should they meet to justify the bypass? I have my own >> opinion but have not seen any studies, thanks in advance. >> >> Drew Bohn NREMT-P >> Operations Training Officer >> Orange County Ambulance Service inc. >> Orange, Texas >> drewbohn@... >> dbohn@... >> >> >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2005 Report Share Posted May 1, 2005 If you can take a severe trauma patient to a trauma center --- then you should do that. If you can take an extensively burned patient to a burn center --- then you should do that. If you can take a suspect cardiac patient to a cardiac center -- then you should do that. If these facilities are not available to you within a reasonable time and distance -- then take them to the closest ER. That decision (what is reasonable time and distance) may take some thought and consultation with your medical director and operations. Decisions about destination hospitals should all be worked out in advance, not at the time you desperately need to transport. One thing for sure. No court of law would convict you of taking patients to the right hospital, even if you bypassed a dozen closer (inappropriate) hospitals in route. Always do what is in the best interest of the patient. Our history of doing exactly that with code III trauma patients has set the standard and has never been seriously challenged. Best regards, Larry MD > What about the burn pt. situation? > > My partner stands his ground about if he was in a court of law, that a lawyer > would hang him out to dry for " passing by one ER to go to another ER that I > think is better. I'm not a DR and I cant make that decision! " I hate to say > it, as it makes all medics who have many years experience look bad, but he's > old school....big time. I can go on & on about other things, but this subject > and the 12-lead are the ones that most concern me. > > > Closest vs. Most Appropriate Facility >> >> >> Does any one have any research on Closest vs. Most appropriate facility? >> Should patients be transported to the facility more capable of >> addressing their illness \ injury even though there is a much closer >> facility that will only begin treatment, many times available on the >> ambulance, then transfer out to the other facility hours later? If so >> what criteria should they meet to justify the bypass? I have my own >> opinion but have not seen any studies, thanks in advance. >> >> Drew Bohn NREMT-P >> Operations Training Officer >> Orange County Ambulance Service inc. >> Orange, Texas >> drewbohn@... >> dbohn@... >> >> >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2005 Report Share Posted May 1, 2005 Not only should you have flown the burn patient, but it was appropriate with your protocols. In your case the flight was less that 40 minutes away and the E/R was a holding zone for a critical burn patient. As long as there was no airway compromise you did right. Did flying the burn patient make the burn better? Not worth an answer, but it did make the patient better in the long run. We had a head, shoulder and entire front chest come in the other night and we drove her to the hospital, stopped in the middle of the street and had the chopper personnel pick her up and take her on their bird before driving onto hospital property. Airway was secured and even the hospital we did not go into was happy. Andy Foote Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2005 Report Share Posted May 1, 2005 Not only should you have flown the burn patient, but it was appropriate with your protocols. In your case the flight was less that 40 minutes away and the E/R was a holding zone for a critical burn patient. As long as there was no airway compromise you did right. Did flying the burn patient make the burn better? Not worth an answer, but it did make the patient better in the long run. We had a head, shoulder and entire front chest come in the other night and we drove her to the hospital, stopped in the middle of the street and had the chopper personnel pick her up and take her on their bird before driving onto hospital property. Airway was secured and even the hospital we did not go into was happy. Andy Foote Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2005 Report Share Posted May 1, 2005 Not only should you have flown the burn patient, but it was appropriate with your protocols. In your case the flight was less that 40 minutes away and the E/R was a holding zone for a critical burn patient. As long as there was no airway compromise you did right. Did flying the burn patient make the burn better? Not worth an answer, but it did make the patient better in the long run. We had a head, shoulder and entire front chest come in the other night and we drove her to the hospital, stopped in the middle of the street and had the chopper personnel pick her up and take her on their bird before driving onto hospital property. Airway was secured and even the hospital we did not go into was happy. Andy Foote Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2005 Report Share Posted May 1, 2005 He also did not tell you that it saves and hour and the pt receives care from a burn center not an er md who may or may not be up on the latest treatment for burns. -------------------------------------------------------------------------------- Closest vs. Most Appropriate Facility > > > Does any one have any research on Closest vs. Most appropriate facility? > Should patients be transported to the facility more capable of > addressing their illness \ injury even though there is a much closer > facility that will only begin treatment, many times available on the > ambulance, then transfer out to the other facility hours later? If so > what criteria should they meet to justify the bypass? I have my own > opinion but have not seen any studies, thanks in advance. > > Drew Bohn NREMT-P > Operations Training Officer > Orange County Ambulance Service inc. > Orange, Texas > <mailto:drewbohn@o...> drewbohn@o... > <mailto:dbohn@g...> dbohn@g... > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2005 Report Share Posted May 1, 2005 He also did not tell you that it saves and hour and the pt receives care from a burn center not an er md who may or may not be up on the latest treatment for burns. -------------------------------------------------------------------------------- Closest vs. Most Appropriate Facility > > > Does any one have any research on Closest vs. Most appropriate facility? > Should patients be transported to the facility more capable of > addressing their illness \ injury even though there is a much closer > facility that will only begin treatment, many times available on the > ambulance, then transfer out to the other facility hours later? If so > what criteria should they meet to justify the bypass? I have my own > opinion but have not seen any studies, thanks in advance. > > Drew Bohn NREMT-P > Operations Training Officer > Orange County Ambulance Service inc. > Orange, Texas > <mailto:drewbohn@o...> drewbohn@o... > <mailto:dbohn@g...> dbohn@g... > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2005 Report Share Posted May 2, 2005 I wouldent fly them, I agree with you on your opinions of flying Pt.s, I just threw the helicopter thing in there so my partner had to give me a reason to take a burn pt to an ER that isnt a trauma facility or burn center, when parkland is 8mins farther down the road runnin code 3. Closest vs. Most Appropriate Facility Does any one have any research on Closest vs. Most appropriate facility? Should patients be transported to the facility more capable of addressing their illness \ injury even though there is a much closer facility that will only begin treatment, many times available on the ambulance, then transfer out to the other facility hours later? If so what criteria should they meet to justify the bypass? I have my own opinion but have not seen any studies, thanks in advance. Drew Bohn NREMT-P Operations Training Officer Orange County Ambulance Service inc. Orange, Texas drewbohn@... dbohn@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2005 Report Share Posted May 2, 2005 I wouldent fly them, I agree with you on your opinions of flying Pt.s, I just threw the helicopter thing in there so my partner had to give me a reason to take a burn pt to an ER that isnt a trauma facility or burn center, when parkland is 8mins farther down the road runnin code 3. Closest vs. Most Appropriate Facility Does any one have any research on Closest vs. Most appropriate facility? Should patients be transported to the facility more capable of addressing their illness \ injury even though there is a much closer facility that will only begin treatment, many times available on the ambulance, then transfer out to the other facility hours later? If so what criteria should they meet to justify the bypass? I have my own opinion but have not seen any studies, thanks in advance. Drew Bohn NREMT-P Operations Training Officer Orange County Ambulance Service inc. Orange, Texas drewbohn@... dbohn@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2005 Report Share Posted May 2, 2005 I wouldent fly them, I agree with you on your opinions of flying Pt.s, I just threw the helicopter thing in there so my partner had to give me a reason to take a burn pt to an ER that isnt a trauma facility or burn center, when parkland is 8mins farther down the road runnin code 3. Closest vs. Most Appropriate Facility Does any one have any research on Closest vs. Most appropriate facility? Should patients be transported to the facility more capable of addressing their illness \ injury even though there is a much closer facility that will only begin treatment, many times available on the ambulance, then transfer out to the other facility hours later? If so what criteria should they meet to justify the bypass? I have my own opinion but have not seen any studies, thanks in advance. Drew Bohn NREMT-P Operations Training Officer Orange County Ambulance Service inc. Orange, Texas drewbohn@... dbohn@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2005 Report Share Posted May 2, 2005 Don't let your personal opinions of a facilities capabilities come into play with destination choices. Do you think that the administrator of an ER that advertises to the general public that it is a full service general hospital will admit that it cant take care of a person with chest pain? Without written guidelines or policies on destination hospitals your service will be playing Russian roulette in a court room one day. I work in a community that has specific written guidelines on treating patients with head injuries. One hospital is the designated receiving hospital for patients that present with head injuries. Every other hospital with an emergency room is considered to have the capability to handle any other type of emergency. The only way we would change this is if the individual hospitals either take off the emergency room sign out front or publicly state which type of emergency they can accept and which type they cant. Guess what, no hospital will admit that they cant take care of any other specific type of emergency especially when they advertise that they have a certain specialist that has privileges at their facility. Re: Closest vs. Most Appropriate Facility What about the burn pt. situation? My partner stands his ground about if he was in a court of law, that a lawyer would hang him out to dry for " passing by one ER to go to another ER that I think is better. I'm not a DR and I cant make that decision! " I hate to say it, as it makes all medics who have many years experience look bad, but he's old school....big time. I can go on & on about other things, but this subject and the 12-lead are the ones that most concern me. Closest vs. Most Appropriate Facility > > > Does any one have any research on Closest vs. Most appropriate facility? > Should patients be transported to the facility more capable of > addressing their illness \ injury even though there is a much closer > facility that will only begin treatment, many times available on the > ambulance, then transfer out to the other facility hours later? If so > what criteria should they meet to justify the bypass? I have my own > opinion but have not seen any studies, thanks in advance. > > Drew Bohn NREMT-P > Operations Training Officer > Orange County Ambulance Service inc. > Orange, Texas > drewbohn@... > dbohn@... > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2005 Report Share Posted May 2, 2005 Don't let your personal opinions of a facilities capabilities come into play with destination choices. Do you think that the administrator of an ER that advertises to the general public that it is a full service general hospital will admit that it cant take care of a person with chest pain? Without written guidelines or policies on destination hospitals your service will be playing Russian roulette in a court room one day. I work in a community that has specific written guidelines on treating patients with head injuries. One hospital is the designated receiving hospital for patients that present with head injuries. Every other hospital with an emergency room is considered to have the capability to handle any other type of emergency. The only way we would change this is if the individual hospitals either take off the emergency room sign out front or publicly state which type of emergency they can accept and which type they cant. Guess what, no hospital will admit that they cant take care of any other specific type of emergency especially when they advertise that they have a certain specialist that has privileges at their facility. Re: Closest vs. Most Appropriate Facility What about the burn pt. situation? My partner stands his ground about if he was in a court of law, that a lawyer would hang him out to dry for " passing by one ER to go to another ER that I think is better. I'm not a DR and I cant make that decision! " I hate to say it, as it makes all medics who have many years experience look bad, but he's old school....big time. I can go on & on about other things, but this subject and the 12-lead are the ones that most concern me. Closest vs. Most Appropriate Facility > > > Does any one have any research on Closest vs. Most appropriate facility? > Should patients be transported to the facility more capable of > addressing their illness \ injury even though there is a much closer > facility that will only begin treatment, many times available on the > ambulance, then transfer out to the other facility hours later? If so > what criteria should they meet to justify the bypass? I have my own > opinion but have not seen any studies, thanks in advance. > > Drew Bohn NREMT-P > Operations Training Officer > Orange County Ambulance Service inc. > Orange, Texas > drewbohn@... > dbohn@... > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2005 Report Share Posted May 2, 2005 Don't let your personal opinions of a facilities capabilities come into play with destination choices. Do you think that the administrator of an ER that advertises to the general public that it is a full service general hospital will admit that it cant take care of a person with chest pain? Without written guidelines or policies on destination hospitals your service will be playing Russian roulette in a court room one day. I work in a community that has specific written guidelines on treating patients with head injuries. One hospital is the designated receiving hospital for patients that present with head injuries. Every other hospital with an emergency room is considered to have the capability to handle any other type of emergency. The only way we would change this is if the individual hospitals either take off the emergency room sign out front or publicly state which type of emergency they can accept and which type they cant. Guess what, no hospital will admit that they cant take care of any other specific type of emergency especially when they advertise that they have a certain specialist that has privileges at their facility. Re: Closest vs. Most Appropriate Facility What about the burn pt. situation? My partner stands his ground about if he was in a court of law, that a lawyer would hang him out to dry for " passing by one ER to go to another ER that I think is better. I'm not a DR and I cant make that decision! " I hate to say it, as it makes all medics who have many years experience look bad, but he's old school....big time. I can go on & on about other things, but this subject and the 12-lead are the ones that most concern me. Closest vs. Most Appropriate Facility > > > Does any one have any research on Closest vs. Most appropriate facility? > Should patients be transported to the facility more capable of > addressing their illness \ injury even though there is a much closer > facility that will only begin treatment, many times available on the > ambulance, then transfer out to the other facility hours later? If so > what criteria should they meet to justify the bypass? I have my own > opinion but have not seen any studies, thanks in advance. > > Drew Bohn NREMT-P > Operations Training Officer > Orange County Ambulance Service inc. > Orange, Texas > drewbohn@... > dbohn@... > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2005 Report Share Posted May 2, 2005 >>> Did flying the burn patient make the burn better? Not worth an answer, but it did make the patient better in the long run. <<< I'm not trying to put words in Dr. Bledsoe's mouth, but I don't think he was questioning the need for a burn center. I think he was questioning the need for a helicopter. Surely, no rational person still believes that a golden hour exists for trauma patients. What survival advantage does helicopter transport offer the burn patient over ground transport? That is the point I think he was trying to make. >>> We had a head, shoulder and entire front chest come in the other night and we drove her to the hospital, stopped in the middle of the street and had the chopper personnel pick her up and take her on their bird before driving onto hospital property. Airway was secured and even the hospital we did not go into was happy. <<< Making a ER staff happy is very different than positively influencing the outcome of a patient. You can make almost every staff member of a hospital happy by NOT bringing them patients. Kenny Navarro UT Southwestern Medical Center Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2005 Report Share Posted May 2, 2005 >>> Did flying the burn patient make the burn better? Not worth an answer, but it did make the patient better in the long run. <<< I'm not trying to put words in Dr. Bledsoe's mouth, but I don't think he was questioning the need for a burn center. I think he was questioning the need for a helicopter. Surely, no rational person still believes that a golden hour exists for trauma patients. What survival advantage does helicopter transport offer the burn patient over ground transport? That is the point I think he was trying to make. >>> We had a head, shoulder and entire front chest come in the other night and we drove her to the hospital, stopped in the middle of the street and had the chopper personnel pick her up and take her on their bird before driving onto hospital property. Airway was secured and even the hospital we did not go into was happy. <<< Making a ER staff happy is very different than positively influencing the outcome of a patient. You can make almost every staff member of a hospital happy by NOT bringing them patients. Kenny Navarro UT Southwestern Medical Center Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2005 Report Share Posted May 2, 2005 This is one of the most useful threads ive seen on here at the time. Everything should be taken on a case by case basis. Sure, there are times When aeromedical is appropriate but if you keep your scene time down to a minimum and transport them ground you can be well on the way the the facility before they even take off. Heck at 60 mph, that's a mile a minute And you can be 5 miles towards the hospital before they lift off Jim davis This e-mail is confidential and intended solely for the use of the individual (s) to whom it is addressed. Any views or opinions presented are solely those of the author and do not necessarily represent those of Baylor Grapevine EMS Medical control or Baylor Health Care System or its policies. If you have received this e-mail message in error, please phone (817)329-4015. Please also destroy and delete the message from your computer. B. , AAS, LP Baylor Regional Medical Center at Grapevine EMS Educator Baylor EMS Medical Control 1601 Lancaster Drive Suite #10 Grapevine, Tx 76051-3300 Office Direct Line Fax Cell Pager Re: Closest vs. Most Appropriate Facility >>> Did flying the burn patient make the burn better? Not worth an answer, but it did make the patient better in the long run. <<< I'm not trying to put words in Dr. Bledsoe's mouth, but I don't think he was questioning the need for a burn center. I think he was questioning the need for a helicopter. Surely, no rational person still believes that a golden hour exists for trauma patients. What survival advantage does helicopter transport offer the burn patient over ground transport? That is the point I think he was trying to make. >>> We had a head, shoulder and entire front chest come in the other night and we drove her to the hospital, stopped in the middle of the street and had the chopper personnel pick her up and take her on their bird before driving onto hospital property. Airway was secured and even the hospital we did not go into was happy. <<< Making a ER staff happy is very different than positively influencing the outcome of a patient. You can make almost every staff member of a hospital happy by NOT bringing them patients. Kenny Navarro UT Southwestern Medical Center Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2005 Report Share Posted May 2, 2005 This is one of the most useful threads ive seen on here at the time. Everything should be taken on a case by case basis. Sure, there are times When aeromedical is appropriate but if you keep your scene time down to a minimum and transport them ground you can be well on the way the the facility before they even take off. Heck at 60 mph, that's a mile a minute And you can be 5 miles towards the hospital before they lift off Jim davis This e-mail is confidential and intended solely for the use of the individual (s) to whom it is addressed. Any views or opinions presented are solely those of the author and do not necessarily represent those of Baylor Grapevine EMS Medical control or Baylor Health Care System or its policies. If you have received this e-mail message in error, please phone (817)329-4015. Please also destroy and delete the message from your computer. B. , AAS, LP Baylor Regional Medical Center at Grapevine EMS Educator Baylor EMS Medical Control 1601 Lancaster Drive Suite #10 Grapevine, Tx 76051-3300 Office Direct Line Fax Cell Pager Re: Closest vs. Most Appropriate Facility >>> Did flying the burn patient make the burn better? Not worth an answer, but it did make the patient better in the long run. <<< I'm not trying to put words in Dr. Bledsoe's mouth, but I don't think he was questioning the need for a burn center. I think he was questioning the need for a helicopter. Surely, no rational person still believes that a golden hour exists for trauma patients. What survival advantage does helicopter transport offer the burn patient over ground transport? That is the point I think he was trying to make. >>> We had a head, shoulder and entire front chest come in the other night and we drove her to the hospital, stopped in the middle of the street and had the chopper personnel pick her up and take her on their bird before driving onto hospital property. Airway was secured and even the hospital we did not go into was happy. <<< Making a ER staff happy is very different than positively influencing the outcome of a patient. You can make almost every staff member of a hospital happy by NOT bringing them patients. Kenny Navarro UT Southwestern Medical Center Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2005 Report Share Posted May 2, 2005 This is one of the most useful threads ive seen on here at the time. Everything should be taken on a case by case basis. Sure, there are times When aeromedical is appropriate but if you keep your scene time down to a minimum and transport them ground you can be well on the way the the facility before they even take off. Heck at 60 mph, that's a mile a minute And you can be 5 miles towards the hospital before they lift off Jim davis This e-mail is confidential and intended solely for the use of the individual (s) to whom it is addressed. Any views or opinions presented are solely those of the author and do not necessarily represent those of Baylor Grapevine EMS Medical control or Baylor Health Care System or its policies. If you have received this e-mail message in error, please phone (817)329-4015. Please also destroy and delete the message from your computer. B. , AAS, LP Baylor Regional Medical Center at Grapevine EMS Educator Baylor EMS Medical Control 1601 Lancaster Drive Suite #10 Grapevine, Tx 76051-3300 Office Direct Line Fax Cell Pager Re: Closest vs. Most Appropriate Facility >>> Did flying the burn patient make the burn better? Not worth an answer, but it did make the patient better in the long run. <<< I'm not trying to put words in Dr. Bledsoe's mouth, but I don't think he was questioning the need for a burn center. I think he was questioning the need for a helicopter. Surely, no rational person still believes that a golden hour exists for trauma patients. What survival advantage does helicopter transport offer the burn patient over ground transport? That is the point I think he was trying to make. >>> We had a head, shoulder and entire front chest come in the other night and we drove her to the hospital, stopped in the middle of the street and had the chopper personnel pick her up and take her on their bird before driving onto hospital property. Airway was secured and even the hospital we did not go into was happy. <<< Making a ER staff happy is very different than positively influencing the outcome of a patient. You can make almost every staff member of a hospital happy by NOT bringing them patients. Kenny Navarro UT Southwestern Medical Center Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2005 Report Share Posted May 2, 2005 The burn center here is more than 100 miles away that is why we fly burn pts from here. I allows them to receive definitive burn care hours faster as much as 8 hours because of the er delay the transfer delay and then they go by ground transport and then the receiving burn center they go through the er first for evaluation because no ems or other hospital know any thing about evaluating a patient. You did good. Now go do a good thing. -------------------------------------------------------------------------------- Closest vs. Most Appropriate Facility Does any one have any research on Closest vs. Most appropriate facility? Should patients be transported to the facility more capable of addressing their illness \ injury even though there is a much closer facility that will only begin treatment, many times available on the ambulance, then transfer out to the other facility hours later? If so what criteria should they meet to justify the bypass? I have my own opinion but have not seen any studies, thanks in advance. Drew Bohn NREMT-P Operations Training Officer Orange County Ambulance Service inc. Orange, Texas drewbohn@... dbohn@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2005 Report Share Posted May 2, 2005 The burn center here is more than 100 miles away that is why we fly burn pts from here. I allows them to receive definitive burn care hours faster as much as 8 hours because of the er delay the transfer delay and then they go by ground transport and then the receiving burn center they go through the er first for evaluation because no ems or other hospital know any thing about evaluating a patient. You did good. Now go do a good thing. -------------------------------------------------------------------------------- Closest vs. Most Appropriate Facility Does any one have any research on Closest vs. Most appropriate facility? Should patients be transported to the facility more capable of addressing their illness \ injury even though there is a much closer facility that will only begin treatment, many times available on the ambulance, then transfer out to the other facility hours later? If so what criteria should they meet to justify the bypass? I have my own opinion but have not seen any studies, thanks in advance. Drew Bohn NREMT-P Operations Training Officer Orange County Ambulance Service inc. Orange, Texas drewbohn@... dbohn@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2005 Report Share Posted May 2, 2005 The burn center here is more than 100 miles away that is why we fly burn pts from here. I allows them to receive definitive burn care hours faster as much as 8 hours because of the er delay the transfer delay and then they go by ground transport and then the receiving burn center they go through the er first for evaluation because no ems or other hospital know any thing about evaluating a patient. You did good. Now go do a good thing. -------------------------------------------------------------------------------- Closest vs. Most Appropriate Facility Does any one have any research on Closest vs. Most appropriate facility? Should patients be transported to the facility more capable of addressing their illness \ injury even though there is a much closer facility that will only begin treatment, many times available on the ambulance, then transfer out to the other facility hours later? If so what criteria should they meet to justify the bypass? I have my own opinion but have not seen any studies, thanks in advance. Drew Bohn NREMT-P Operations Training Officer Orange County Ambulance Service inc. Orange, Texas drewbohn@... dbohn@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2005 Report Share Posted May 2, 2005 Here is the evidence that burn patients less than 200 miles from a burn center should be transported by helicopter. Where is your supportive evidence to the contrary? ---------------------------------------------------- J Trauma. 2004 Jul;57(1):57-64; discussion 64. Related Articles, Links Regional air transport of burn patients: a case for telemedicine? Saffle JR, Edelman L, SE. Department of Surgery and the Intermountain Burn Center, University of Utah Health Center, Salt Lake City, Utah 84132, USA. jeffrey.saffle@... BACKGROUND: Air transport of burn patients is plagued by frequent " overtriage. " We examined the use of air transport and the feasibility of using alternative methods such as telemedicine to assist in evaluation and treatment of burn patients within our region. METHODS: We reviewed all burn patients transported by air during 2000 to 2001. Each patient was classified as being most appropriate for air, ground, or family transport. In addition, a decision was made regarding whether telemedicine evaluation of the patient before transport could have significantly altered initial treatment decisions. RESULTS: Two hundred twenty-five acutely burned patients were transferred from referring hospitals in nine states, at a mean distance of 246 air miles. Mean burn size calculated by burn center physicians was 19.7% total body surface area, whereas referring physicians' mean estimate was 29% total body surface area. In 92 cases, over- or underestimation of burn size by referring physicians of as much as 560% or decisions regarding performance of endotracheal intubation suggested that telemedicine evaluation before transport might have significantly altered transport decisions or care. Air transport charges exceeded hospital charges in 21 cases. CONCLUSION: Frequent discrepancies in burn assessment contribute to overuse of air transport. The ability to evaluate burn patients by telemedicine may have the potential to assist decisions regarding transfer, avoid errors in initial care, and reduce costs. We are currently attempting to develop and test such a system. ----------------------------------------------------- Burns. 2002 Feb;28(1):70-2. Related Articles, Links Helicopter transportation of burn patients. Slater H, O'Mara MS, Goldfarb IW. The Western Pennsylvania Hospital, 4815 Liberty Avenue, Pittsburgh, PA 15224, USA. hslater@... Analysis of 437 consecutive acute burn patients transported to our burn center revealed 339 transported by ground and 98 by helicopter. There were 18 air transport patients from within a 25-mile-radius, and 80 flown further than 25 miles. Mean age was the same in all groups (P>0.05). Percent total body surface area (TBSA) burned was 8.26% in ground transport patients, significantly less than the 20.35% (within 25 miles) and 21.40% (greater than 25 miles) seen in helicopter transports (P<0.0001). Three percent of ground transport patients and 28% of helicopter patients had inhalation injury (P<0.0001). There was no difference in incidence of inhalation injury among helicopter groups (28 vs. 29%, P=0.8). In patients with coexistent inhalation injury, the mean TBSA burned was significantly larger when compared with the TBSA of burns without inhalation injury (P<0.001). Air transported groups contained patients whose status was not critical based upon lack of inhalation injury and small burn size, and who could have been transported by ground. Non clinical factors such as insurance status, desire to keep ground ambulances in their community, and competing helicopter services reluctant to refuse to transport a patient appears to be factors in choosing air ambulance transportation. Regional single helicopter services and regional cooperative ground ambulance services should reduce use of helicopter transport of burn patients when it is not clinically indicated. -------------------------------------------------- J Burn Care Rehabil. 2000 Nov-Dec;21(6):535-40. Related Articles, Links Cost-effective use of helicopters for the transportation of patients with burn injuries. De Wing MD, Curry T, son E, Palmieri T, Greenhalgh DG. Shriners Hospital for Children, Northern California, Sacramento 95817, USA. We performed a retrospective review to analyze the use of helicopters for the transportation of patients with burn injuries to determine whether a more cost-effective approach could be developed without impairing the quality or delivery of health care. Charts were reviewed for all patients with burn injuries who were transported by helicopter to our hospitals during a 2-year period. Patients with inhalation injuries, with burn injuries received more than 24 hours before admission or more than 200 miles from our burn center, with more than 30% total body surface area (TBSA) burned, or with associated trauma injuries were excluded. Control patients with burn injuries who were transported by ambulance were identified and matched to the patients with burn injuries transported by helicopter for the percentage of TBSA burned, the percentage of third-degree burns, transport mileage, and age. The outcome was evaluated by comparison of length of stay, days on ventilator, and mortality rate. Comparisons were performed with Student t test. The transportation charge was determined for the patients transported by helicopter who we believed were eligible for transport by ambulance. Forty-seven of 85 patients transported by helicopter matched the inclusion criteria and had survived. There was no statistically significant difference between the percentage of TBSA burned, the percentage of third-degree burns, length of stay, days on ventilator, age, or transport mileage. There was, however, a significant difference in the time from the injury to admission to the hospital, as well as in the charge for transportation. Patients who had less than 30% TBSA thermal cutaneous injuries without evidence of inhalation injury, and who are less than 200 miles from a burn center may be safely transported by ambulance. Ambulance transportation may take additional time; however, stricter protocols for helicopter transportation of patients with burn injuries will result in potentially substantial savings without affecting outcomes for patients. ------------------------------------------------ J Burn Care Rehabil. 1991 May-Jun;12(3):229-33. Related Articles, Links Helicopter transport of the patient with acute burns. Baack BR, Smoot EC 3rd, Kucan JO, Riseman L, Noak JF. Division of Plastic and Reconstructive Surgery, Southern Illinois University School of Medicine. Helicopter transportation of acutely injured or ill patients has become common practice at most major medical centers. However, its specific effectiveness in the transportation of acute-condition patients with burns has never been critically assessed. This study, for the period 1984 through 1988, evaluated the use of the helicopter for transportation of acute-condition patients with burns to a regional burn center for a rural area. It is concluded that helicopter transport within a 180-mile radius in a non-hospital-based system is not appreciably faster than is ambulance transport, and does not clinically benefit most burned patients. Consideration such as safety, cost, and working space are discussed. It is recommended that at least one of three criteria be met before helicopter transfer is considered for patients with burns: the surface area involved should be enough to require a formal fluid resuscitation, an inhalation injury should be present or suspected, or there should be a possible need for an escharotomy. PMID: 1885639 [PubMed - indexed for MEDLINE] Quote Link to comment Share on other sites More sharing options...
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