Re: Closest vs. Most Appropriate Facility

[Guest guest]

From: [mailto: ] On

>>I can't seem to use the word " not " today (Freudian?)

No comment.....

>>Should have read, " Also, if your patient is in pain, you are not

treating

>>them properly. "

Amen

Mike

[Guest guest]

From: [mailto: ] On

>>I can't seem to use the word " not " today (Freudian?)

No comment.....

>>Should have read, " Also, if your patient is in pain, you are not

treating

>>them properly. "

Amen

Mike

[Guest guest]

You have to first get on the scene and call the helicopter and then wait.

Leaving Cleburne, you would be halfway up 67 to Dallas before the helicopter

arrived at the scene. Besides, the case that was mentioned (leg burns on a

10-year-old) may not have met burn center criteria.

Re: Re: Closest vs. Most Appropriate Facility

>

> 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...

> >

> >

> >

> >

> >

> >

[Guest guest]

You have to first get on the scene and call the helicopter and then wait.

Leaving Cleburne, you would be halfway up 67 to Dallas before the helicopter

arrived at the scene. Besides, the case that was mentioned (leg burns on a

10-year-old) may not have met burn center criteria.

Re: Re: Closest vs. Most Appropriate Facility

>

> 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...

> >

> >

> >

> >

> >

> >

[Guest guest]

You have to first get on the scene and call the helicopter and then wait.

Leaving Cleburne, you would be halfway up 67 to Dallas before the helicopter

arrived at the scene. Besides, the case that was mentioned (leg burns on a

10-year-old) may not have met burn center criteria.

Re: Re: Closest vs. Most Appropriate Facility

>

> 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...

> >

> >

> >

> >

> >

> >

[Guest guest]

If I

am in Cleburne Texas and I am burned, Parkland is about 1 hr 10 min

without traffic by ground and about a 25-30 min by air, I believe

that the answer is obvious, regardless of the cost / risk involved

the benifit of the higher level of care would be a benifit to the

patient.>>>

KN: Flymedic1 (if that IS your real name,) I believe that critical

and even serious burns should be treated long-term at burn centers

and Parkland is an excellent one. If you would save 40 minutes by

flying a patient from where you are as opposed to driving them, my

question would be, " Does that 40-minute time savings influence the

morbidity and mortality of the burn patient? " The evidence seems to

suggest that the patient would do as well if the transport was

provided by a ground ambulance rather than by helicopter. If there

are no survival benefits to air transport, then why do it?

>>> So, If I was not transported to the Burn center by ground

initally.... then If I am lucky, I am admitted to the burn ward 4-6

hours after my injury ??? Ehat is the best for the patient.>>>

KN: I would suggest that perhaps the advantages of being at a burn

center do not come in the first few hours. Burn centers shine in

their long term care of the patient. Any reasonably intelligent

physician in a reasonably equipped emergency room can (in my

opinion) manage the burn patient as well as the ER at Parkland. (I

actually believe any reasonably intelligent paramedic should be able

to do it as well.)

>>> I would suggest that being a Paramedic in the field, on every

patient that you see you ask your self this question. " What would I

ant if this were me, my wife,child,mother,father,grandmother or

grandfather? " >>>

KN: My step-father suffered second and third degree burns over 60%

of his body near Cleburne and was driven to Parkland. I sustained

second and third degree burns over 37% of my body in a small town

south of Dallas. I was driven by ambulance to Parkland. If I had

it to do over I wouldn't change a thing, (except for the getting

burned part.)

What I want for my family is for medical care providers to provide

care based on science, not on myths.

Kenny Navarro

UT Southwestern

[Guest guest]

If I

am in Cleburne Texas and I am burned, Parkland is about 1 hr 10 min

without traffic by ground and about a 25-30 min by air, I believe

that the answer is obvious, regardless of the cost / risk involved

the benifit of the higher level of care would be a benifit to the

patient.>>>

KN: Flymedic1 (if that IS your real name,) I believe that critical

and even serious burns should be treated long-term at burn centers

and Parkland is an excellent one. If you would save 40 minutes by

flying a patient from where you are as opposed to driving them, my

question would be, " Does that 40-minute time savings influence the

morbidity and mortality of the burn patient? " The evidence seems to

suggest that the patient would do as well if the transport was

provided by a ground ambulance rather than by helicopter. If there

are no survival benefits to air transport, then why do it?

>>> So, If I was not transported to the Burn center by ground

initally.... then If I am lucky, I am admitted to the burn ward 4-6

hours after my injury ??? Ehat is the best for the patient.>>>

KN: I would suggest that perhaps the advantages of being at a burn

center do not come in the first few hours. Burn centers shine in

their long term care of the patient. Any reasonably intelligent

physician in a reasonably equipped emergency room can (in my

opinion) manage the burn patient as well as the ER at Parkland. (I

actually believe any reasonably intelligent paramedic should be able

to do it as well.)

>>> I would suggest that being a Paramedic in the field, on every

patient that you see you ask your self this question. " What would I

ant if this were me, my wife,child,mother,father,grandmother or

grandfather? " >>>

KN: My step-father suffered second and third degree burns over 60%

of his body near Cleburne and was driven to Parkland. I sustained

second and third degree burns over 37% of my body in a small town

south of Dallas. I was driven by ambulance to Parkland. If I had

it to do over I wouldn't change a thing, (except for the getting

burned part.)

What I want for my family is for medical care providers to provide

care based on science, not on myths.

Kenny Navarro

UT Southwestern

[Guest guest]

If I

am in Cleburne Texas and I am burned, Parkland is about 1 hr 10 min

without traffic by ground and about a 25-30 min by air, I believe

that the answer is obvious, regardless of the cost / risk involved

the benifit of the higher level of care would be a benifit to the

patient.>>>

KN: Flymedic1 (if that IS your real name,) I believe that critical

and even serious burns should be treated long-term at burn centers

and Parkland is an excellent one. If you would save 40 minutes by

flying a patient from where you are as opposed to driving them, my

question would be, " Does that 40-minute time savings influence the

morbidity and mortality of the burn patient? " The evidence seems to

suggest that the patient would do as well if the transport was

provided by a ground ambulance rather than by helicopter. If there

are no survival benefits to air transport, then why do it?

>>> So, If I was not transported to the Burn center by ground

initally.... then If I am lucky, I am admitted to the burn ward 4-6

hours after my injury ??? Ehat is the best for the patient.>>>

KN: I would suggest that perhaps the advantages of being at a burn

center do not come in the first few hours. Burn centers shine in

their long term care of the patient. Any reasonably intelligent

physician in a reasonably equipped emergency room can (in my

opinion) manage the burn patient as well as the ER at Parkland. (I

actually believe any reasonably intelligent paramedic should be able

to do it as well.)

>>> I would suggest that being a Paramedic in the field, on every

patient that you see you ask your self this question. " What would I

ant if this were me, my wife,child,mother,father,grandmother or

grandfather? " >>>

KN: My step-father suffered second and third degree burns over 60%

of his body near Cleburne and was driven to Parkland. I sustained

second and third degree burns over 37% of my body in a small town

south of Dallas. I was driven by ambulance to Parkland. If I had

it to do over I wouldn't change a thing, (except for the getting

burned part.)

What I want for my family is for medical care providers to provide

care based on science, not on myths.

Kenny Navarro

UT Southwestern

[Guest guest]

-- " Kenny Navarro " wrote:

" The evidence seems to suggest that the patient would do as well if the

transport was provided by a ground ambulance rather than by helicopter. If

there are no survival benefits to air transport, then why do it? "

When your transport is from a REAL rural area (Chinle AZ, Navajo Nation)and it

is 1.5 - 2 hours by fixed wing turbo-prop to PHX or 2-2.5 hours to either SLC or

ABQ (with a 15-20 ground transport from the airport to the receiving hospital in

any case), compared to ground transports of anywhere from 6-10 hours, then yes,

air evacuation makes sense. (Fixed wing is safer than rotary) Under those

circumstances, the patient arrives in better condition than by ground, but the

long term survival, when compared, is unknown.

" Money can buy you a fine dog, but only love can make him wag his tail. " - Kinky

Friedman

Larry RN LP

[Guest guest]

-- " Kenny Navarro " wrote:

" The evidence seems to suggest that the patient would do as well if the

transport was provided by a ground ambulance rather than by helicopter. If

there are no survival benefits to air transport, then why do it? "

When your transport is from a REAL rural area (Chinle AZ, Navajo Nation)and it

is 1.5 - 2 hours by fixed wing turbo-prop to PHX or 2-2.5 hours to either SLC or

ABQ (with a 15-20 ground transport from the airport to the receiving hospital in

any case), compared to ground transports of anywhere from 6-10 hours, then yes,

air evacuation makes sense. (Fixed wing is safer than rotary) Under those

circumstances, the patient arrives in better condition than by ground, but the

long term survival, when compared, is unknown.

" Money can buy you a fine dog, but only love can make him wag his tail. " - Kinky

Friedman

Larry RN LP

[Guest guest]

-- " Kenny Navarro " wrote:

" The evidence seems to suggest that the patient would do as well if the

transport was provided by a ground ambulance rather than by helicopter. If

there are no survival benefits to air transport, then why do it? "

When your transport is from a REAL rural area (Chinle AZ, Navajo Nation)and it

is 1.5 - 2 hours by fixed wing turbo-prop to PHX or 2-2.5 hours to either SLC or

ABQ (with a 15-20 ground transport from the airport to the receiving hospital in

any case), compared to ground transports of anywhere from 6-10 hours, then yes,

air evacuation makes sense. (Fixed wing is safer than rotary) Under those

circumstances, the patient arrives in better condition than by ground, but the

long term survival, when compared, is unknown.

" Money can buy you a fine dog, but only love can make him wag his tail. " - Kinky

Friedman

Larry RN LP

[Guest guest]

" It delays definitive care by at least an hour or more, which

places these patients in grave jeopardy (time is muscle) and unduly

stresses them with another ambulance ride "

Unless you are a cardiologist who refers your patients to facilities

with diagnostic capability only. A " routine " or " it's not your heart "

or " just to be sure, we won't find anything " precedure results in a

Code 3 or helicopter response to transfer the patient to a TRUE cardiac

capable hospital. It brings up one of my favorite sayings " Lack of

planning on your part does not constitute an emergency on mine. "

I bypass those hospitals not because of protocol, but because of common

sense.

Eddie

[Guest guest]

I thought well versed should be " well-versed " so it does not look like

well lorazepam.

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: Re: Closest vs. Most Appropriate Facility

sir you are not living in the real world it takes an hour for a or more

to

get the pt to the local hospital then he has a wait time if he is

breathing

of an indefinite time then he is evaluated and the transfer process

begins

that takes from 2 two 24 hours and he ends up in the burn center any

way.

Yes hours that we have no control over unless we transport by air and

this

removes the pt from some not so well versed dr who insist on treating

things

as they were done 50 years ago also not under our control. No matter how

much pain treatment is given it does not remove the hours of mental

anguish

the pt and his/her family goes through.

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

----

----

Re: Closest vs. Most Appropriate Facility

> 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.... >>>

What " definitive " burn care are you talking about?

Kenny Navarro

UT Southwestern Medical Center at Dallas

[Guest guest]

I thought well versed should be " well-versed " so it does not look like

well lorazepam.

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: Re: Closest vs. Most Appropriate Facility

sir you are not living in the real world it takes an hour for a or more

to

get the pt to the local hospital then he has a wait time if he is

breathing

of an indefinite time then he is evaluated and the transfer process

begins

that takes from 2 two 24 hours and he ends up in the burn center any

way.

Yes hours that we have no control over unless we transport by air and

this

removes the pt from some not so well versed dr who insist on treating

things

as they were done 50 years ago also not under our control. No matter how

much pain treatment is given it does not remove the hours of mental

anguish

the pt and his/her family goes through.

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

----

----

Re: Closest vs. Most Appropriate Facility

> 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.... >>>

What " definitive " burn care are you talking about?

Kenny Navarro

UT Southwestern Medical Center at Dallas

[Guest guest]

I thought well versed should be " well-versed " so it does not look like

well lorazepam.

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: Re: Closest vs. Most Appropriate Facility

sir you are not living in the real world it takes an hour for a or more

to

get the pt to the local hospital then he has a wait time if he is

breathing

of an indefinite time then he is evaluated and the transfer process

begins

that takes from 2 two 24 hours and he ends up in the burn center any

way.

Yes hours that we have no control over unless we transport by air and

this

removes the pt from some not so well versed dr who insist on treating

things

as they were done 50 years ago also not under our control. No matter how

much pain treatment is given it does not remove the hours of mental

anguish

the pt and his/her family goes through.

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

----

----

Re: Closest vs. Most Appropriate Facility

> 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.... >>>

What " definitive " burn care are you talking about?

Kenny Navarro

UT Southwestern Medical Center at Dallas

[Guest guest]

You mean midazolam?

E. Bledsoe, DO, FACEP

Midlothian, TX

Don't miss EMStock 2005 (http://www.EMStock.com)

Re: Re: Closest vs. Most Appropriate Facility

sir you are not living in the real world it takes an hour for a or more to

get the pt to the local hospital then he has a wait time if he is breathing

of an indefinite time then he is evaluated and the transfer process begins

that takes from 2 two 24 hours and he ends up in the burn center any way.

Yes hours that we have no control over unless we transport by air and this

removes the pt from some not so well versed dr who insist on treating things

as they were done 50 years ago also not under our control. No matter how

much pain treatment is given it does not remove the hours of mental anguish

the pt and his/her family goes through.

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

----

----

Re: Closest vs. Most Appropriate Facility

> 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.... >>>

What " definitive " burn care are you talking about?

Kenny Navarro

UT Southwestern Medical Center at Dallas

[Guest guest]

You mean midazolam?

E. Bledsoe, DO, FACEP

Midlothian, TX

Don't miss EMStock 2005 (http://www.EMStock.com)

Re: Re: Closest vs. Most Appropriate Facility

sir you are not living in the real world it takes an hour for a or more to

get the pt to the local hospital then he has a wait time if he is breathing

of an indefinite time then he is evaluated and the transfer process begins

that takes from 2 two 24 hours and he ends up in the burn center any way.

Yes hours that we have no control over unless we transport by air and this

removes the pt from some not so well versed dr who insist on treating things

as they were done 50 years ago also not under our control. No matter how

much pain treatment is given it does not remove the hours of mental anguish

the pt and his/her family goes through.

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

----

----

Re: Closest vs. Most Appropriate Facility

> 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.... >>>

What " definitive " burn care are you talking about?

Kenny Navarro

UT Southwestern Medical Center at Dallas

[Guest guest]

You mean midazolam?

E. Bledsoe, DO, FACEP

Midlothian, TX

Don't miss EMStock 2005 (http://www.EMStock.com)

Re: Re: Closest vs. Most Appropriate Facility

sir you are not living in the real world it takes an hour for a or more to

get the pt to the local hospital then he has a wait time if he is breathing

of an indefinite time then he is evaluated and the transfer process begins

that takes from 2 two 24 hours and he ends up in the burn center any way.

Yes hours that we have no control over unless we transport by air and this

removes the pt from some not so well versed dr who insist on treating things

as they were done 50 years ago also not under our control. No matter how

much pain treatment is given it does not remove the hours of mental anguish

the pt and his/her family goes through.

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

----

----

Re: Closest vs. Most Appropriate Facility

> 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.... >>>

What " definitive " burn care are you talking about?

Kenny Navarro

UT Southwestern Medical Center at Dallas

[Guest guest]

Whoops. At least I got the class of drug correct.

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: Re: Closest vs. Most Appropriate Facility

sir you are not living in the real world it takes an hour for a or more

to

get the pt to the local hospital then he has a wait time if he is

breathing

of an indefinite time then he is evaluated and the transfer process

begins

that takes from 2 two 24 hours and he ends up in the burn center any

way.

Yes hours that we have no control over unless we transport by air and

this

removes the pt from some not so well versed dr who insist on treating

things

as they were done 50 years ago also not under our control. No matter how

much pain treatment is given it does not remove the hours of mental

anguish

the pt and his/her family goes through.

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

----

----

Re: Closest vs. Most Appropriate Facility

> 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.... >>>

What " definitive " burn care are you talking about?

Kenny Navarro

UT Southwestern Medical Center at Dallas

[Guest guest]

Not all helicopters have 30-40 min response times. We have four

helicopters 10 min or less from anywhere in our district Where as we

are 45 min to the nearest burn center and over an hour from the

second burn center...I agree with what was stated earlier the

decision to fly or ground transport should be left up to the

incharge and the patient

> > > 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...

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

Not all helicopters have 30-40 min response times. We have four

helicopters 10 min or less from anywhere in our district Where as we

are 45 min to the nearest burn center and over an hour from the

second burn center...I agree with what was stated earlier the

decision to fly or ground transport should be left up to the

incharge and the patient

> > > 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...

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

I still have many more letters to read on this subject but Mr. Hatfield does

come up with a well thought out note. I just don't agree totally with his

thoughts. I have always supported the Bledsoe Theory on helicopter's in

prehospital settings. I watch a service locally that flies any and every

non-qualified medical or injury patient daily because they also own the

helicopter

service. It's use of medical forethought is ridiculous. Keeps my medical

insurance premiums at a high rate and totally distorts the reason we flew

victims

out of the rice patties in Viet Nam.

In this area however, we have the UTMB burn center less than 35 minutes away

by air and 2 hours by ground if the ferry has not just left the dock when

you arrive. We do excellent triage in the field, secure the airways, give

analgesics and get them there about the same time it takes to get to the local

hospital by ground.

Are helicopters overused? Yes!!!!! Do the local hospitals give good

definitive care. Yes, if there is a life threatening reason to stop there. Is

the

Golden Hour overrated? Yes!!!!! in some cases and I feel that severe burns

are not one of those. I try to make myself the patient in this case and I

feel that I would rather be flown immediately to Galveston than stop at the

local hospital and see my friends. Just color me crazy.

Andy

[Guest guest]

I still have many more letters to read on this subject but Mr. Hatfield does

come up with a well thought out note. I just don't agree totally with his

thoughts. I have always supported the Bledsoe Theory on helicopter's in

prehospital settings. I watch a service locally that flies any and every

non-qualified medical or injury patient daily because they also own the

helicopter

service. It's use of medical forethought is ridiculous. Keeps my medical

insurance premiums at a high rate and totally distorts the reason we flew

victims

out of the rice patties in Viet Nam.

In this area however, we have the UTMB burn center less than 35 minutes away

by air and 2 hours by ground if the ferry has not just left the dock when

you arrive. We do excellent triage in the field, secure the airways, give

analgesics and get them there about the same time it takes to get to the local

hospital by ground.

Are helicopters overused? Yes!!!!! Do the local hospitals give good

definitive care. Yes, if there is a life threatening reason to stop there. Is

the

Golden Hour overrated? Yes!!!!! in some cases and I feel that severe burns

are not one of those. I try to make myself the patient in this case and I

feel that I would rather be flown immediately to Galveston than stop at the

local hospital and see my friends. Just color me crazy.

Andy

[Guest guest]

I still have many more letters to read on this subject but Mr. Hatfield does

come up with a well thought out note. I just don't agree totally with his

thoughts. I have always supported the Bledsoe Theory on helicopter's in

prehospital settings. I watch a service locally that flies any and every

non-qualified medical or injury patient daily because they also own the

helicopter

service. It's use of medical forethought is ridiculous. Keeps my medical

insurance premiums at a high rate and totally distorts the reason we flew

victims

out of the rice patties in Viet Nam.

In this area however, we have the UTMB burn center less than 35 minutes away

by air and 2 hours by ground if the ferry has not just left the dock when

you arrive. We do excellent triage in the field, secure the airways, give

analgesics and get them there about the same time it takes to get to the local

hospital by ground.

Are helicopters overused? Yes!!!!! Do the local hospitals give good

definitive care. Yes, if there is a life threatening reason to stop there. Is

the

Golden Hour overrated? Yes!!!!! in some cases and I feel that severe burns

are not one of those. I try to make myself the patient in this case and I

feel that I would rather be flown immediately to Galveston than stop at the

local hospital and see my friends. Just color me crazy.

Andy

[Guest guest]

In a message dated 5/2/2005 5:19:37 P.M. Central Standard Time,

bbledsoe@... writes:

You have to first get on the scene and call the helicopter and then wait.

Leaving Cleburne, you would be halfway up 67 to Dallas before the helicopter

arrived at the scene. Besides, the case that was mentioned (leg burns on a

10-year-old) may not have met burn center criteria.

Andy Replies:

Then in your case it would not have been a good thing to fly, right? Gosh,

it's a no-brainer and someone actually made the point. How bad the burn, how

close the hospital by ground, and how close the helicopter to burn center.

Get out of the all or nothing state of mind and start thinking about the

patient, not how bad you hate the frigging helicopter services.