Re: Closest vs. Most Appropriate Facility

[Guest guest]

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@...

[Guest guest]

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...

>

>

>

>

>

>

[Guest guest]

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...

>

>

>

>

>

>

[Guest guest]

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@...

>>

>>

>>

>>

>>

>>

[Guest guest]

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@...

>>

>>

>>

>>

>>

>>

[Guest guest]

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

[Guest guest]

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

[Guest guest]

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

[Guest guest]

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]

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]

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@...

[Guest guest]

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@...

[Guest guest]

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@...

[Guest guest]

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@...

>

>

>

>

>

>

[Guest guest]

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@...

>

>

>

>

>

>

[Guest guest]

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@...

>

>

>

>

>

>

[Guest guest]

>>> 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

[Guest guest]

>>> 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

[Guest guest]

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

[Guest guest]

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

[Guest guest]

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

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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

[Guest guest]

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@...

[Guest guest]

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@...

[Guest guest]

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@...

[Guest guest]

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]