flight-lp

I'm curious as to why there is a sudden interest in UAV? All you are really doing is eliminating the most vital and one of the the more lowest cost items from the equation. I really do not understand the point. Besides, do you honestly believe that any flight medic in his / her right mind is going to board an air vehicle that is controlled by remote control? Do you believe that the FAA or NTSB will ever let it get off the ground? Not a chance in hell. Find a more cost effective fuel with the same lift and thrust capabilities as Jet-A or vehicles with lower operating / maintenence costs. Now that will save you some money.

All of our jump bags are stored on the stretcher and are ready for any call. We carry the Zoll monitor, our airway bag, our critical care bag (which includes our pedi bag), and an extra O2 tank with regulator mounted on the stretcher. Basically, everything except our portable suction (which is kept on the charger) and nitrous tank (usually not needed on a scene, given enroute).

It is a BLS truck, that is why. Why would you sit and wait for ALS when the hospital is 3-4 minutes away? Why not just transport to the hospital. If they puke, give them an emesis bag or basin. Honestly, I fail to see the significant events transpiring that call for a delay to wait for an ALS unit. Now granted it would be optimal to have a Paramedic on the truck, but unfortunately thats not always the case. So with that in mind they have to do what they can with the resources and knowledge that they are equipped with, its called improvision. You can't just throw your hands in the air and say "we aren't going to take this patient" or "why didn't an ALS unit take this call". Deal with the situation at hand. Also, since the " EMT books" call for ALS on an ALS call, does that mean we can call a nurse for nursing home calls?? (Sorry Rid / Dust / etc.........Had to take a jab) Throw your book out the window and use some practical hands on common sense, it will get you further down the road in this career........ Diprivan?? For RSI?? In the field??

I find it interesting to say that there is no evidence of positive outcomes from diuretic treatment pre-hospital. Personally, I do not have enough fingers or toes to count the many patients I have witnessed first hand improving from the use of various diuretic agents. I am sorry to say this, but your study is indicative of what many ED physicians do...........blame the pre-hospital folks for patients gone bad. Removing Lasix is not the answer and most of us do not have any urge to give something just because we can, again, typical ED physician's false belief. A proficient examination utilizing adjuncts available to all medics (i.e eyes, hands, ears, thermometer, stethoscope, etc.) WILL reveal the difference between CHF and Pneumonia. Citing half assed points and creating it into a study will work for some, but for the rest of us who actually know what we are doing, this is just another "study" that will fizzle off into the wind. Now using Morphine on the other hand, well that is a whole different thread..........................

Vaild points Nate, but the problem, at least locally, is the same as in the OR. Trying to find facilities that will allow a Paramedic student to practice needed skills, perform their assessments, and utilize their pharmacology knowledge (i.e. being able to push drugs) is difficult. The trauma centers (again locally) are focused on training and educating their own intern and resident staff. Plus, several years back, BOTH level I's were burned by Paramedic students doing stupid things, one causing the death of a patient. They don't want the liability. 10 years ago it was great, the educational process was outstanding, but the times have changed. And until the local colleges get back on the right track and these "mom and pop" education centers get completely eliminated from the picture, its not going to change.............At least not here.............

Since we are on the topic of "old school" SVT drugs, does anyone still use or remember using Endrophonium (Tensilon)? I remember carrying it years ago with great results. A heck of a lot better than Verapamil (Verapakill, I like that!!!!). I never had that whole "calcium channel blocked and you are now dead" asystolic issue.....

Absolutely unbelievable! Asys, if you find out any donation information, please pass it on to us all..............

"In the defense of flight-lp, I think he was suggesting that if they were up walking around after the accident, then mostly likely they probably did not meet flight criteria." Thanks for having my back Nate, but I wasn't suggesting anything, I was making a factual statement. If a patient is ambulatory after self-extrication and then receives treatment on scene, then either they are stable or the medics' are substandard in their assessment skills. Having knowledge of some specifics of this particular wreck, there was no need to send them by helicopter....... @EMS49393 -As far as Maryland goes, their issues go beyond just the private services. MEIMSS is behind the 8 ball period, especially in the BLS realm. Between the aforementioned "broke ass momma with 12 kids can be an EMT" legislation and having the state agency provide minimal if not substandard air services, they have a lot of work to do. I applaud you for trying to make a difference. I on the other hand saw the hoplessness of the cause at the time and departed, looking back, I am glad that I did... Again, my opinion and view of that particular system. Having been there, I can provide a hint of insight.............

I like the idea in theory, but it just not practical. First off, the Airlines will never back it. It is their flight, their plane, and their crew. They will never relinquish any control to any paasenger on the plane. They will always want to be in charge. 2nd, it would be a jurisdictional nightmare. For example, an EMT is certified in Ohio and is on a plane over Texas when a medical emergency occurs. Can he legally provide assistance as an EMT? Most states will not cover it. Police will encounter the same issue, unless they are federal, they are limited. What about equipment? Passenger airliners have a small "D" cylinder, a Defibrillator, and a first aid kit. Nothing more. They are just not equipped to handle most medical and traumatic emergencies............... They would be of little more usefullness than any other passenger on the plane. Still confused on how the firefighter will help. If the plane's on fire, you are pretty well screwed anyways. Nothing they can do............

Well spoken Nate! Personally, I think the Paramedics that work interfacility transfers actually provide a better level of care with critical care calls (i.e. LVAD / IABP, Pedi / Neonate, CVP monitoring, etc.) vs. most 911 medics. To say that one form is better than another is just sheer immaturity. Maryland needs to grow up and while their at it, they need to stop wasting taxpayer money and risking the lives of their personnel by needlessly flying people who have absolutely no need to be flown (more fuel for Bledsoe and his croonies!)..............

#2 gets my vote!!!! Trauma center is less than an hour away by ground and Carroll County apparantly has a few ambulances available to assist. 5 pts. with 4 ambulances responding is not a mass casualty......

Sheer stupidity! I would be interested to hear the results of the investigation. While I cannot make any statements other than assumptive, I wonder if the damage to the ambulance in relation to the other vehicles was due to a higher rate of speed? The impact was to the rear of the dump truck and the ambulance was behind it so obviously someone wasn't paying attention. Please post a follow-up if you can......... "Upon the arrival of Sykesville fire and EMS crews, the private ambulance crew had self-extricated themselves from the wreckage." "Two members of the private ambulance crew were treated on the scene and then flown to Shock Trauma by Maryland State Police Troopers #2 and #3." Why were these people flown? They got themselves out and were stable enough to be treated on scene. Was there truly any need for HEMS or was this a courtesy transport? I'm all for helping out fellow EMS'r, but it sounds like a misuse of resources to me......... Just my humble opinion................

@toysoldier - I noticed you have "Pilot" listed under your avatar. Is there any particular reason why you are choosing EMS vs. aviation? As a pilot myself, one that is in the process of transitioning out of EMS into aviation full-time, I look back and realize that I should have considered this change sooner. Interested in hearing your thoughts about it..............

With or without spermacide???? Ribbed for her pleasure!!!!! Sorry, couldn't resist..........................

You can't help people who do not want to help themselves.... The main reason why we do not see more trauma centers is because the public usually votes against it, plain and simple. Same reason why many tax districts refuse to go with a full time paid service instead of keeping their "free" volunteer service. And I'm sorry, but if you need an I-Stat to assist you in destination determination, then you shouldn't be on an MICU truck..........

DEFINATELY, without a doubt in my mind! I'm not going to re-hash the already made points, but yea this is one for a higher rate of speed than afforded by an ambulance...........

"Get them off my scene and to definitive care faster." The sole reason for our existance! Speed............ A lot of people dog some air services because they don't fly the "cool looking" helicopters or that they don't carry the "cool equipment". What they do not realize is that neither is of much benefit to a trauma patient. Flight crews don't save trauma patients, trauma centers do! The sole reason for the existance of HEMS is to haul ass, period. The nicer helicopters and nicer equipment materialized mainly from hospital based systems who wished to increase their urban based funding by performing specialty transports. Don't believe me...........Tell me the last time you saw an EC-145 sitting in the middle of farmer Joe's field in rural america? Or a worn out Bell 206-L1 sitting on top of a prestigious hospital based system's pad? It just doesn't happen that way. Yea, there are some knuckleheads out there, even have a few in Texas.............

too expensive, too risky, not needed in the pre-hospital environment.......................

Now that funny!!!!

Well, human error is the culprit over 90% of the time, usually from over stretching either the aircrafts ability, the weather, or a combination of both. Rarely is it a non human catastrophic event. Bottom line is people need to put emotion aside and think a little clearer. I do not care how sick or injured someone is, if the weather is not condusive for air operations, we do not go PERIOD! Ground EMS will have to improvise, adapt, and overcome. One dead or dying person does not justify the increased risk of 3 others joining him because they made a bad decision to fly in bad weather. I value my life and will not end it voluntarily to attempt to save someone elses when there are other medical options available. They may not be as good as the optimal level of care, but its better than killing another HEMS crew and adding one more mark to the NTSB statistics. If more people had this mentality, then I believe the statistics will improve......... Other improvement items would include an increase in the use of risk assessments, updated weather observation capabilities for remote area, and continued crew resource training..................

This might sound a little crazy, but I had a similar experience earlier this year and after consulting our MD tried a rather unusual cocktail that despite our initial reservations actually saved our patients life. Keep in mind the goals of an MI.........Reduce the workload (i.e. reduce SVR), maintain a perfusing MAP (>70), and at the same time, keep the heart contracting. We started with a BP of 72P, pale crappy presentation, diaphoretic, vomiting, SOB, light rales, etc. EKG showed 4-6mm ST elevation in II, III, aVF, V7, V8, V9, and V4R. Initiated Dopamine @ 10mcg/kg/min then started Dobutamine @ 5mcg/kg/min and started a fluid bolus of 250cc. Soon our BP and MAP were acceptable and we then started low dose Nipride @ 0.2mg/kg/min. The patients HR, which was initially 42 increased to the upper 50's, the patient was pain free and looked ten times better than origianal presentation, and the BP upon arrival to the ER was 92/56 and the MAP was 74. Soon after, the Dopamine was dc'd and the Dobutamine and Nipride were continously balanced against each other until an IABP was placed in the Cath Lab. The patient subsequently underwent bypass and made a full recovery. Interesting combo, but it worked..................... Had a bit of pucker factor though the whole time!!!!!!

You ought to be a writer, thats the best fictional drama that I have read all week!!! To bad it wouldn't occur that way. Any decent defense lawyer and any sound medical professional can offer rebuting testimony as to why it is rarely ever used pre-hospital anymore. But then again, we are wrong of course................

Very well spoken.........

That happened to us once with DPS. They refused to shut down U.S. 59 for a 3 helicopter scene involving a tour bus. So we in turn refused to land. Its amazing how quickly a single sheriff's deputy can shut down a highway. Hasn't happened since then...........