More on flying trauma patients...

[paramedicmike]

I'm sure you've heard of the crash of the Maryland State Police helicopter last weekend. Part of the investigation, at least as far as the media is concerned, is whether or not the patients being transported (one of whom is now dead as a result of the crash) really needed air medical transport to a trauma center.

Now, I am not speculating with regards to the actions of the medics on the ground. I wasn't there and will not armchair quarterback them. I am not speculating with regards to the actions of the pilot for the same reasons. However, that being said, if you work in an environment where you routinely or even occasionally fly patients to specialty centers, think long and hard before you decide to fly that patient.

Look at your patient. Do a thorough assessment. Be smart about it. If you have questions, call your command doc. I'm not saying don't fly the patient. I'm not saying fly him/her anyway. I'm saying use your head.

While the picture offered by the media with any specific event is often incomplete, it is often the basis for driven and heated discussion. Take the following for example:

Baltimore Sun story

Hometown Annapolis story

Another Hometown Annapolis story

Right, wrong, or indifferent this is going to affect not only the use of air medical but also how ground providers do their job. Why? Media coverage has driven the conversation.

Be smart. Use your head. Don't fly that patient because it's cool (you whackers out there know who you are). Don't do it because it's the end of your shift and you want to go home on time. Do it because it is absolutely, without a doubt in the best interest of your patient.

Will we always fly people who don't need to be flown? Unfortunately, until they perfect the ambulance mounted CT scanner, yes. In the meantime, can ground based providers reduce the number of patients they fly through smart assessment, education, and critical thinking? Yes.

Some places have a dire need for air medical services. Others not so much. Be smart. Use your head. Let's all do our part to keep all of us, ground and air based providers, safe.

Thanks.

-be safe

[Dustdevil]

Although I don't believe it was a factor in this particular incident, there is one factor that will always plague us in our attempts to reduce the frequency of this tragedy.

Think about this; who most whines and complains about any attempts to significantly elevate educational standards in EMS?

Now, who most often requests or needs HEMS?

Yep, they are one in the same: The rural communities that don't think they can afford paid and educated professionals. To them, HEMS is a crutch. It is a resource that they can point to as an excuse why they don't need all that book learnin'. After all, all the serious patients get a bird anyhow, right? If suddenly they were the ones that had to care for those critical patients for the next hour and a half of ground transport, instead of pawning them off on a flight nurse, they might have a different view of what their community really needs.

HEMS has got to come to be seen realistically by EMS providers as nothing more than a rapid means of transport for the most critical of our patients. It is not an elevation of care. If it is, then your EMS sucks, and improving that suckage should be your prime goal. But they don't want to hear that in the rural areas because it means fewer hobbies for whackers, and fewer dollars for Christmas lights at city hall. So sorry, but you get what you pay for.

You highlighted the one and only important term in the solution, Mike. Education is indeed the only cure for this tragedy. Unfortunately, I have little to no faith in the ranks of EMS today to ever intelligently implement it, because they are all more concerned with "brotherhood" and Kum Ba Yah than they are with human life.

I wonder how many rural communities could have paid ALS EMS for the cost of one MSP helicopter?

For that matter, I wonder how many rural communities could have paid ALS EMS for the cost of all the POV lights bought in Pennsylvania and New Jersey last year?

[Don1977]

I heard the weather was horrible, if thats true, that chopper should not have been in the air, period!

[Chief1C]

Till there's an official report on what caused the crash, lets not place any blame.

[Dustdevil]

Till there's an official report on what caused the crash, lets not place any blame.

While I generally agree with that sentiment, I don't think that it is too early to start placing blame on the flawed system that creates this atmosphere. It doesn't matter what the weather was like. If the responders on that scene hadn't been uneducated whackers, the flight never would have been requested.

[fireflymedic]

Dust, while I agree with you on the state of many rural services having the mentality you state, there are some which provide a quality service to the area. Where I work is one such service. However, many surrounding us are only basic level services and yes, HEMS is a huge crutch to them, and if they can't get a bird they go into a full panic. My main arguement with having basic level only services for this reason. However, when time is a factor, and you are the distance I am from trauma/cardiac/specialty centers, it's definitely a plus to have that added benefit of quicker transport if and when appropriate.

Key thing being said appropriate. After having worked in an ER and for several rural services, I'm quite aware of the practice of helicopter shopping when one service turns the flight down, they just keep calling or even will call same service two or three times pleading them to take it until they finally relent. It's not a safe practice. If we get one service telling us no, we may call a different base that will avoid bad weather which may have hit the other base, but if they say no as well we're done. That's the only time we may call another service. I'm not looking to kill anybody out there and I make pretty dang sure my patient will benefit from risking those crew's lives before I put a bird in the air. Alot of other people are flight happy - I do utilize choppers when appropriate and I see a definite benefit to my patient, but I have one of the lowest call rates as we function as ground CCT as well, so I really don't see the need to call as often. Many times less is more. I think issue of calling a chopper is also a matter of convenience for rural crews - they don't want to keep more crews on to simply take transfers so they call the birds to avoid having a crew out of service for three hours or so. In addition they won't know how to manage a very critical patient for that long, nor have the resources, training, or meds required to maintain that patient. It is just as Dust said, a crutch for them, and heaven forbid we should take it away from them. I will not insult the memory of this crew by trying to say what was right or wrong, because as I know most flight crews (at least in this area) don't have the capability to refuse a flight once on scene unless for safety reasons. Them thinking the patient doesn't need it doesn't allow them to say no. This in and of itself is a shame because I definitely think there needs to be a greater education placed on what really deserves a flight and trauma call as opposed to what is going to get a pretty chopper to appear.

Let's take a deep look at the current flight criteria. If you look at it truly, just about any patient could be made to fit into the criteria. Heck, if that's the case, let's just call a chopper for everybody, not even bother transporting ourselves ! And sadly the HEMS industry feeds this by providing nice little posters and talks saying call us for this this and this. Never once have I heard nor seen anything saying this doesn't warrant a flight. Perhaps it has been said behind closed doors (I work with several flight medics on the ground and have heard the comments) but never is it said within the confines of their flight job for fear of losing it. And heaven forbid they do that because there is a multitude of those waiting to fill the seats. And in reality, with medicare/medicaid it is easier to get a helicopter trip reimbursed than an ambulance trip, even when ground transport would have been more appropriate and cheaper ! It's an industry fueled by money like any other, but one where safety should surpass that greed and sadly in it's current state isn't. Some things need to have a hard looking at and education on both sides from when to and not to fly for ground perspective and the flight persepctive to have the right to refuse inappropriate flights. Then I see things possibly changing, until then, it will be all talk with no benefit.

[paramedicmike]

I heard the weather was horrible, if thats true, that chopper should not have been in the air, period!

Without directly addressing the ignorance of the quoted statement (it has been appropriately addressed by others) there is some validity to weather as a factor in deciding to fly.

Bad weather drastically changes the ability to operate safely. You (a general "you", not anyone in particular) as a ground provider should be aware of the weather and at least recognize that bad weather could negatively affect the outcome of the patient if you decide to call for a helicopter.

Be aware. Use your head. Be smart. Educate yourself. This isn't a time for being a hero.

FWIW, it may take up to a year for the official NTSB report to be released as to the cause of the crash. Speculation serves no one. Let's be professional here.

-be safe

[Richard B the EMT]

Here, I know I am repeating myself from other strings in the past.

When a Medivac flight is requested in New York City, first, remember that ground ambulances have the luxury of being usually no more than 15 minutes from the nearest ER. With only one exception that I know about, Medivac flights almost never take place from the scene of the incident to the ER.

When the request is made, from the FDNY EMS side, it has to be from an ER that's crew feels the patient needs some specialty they cannot do, and usually have contacted the hospital that does do the spoecailty. Next, the request needs to be approved by the FDNY EMS EMD "tour commander" after approval by OLMC that the patient can and would benefit by going by air.

Next, it has to be approved by the on duty commanding officer of NYPD Aviation's command.

Final approval is the NYPD Helo pilot. If he feels, due to weather (or other contributing factors I don't know about as I am not a pilot), that he's endangering himself, the aircraft, and his observer/partner, it ain't gonna happen.

If the above conditions are met, an FDNY EMS ambulance, or one under it's control via the 9-1-1 system, will bring the patient to meet the helo at the nearest helipad, and have another one on the receiving end for transport to the hospital receiving the patient.

NYPD, however, has no control over other Medivac providers flying into New York City airspace. When contacted by the out of towners they're inbound, all we provide is ground transportation from one of the commercial helipads to the predetermined ER.

I had to explain all that to the Chief of Operations of my own VAC, when he tried to tell me tales of grandeur, of ordering up a landing of a helo on top of apartment buildings for an emergency patient evacuation of a patient from those buildings. He's a Chief, hence, he could do it, dispite my telling him it was a "No Can Do" Situation, and as someone then working in the EMD who knows the rules.

Is there a level of "ParaGod" for EMTs who are also suffering from Munchausen's Syndrome while in a Chief's capacity?

This is also NOT taking into account if the building's roof could hold the weight of a Textron-Bell 244 Jet Long-Ranger landing on it.

[defib_wizard]

As a rural provider we use helicopters frequently. However the majority of the time we transport to the local ED. and they set up the flight. We also use multiple fixed wing services for air transport. They are cheaper and the cabin is pressurized. There are some circumstances that almost make calling for a helicopter mandatory. The other night while finishing my paper at the ED the doc. was getting upset about waiting for a CT report. The Radiology dept finally let him know the system that transmits the CTs to the radiologists is down. We were then dispatched to a rollover mva. The ED staff requested we fly the pt if it appears he would need a CT. Well he had s/s of a closed head injury so he got a helicopter ride to the trauma center. I agree it is much safer for everybody to use lit helipads, than a hot load on a dark interstate. But sometimes it is what is necessary in our area.

[Chief1C]

So.. Which is more ignorant, or inappropriate to suggest with out further details from investigations?

This:

I heard the weather was horrible, if thats true, that chopper should not have been in the air, period!

Or This?

It doesn't matter what the weather was like. If the responders on that scene hadn't been uneducated whackers, the flight never would have been requested.

Mechanics? Federal law makers, who don't require instrumentation that could prevent crashes caused by not being aware of distance to the ground? I haven't read anything about the extent of the injuries of the victims, from the auto crash. I have read statements about Maryland EMS and trauma patient destination protocols. Waldorf is about an hour, by road, from the Shock Trauma Center in Balt. So many factors to go over, I'm not too familiar with Maryland, as far was other Trauma centers, if protocol suggested the patient needs to be taken to one. Ultimately, no matter what the medevac dispatch centers report, it's the pilot's decision to take the flight or not. I don't think anything has been suggested yet to clue in that it was pilot ignorance, seems like either equipment failure, or lack of flight instruments.