More on flying trauma patients...

[Dustdevil]

The "Golden Hour," what a magnificent farce. From what I can tell, it was a really neat concept that grabbed medical providers and the public's attention, resulting in funding for somebody's pet project. Something to do with buying cool new helicopters for a hospital. :wink:

Of course. Because, if we have a bunch of helicopters available, then we can get by with nothing but BLS vollies on the ground. Or, at least that was the theory. :roll:

When all is said and done, does anything that Maryland points to as evidence that they are leaders in trauma care really hold up to scrutiny?

[UMSTUDENT]

Of course. Because, if we have a bunch of helicopters available, then we can get by with nothing but BLS vollies on the ground. Or, at least that was the theory. :roll:

When all is said and done, does anything that Maryland points to as evidence that they are leaders in trauma care really hold up to scrutiny?

Dust,

As someone living and working MD, I'd like to respectively clarify some common misconceptions.

First, Cowley readily admitted that the term the "Golden Hour" was pretty much a marketing scheme. There was no "set" time that the body had before shock was irreversible, but try explaining that to the general public while you're simultaneously trying to establish a state funded trauma system. It was just rather unfortunate that generations of EMS textbooks started using this nonsense...

Second, there is some anecdotal evidence to suggest that the MSP helicopter system was an elaborately ingenious "referral" system designed to keep paying/interesting customers coming to Shock Trauma. As anyone knows who has done any amount of clinical training in the Baltimore/Metropolitan region can tell you, there isn't a lot of "insurance card carrying" trauma victims within city limits. Add to the fact that you would see an awful lot of small arms fire related trauma...Take some time and watch "The Wire" for a fairly realistic view of Baltimore/Murdaland/Charm City/Little Beirut.

To this day, Shock Trauma really is an amazing place to go watch. Dr. Scalea is an amazing doctor still running Cowley's dream of a world class institution. Trauma victims who come into the TRU (Trauma Resuscitation Unit) are generally met with no less than 5-10 specialist physicians/residents. Hell, the unit has CAT Scan machines that were specially developed for the center that are capable of completing a high quality, full-body scan in less than 60 seconds. The technology was modified from imaging systems in use in Africa to check diamond mine worker's body cavities for stolen merchandise. ExpressCare, the university's private fleet of ambulances and one helicopter, transports in patient's from the Mid-Atlantic Region who are deemed "interesting" or who require the speciality services of the unit.

I mean the overall system is a great thing. Unfortunately, while Shock Trauma has stayed on the cutting edge, our EMS protocols have been stagnate in progress under the direction of some rather intrenched leadership. State-wide protocols are just not the best thing...

[paramedicmike]

I mean the overall system is a great thing. Unfortunately, while Shock Trauma has stayed on the cutting edge, our EMS protocols have been stagnate in progress under the direction of some rather intrenched leadership. State-wide protocols are just not the best thing...

Statewide protocols could be a great thing IF (and in this case it's a huge "if") the fire service releases it's strangle-hold on EMS within the Maryland state lines.

Seeing as that will not happen anytime in the near future, Maryland EMS will continue to flounder and, in very general terms, suck.

That is also a major reason why I left Maryland. So this is a former insider's informed observation.

-be safe

[UMSTUDENT]

Statewide protocols could be a great thing IF (and in this case it's a huge "if") the fire service releases it's strangle-hold on EMS within the Maryland state lines.

Seeing as that will not happen anytime in the near future, Maryland EMS will continue to flounder and, in very general terms, suck.

That is also a major reason why I left Maryland. So this is a former insider's informed observation.

-be safe

Very true. MIEMSS can't be entirely blaimed for the situation in MD. Fire-based institutions run every major EMS jurisdiction within the state. I myself almost left Maryland for greener pastures. A good salary and a fiance' kept me here.

[CBEMT]

Statewide protocols are pretty essential if the state in question is not quite as large as some counties are in other states. :wink:

[Arizonaffcep]

It all boils down to the medic's education. If they are taught the "2 blue, 1 yellow" style mentality, without the needed critical thinking skills you get a crappy medic. No thanks. This is why I opened my own place.

[UMSTUDENT]

Statewide protocols are pretty essential if the state in question is not quite as large as some counties are in other states. :wink:

Maryland has almost 6 million residents (19th among 50 states). It's 5th by population density and 1st according to median household income. It has the lowest poverty rate in the nation at 7.8% (even with Baltimore City).

Essentially, no, state wide protocols are not necessary. Maryland is one of the most geographically and demographically unique states in the union ("America in Miniature"). Tax payers are widely different depending on the area of the state you visit. For instance, the western portion is separated by several mountain ranges (Blue Ridges) and therefore has a fairly unique culture almost independent from the rest of the state. The types of EMS and the quality of EMS provided to these people, in different regions, definitely would allow for unique county/regional protocols.

It is true that 90% or more of the population lives in the Baltimore-Washington Metropolitan area (the Interstate 95 corridor).

[paramedicmike]

So the laws of physics change requiring a different set of guidelines to treat patients once you get west of Frederick? Somehow patients are different the further west you go?

Medicine is medicine and treatment doesn't really change that much especially in a place like Maryland. You may have specialty considerations (prolonged extrication from some obscure trail out near Deep Creek, for example) but your general treatment isn't going to change.

Some of those specialty considerations may include how you'll transport. Specifically, it may include HEMS. But that doesn't mean you write up a completely separate set of guidelines for more rural providers.

Factionalization is enough trouble as it is. We don't need to further it buy suggesting that somehow physics operates differently in certain areas.

-be safe

[Dustdevil]

It depends upon the focus of such protocols. Are they there to establish a minimum standard of care? Or are they there to provide for a rigid framework of technical practice? I don't care how big or small your state is, statewide protocols are an albatross around the neck of the profession. Physics don't change, but protocols do not address physics. Protocols address the art of medical practice. And the educational preparation and competency of individual practitioners do indeed vary from location to location. One only need look at the providers within their organisation in order to understand that concept. In any organisation, there will be practitioners who you respect and look up to for a higher standard, and those who you you hesitate to ever leave alone with a patient because they function on a lower level. If you establish statewide protocols that restrain the former from providing the best possible care to their patients, the patients and the profession lose. If you establish statewide protocols that don't encourage the latter to elevate their game, again, both the patients and the profession lose. So now, apply that to the system in city "A", whose medics typically graduate from a two-year college programme, versus the medics next door in city "B", whose firemen attend a thirteen-week patch factory, and did not want to do so in the first place. Who benefits from statewide protocols in this case? Not the patients. And certainly not the profession.

[Richard B the EMT]

I mentioned the pilot has final decision as to fly, dependant on known obstructions, weather, and other stuff that I, as a non-pilot, am unaware of.

I am aware of one call, within my jurisdiction, and with paramedics who are now my supervisors (as lieutenants), where flying a smoke inhalation patient to a recompression chamber, the weather deteriorated so much, and so quickly, the pilot landed the helo, the Paramedic accompanying the patient put in a request for his partner to respond to the LZ (which the partner did, unsurprisingly very quickly), and the rest of the transfer was done on the ground. The time, flying, would have been perhaps 10 minutes, but by the ground ambulance was only 45 or 50 minutes, and the patient had a non deficit full recovery.