9 Choppers Down in 11 Months

[paramedicmike]

Perhaps something can come of this:

[web:9c89785bb7]http://www.ntsb.gov/Recs/brochures/MostWanted_2008.pdf[/web:9c89785bb7]

Or this:

[web:9c89785bb7]http://www.usatoday.com/news/nation/2008-10-28-ntsb_N.htm?loc=interstitialskip[/web:9c89785bb7]

[UMSTUDENT]

Need more, better, and tougher education for ground providers so they can operate intelligently without protocols.

I have a close relative who works in the air medical industry for a great company that is extremely safety oriented. Obsessively...

One of the things that seems to come up time and time again is the capability of ground providers to triage patients who need transport via helicopter. Local dispatches will try to self-dispatch commercial helicopters to scenes. Crews arrive on scene to find patients not injured. Even still, if none of the above happens they may look up to see another commercial helicopter inbound that they were never made aware of!

Not only does this raise the costs of providing service because of unnecessary launches, but crews really can't lecture the "customer" about their poor choice. Local EMS agencies/fire departments get to make a choice when they start calling around for an available helicopter. EVERY single agency needs to follow standardized procedures when making request for aviation. PSAPs need to be made accountable, by law, for their decisions as well.

[Dustdevil]

Something that seems to be happening a lot around Dallas-Fort Worth these days is the "airborne standby", where HEMS launches before even being given the "go" from the requesting agency. They just hit the air and start heading that way "just in case", I suppose. This was completely unheard of until very recently. But there are about 20 helos in this area these days, so it has become very commercially competitive. This cannot be a good thing for safety.

[UMSTUDENT]

Something that seems to be happening a lot around Dallas-Fort Worth these days is the "airborne standby", where HEMS launches before even being given the "go" from the requesting agency. They just hit the air and start heading that way "just in case", I suppose. This was completely unheard of until very recently. But there are about 20 helos in this area these days, so it has become very commercially competitive. This cannot be a good thing for safety.

Yeah, that used to be fairly common around here as well. At least south of here. The birds would self launch towards accidents where they heard ground crews requesting assistance or where they were fairly certain there was entrapment, etc. As long as the weather was right, some of these crews could be greeted by a bird hovering overhead. It's good PR.

To my knowledge that is a thing of the past. I think a combination of high fuel costs and heightened safety awareness has now led most to require a call from the PSAP to launch. What is still fairly common is for PSAP's to call and request a bird go on "stand by," essentially asking the bird to begin pre-flight check-offs, spin the rotors, and await further instruction.

Up until the recent protocol changes in Maryland and the recent crash it was not uncommon to have the Troopers literally dispatched as first due units to scenes that were reported serious. You would occasionally hear Ex:"12345 George Washington Blvd-MVC, reported serious with entrapment. Engine 8-2, Rescue Squad 4, Medic 702, Trooper 3 respond."

The dispatchers would be simultaneously speaking with SYSCOM to have the bird launched. It also wasn't uncommon to then hear: "Engine 8-2, Rescue Squad 4, Medic 702, Trooper 3 responding." As the bird entered the county they often marked up on the air essentially as an incoming unit. See in Maryland, up until the last year or so, the helicopters weren't just seen as a resource for critical patients-they were seen as a resource period (in certain counties). Any MVC or incident where there was the anticipation of prolonged entrapment or multiple patients the Trooper simply served as another ambulance that could bypass the local trauma center, who may be overwhelmed, and take the patient to Shock Trauma, etc. In Western Maryland and the Eastern Shore this was actually necessary because the local Level III centers were (and still) not capable of handling more than one serious trauma.

Maryland also practices the whole "right patient to the right place" thing. Specialty centers abound. Hand center, Wilmer Eye Institute, Hyperbarics, Spinal Trauma, Burn patients, Pediatric trauma, and severe priority 1 patients pretty much all used to get flown from rural areas.

[cynical_as_hell]

Unfortunately that is not the issue for some of these flights. It seems they fly because they can.

And some commonsense.

http://www.ems1.com/ems-products/consultin...itical-patients

Study: Many Medevac crashes were for non-critical patients

October 23, 2008

By Robert Little

The Baltimore Sun

PRINCE GEORGE'S COUNTY, Md. — The medical helicopter crash in Prince George's County that killed four people last month was one of more than a dozen fatal crashes nationally during the past six years that raise doubts about whether the victims ever needed to leave the ground.

A review by The Baltimore Sun of crash records and other documents on the 26 fatal medevac crashes in the United States since 2003 shows that many did not involve urgent, minutes-from-death missions. At least eight involved patients who waited longer for a helicopter than a ground ambulance might have needed to drive them to a hospital. And at least six were for patients discharged soon after a helicopter dropped them off at a hospital, or who survived a lengthy ambulance ride after the helicopter sent to get them went down.

The recent history of medevac crashes also includes heroic accounts of late-night flights to retrieve critically ill or injured people in foul weather and urgent missions such as transferring a sick woman from an underequipped hospital in rural Alaska or plucking a young hiker with heat stroke off a mountain in Utah. In the wake of last month's deaths, Maryland officials have repeatedly defended the state's 4,500 annual flights as safe and necessary for saving lives, even if some flights appear unnecessary in hindsight.

But one patient who died after an accident in Arkansas had waited in an ambulance for more than an hour for a helicopter that was to fly him 35 miles. Another victim with a broken leg waited while three helicopters tried to fly through fog, even as ambulance drivers offered to take her to a hospital.

In four cases, including the Sept. 28 incident in Forestville, patients survived not only their initial condition but a subsequent helicopter crash.

Half of the 26 fatal medevac accidents occurred during missions to transfer patients between hospitals — one for a distance of 10 miles — and many of the transferred patients waited hours from the time a helicopter was called until it arrived and was ready to take off again, records show.

Officials at the state agency that oversees emergency medical care in Maryland plan to convene a panel of national specialists to review the state's medevac system and recommend potential improvements. The National Transportation Safety Board will hold a public hearing next year to explore the potential causes of a sharp increase in fatal medevac crashes, including eight this year.

But a growing list of medical specialists are planning their own national dialogue. While regulators such as the NTSB and the Federal Aviation Administration focus on issues of maintenance and safety each time a helicopter crashes, some doctors say that a critical review of helicopter flights from the medical perspective is overdue.

"I'm all for heroes — for the firefighters who climbed up the stairs while the World Trade Center was falling down or anyone else who risks their life to help people," said Dr. Jeffrey P. Salomone, deputy chief of surgery at Grady Memorial Hospital in Atlanta, and chairman of an American College of Surgeons committee that considers guidelines for pre-hospital emergency care. "But it's a real tragedy to think someone could die trying to help a patient who didn't have a life-threatening injury to begin with."

"I remember a patient, an 11-year-old boy, who flew in from a motor vehicle accident and was just standing there, and I asked him, 'Are you hurt?' and he looked at me and said no," said Dr. Marc R. Matthews, trauma director of the Maricopa Medical Center in Phoenix.

"It's that kind of laxity that can get people killed," Matthews added. "It's unintentional, of course, but it's dangerous and it needs to stop."

The records of helicopter crashes do not always include detailed medical information, and doctors caution that the complexities of each case often are not apparent from the paperwork. Police accounts of the fatal collision of two helicopters in Flagstaff, Ariz., in June, for instance, do not reveal that one of the patients onboard, a firefighter bitten by a spider, was apparently in anaphylactic shock, a condition that can be quickly fatal without advanced care.

But the records do show that patients sometimes are not in such dire medical condition that a few minutes — or even a few hours — would make a difference.

For example, a 71-year-old man injured in a vehicle rollover in Arkansas last year waited with an ambulance crew for more than an hour before a helicopter came to fly him 35 miles. He died from injuries received when the aircraft crashed soon after takeoff.

In June, a 58-year-old in Huntsville, Texas, with a ruptured aortic aneurysm waited more than two hours for a helicopter to take him to a Houston hospital, 72 miles away. He and three crew members died when the helicopter crashed into the woods two minutes into the flight.

In the case of Alicia May Goodwin, 27, who was hit by a truck on South Carolina's Interstate 26 in 2004, ambulance crews offered over the radio to drive her to a trauma center 48 miles away, according to records from the Newberry County Sheriff's Department. They were told to wait for a helicopter — the third to attempt the flight on a foggy July morning. More than an hour later, Goodwin and three medevac crewmembers died in a crash less than a mile away. Before the helicopter crash, Goodwin had suffered what medics and her family's attorney described as a serious leg injury but was not in any immediate danger.

"All the medical experts we could find said she was stable and coherent," said Jeffrey R. Harris, a Georgia attorney who won Goodwin's family an undisclosed settlement from the helicopter's operator. "Getting her into an ambulance and to a trauma center would have been easier."

Some advocates of helicopter transport say a simple assessment ignores one of the key benefits of a medevac system - minimizing the amount of time that patients spend in transit. Because providing medical care can be difficult inside an ambulance or inside a helicopter, limiting the duration of the trip can be the most important concern.

"Think of a hospital as a safe zone," said Jonathan Godfrey, transport coordinator for the Children's National Medical Center in Washington. "When a patient leaves the hospital to go to another hospital, whether by ambulance or by air, the resources available to the medical crew are greatly diminished."

Godfrey, a registered nurse, was the sole survivor of a 2005 crash into the Potomac River, which happened after he and his crew delivered a cardiac patient from Frederick to Washington. The patient, Godfrey said, benefited from the helicopter trip's speed and advanced care, and even the crash has not caused him to question the medical value of flying.

Some recent crashes illustrate the kinds of cases that Godfrey describes.

A flight that crashed in 2004, killing four people, was ferrying a 3-month-old child with pneumonia about 300 miles across rural Texas. The child was in respiratory distress, according to news accounts, and the 1 1/2 hour flight to advanced care might have taken more than four hours by ground.

The flight of a 60-year-old woman with an infection and low blood pressure across Alaska, which crashed last December on the way to a hospital in Anchorage, would have required a ground ambulance to take either a ferry or a 400-mile detour around Prince William Sound.

But the potential medical benefits are not always so apparent. In Falkner, Miss., a helicopter responding to a traffic accident crashed after experiencing mechanical trouble. The patient, who had what the local fire chief described as "a pretty bad leg injury," was driven 57 miles to a trauma center in Tupelo without incident.

Maryland has implemented a change since last month's crash that is designed to limit the number of flights that are not medically necessary. Patients with obvious severe injuries are flown whenever helicopters offer a "clinically significant reduction in transport time," but more questionable cases now require consultation with doctors at the receiving hospital.

But specialists outside Maryland say they will pursue a broader re-evaluation of helicopters for medical transport, particularly as examples mount of flights that might not have benefited the patients onboard.

"Every time a helicopter crashes, there's always this emotive, knee-jerk reflex from the community that everything's OK," said Matthews. "I could understand if a crash was an infrequent event, but it seems like there's a new one every few weeks."

based on this article and the bold statements contained in it, there was no need for these patients to go by air to hopsitals that were within reasonable miles. some of these patients could have been taken by ground and at the next facility long before the helicopter crew could get to them. some of my questions would be, why are the doctors insisting these patients go by air? why is this practice being allowed to go on? in the area i work in, when a patient has to go by air, they are going to another hospital that is minimum 110 miles away for "needs higher care" or "needs a specialist" and the doctor feels its not safe for them to endure the 2 hour at least drive that it would take to get them to the next place. i've also had issues though of patients needing to be flown and the doctor refusing. i guess everyone does their own things and have their reasons for doing so.

i agree that the causes for these crashes need to be looked into and corrected immediately. i also feel that the doctors that sent these patients on these choppers, need to be evaluated for the decisions they have made. like i said before, in some of these cases, there was no need for a helicoper, or for the patient to have to wait as long as they did, when they can go by ground and still get there sooner.

i guess the more common sense you lack, the higher paid you are.

[firedoc5]

Something that seems to be happening a lot around Dallas-Fort Worth these days is the "airborne standby", where HEMS launches before even being given the "go" from the requesting agency. They just hit the air and start heading that way "just in case", I suppose. This was completely unheard of until very recently. But there are about 20 helos in this area these days, so it has become very commercially competitive. This cannot be a good thing for safety.

The three main air services we utilized when I was still active in the field were really good with if we called them prior to getting to the scene and then find out we don't need them and for them to turn around.

Sometimes we'd get a dispatch described as a "bad" call, especially an MVA, we'd contact them and get them on the way to cut down on ETA if we did need them. But they didn't mind at all if we'd cancelled them. In matter of fact, they encouraged for us to do that. They didn't have a problem with being turned around. But I would say that 95% of the time that we did notify them early, we definitely needed them.

[Asysin2leads]

"In June, a 58-year-old in Huntsville, Texas, with a ruptured aortic aneurysm waited more than two hours for a helicopter to take him to a Houston hospital, 72 miles away. He and three crew members died when the helicopter crashed into the woods two minutes into the flight."

Okay, hang on here. The problem was that the hospital did not have a standby ground crew to transport critically ill patients that they could not handle. If there was an ambulance at the hospital waiting, they could have done about 30mph to the hospital and gotten there before the helicopter even landed, There's an idea, require any hospital that cannot handle specialty cases to have a paid crew and ambulance ready to transport to an appropriate facility. Ooooh... I smell legislation. Tack it on to the next round of EMTALA and tie it to Medicare and Medicaid money.

When it comes to accidents and fatalities, the biggest factor is the amount of traffic. Increased traffic means increased accidents and fatalities, while decreased traffic means decreased accidents and fatalities. There was a dip in MVA deaths when gas hit $4.00 a gallon. Now the NTSB will investigate and go ever rotor bearing with a fine tooth comb, and when they're done wasting our tax money, they'll come to the conclusion that the only correlation with the increased amount of accidents is that there are more choppers in the air. Unless, that is, principles of deregulation have hit the helicopter maintenance agency too.

Medicare recently loosened the payment restrictions on reimbursement for Medivac. Shockingly, the amount of patients being flown has increased. Odd, isn't it? Rules meant to save lives are taking them. That's the government for you.

[firedoc5]

"In June, a 58-year-old in Huntsville, Texas, with a ruptured aortic aneurysm waited more than two hours for a helicopter to take him to a Houston hospital, 72 miles away. He and three crew members died when the helicopter crashed into the woods two minutes into the flight."

Okay, hang on here. The problem was that the hospital did not have a standby ground crew to transport critically ill patients that they could not handle. If there was an ambulance at the hospital waiting, they could have done about 30mph to the hospital and gotten there before the helicopter even landed, There's an idea, require any hospital that cannot handle specialty cases to have a paid crew and ambulance ready to transport to an appropriate facility. Ooooh... I smell legislation. Tack it on to the next round of EMTALA and tie it to Medicare and Medicaid money.

When it comes to accidents and fatalities, the biggest factor is the amount of traffic. Increased traffic means increased accidents and fatalities, while decreased traffic means decreased accidents and fatalities. There was a dip in MVA deaths when gas hit $4.00 a gallon. Now the NTSB will investigate and go ever rotor bearing with a fine tooth comb, and when they're done wasting our tax money, they'll come to the conclusion that the only correlation with the increased amount of accidents is that there are more choppers in the air. Unless, that is, principles of deregulation have hit the helicopter maintenance agency too.

Medicare recently loosened the payment restrictions on reimbursement for Medivac. Shockingly, the amount of patients being flown has increased. Odd, isn't it? Rules meant to save lives are taking them. That's the government for you.

We had situations when the ER wanted to fly someone out ASAP somewhere, like say to St.Louis. They would call for which ever helo. service, which at the time there were three, but none local. If their ETA was more than an hour we would basically tell them to forget it. We could go by ground and be in St.Louis within a time span of an hour.. Depending on which hosp., we could make it in less than an hour. Our main destination was usually Barnes/Jewish/Children's Hosp. or St. Louis U/ Cardinal Glennon. I thought I had a record of 52 min. one day. But one other guy made it in 48 mins. Of course these "records" were unofficial stats. Just stuff we'd scuttlebutt about. But when Bill made it in 48 mins. it was late night and hardly any traffic.

Now they have a helo. service right in town. So unless they are grounded or on another flight, their ETA time could be less then ten minutes.

[Dustdevil]

Okay, hang on here. The problem was that the hospital did not have a standby ground crew to transport critically ill patients that they could not handle. If there was an ambulance at the hospital waiting, they could have done about 30mph to the hospital and gotten there before the helicopter even landed, There's an idea, require any hospital that cannot handle specialty cases to have a paid crew and ambulance ready to transport to an appropriate facility. Ooooh... I smell legislation.

Holy shyte, dude! That is some classic, outside the box genius right there! I love it! =D>

[crotchitymedic1986]

I agree with taking another look at "who gets flown". I can remember when there was only one helicopter in my city, now there are 8-10. A good many of the trauma patients are not salvageable and are only being flown because no local hospital will accept them. Much like it doesnt make sense to start CPR on a 98 year old with contractures, I think we need to ask is it worth the lives of helicopter crews to transport brain injury patients that have no hope of recovery, burn pts with greater than 75% BSA, or patients that dont have a scratch on their body (or minimal injury) but have "mechanism". This is assumming that a trauma/burn center can be reached by ground within the golden hour. But remember, on the vast majority of helicopter calls --- you have a 10minute ems response time, the chopper is called and has 10-20 minute response time, then they have to assess and package the patient so they spend 10-15 minutes on scene, and then they have the flight time to the hospital, which pretty much eats up your golden hour anyway.