Whats the go with HEMS in the states?

[BushyFromOz]

i saw this on Good Morning America this morning (yeah, i was up in the middle of the night)

At 11:45 p.m., the helicopter took off for the 25-mile flight to the emergency room at Prince George's County Hospital. But almost from the moment of liftoff, Bunker knew he was in trouble.. Jordan Wells began to panic again. It was raining much harder than he'd been told and there was a dense fog

"I remember taking off," she said. "I remember flying. I remember kind of looking out the window, seeing a building. I remember feeling the helicopter trying to land. But he said he couldn't land because it was raining too much. And he said, 'we're going to turn around and take you to southern Maryland.' And I think I remember us hitting the first tree and that's when my face hit the side of the helicopter. ... And that's when I blacked out."

I mean why was this thing in the air anyway?? Earlier in the story, the MCA the patient was involved in happened because of heavy rain and low visibility, and its the middle of the night. I dont understand why a helicopter was saent to this job, based on the story anyway. And can someone tell me, what exactly is a "Shock Trauma Center" ???, or is it just another fancy name?

Cheers

GMA Story

[WelshMedic]

i saw this on Good Morning America this morning (yeah, i was up in the middle of the night)

I mean why was this thing in the air anyway?? Earlier in the story, the MCA the patient was involved in happened because of heavy rain and low visibility, and its the middle of the night. I dont understand why a helicopter was saent to this job, based on the story anyway. And can someone tell me, what exactly is a "Shock Trauma Center" ???, or is it just another fancy name?

Cheers

GMA Story

I'll hava a go, Bushy m8:

1) Helicopter services are run as private enterprises, no flights, no money. It even gets to the point where people helicopter shop until they find a crew willing to fly, whatever the weather.

2) Baltimore Shock Trauma is a leading trauma unit in the US, (some would say the world) set up by the famous R Cowley Adams. He was also responsible for the Golden Hour. Colleagues of mine from the Netherlands visited last year during JEMS and were stuck in a corner and basically ignored by everyone. So in my book it is not that great!

Hope this helps...

WM

[paramedicmike]

Well, the easy part is answering what the "Shock Trauma Center" is. It's full name is the "R. Adams Cowley Shock Trauma Center". It is run by the University of Maryland in Baltimore. At one time it was the preeminent trauma facility on the US east coast if not the country.

As to why this aircraft was in the air, well, that's another story entirely. There's been a lot of news coverage questioning why they flew. If you Google "Trooper 2 Crash" (the callsign for the aircraft in question), you'll find a lot of information regarding this particular incident. If you come across the transcripts between the pilot and the dispatchers prior to the aircraft departure, you may get an insight as to why they decided to fly.

While I know you, Bushy, are smart enough to know this, I feel compelled to throw this out for the masses. Of course, none of us were there and speculation is pointless until the final results of the NTSB investigation are complete and released.

HEMS in the US is in a pretty bad way at the moment. I guess the upside to all this negativity is that with so much attention being focused on the industry, complete with congressional investigations and hearings, we can only hope that some positive changes will take place to make this safer for those who fly and those who are flown.

-be safe

[VentMedic]

2) Baltimore Shock Trauma is a leading trauma unit in the US, (some would say the world) set up by the famous R Cowley Adams. He was also responsible for the Golden Hour. Colleagues of mine from the Netherlands visited last year during JEMS and were stuck in a corner and basically ignored by everyone. So in my book it is not that great!

It is a hospital that is dedicated to trauma and actually can function independent of the rest of the hospital. It will have its own ORs, diagnostic services, personnel and ICU. Ryder Trauma Center in Miami is another example. Usually a trauma center is just an ED that has specific abilities and services with the patients becoming part of the regular hospital.

As far as the HEMS and all medical helicopter situation, there have been numerous articles posted on this forum.

Recent bill introduced:

http://www.govtrack.us/congress/billtext.xpd?bill=h111-978

Recent statement from ACEP:

http://www.acep.org/pressroom.aspx?id=44232

Differing opinions about costs:

http://marketplace.publicradio.org/display...ue_helicopters/

NTSB hearings on HEMS (you'll find all 4 days here)

http://www.verticalmag.com/control/news/te...?a=9911&z=5

You can also find out more info about each crash at:

http://www.ntsb.gov/

[spenac]

It is a hospital that is dedicated to trauma and actually can function independent of the rest of the hospital. It will have its own ORs, diagnostic services, personnel and ICU. Ryder Trauma Center in Miami is another example. Usually a trauma center is just an ED that has specific abilities and services and the patients are part of the regular hospital.

As far as the HEMS and all medical helicopter situation, there have been numerous articles posted on this forum.

Recent bill introduced:

http://www.govtrack.us/congress/billtext.xpd?bill=h111-978

Recent statement from ACEP:

http://www.acep.org/pressroom.aspx?id=44232

Differing opinions about costs:

http://marketplace.publicradio.org/display...ue_helicopters/

NTSB hearings on HEMS (you'll find all 4 days here)

http://www.verticalmag.com/control/news/te...?a=9911&z=5

You can also find out more info about each crash at:

www.ntsb.gov

Good info Vent, This time I won't have to fight with you.

[paramedicmike]

I'll hava a go, Bushy m8:

1) Helicopter services are run as private enterprises, no flights, no money. It even gets to the point where people helicopter shop until they find a crew willing to fly, whatever the weather.

Close, but not quite.

It is true that there are quite a few private enterprise air medical transport organizations spread throughout the United States. This particular aircraft was owned, operated and staffed by a governmental agency, namely the Maryland State Police (MSP). In the State of Maryland, MSP is the primary resource for scene flights within the entire state. There is very little, if any, helicopter shopping that takes place in this area. (While there are private services in the area, they are pretty much limited to interfacility transfers.)

MSP is also well known for their excellent safety record. That's partly why this accident was such a shock to so many people.

2) Baltimore Shock Trauma is a leading trauma unit in the US, (some would say the world) set up by the famous R Cowley Adams. He was also responsible for the Golden Hour. Colleagues of mine from the Netherlands visited last year during JEMS and were stuck in a corner and basically ignored by everyone. So in my book it is not that great!

Hope this helps...

WM

I don't want to defend the institution as I wasn't there, but Shock Trauma (as it's widely known) is a busy place. Like many big city hospitals, staff can become, shall we say, less than friendly. Being assertive counts. However, given the facility status as the prime trauma center in the state and as a busy teaching hospital, observers do tend to be shuffled to the side. I'm sure your colleagues didn't want to make too many waves. But sometimes a good wave is all it takes.

Although, I do regret their experience wasn't what they hoped it would be.

-be safe

[VentMedic]

2) Baltimore Shock Trauma is a leading trauma unit in the US, (some would say the world) set up by the famous R Cowley Adams. He was also responsible for the Golden Hour. Colleagues of mine from the Netherlands visited last year during JEMS and were stuck in a corner and basically ignored by everyone. So in my book it is not that great!

Were they invited and did they have a personal escort? Chances are you might not even make it past the front door with very tight security in some trauma centers so they should consider themselves lucky they got as far as they did.

[VentMedic]

A news update was just posted:

Maryland May Lose 'Trooper' Medevac Program

MARYLAND - 2/27/2009

On March 4, there will be a rally in Annapolis by Emergency Medical Service and Fire Department personnel from all across Maryland to protest the Senate Bill 650, which is being reviewed for approval. The bill, co-sponsored by Senators Picken and Astle, seeks to eliminate the current Maryland Emergency Medical Department helicopter program in favor of third party vendors.

Upon review of SB 650, it would appear that the state is looking to do away with the expense of the helicopter medevac overhead including the maintenance and staff by bringing in a third party vendor to do the job.

The use of third party vendors gives rise to a number of concerns, especially here in Southern Maryland where a medevac helicopter service is stationed in the area and the rapid response afforded by that close proximity has saved an incalculable number of lives.

In any serious and life threatening accident or trauma situation it has long been established that the first 60 minutes, or ‘Golden Hour’ is the most critical difference between saving a threatened life or losing the battle. It has been proven time, and time again that critically injured patients who are treated within the first hour of trauma have an exponentially better chance at survival than patients who receive treatment after that first hour.

Given the number of ‘Trooper’ fly-outs that occur in Southern Maryland, having a medical emergency response which has to be called in from miles away is sure to cost lives in the long run. However, there is more at stake than the number of lives placed in jeopardy by any prospective delay in treatment.

There is a potential for a severe economic impact to patients and families as well. In the current system, Maryland’s Emergency Medical Department helicopters cost individuals nothing. The costs of private, emergency medevac helicopter services can be exorbitant – the average cost of a personal ride from Southern Maryland to PG Hospital is/was $7,500 - $8,000. These costs were experienced immediately after the Trooper medevac fleet was grounded after the Trooper 2 accident.

However, SB 650 does not specifically address any real hard dollar costs. The bill does state that private contractors would be reimbursed by the state, but that is after any other form of reimbursement including insurance payments. While the bill does specifically prohibit billing patients directly; there is no language that prohibits third-party providers from billing insurance carriers for the costs of the transport.

The two most prevalent concerns by EMS and Fire Department personnel across the state is first, the delay in coverage and second, the potential costs to Maryland’s citizens. As one EMS volunteer put it, “There is a huge potential for everyone’s health insurance premiums to be raised because of this cost to patients.”

“The Troopers are available to us 24/7. [With] these private industries, we don't know how quick we could get one for a trauma transport. The troopers have been here much longer and we don't see where they have ever done us wrong,” said the EMS who wishes to remain anonymous.

He continued, “Why fix something that isn't broken. This seems to have come up since the Trooper 2 accident. I realize it takes a long time to do the 100 hour inspections and the cost impacted to fix these vehicles. We need to fight to keep them here.”

If the bill passes and becomes enabled, it is scheduled to take effect by Oct. 1.

SENATE BILL 650 Introduced and read first time; February 6, 2009

A BILL ENTITLED:

AN ACT concerning Medevac Helicopter Improvement Act of 2009

FOR the purpose of requiring the Department of Emergency Services, or the Department of General Services under certain circumstances, to issue a request for proposals under State procurement law to select an entity to operate the State's helicopter fleet for emergency medical services; requiring a certain number of fleets of helicopters to operate in the State; requiring the Maryland State Police and other appropriate law enforcement agencies to operate a certain fleet; requiring a certain fleet of helicopters to consist of a certain number of helicopters; requiring the Maryland State Police to submit a proposal in response to a certain request for proposals; requiring the consideration of a State-operated helicopter fleet for emergency medical services and certain options in the evaluation of requests for proposals; requiring the request for proposals to include certain requirements; requiring certain savings to be distributed to a certain fund; requiring the Secretary of Emergency Services, or the Secretary of General Services under certain circumstances, to adopt certain regulations; requiring the Secretary of Emergency Services or the Secretary of General Services to submit a certain report to the Governor and the General Assembly on or before a certain date and annually thereafter; making a certain section of this Act contingent on the taking effect of another Act; making a certain section of this Act contingent on the failure of certain legislation; defining certain terms; and generally relating to State helicopters.

[spenac]

For the tax payers though it is more finacially responsible use of money. And as we see in ground EMS no one thinks of us till they need us. So hey save me some money I have never needed an ambulance or a helicoptor cheaper is better.

[VentMedic]

For the tax payers though it is more finacially responsible use of money. And as we see in ground EMS no one thinks of us till they need us. So hey save me some money I have never needed an ambulance or a helicoptor cheaper is better.

Although, as it was mentioned in the many investigations, the helicopters were called because they "could" and not because they "should". I believe in one of the reports published it mentioned how many patients walked out of the trauma center before the helicopter even got back to base.