Medical helicopter industry 'out of control'

[DwayneEMTP]

Funny that this post pulls me out of lurkerdom.As usual, I take some issue with Dr. Bledsoe. There seems to be no "grey" area with him on most matters (Pre hospital intubation My link, HEMS, ETC:). The problem I see with this is that he makes generalized statements about an entire industry and, in turn, makes the whole industry look bad.

I'm going to approach this, as I do most things, from the point of genuine ignorance as I have no idea what the facts are and have not been interested enough in the flight industry to spend any time on it. Not being facetious, but accurate.Should the entire industry not look bad? I'm only aware of the two services we use locally. One that seems inspiring, and the other that seems akin to a monkey humping a football. If the rest of the industry is like that, 50% (appearing) great and 50% (appearing) ridiculous, then isn't that a high enough failure rate to say that the whole thing is broken and then attack it as a whole?

Has there been a huge increase in the # of HEMS programs in the last 10 years? Absolutely! However, if you look at the majority of those programs, they are privately ran enterprises that approach a hospital and ask " would you like a helicopter based here??" of course the hospital agrees..what do they have to lose?? The program pays the staff, pilots and mechanics..why wouldn't a hospital want a helicopter to call "theirs"? If the hospital says "no" and the program still thinks they can eek their way into the system in the area they simply station it at the nearest airport and PR the hell out of the thing. If it works, great, if not, they pack up and head to the next area they think they can make a profit in.

As above, if so many are not 'state of the art', creating many medical and mechanical failures in care and safety, and the 'state of the art' are having a hard time proving that their services make the risk worthwhile, then aren't we again morally and ethically bound to approach the issue as a whole?

THAT--IMO is what needs regulated, that type of business plan is dangerous in any industry..but it is super dangerous in the HEMS world.

Is there a realistic chance that that regulation is in the foreseeable future?

...It's pretty hard to maintain a "3 to go 1 to say no"

I don't know what that means..

...attitude when you know your base is needing numbers to stay afloat. The feeling of competition leads to folks pushing things like weather minimums or trying to take flights that have already been turned down. Additionally, what does the program have invested in it's employees? As said earlier lots of folks want to be flight medics/nurses right? So, in the above business model, why not hire somebody with less experience who will take a lower salary to call themselves a "Flight medic/nurse".

Again, is it possible that this is the pathology that will terminate the entire organism? And if not, and you're able irradiate this away, how would that happen?

...Even more, where does it end. Dual pilot IFR ships are a great idea, but they are by no means practical in some areas of the US.

How come? Money? Isn't this the same argument many use to support the volly systems? Not sure. The Creeper (you know who) gave me his viral respiratory infection and I'm trying the non AMA approved method of drowning it in tequila as a cure, so perhaps I'm missing your point.

...Do you have any idea what type of AC would be needed to meet that requirement and still be able to function in the altitudes of Alaska, Montana, Colorado or Utah?? Sorry folks, its just not gonna happen.

I have no idea. Though I know it would take a hell of a helicopter to fly my air conditioner anywhere. So I'm guessing the issue is significant.

...What Bledsoe fails to look at is that there ARE great HEMS programs out there. Just like there ARE great Paramedics and EMT's out there that need to be looked at as the model for where EMS and HEMS SHOULD be going..rather than breaking down the entire industry to a nice, easy to understand, black and white box.

I agree, though I am losing faith that EMS in general will ever get behind a 'this change is right, and good, and we need to move it forward even if it hurts' approach to resolving issues. Think if fire decides to get involved in HEMS? I would hate to see the end of HEMS.

I think I speak for most of us when I say that I use them often, but mostly because the flight nurses have those gnarly great assess in their tailored flight suits! (Ok, so I've never actually landed a helicopter stateside. I've started them several times, but cancelled them en-route. But I really, really, like to know you're coming when my sphincter is chewing holes in my underwear.)(Ok, not a great mental image, but you know what I mean.)

Again, just my .02¢. Thanks for having me.

No need to thank me, as you've already proved to be a gift. Thanks for your thoughts brother..

Dwayne

As seems to be happening most often, the formatting got hosed just when I posted and I have no patience to going through and fixing it again. Admin, is this a browswer issue? Or are others having the same problem. I preview over and over with the formatting looking and displaying fine, and then all of a sudden it simply bunches everything together. I used to be able to continue to hit 'preview' and it would eventually sort itself out and be good again, but that doesn't seem to work any more...could it be a Safari issue?

Yeah, ok, so it made me batshit and I had to go and fix it, but the previous paragraph is still valid.

Edited May 7, 2010 by DwayneEMTP

[billygoatpete]

D:

Sorry for my delay in getting back to this topic, between work, moms day, chasing turkeys, and this wicked resp. thing I am fighting off, I haven't had much initiative to get back to the "city".

As usual, you are asking great questions. Many of which I can't even begin to answer for you (remember my one promise...I will always be willing to say "I don't know") this is one of those issues where "I don't know" is even harder because I don't think the answers are easy to find.

I'm going to approach this, as I do most things, from the point of genuine ignorance as I have no idea what the facts are and have not been interested enough in the flight industry to spend any time on it. Not being facetious, but accurate.Should the entire industry not look bad? I'm only aware of the two services we use locally. One that seems inspiring, and the other that seems akin to a monkey humping a football. If the rest of the industry is like that, 50% (appearing) great and 50% (appearing) ridiculous, then isn't that a high enough failure rate to say that the whole thing is broken and then attack it as a whole?

Good point, my gut tells me you are right in that regard but I'm not sure that the industry, as a whole, will accept being labeled as "broken". As is often the case with Dr. Bledsoe, his data does not break down specific area's and/or programs. I would LOVE to see this type of data as I believe you would be able to identify the problem area's quite a bit easier. In fact, I would like to see a breakdown of HEMS incidents that includes things such as CAMTS accreditation vs non accredited programs. (Because I know you will ask CAMTS site) Again, I'm not sure it would matter but my suspicion is that programs that have taken the steps to become accredited will probably have a better safety emphasis.

As above, if so many are not 'state of the art', creating many medical and mechanical failures in care and safety, and the 'state of the art' are having a hard time proving that their services make the risk worthwhile, then aren't we again morally and ethically bound to approach the issue as a whole?

Absolutely, I'm just not sure that Government regulation on the national level is the answer. I think the individual states taking a look at things like accreditation requirements and system needs is a great start. An example would be the state ems agencies requiring any HEMS service applying for a state license to provide proof of CAMTS accreditation as well as a form of evidence that the service is, in fact, needed in the service area they intend to serve. An example of this would be providing the state with something similar to an RFP bid that provides evidence that the service they intend to provide is not already being provided or available in the areas they intend to service. Being that this is America, I don't see the 2nd portion of that flying well (no pun intended). IMO this would limit the # of programs operating in the area and, hopefully, would limit the "competition" mindset. Part of the reason I think that the 2nd portion of that statement is important can even be backed up by Dr. Bledsoe's article (ex: the "explosion" of HEMS services in the U.S. over the last 15 years). If the HEMS agencies had to provide "evidence" that the service was actually needed in the area they were moving into, I don't think we would be seeing near the #'s of HEMS programs popping up all over.

Is there a realistic chance that that regulation is in the foreseeable future?

Again, "I don't know". I would hope that any regulation is looked at from multiple angles with multiple agencies involved (FAA, State EMS etc.) My fear is that the regulation would come as a "knee jerk" type reaction that would set the industry back rather than moving it forward.

I don't know what that means..

"3 to go 1 to say no"relates to a generally accepted rule in HEMS meaning that any crew member can turn down a flight, at any time, for any reason, without fear of getting in trouble for it. An example of this would be a crew taking off with decent weather and getting into something like heavy winds, if, at any point, any crew member becomes uncomfortable with the safety of the mission, they can request to abort it. This request will result in the aircraft immediately turning around and returning to their base. Once on the ground, the crew will debrief and only then will the decision be looked at. Even at that point, the requesting crew member cannot be disciplined for their decision.

The reason this is important is that it gives each crew member the ability to have a certain amount of power over the type of situation they put themselves into.

In the "competition" mindset, I see this rule getting broken and crew members being less willing to "speak up" due to the pressures of "keeping the numbers up".

I'm not sure if I made that point clear....let me know if you need further clarification. Also, this is one thing that I have not encountered, the folks that I know certainly have a certain amount of pride in what they do, but they are by no means "pushed" by the competition in their service area and won't hesitate to turn down a flight if things look hinky.

Again, is it possible that this is the pathology that will terminate the entire organism? And if not, and you're able irradiate this away, how would that happen?

I'm gonna preface this response with a "the thoughts of JP are merely his own and do not reflect anyone or any agency he works for :-)" Because I know I'm a little on the "harsh" side of things with my thinking.

Jesus, my brain hurts from thinking about this issue...and not just on the HEMS side of things. I think EMS as a whole needs to do away with the whole "hand holding, it's ok, you'll get em' next time tiger" mentality. Lets face it, there are folks out there that just SHOULD NOT be in this business. We, as a profession, are doing ourselves and our profession a huge disservice by allowing them to continue in this field. If we, as a profession, could ever get our shit together and come up with a base set of standards that would reflect the profession as a whole (and NREMT isn't it) I think the problem would be self correcting by weeding out those that should not be touching patients.

Again though, I think in the HEMS world, CAMTS is a good start, as well as requiring the nurses/paramedics to have the respective CFRN/FP-C certifications. Most programs have the CFRN/FP-C requirements within 1-3 years of hire which I think is a good thing...those tests are not easy and will certainly identify the folks with a less than solid didactic background. Is that the beat all end all? No..but it's a start.CAMTS also sets patient contact requirements for crew members to ensure that they are, at a minimum, encountering a certain number of various patients over a year period. If these contacts are not met, that crew member gets some clinical time in the deficient area. (Example: OB contact, if a crew member doesn't have X number of contacts per year, that person does an OB clinical to meet the requirement). The non CAMTS programs are not held to this standard.

How come? Money? Isn't this the same argument many use to support the volly systems? Not sure. The Creeper (you know who) gave me his viral respiratory infection and I'm trying the non AMA approved method of drowning it in tequila as a cure, so perhaps I'm missing your point.

I hate to say money is the only reason as I would then look as though I am saying "safety is only worth x amount of dollars". Money does play a huge role in it though, the logistics alone of a dual engine, dual pilot, IFR rated ship are staggering...that means doubling the pilot staff, a significant increase in pilot and mechanic wages (2 engines= double the inspections, PM's etc:) can it be done? I don't know. I'm also not sure that it's the answer. I think that before we go off an mandate the type of aircraft a program uses, we need to look at the basic safety measures each program is employing and go from there.

I have no idea. Though I know it would take a hell of a helicopter to fly my air conditioner anywhere. So I'm guessing the issue is significant.

It is...I think the minimum we could get away with in Colorado would be an EC 145 and I'm not even sure that would get it done. EC145 I'm not much of a helicopter buff but when I asked a pilot...that was his response...as well as a good bit of scoffing at the suggested "regulation" to dual pilot, dual engine, IFR rated aircraft for EMS. Suffice it to say, he's all about safety but doesn't see this as the answer either...

I agree, though I am losing faith that EMS in general will ever get behind a 'this change is right, and good, and we need to move it forward even if it hurts' approach to resolving issues. Think if fire decides to get involved in HEMS? I would hate to see the end of HEMS. I would agree with the 1st statement....Change IS hard but very, very, necessary when it becomes obvious that the "status quo" is no longer cutting it. To go back to my "hand holding" comment above, this type of behavior has got to stop if we ever want to evolve. When it is obvious that a change is needed, we need to study it, find out whats working, whats not, and make the needed changes. For those that don't have the ability to keep up....too bad..taco bell is hiring:-) Unfortunately, you and I both know that day isn't coming any time soon.

As to FD's and HEMS...I'll leave that one alone:-)

I think I speak for most of us when I say that I use them often, but mostly because the flight nurses have those gnarly great assess in their tailored flight suits! (Ok, so I've never actually landed a helicopter stateside. I've started them several times, but cancelled them en-route. But I really, really, like to know you're coming when my sphincter is chewing holes in my underwear.)(Ok, not a great mental image, but you know what I mean.)

I just threw up a bit in my mouth.....

No need to thank me, as you've already proved to be a gift. Thanks for your thoughts brother..

Dwayne

As usual, you have challenged me with your questions, I hope I have provided some of the answers you were looking for. I feel like the majority of my post is strictly opinion...for a reason. This is a pretty challenging topic and I don't believe that there is 1 right answer for it. I've also left lots of "I don't know" answers out there because I honestly don't know where to even begin to approach some of the issues you presented.

Take care,

JP

[DwayneEMTP]

Sorry JP. I've spent a few hours replying to your post and each time the fucking editor ate it, so I'm giving up. I'll have to continue this with you when I see you next as I don't know how to formatt a reply in small enough chunks to make this editor happy yet not sound as if I'm missed most of your points...

Thanks for your response, it did not go unnoticed...

Dwayne

[billygoatpete]

I had the same issue with the whole "multi quote" thing...which is why my reply reads the way it does. After 45 minutes of messing with it I decided to just post it as it was.

I'm sure we can continue the conversation in the near future.

Take care,

JP

[DwayneEMTP]

I had the same issue with the whole "multi quote" thing...which is why my reply reads the way it does. After 45 minutes of messing with it I decided to just post it as it was.

I'm sure we can continue the conversation in the near future.

Take care,

JP

Ahhh....got it. I'll try it your way after I get a bit of sleep. I am truly interested in this conversation and excited to have some intelligent folks to poke holes in my thoughts...

Dwayne