Indiana considers mandtory trauma transport times

[brentoli]

Indiana considers 30-minute trauma system rule - WTHR

This article is a little confusing. You can see the actual rule draft here: IDHS - Proposed Rule

[Eydawn]

First of all, I thought we had disproven the concept of the Golden Hour?

Second of all, it seems that the greatest challenge to this 30 minute response is resources. If your heli-go-flopter is not always available, and is coming from a distance away, you're going to have a hard time meeting this goal. Ditto for rural ambulances. Heck, a company I know of in CO provides for a mixed urban/rural county, and it can take upwards of 40 minutes to get to a scene. That's why local FD's have BLS crews... to provide immediate treatment... but they aren't allowed to transport, and seldom allowed to transport-to-rendezvous... so that county in my state would fail to meet that 30 minute criteria.

It seems that the major issue they hit on is facilities contracting with private companies instead of using the fastest available resource... I know in some cases that a facility will contract solely with a private, but is mandated to call 911 in a life threatening situation... seems that isn't the case in Indiana?

Hm. It's good to try to improve performance, but it looks like this hasn't been considered from very many angles yet.

Wendy

CO EMT-B

[Chief1C]

We'd have to drive like 120MPH to get to a trauma center in under a half hour.

[Katiebug]

I'd like to see how the crews in California handled it. How did they make it work? It just doesn't seem practical to me.

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[tniuqs]

Firstly good to see you back brentoli .

So a hard and fast blanket rule sound's more like a dictated scoop and run ignoring EBM that in many cases, fast only means pronounced faster in an ER .

So how much $$$ does the state kick into the ambulance operations if the government is bound and determined to save lives ... maybe drop the speed limits get more drunks off the road, bottom line is response times are not the "root cause" of fatalities on highways.

I can see that this will directly result in more crashes both ground and air, I sure would like to hear Bledsoe's opinion, on the use of more choppers in the air in crappy weather ?

Any mention of more funding for things like ultrasound, blood volume expanders, or more for education for Paramedics ?

This pipe dream would NEVER work in Alberta, you could make the rule but unless you have a star trek tele-transporter on every rig, it just ain't reality.

Edited July 30, 2011 by tniuqs

[Katiebug]

Firstly good to see you back brentoli .

So a hard and fast blanket rule sound's more like a dictated scoop and run ignoring EBM that in many cases, fast only means pronounced faster in an ER .

So how much $$$ does the state kick into the ambulance operations if the government is bound and determined to save lives ... maybe drop the speed limits get more drunks off the road, bottom line is response times are not the "root cause" of fatalities on highways.

I can see that this will directly result in more crashes both ground and air, I sure would like to hear Bledsoe's opinion, on the use of more choppers in the air in crappy weather ?

Agreed

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[brentoli]

So how much $$$ does the state kick into the ambulance operations if the government is bound and determined to save lives ... maybe drop the speed limits get more drunks off the road, bottom line is response times are not the "root cause" of fatalities on highways.

I can see that this will directly result in more crashes both ground and air, I sure would like to hear Bledsoe's opinion, on the use of more choppers in the air in crappy weather ?

Any mention of more funding for things like ultrasound, blood volume expanders, or more for education for Paramedics ?

They have been fighting for over two years on how to handle people who turn in their inservice late. When you go to an EMS commission meeting, the first hour of it is them approving waivers for people who didn't get their recert submitted in time. I think (but I'm not sure) they finally passed the rule charging people for this.

I'm not holding my breath to see any money come down the pipeline, nor am I holding my breath to see any changes in the near future.

Someone mentioned that they were talking about nursing homes and private contracts in the story..... Earlier this summer, that TV station did an "expose'" on nursing homes calling for private services on cardiac arrests, who had 45 min response times. Thats why they thru that jab in there.

I'll admit my knowlege of the this latest guideline isn't deep. I missed it, because I have been paying attention to how Indiana is going to restructure provider levels in accordance with the national guidelines. I think we will be going to a NREMT state soon, but I'm not 100% sure on that either. Lovely thing about rule by committee, right?

[Bieber]

It's all about times these days, it seems. I know at my service we have ten minute target scene times on traumas, and the majority of our evaluations are based on our times. Like everyone else has said, instead of focusing on times that for the VAST majority of patients mean nothing, how about we start focusing on clinical excellence and increasing our education?

[BushyFromOz]

When our state trauma uidelines were introdiced, it mandated that time critical patients be triaged to the highest level of ar within 30 mins ( i believe that this will be changed to an hour soon). It was made quite clear that this did not infer increasing speed of tranposrt, but rather be time conscious throughout the entirety of the job. It also did not mean we had to scream lights and sirens to higher level facilities, but rather byapass smaller hospitals for larer ones should the patient require it.

The other part was that higher level of care did not have to be a hospital. For example, half and hour transport to a low care rural facility v's half an hour to meet a helicopter that will transport to a major trauma center, the chopper gets picked every time.

To back this all up, it came out of a white paper on preventable deaths in road accidents, the system was developed and there was a retrospectivce analysys done last year that showed a significant decrease in road trauma deaths.

My point? the 30 min rule is appropriate and proven to beneficial here, not because we drive faster, but because we transport appropriately.

[Lone Star]

The biggest problem that you'll find when you set a hard and fast inflexible rule to govern all situations along with penalties that are enforced for non-compliance, is that there are far too many situations where it cannot be applied to.

Michigan's biggest rule is that patients are transported to the closest appropriate facility. This simply means that if you have a cardiac patient, you're not going to transport them to the trauma unit (unless it's the same hospital that has the local cardiac unit).

It's amazing hat as we disprove the 'Golden Hour' and the 'Platinum 10' rules; someone like this does their best to keep things in the dark ages, despite evidence to the contrary!