Was the helicopter necessary?

[ERDoc]

http://www.wkyt.com/home/headlines/Lincoln-Co-girls-put-on-AirEvac-flight-for-minor-injuries-despite-parents-wishes-224175611.html

[Kaisu]

I guess stupid people that lack pediatric assessment skills would find the helicopter necessary

[ERDoc]

Let's play Devil's Advocate for a second. Even if skull is visible, does that require a helicopter? Has this guy never seen a scalp lac? I must be a bad parent because I don't call 911 every time my kids get a bump to the head.

[paramedicmike]

Sounds like he's digging in his heels, too. It sounds like that even if he realizes he was wrong he'll never admit it.

[Timmy]

It’s hard to say with the limited details provided in a media report. Obviously you need to take into consideration the time and means of getting the kids to an appropriate facility via the quickest way possible. There’s no information on what services the hospital they bypassed has nor is there any real justification on why he called a helicopter.

It also doesn’t state what type of store this incident occurred in nor does it say what was sitting on the shelving (normal groceries in a convenience store VS a bags of cement in a hardware store, for example). It states the shelving fell on the children, it doesn’t detail what the actual mechanism of injury or the height from which the shelving fell from – that being a possibility of compression fracture from direct impact etc. There’s no mention of any abnormal neurological findings, who’s to say one of the kids didn’t complain of altered sensation or have an abnormal vital signs survey.

It could just be a simple lac to the head requiring suturing but on the flip side he could have arrived to find a pale and tachycardic child with laceration to head post head strike from a 1.5 meter falling object with initial abnormal neurological findings. I'd also take into consideration the motive behind a fly paramedic and nurse (who I assume have high clinical standing to be in such a position) decision to transport the second child by air as well.

Edited September 21, 2013 by Timmy

[triemal04]

Highly doubt there was any indication that made flying the kids neccasary. While it's hard to be completely sure without actually being there and doing my own assessment, seeing what actually happened and knowing the area, I would be shocked if there was anything going on that really neccesitated a flight.

If you watch the video it looks like the mom indicates that the shelf was actually a large bookcase; depending on what was on it there definetly could have been a lot of force involved...or there might not have been. Either way, a real assessment should have given enough info to make an informed decision.

As far as "seeing the skull"...the video shows one kid with a bandage on her forehead. Not like there's a lot of tissue over the bone there, especially in a 3 year old so it wouldn't exactly be shocking that a cut that required stitches exposed the skull.

Poor call all around.

[MikeEMT]

Anyone that has been in this field for awhile has certainly assessed their share of Peds patients. Anyone who has even a general knowledge should know that Peds patients compensate very well and then crash suddenly.

I don't like relying on "news" reports to base my decisions on. What I will say is this, Pediatric patients can be very difficult to treat. There are a lot of unknowns. What were the patients vitals? Did the patient's condition deteriorate during assessment? Did the Paramedic on scene notify his Medical Control or provide a HEAR report to local ER? If so was the local ER equipped to handle these patients?

Helicopters / aircraft are no different than a ground ambulance, minus the cost of course. I don't see a problem with flying these patients. In my Law Enforcement days, we had a toddler who died when a tv fell on him. There is no telling how heavy these shelves were or the weight of what was on them. Had I been in his shoes there is a very strong chance that I would have come to the same decision.

[island emt]

transport time 15 minutes to the hospital """ But they waited 30 minutes for the rotary wing aircraft to get to them :: WTF ?????????????

While he may have thought they needed a specialized pediatric hospital, it would have made more sense to load and go to the nearby hospital and let the medivac meet them there as necessary.

My guess is the local ER could have handled these children and not cost the added $$$$.

Far too often you read of reports where the PT was flown out by helicopter and treated & released within hours with minor injuries. AND a many thousand $$$$$$ bill for a helicopter ride.

[ERDoc]

Any ER with a board certified doc would have been able to handle these kids. I obviously don't know the situation at the local hospital. Anyone that has been doing this for any amount of time knows when kids look sick and when they look well. There is nothing in this that says these kids looked sick. It sounds more to me like the medic on the scene freaked when he saw a bleeding scalp wound and panicked. HEMS is abused and we all know it and I think this was a perfect example.

[paramedicmike]

All of this is in addition to the mother not wanting the flight. Mom had a reasonable plan. Go local.

Yes, this is all based on a single news article. However, there are an awful lot of practice and ethics questions raised by this incident. If all of this is true mom may have a case for kidnapping.

Edited September 24, 2013 by paramedicmike