Was the helicopter necessary?

[Spock]

I'm nor going to pass judgement on the medic's decision but we've had this happen in our area far to many times. Many medical directors have implemented protocols that require medical command consult before calling for HEMS. We had one medic who responded to a call for a patient with a nose bleed, she decided the pt had an abdominal aneurysm and she called for a bird. Pt was transported to a trauma center by HEMS and was later discharged with a diagnosis of epistaxis. Insurance companies need to take a role in this by refusing to pay and sending the bill to the ambulance service. It would make people think twice. In my 24 years of experience as a medic, I've only flown two people but we have short ground transport times to a trauma center.

[ERDoc]

I'm nor going to pass judgement on the medic's decision but we've had this happen in our area far to many times. Many medical directors have implemented protocols that require medical command consult before calling for HEMS. We had one medic who responded to a call for a patient with a nose bleed, she decided the pt had an abdominal aneurysm and she called for a bird. Pt was transported to a trauma center by HEMS and was later discharged with a diagnosis of epistaxis. Insurance companies need to take a role in this by refusing to pay and sending the bill to the ambulance service. It would make people think twice. In my 24 years of experience as a medic, I've only flown two people but we have short ground transport times to a trauma center.

WTF??? How do you go from a nose bleed to an abdominal aneurysm? (Asks the guy that coded and pronounced a nose bleed once)

[BushyFromOz]

Interesting thread

No way i could get HEMS to this. all Air Ambulance in this state is owned and operated by my service (noth fixed wing and HEMS)

I mean i could ASK for HEMS, and im sure i would be politely refused, followed by a "WTF were you thinking" conversation a few days later

Are requests for HEMS vetted when they are recieved, or is the report from the scene the only information required?

[triemal04]

I've worked around 3 different rotary-wing services, and sadly, no requests from the field were vetted by any of them or had to meet any requirements. Basically, as long as they were available and the weather permitted...you called, they hauled. Very sad, very pathetic, and very, very dangerous.

Why it works like that is a bit complicated, but really it comes down to the fact that a large part of EMS in the US is delivered by for-profit companies, and I feel very comfortable in saying that the vast majority of flight services are for-profit as well. Helicopters (and airplanes) are expensive to buy, maintain, and provide pilots for; with the amount of overhead, if they aren't flying regularly, they aren't making any profits...bad for the owners. But worse for the employees when they will staff them with only 1 pilot, use smaller, cheaper helicopters, take off in questionable conditions, fly with no questions asked, and fly to anything instead of reserving themselves for calls where they are actually needed.

In the areas that I've worked, flight services were not regulated the way that ground EMS was; no contracts with specific hospitals/nursing homes/whatever were needed, no approval from the state or local ASA were needed, there was no requirement to prove that a "need" existed for that area...all that was needed was for a company to shell out the money to start a base. Unfortunately, that lead to there being multiple helicopters from different companies covering the same area...so to make a profit (that word again)...you called...they hauled.

Until flight services are regulated at the same level as ground EMS this problem will continue.

Until flight services will only respond when specific patient criteria is met this problem will continue.

Until flight services do not need to worry about making a profit this problem will continue.

[ERDoc]

I've been lucky in that the 2 places I've worked have had not for profit HEMS. In NY, the HEMS service was provided by the county police dept and have a paramedic from the academic center to provide care. You can bet your ass that the PD kept the helicopters in perfect shape and were overly cautious about weather conditions. In MI, the HEMS is run by the large hospital system in the area. They are a not for profit organization and safety is of prime importance. Neither one would question the need for a helicopter from the field. They would assume that since the ground people are with the pt, they know what is going on. Calling the helicopter from an outlying hospital here in MI, they do start to question if it necessary.

[triemal04]

Neither one would question the need for a helicopter from the field. They would assume that since the ground people are with the pt, they know what is going on. Calling the helicopter from an outlying hospital here in MI, they do start to question if it necessary.

I don't know if any of the service's I've dealt with had set standards for interfacility trips but I've heard of others that do, but at the same time didn't for field responces.

I've got my own opinions on why that contradiction exists, but I'd like to hear your take on it.

[ERDoc]

I don't know if any of the service's I've dealt with had set standards for interfacility trips but I've heard of others that do, but at the same time didn't for field responces.

I've got my own opinions on why that contradiction exists, but I'd like to hear your take on it.

My guess would be that they have higher expectations of us in the ER. Personally, I hardly ever call for a helicopter. We are close enough to the big hospital that there is not much difference between ground and air time if there is an ambulance available. The only thing that changes my choice of transportation method is level of care needed by the pt, but our helicopters are staffed with a doc and a nurse.

[Hooch.NREMT]

if it were my kids, ida given the smaller one a popsicle and told her not to play on the shelves and taken the other to see the doctor on my own dime… Let the Paramedic be remediated… sheesh. FAIL

[Chief1C]

You can always fall back on fear of sick kids. Some providers are simply terrified for sick and injured pediatric patients. It just shuts them down, or makes their mind all quirky. It's possible that the provider had a mental "how can I get them out of my hands, and into someone elses" moment. It happens, doesn't make one a bad provider; yanno, unless you can't treat them at all. It sounds like there is more to the story, but then again, with all the country wisdom, who the hell knows.

Besides... for those of us who have to use aircraft, we have all had people be released the same day. Usually b/c a medic couldn't read the EKG.

[Kiwiology]

It was not