Ambulance Crash, buckle up guys.

[paramedicmike]

I also used to live and work in Maryland. Just like every other place it has it's problems. It's not better or worse than anyplace else. It's just different. Please keep in mind that things are very different when it comes to 911 and private ambulance services in MD. Please don't assume that they way it works in your area is the way it works in other areas.

Someone mentioned that the MSP aviation units are always in the air. Not so. I've gone in for fly alongs with an aviation unit. We sat at the base all day and didn't turn a rotor.

The issue of flying someone from an accident in MD came up in another thread recently. Maryland protocols do, in fact, have a list of MOI issues that meet the statewide trauma criteria. However, if you read carefully, it says quite plainly "CONSIDER helicopter transport". It doesn't say you have to fly them. And I'll agree with others who've said that it doesn't sound like they needed to be flown.

So they were hurting more than they initially thought. Big deal. They still didn't meet any fly out criteria. They met the "consider helicopter transport" criteria. But by all accounts they were good for ground transport. Perhaps the paramedic was just lazy? Didn't want to deal with traffic?

Rehkopf, why don't you invite the paramedic who, like you, misquoted the protocols to defend himself here regarding this call. That way, we can tell him, too, that being a protocol monkey sucks and that he should be smarter than that.

-be safe.

[SSG G-man]

Well, I run with a guy who is a SGT with MSP Aviation. HE is a medic on a trooper. He has stated he would rather transport some that might not need it, than to have someone die because they did not get flown to the right place in the required time.

But I guess we have totally hijacked the thread now.

I guess I need a banana.

[Dustdevil]

The day I let my pride and arrogance start telling me that I am smarter than my Medical Director (the PHYSICIAN under whose license I touch my every patient, and who signed off on my protocols), I'll be out of a job... and rightly so.

This is why a year of English should be required for paramedic licensure. Read your protocols more carefully and you will find that you are not being told that you "must" fly everybody for whom you imagine an "MOI."

When I hear this, I always wonder if these people really misunderstand their protocols that badly, or if they are simply utilising them as an excuse to call out helicopters as often as possible. Either way, it makes medics look really bad.

[iMac]

waw, it takes a talent.

[Nate]

In Texas we have conditions that one would consider flying the patient if they are in that group. However, I have to agree with Dustdevil; there are other things to look at besides the MOI. I don't know what was going on, so I can't say if he should have flown them out or not. I also don't know how far the trauma center is or anything else.

What I do know is that Maryland sounds like some place I probably shouldn't have an accident in.

[SSG G-man]

I think I would rather have an accident where I might be flown to a truma center then one wher I will be taken by ground to a hospital a long ride away, that m ight not be able to care for me!

[paramedicmike]

In Texas we have conditions that one would consider flying the patient if they are in that group. However, I have to agree with Dustdevil; there are other things to look at besides the MOI. I don't know what was going on, so I can't say if he should have flown them out or not. I also don't know how far the trauma center is or anything else.

What I do know is that Maryland sounds like some place I probably shouldn't have an accident in.

Aw...c'mon! It's not that bad, Nate! Same goes for MD as it does for TX. There are places where the closest trauma center is by air. There are places where it's just down the road. And just like everywhere else, there are medics who do well and understand what they're doing. And then there's everyone else.

-be safe.

[gdickens]

... those who are still making these decisions based upon such neanderthal criteria define the term "protocol monkey."

Maybe I need to apologize, because I apparently don't understand the term "protocol monkey" the same way you do. Where I come from, this is a derogatory term most often used by the "ParaGods" (NO, I am not calling you a ParaGod... I am just using local lingo to describe the context of my comprehension) toward those who are meticulous about their adherence to protocols and complete documentation of patient care. My best medics have always been the ones who fall somewhere between the ParaGods and the Protocol Monkeys because the former so often let their arrogance stand in the way when it comes to detail and following directives that they don't agree with, and the latter often can't get beyond algorithm medicine.

My point is simply that if the protocol said to fly them based on specific criteria, then they should be flown if they meet that criteria. If the criteria is out of date or wrong, it should be discussed with the Medical Director and updated when he/she has been educated about the appropriate standard of care. Due to my (different from your) definition of "Protocol Monkey", I took your post to mean that even if the protocol (was neanderthal and) said to fly them, that they shouldn't have been flown if the medic on scene didn't think they needed it.

This is why a year of English should be required for paramedic licensure.

LMAO!!! Two years of English didn't do me any more good than my Master's degree. Apparently, I'm still an idiot.

Read your protocols more carefully and you will find that you are not being told that you "must" fly everybody for whom you imagine an "MOI."

ROTFLMAO!!!! When did Dr. Murray forward you a copy of our protocols??? I guess that doesn't matter... when you get a chance, just forward me the protocol number, section and subsection that I need to review to educate myself. I'll be sure to brush up real fast.

Thanks!

GD

[Dustdevil]

Due to my (different from your) definition of "Protocol Monkey", I took your post to mean that even if the protocol (was neanderthal and) said to fly them, that they shouldn't have been flown if the medic on scene didn't think they needed it.

Ah... I apologise for the misunderstanding. I was going by the earlier post which said your protocols read to "consider" air evac for significant MOI, not to automatically fly everybody with significant MOI. If your protocols were misquoted, then I stand corrected. But if not, then yes... those who substitute the words "must fly" for what the protocols actually say are protocol monkeys. Those who use ambiguous protocols as an excuse to operate like a robot instead of actually evaluating their patient.

I certainly agree with you that the best medics I find are those who exist somewhere in the happy medium between protocol monkey and rogue. Like life itself, medicine is about balance.

[paramedicmike]

If anyone feels like going through them, here's the link to MD's statewide protocols:

http://miemss.umaryland.edu/protocol2005.pdf

The trauma decision tree can be found on page 138 (out of the entire document or page 128 out of the table of contents).

Hope this helps.

-be safe.