Guest guest Posted March 10, 2004 Report Share Posted March 10, 2004 I'M ALWAYS LOOKING TO EXPEND TO LIBARY.. --- Bledsoe wrote: > PHTLS 2/ed (1990) > Essentials of Emergency Care: A Refresher for the > Practicing EMT-B 1/ed > (Brady) > > Will send to first two emails (no repeats please) > > BEB > > > Bledsoe, DO, FACEP > > Midlothian, TX > > > > Ours is a useful trade, a worthy calling: with all > its lightness and > frivolity it has one serious purpose, one aim, one > specialty, and it is > constant to it--the deriding of shams, the exposure > of pretentious > falsities, the laughing of stupid superstitions out > of existence; and that > whoso is by instinct engaged in this sort of warfare > is the natural enemy of > royalties, nobilities, privileges and all kindred > swindles, and the natural > friend of human rights and human liberties. > > -Mark Twain > > > > Don't miss EMStock 2004! > > http://www.emstock.com <http://www.emstock.com/> > > > > > [Non-text portions of this message have been > removed] > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2004 Report Share Posted April 15, 2004 Why? What benefit would HEMS bestow? If you can load and go, which you should, you would be in the hospital before the helo arrived on scene in most cases. Exceptions: heavy freeway traffic and gridlock. Otherwise, I see no benefits whatsoever to helo transport and a number of downsides, not the least of which is the risk to 4 lives in a mode of transportation that is documented as the most dangerous form of air transportation in America. Further, why add a $5,000 bill to the patient when there is no benefit from choosing the helo and possibly a detriment? You can work the patient better in the ambulance than you can in the helo. I don't see your logic. Am I missing something? GG In a message dated 4/15/2004 1:53:19 PM Central Daylight Time, Etlaesium@... writes: > I am having trouble seeing that helicopters cause a negative impact to the > patient. Maybe the study doesn't take into account the severity of the > patients' conditions as much as they should?? I do think that some > providers within the 15 mi. radius might request the whirly-bird for the > " bad patient " . Any other thoughts here? > > > > Mike > > > > > > > > Abstracts > Comparison between helicopter-EMS and ground-EMS transport time and outcomes > for severely injured patients in areas within a 5- to 15-mile radius from a > trauma center > > > > Jack F. Basil [MEDLINE LOOKUP] > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search & db=PubMed & term=Bas > > & db=PubMed & term=Bas > ile+JF%20%5bAuthor%20Name%5d> > Barbara Sorondo [MEDLINE LOOKUP] > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search & db=PubMed & term=Sor > > & db=PubMed & term=Sor > ondo+B%20%5bAuthor%20Name%5d> > > > > > > > > > > Objective > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 & n > > & n > av=full#top> TOP > > Helicopter transport has always provided numerous advantages in long > distance trauma scene flights (TSFs), but the discussion over the > effectiveness of helicopter transport for short distance TSFs still remains. > The aim of this study is to analyze and compare transport times and patient > outcomes for those severely injured patients (ISS>15) transported by > helicopter (HEMS) and those transported by ambulance (GEMS) when the > incident was located within a 5- to 15-mile radius from a trauma center > (TC). > > > > Methods > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 & n > > & n > av=full#top> TOP > > This is a descriptive, cross-sectional, population-based study using CODES > records from January 1995 to December 2000. All patients with an ISS>15, > transported to a TC within the 5-15-mile radius were included in the > analysis. Data were divided into two groups: HEMS and GEMS transports, and > compared using average transport time, ISS, MAIS, mortality, and > complications. > > > > Results > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 & n > > & n > av=full#top> TOP > > A total of 29,074 transports were analyzed; 4,640 were severely injured > cases, and 69% of those were transported to TC. A total of 1,245 were EMS > transports within the 5-15-mile radius. Of those, 12.24% were HEMS compared > with 87.66% of GEMS. The mean time of HEMS was 5 minutes longer than the > mean of GEMS time (40.07 vs 35.04; p<0.005). When the on scene times were > compared between the two groups, there were no differences between scene > time spent by the HEMS versus the scene time spent by the GEMS. There were > higher in-hospital mortality rates, in-hospital mortality within 24 hours of > admission rates, and complications among patients transported by helicopters > than those transported by ambulance (p=0.001, 0.012, and 0.001, > respectively). > > > > Conclusions > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 & n > > & n > av=full#top> TOP > > The average time of HEMS, when within a 5-15-mile radius of the admitted > hospital, is longer than the average time of transport of patients by > ambulance. After controlling for severity, there were higher in-hospital > mortality rates, in-hospital mortality within 24 hours of admission rates, > and complications among patients transported by helicopters than those > transported by ambulance. > > > Publishing and Reprint Information > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 & n > > & n > av=full#top> TOP > > * Philadelphia College of Osteopathic Medicine USA > > > * 56 > > > * > Copyright C 2004 by Prehospital Emergency Care > > > * doi:10.1197/S1090-3127(03)00372-1 > > > > Bledsoe, DO, FACEP > > Midlothian, TX > > > > " Faith is believing what you know ain't so. " > > Mark Twain > > Following the Equator > > > > > Don't miss EMStock 2004!http://www.emstock.com <http://www.emstock.com/> > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2004 Report Share Posted April 15, 2004 Why? What benefit would HEMS bestow? If you can load and go, which you should, you would be in the hospital before the helo arrived on scene in most cases. Exceptions: heavy freeway traffic and gridlock. Otherwise, I see no benefits whatsoever to helo transport and a number of downsides, not the least of which is the risk to 4 lives in a mode of transportation that is documented as the most dangerous form of air transportation in America. Further, why add a $5,000 bill to the patient when there is no benefit from choosing the helo and possibly a detriment? You can work the patient better in the ambulance than you can in the helo. I don't see your logic. Am I missing something? GG In a message dated 4/15/2004 1:53:19 PM Central Daylight Time, Etlaesium@... writes: > I am having trouble seeing that helicopters cause a negative impact to the > patient. Maybe the study doesn't take into account the severity of the > patients' conditions as much as they should?? I do think that some > providers within the 15 mi. radius might request the whirly-bird for the > " bad patient " . Any other thoughts here? > > > > Mike > > > > > > > > Abstracts > Comparison between helicopter-EMS and ground-EMS transport time and outcomes > for severely injured patients in areas within a 5- to 15-mile radius from a > trauma center > > > > Jack F. Basil [MEDLINE LOOKUP] > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search & db=PubMed & term=Bas > > & db=PubMed & term=Bas > ile+JF%20%5bAuthor%20Name%5d> > Barbara Sorondo [MEDLINE LOOKUP] > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search & db=PubMed & term=Sor > > & db=PubMed & term=Sor > ondo+B%20%5bAuthor%20Name%5d> > > > > > > > > > > Objective > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 & n > > & n > av=full#top> TOP > > Helicopter transport has always provided numerous advantages in long > distance trauma scene flights (TSFs), but the discussion over the > effectiveness of helicopter transport for short distance TSFs still remains. > The aim of this study is to analyze and compare transport times and patient > outcomes for those severely injured patients (ISS>15) transported by > helicopter (HEMS) and those transported by ambulance (GEMS) when the > incident was located within a 5- to 15-mile radius from a trauma center > (TC). > > > > Methods > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 & n > > & n > av=full#top> TOP > > This is a descriptive, cross-sectional, population-based study using CODES > records from January 1995 to December 2000. All patients with an ISS>15, > transported to a TC within the 5-15-mile radius were included in the > analysis. Data were divided into two groups: HEMS and GEMS transports, and > compared using average transport time, ISS, MAIS, mortality, and > complications. > > > > Results > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 & n > > & n > av=full#top> TOP > > A total of 29,074 transports were analyzed; 4,640 were severely injured > cases, and 69% of those were transported to TC. A total of 1,245 were EMS > transports within the 5-15-mile radius. Of those, 12.24% were HEMS compared > with 87.66% of GEMS. The mean time of HEMS was 5 minutes longer than the > mean of GEMS time (40.07 vs 35.04; p<0.005). When the on scene times were > compared between the two groups, there were no differences between scene > time spent by the HEMS versus the scene time spent by the GEMS. There were > higher in-hospital mortality rates, in-hospital mortality within 24 hours of > admission rates, and complications among patients transported by helicopters > than those transported by ambulance (p=0.001, 0.012, and 0.001, > respectively). > > > > Conclusions > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 & n > > & n > av=full#top> TOP > > The average time of HEMS, when within a 5-15-mile radius of the admitted > hospital, is longer than the average time of transport of patients by > ambulance. After controlling for severity, there were higher in-hospital > mortality rates, in-hospital mortality within 24 hours of admission rates, > and complications among patients transported by helicopters than those > transported by ambulance. > > > Publishing and Reprint Information > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 & n > > & n > av=full#top> TOP > > * Philadelphia College of Osteopathic Medicine USA > > > * 56 > > > * > Copyright C 2004 by Prehospital Emergency Care > > > * doi:10.1197/S1090-3127(03)00372-1 > > > > Bledsoe, DO, FACEP > > Midlothian, TX > > > > " Faith is believing what you know ain't so. " > > Mark Twain > > Following the Equator > > > > > Don't miss EMStock 2004!http://www.emstock.com <http://www.emstock.com/> > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2004 Report Share Posted April 15, 2004 Why? What benefit would HEMS bestow? If you can load and go, which you should, you would be in the hospital before the helo arrived on scene in most cases. Exceptions: heavy freeway traffic and gridlock. Otherwise, I see no benefits whatsoever to helo transport and a number of downsides, not the least of which is the risk to 4 lives in a mode of transportation that is documented as the most dangerous form of air transportation in America. Further, why add a $5,000 bill to the patient when there is no benefit from choosing the helo and possibly a detriment? You can work the patient better in the ambulance than you can in the helo. I don't see your logic. Am I missing something? GG In a message dated 4/15/2004 1:53:19 PM Central Daylight Time, Etlaesium@... writes: > I am having trouble seeing that helicopters cause a negative impact to the > patient. Maybe the study doesn't take into account the severity of the > patients' conditions as much as they should?? I do think that some > providers within the 15 mi. radius might request the whirly-bird for the > " bad patient " . Any other thoughts here? > > > > Mike > > > > > > > > Abstracts > Comparison between helicopter-EMS and ground-EMS transport time and outcomes > for severely injured patients in areas within a 5- to 15-mile radius from a > trauma center > > > > Jack F. Basil [MEDLINE LOOKUP] > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search & db=PubMed & term=Bas > > & db=PubMed & term=Bas > ile+JF%20%5bAuthor%20Name%5d> > Barbara Sorondo [MEDLINE LOOKUP] > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search & db=PubMed & term=Sor > > & db=PubMed & term=Sor > ondo+B%20%5bAuthor%20Name%5d> > > > > > > > > > > Objective > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 & n > > & n > av=full#top> TOP > > Helicopter transport has always provided numerous advantages in long > distance trauma scene flights (TSFs), but the discussion over the > effectiveness of helicopter transport for short distance TSFs still remains. > The aim of this study is to analyze and compare transport times and patient > outcomes for those severely injured patients (ISS>15) transported by > helicopter (HEMS) and those transported by ambulance (GEMS) when the > incident was located within a 5- to 15-mile radius from a trauma center > (TC). > > > > Methods > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 & n > > & n > av=full#top> TOP > > This is a descriptive, cross-sectional, population-based study using CODES > records from January 1995 to December 2000. All patients with an ISS>15, > transported to a TC within the 5-15-mile radius were included in the > analysis. Data were divided into two groups: HEMS and GEMS transports, and > compared using average transport time, ISS, MAIS, mortality, and > complications. > > > > Results > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 & n > > & n > av=full#top> TOP > > A total of 29,074 transports were analyzed; 4,640 were severely injured > cases, and 69% of those were transported to TC. A total of 1,245 were EMS > transports within the 5-15-mile radius. Of those, 12.24% were HEMS compared > with 87.66% of GEMS. The mean time of HEMS was 5 minutes longer than the > mean of GEMS time (40.07 vs 35.04; p<0.005). When the on scene times were > compared between the two groups, there were no differences between scene > time spent by the HEMS versus the scene time spent by the GEMS. There were > higher in-hospital mortality rates, in-hospital mortality within 24 hours of > admission rates, and complications among patients transported by helicopters > than those transported by ambulance (p=0.001, 0.012, and 0.001, > respectively). > > > > Conclusions > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 & n > > & n > av=full#top> TOP > > The average time of HEMS, when within a 5-15-mile radius of the admitted > hospital, is longer than the average time of transport of patients by > ambulance. After controlling for severity, there were higher in-hospital > mortality rates, in-hospital mortality within 24 hours of admission rates, > and complications among patients transported by helicopters than those > transported by ambulance. > > > Publishing and Reprint Information > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 & n > > & n > av=full#top> TOP > > * Philadelphia College of Osteopathic Medicine USA > > > * 56 > > > * > Copyright C 2004 by Prehospital Emergency Care > > > * doi:10.1197/S1090-3127(03)00372-1 > > > > Bledsoe, DO, FACEP > > Midlothian, TX > > > > " Faith is believing what you know ain't so. " > > Mark Twain > > Following the Equator > > > > > Don't miss EMStock 2004!http://www.emstock.com <http://www.emstock.com/> > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2004 Report Share Posted April 15, 2004 I am having trouble seeing that helicopters cause a negative impact to the patient. Maybe the study doesn't take into account the severity of the patients' conditions as much as they should?? I do think that some providers within the 15 mi. radius might request the whirly-bird for the " bad patient " . Any other thoughts here? Mike Abstracts Comparison between helicopter-EMS and ground-EMS transport time and outcomes for severely injured patients in areas within a 5- to 15-mile radius from a trauma center Jack F. Basile [MEDLINE LOOKUP] <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search & db=PubMed & term=Bas > & db=PubMed & term=Bas ile+JF%20%5bAuthor%20Name%5d> Barbara Sorondo [MEDLINE LOOKUP] <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search & db=PubMed & term=Sor > & db=PubMed & term=Sor ondo+B%20%5bAuthor%20Name%5d> Objective <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 & n > & n av=full#top> TOP Helicopter transport has always provided numerous advantages in long distance trauma scene flights (TSFs), but the discussion over the effectiveness of helicopter transport for short distance TSFs still remains. The aim of this study is to analyze and compare transport times and patient outcomes for those severely injured patients (ISS>15) transported by helicopter (HEMS) and those transported by ambulance (GEMS) when the incident was located within a 5- to 15-mile radius from a trauma center (TC). Methods <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 & n > & n av=full#top> TOP This is a descriptive, cross-sectional, population-based study using CODES records from January 1995 to December 2000. All patients with an ISS>15, transported to a TC within the 5-15-mile radius were included in the analysis. Data were divided into two groups: HEMS and GEMS transports, and compared using average transport time, ISS, MAIS, mortality, and complications. Results <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 & n > & n av=full#top> TOP A total of 29,074 transports were analyzed; 4,640 were severely injured cases, and 69% of those were transported to TC. A total of 1,245 were EMS transports within the 5-15-mile radius. Of those, 12.24% were HEMS compared with 87.66% of GEMS. The mean time of HEMS was 5 minutes longer than the mean of GEMS time (40.07 vs 35.04; p<0.005). When the on scene times were compared between the two groups, there were no differences between scene time spent by the HEMS versus the scene time spent by the GEMS. There were higher in-hospital mortality rates, in-hospital mortality within 24 hours of admission rates, and complications among patients transported by helicopters than those transported by ambulance (p=0.001, 0.012, and 0.001, respectively). Conclusions <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 & n > & n av=full#top> TOP The average time of HEMS, when within a 5-15-mile radius of the admitted hospital, is longer than the average time of transport of patients by ambulance. After controlling for severity, there were higher in-hospital mortality rates, in-hospital mortality within 24 hours of admission rates, and complications among patients transported by helicopters than those transported by ambulance. Publishing and Reprint Information <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 <http://www2.peconline.org/scripts/om.dll/serve?article=as1090312703003721 & n > & n av=full#top> TOP * Philadelphia College of Osteopathic Medicine USA * 56 * Copyright C 2004 by Prehospital Emergency Care * doi:10.1197/S1090-3127(03)00372-1 Bledsoe, DO, FACEP Midlothian, TX " Faith is believing what you know ain't so. " Mark Twain Following the Equator Don't miss EMStock 2004!http://www.emstock.com <http://www.emstock.com/> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2004 Report Share Posted April 15, 2004 Mike: You are missing a great deal. Several points: 1. Over 60-70% of patients transported by helicopter from a trauma scene have minor injuries based on the ISS, RTS, TS or TRISS. 2. Speed makes a difference in very few trauma patients perhaps less than 1-2%(primarily people who are hypotensive when EMS arrives). Of this 1-2%, 1/3 will die (and this number has remained constant since the Crimean War), 1/3 will have hypotension from another cause (pneumo, gastric insufflation, toxic state), and the final 1/3 will benefit from rapid transport (less than 1% of all trauma patients). 3. The trauma paradigm is changing especially in kids. We rarely operate on trauma in kids anymore. We monitor them with U/S and CT and they for the most part do OK. 4. Some degree of post-traumatic hypotension is protective. 5. What can a helicopter offer that Austin/ County EMS cannot? Bledsoe, DO, FACEP Midlothian, TX " Faith is believing what you know ain't so. " Mark Twain Following the Equator Don't miss EMStock 2004!http://www.emstock.com > > > > Abstracts > Comparison between helicopter-EMS and ground-EMS transport time and > outcomes for severely injured patients in areas within a 5- to 15-mile > radius from a trauma center > > > > Jack F. Basil [MEDLINE LOOKUP] > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search & db=PubMed & te > rm=Bas > > & db=PubMed & term=Bas > ile+JF%20%5bAuthor%20Name%5d> > Barbara Sorondo [MEDLINE LOOKUP] > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search & db=PubMed & te > rm=Sor > > & db=PubMed & term=Sor > ondo+B%20%5bAuthor%20Name%5d> > > > > > > > > > > Objective > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > Helicopter transport has always provided numerous advantages in long > distance trauma scene flights (TSFs), but the discussion over the > effectiveness of helicopter transport for short distance TSFs still remains. > The aim of this study is to analyze and compare transport times and > patient outcomes for those severely injured patients (ISS>15) > transported by helicopter (HEMS) and those transported by ambulance > (GEMS) when the incident was located within a 5- to 15-mile radius > from a trauma center (TC). > > > > Methods > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > This is a descriptive, cross-sectional, population-based study using > CODES records from January 1995 to December 2000. All patients with an > ISS>15, transported to a TC within the 5-15-mile radius were included > in the analysis. Data were divided into two groups: HEMS and GEMS > transports, and compared using average transport time, ISS, MAIS, > mortality, and complications. > > > > Results > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > A total of 29,074 transports were analyzed; 4,640 were severely > injured cases, and 69% of those were transported to TC. A total of > 1,245 were EMS transports within the 5-15-mile radius. Of those, > 12.24% were HEMS compared with 87.66% of GEMS. The mean time of HEMS > was 5 minutes longer than the mean of GEMS time (40.07 vs 35.04; > p<0.005). When the on scene times were compared between the two > groups, there were no differences between scene time spent by the HEMS > versus the scene time spent by the GEMS. There were higher in-hospital > mortality rates, in-hospital mortality within 24 hours of admission > rates, and complications among patients transported by helicopters > than those transported by ambulance (p=0.001, 0.012, and 0.001, respectively). > > > > Conclusions > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > The average time of HEMS, when within a 5-15-mile radius of the > admitted hospital, is longer than the average time of transport of > patients by ambulance. After controlling for severity, there were > higher in-hospital mortality rates, in-hospital mortality within 24 > hours of admission rates, and complications among patients transported > by helicopters than those transported by ambulance. > > > Publishing and Reprint Information > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > * Philadelphia College of Osteopathic Medicine USA > > > * 56 > > > * > Copyright C 2004 by Prehospital Emergency Care > > > * doi:10.1197/S1090-3127(03)00372-1 > > > > Bledsoe, DO, FACEP > > Midlothian, TX > > > > " Faith is believing what you know ain't so. " > > Mark Twain > > Following the Equator > > > > > Don't miss EMStock 2004!http://www.emstock.com > <http://www.emstock.com/> > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2004 Report Share Posted April 15, 2004 Mike: You are missing a great deal. Several points: 1. Over 60-70% of patients transported by helicopter from a trauma scene have minor injuries based on the ISS, RTS, TS or TRISS. 2. Speed makes a difference in very few trauma patients perhaps less than 1-2%(primarily people who are hypotensive when EMS arrives). Of this 1-2%, 1/3 will die (and this number has remained constant since the Crimean War), 1/3 will have hypotension from another cause (pneumo, gastric insufflation, toxic state), and the final 1/3 will benefit from rapid transport (less than 1% of all trauma patients). 3. The trauma paradigm is changing especially in kids. We rarely operate on trauma in kids anymore. We monitor them with U/S and CT and they for the most part do OK. 4. Some degree of post-traumatic hypotension is protective. 5. What can a helicopter offer that Austin/ County EMS cannot? Bledsoe, DO, FACEP Midlothian, TX " Faith is believing what you know ain't so. " Mark Twain Following the Equator Don't miss EMStock 2004!http://www.emstock.com > > > > Abstracts > Comparison between helicopter-EMS and ground-EMS transport time and > outcomes for severely injured patients in areas within a 5- to 15-mile > radius from a trauma center > > > > Jack F. Basil [MEDLINE LOOKUP] > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search & db=PubMed & te > rm=Bas > > & db=PubMed & term=Bas > ile+JF%20%5bAuthor%20Name%5d> > Barbara Sorondo [MEDLINE LOOKUP] > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search & db=PubMed & te > rm=Sor > > & db=PubMed & term=Sor > ondo+B%20%5bAuthor%20Name%5d> > > > > > > > > > > Objective > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > Helicopter transport has always provided numerous advantages in long > distance trauma scene flights (TSFs), but the discussion over the > effectiveness of helicopter transport for short distance TSFs still remains. > The aim of this study is to analyze and compare transport times and > patient outcomes for those severely injured patients (ISS>15) > transported by helicopter (HEMS) and those transported by ambulance > (GEMS) when the incident was located within a 5- to 15-mile radius > from a trauma center (TC). > > > > Methods > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > This is a descriptive, cross-sectional, population-based study using > CODES records from January 1995 to December 2000. All patients with an > ISS>15, transported to a TC within the 5-15-mile radius were included > in the analysis. Data were divided into two groups: HEMS and GEMS > transports, and compared using average transport time, ISS, MAIS, > mortality, and complications. > > > > Results > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > A total of 29,074 transports were analyzed; 4,640 were severely > injured cases, and 69% of those were transported to TC. A total of > 1,245 were EMS transports within the 5-15-mile radius. Of those, > 12.24% were HEMS compared with 87.66% of GEMS. The mean time of HEMS > was 5 minutes longer than the mean of GEMS time (40.07 vs 35.04; > p<0.005). When the on scene times were compared between the two > groups, there were no differences between scene time spent by the HEMS > versus the scene time spent by the GEMS. There were higher in-hospital > mortality rates, in-hospital mortality within 24 hours of admission > rates, and complications among patients transported by helicopters > than those transported by ambulance (p=0.001, 0.012, and 0.001, respectively). > > > > Conclusions > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > The average time of HEMS, when within a 5-15-mile radius of the > admitted hospital, is longer than the average time of transport of > patients by ambulance. After controlling for severity, there were > higher in-hospital mortality rates, in-hospital mortality within 24 > hours of admission rates, and complications among patients transported > by helicopters than those transported by ambulance. > > > Publishing and Reprint Information > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > * Philadelphia College of Osteopathic Medicine USA > > > * 56 > > > * > Copyright C 2004 by Prehospital Emergency Care > > > * doi:10.1197/S1090-3127(03)00372-1 > > > > Bledsoe, DO, FACEP > > Midlothian, TX > > > > " Faith is believing what you know ain't so. " > > Mark Twain > > Following the Equator > > > > > Don't miss EMStock 2004!http://www.emstock.com > <http://www.emstock.com/> > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2004 Report Share Posted April 15, 2004 Mike: You are missing a great deal. Several points: 1. Over 60-70% of patients transported by helicopter from a trauma scene have minor injuries based on the ISS, RTS, TS or TRISS. 2. Speed makes a difference in very few trauma patients perhaps less than 1-2%(primarily people who are hypotensive when EMS arrives). Of this 1-2%, 1/3 will die (and this number has remained constant since the Crimean War), 1/3 will have hypotension from another cause (pneumo, gastric insufflation, toxic state), and the final 1/3 will benefit from rapid transport (less than 1% of all trauma patients). 3. The trauma paradigm is changing especially in kids. We rarely operate on trauma in kids anymore. We monitor them with U/S and CT and they for the most part do OK. 4. Some degree of post-traumatic hypotension is protective. 5. What can a helicopter offer that Austin/ County EMS cannot? Bledsoe, DO, FACEP Midlothian, TX " Faith is believing what you know ain't so. " Mark Twain Following the Equator Don't miss EMStock 2004!http://www.emstock.com > > > > Abstracts > Comparison between helicopter-EMS and ground-EMS transport time and > outcomes for severely injured patients in areas within a 5- to 15-mile > radius from a trauma center > > > > Jack F. Basil [MEDLINE LOOKUP] > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search & db=PubMed & te > rm=Bas > > & db=PubMed & term=Bas > ile+JF%20%5bAuthor%20Name%5d> > Barbara Sorondo [MEDLINE LOOKUP] > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search & db=PubMed & te > rm=Sor > > & db=PubMed & term=Sor > ondo+B%20%5bAuthor%20Name%5d> > > > > > > > > > > Objective > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > Helicopter transport has always provided numerous advantages in long > distance trauma scene flights (TSFs), but the discussion over the > effectiveness of helicopter transport for short distance TSFs still remains. > The aim of this study is to analyze and compare transport times and > patient outcomes for those severely injured patients (ISS>15) > transported by helicopter (HEMS) and those transported by ambulance > (GEMS) when the incident was located within a 5- to 15-mile radius > from a trauma center (TC). > > > > Methods > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > This is a descriptive, cross-sectional, population-based study using > CODES records from January 1995 to December 2000. All patients with an > ISS>15, transported to a TC within the 5-15-mile radius were included > in the analysis. Data were divided into two groups: HEMS and GEMS > transports, and compared using average transport time, ISS, MAIS, > mortality, and complications. > > > > Results > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > A total of 29,074 transports were analyzed; 4,640 were severely > injured cases, and 69% of those were transported to TC. A total of > 1,245 were EMS transports within the 5-15-mile radius. Of those, > 12.24% were HEMS compared with 87.66% of GEMS. The mean time of HEMS > was 5 minutes longer than the mean of GEMS time (40.07 vs 35.04; > p<0.005). When the on scene times were compared between the two > groups, there were no differences between scene time spent by the HEMS > versus the scene time spent by the GEMS. There were higher in-hospital > mortality rates, in-hospital mortality within 24 hours of admission > rates, and complications among patients transported by helicopters > than those transported by ambulance (p=0.001, 0.012, and 0.001, respectively). > > > > Conclusions > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > The average time of HEMS, when within a 5-15-mile radius of the > admitted hospital, is longer than the average time of transport of > patients by ambulance. After controlling for severity, there were > higher in-hospital mortality rates, in-hospital mortality within 24 > hours of admission rates, and complications among patients transported > by helicopters than those transported by ambulance. > > > Publishing and Reprint Information > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > * Philadelphia College of Osteopathic Medicine USA > > > * 56 > > > * > Copyright C 2004 by Prehospital Emergency Care > > > * doi:10.1197/S1090-3127(03)00372-1 > > > > Bledsoe, DO, FACEP > > Midlothian, TX > > > > " Faith is believing what you know ain't so. " > > Mark Twain > > Following the Equator > > > > > Don't miss EMStock 2004!http://www.emstock.com > <http://www.emstock.com/> > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2004 Report Share Posted April 15, 2004 But can you not see the difference in the situation you describe and the one where the patient is 15 minutes by ground to the trauma center? BTW, why would the guy with facial fx have died? Unable to control his airway? If you were able to control it for during the flight, why wouldn't you have been able to for a boat ride? Just playing devil's advocate. Of course I would have flown him too, but let's think critically about what we do. Would he really have died? If so, from what condition that helo txp prevented? GG In a message dated 4/15/2004 9:02:58 PM Central Daylight Time, lverrett@... writes: I will gladly post a reply on the positive use of helo's in EMS. Not to long back while working a shift in Galveston the crew I was on was called to fly out to a rig and transport two patients. We flew via PHI out to a rig in Galveston Bay. On had a critical facial fracture with a very compromised airway. The second sever head lacerations. By small boat the two injured would have taken 45 mins or more to get help. By helo. less than 20. The guy with the facial fractures would have died. Helo's do save lives. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2004 Report Share Posted April 15, 2004 But can you not see the difference in the situation you describe and the one where the patient is 15 minutes by ground to the trauma center? BTW, why would the guy with facial fx have died? Unable to control his airway? If you were able to control it for during the flight, why wouldn't you have been able to for a boat ride? Just playing devil's advocate. Of course I would have flown him too, but let's think critically about what we do. Would he really have died? If so, from what condition that helo txp prevented? GG In a message dated 4/15/2004 9:02:58 PM Central Daylight Time, lverrett@... writes: I will gladly post a reply on the positive use of helo's in EMS. Not to long back while working a shift in Galveston the crew I was on was called to fly out to a rig and transport two patients. We flew via PHI out to a rig in Galveston Bay. On had a critical facial fracture with a very compromised airway. The second sever head lacerations. By small boat the two injured would have taken 45 mins or more to get help. By helo. less than 20. The guy with the facial fractures would have died. Helo's do save lives. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2004 Report Share Posted April 15, 2004 I will gladly post a reply on the positive use of helo's in EMS. Not to long back while working a shift in Galveston the crew I was on was called to fly out to a rig and transport two patients. We flew via PHI out to a rig in Galveston Bay. On had a critical facial fracture with a very compromised airway. The second sever head lacerations. By small boat the two injured would have taken 45 mins or more to get help. By helo. less than 20. The guy with the facial fractures would have died. Helo's do save lives. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2004 Report Share Posted April 15, 2004 I will gladly post a reply on the positive use of helo's in EMS. Not to long back while working a shift in Galveston the crew I was on was called to fly out to a rig and transport two patients. We flew via PHI out to a rig in Galveston Bay. On had a critical facial fracture with a very compromised airway. The second sever head lacerations. By small boat the two injured would have taken 45 mins or more to get help. By helo. less than 20. The guy with the facial fractures would have died. Helo's do save lives. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2004 Report Share Posted April 15, 2004 I will gladly post a reply on the positive use of helo's in EMS. Not to long back while working a shift in Galveston the crew I was on was called to fly out to a rig and transport two patients. We flew via PHI out to a rig in Galveston Bay. On had a critical facial fracture with a very compromised airway. The second sever head lacerations. By small boat the two injured would have taken 45 mins or more to get help. By helo. less than 20. The guy with the facial fractures would have died. Helo's do save lives. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2004 Report Share Posted April 15, 2004 Nobody will argue with that. There is a role for helicopters (rescue, off-shore, limited access) in EMS. But, I'll bet you could get rid of 90% of the medical helicopters in Texas without any compromise in patient care or outcomes. That is a lot of money that could be re-directed to improving ground EMS care--especially rural EMS. What we need are a fleet of fixed-wing aircraft (King Airs, turboprops) that are faster, cheaper and can cover much greater distances than helicopters for a fraction of the cost. Helicopters (execpt the tilt rotors) will functionally never exceed 150 knots air speed. The only way for them to make a difference is for all to be placed in rural areas where they are closer to the people most like to benefit from them. They also need to be operated as a part of the EMS system (like Star Flight) instead of by hospitals and private companies. Using a helicopter in a suburban area is foolishness unless there is a SIGNIFICANT delay in traffic or a disaster. For example, in Houston, they compared 122 consecutive victims of non-cranial penetrating trauma transported by air and compared them to a cohort transported ny ground. NOT A SINGLE PATIENT ARRIVED FASTER BY HELICOPTER THAN BY GROUND and Houston is among the largest cities in the nation in terms of urban sprawl. Don't believe me? Read for yourself: J Trauma. 1997 Jul;43(1):83-6; discussion 86-8. Related Articles, Links Are scene flights for penetrating trauma justified? Cocanour CS, Fischer RP, Ursic CM. University of Texas Health Science Center at Houston, 77030, USA. OBJECTIVE: To evaluate the medical efficacy of helicopter scene flights for patients with noncranial penetrating injuries. DESIGN: A retrospective review of 122 consecutive victims of noncranial penetrating injuries evacuated by helicopter from the scene of injury to a level I trauma center. There were no medical criteria for accepting or rejecting a request for a scene flight by any public safety agency or emergency medical service (EMS). Flights were dispatched if the weather permitted and if a helicopter was available. RESULTS: The majority of patients were critically wounded. Their average Revised Trauma Score was 10.6, and 15.6% of the patients died (19 of 122), including all 11 patients who required prehospital cardiopulmonary resuscitation. Helicopter transport from the scene did not hasten trauma center arrival for any of the 122 patients. Ninety-two of the first-responder EMS units (75.4%) were advanced life support units (ALS) with crews of paramedics. The remaining 30 (24.6%) first-responder EMS units were basic life support units (BLS) with crews of emergency medical technicians (EMTs). Six of 122 patients (4.9%) required medical interventions by the medical flight crews beyond the capabilities of the ground EMS personnel. Only 3 of the 92 patients (3.3%) treated by first-responding paramedics received medical interventions by the medical flight crews beyond those authorized for paramedics (one cricothyroidotomy and two needle thoracenteses). Two of the 30 patients (6.7%) treated by first-responding EMTs received medical interventions by the medical flight crews not authorized for the EMTs. The on-scene paramedics performed endotracheal intubation on 10 patients. However, because of subsequent clinical deterioration, the medical flight crews performed endotracheal intubations on nine additional patients. In addition, two patients intubated by the first-responding paramedics required reintubation by the medical flight crews. CONCLUSIONS: Scene flights in this metropolitan area for patients who suffered noncranial penetrating injuries demonstrated that these flights were not medically efficacious. This conclusion rests on the findings that arrival at a trauma center was not hastened by scene flights and that only 4.9% of patients required prehospital care by the medical flight crew beyond the capabilities of the first-responding EMS personnel (2.5 and 6.7% for ALS and BLS responders, respectively). Based on this experience, we believe that in metropolitan areas, scene flights for victims of noncranial penetrating injuries should be restricted to critically injured patients likely to require prehospital care by the medical flight crew that is beyond the capabilities of the first responders or when the scene flight is likely to significantly hasten the arrival of the injured patient to an appropriate trauma center Bledsoe, DO, FACEP Midlothian, TX " Faith is believing what you know ain't so. " Mark Twain Following the Equator Don't miss EMStock 2004!http://www.emstock.com Re: I will gladly post a reply on the positive use of helo's in EMS. Not to long back while working a shift in Galveston the crew I was on was called to fly out to a rig and transport two patients. We flew via PHI out to a rig in Galveston Bay. On had a critical facial fracture with a very compromised airway. The second sever head lacerations. By small boat the two injured would have taken 45 mins or more to get help. By helo. less than 20. The guy with the facial fractures would have died. Helo's do save lives. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2004 Report Share Posted April 15, 2004 Nobody will argue with that. There is a role for helicopters (rescue, off-shore, limited access) in EMS. But, I'll bet you could get rid of 90% of the medical helicopters in Texas without any compromise in patient care or outcomes. That is a lot of money that could be re-directed to improving ground EMS care--especially rural EMS. What we need are a fleet of fixed-wing aircraft (King Airs, turboprops) that are faster, cheaper and can cover much greater distances than helicopters for a fraction of the cost. Helicopters (execpt the tilt rotors) will functionally never exceed 150 knots air speed. The only way for them to make a difference is for all to be placed in rural areas where they are closer to the people most like to benefit from them. They also need to be operated as a part of the EMS system (like Star Flight) instead of by hospitals and private companies. Using a helicopter in a suburban area is foolishness unless there is a SIGNIFICANT delay in traffic or a disaster. For example, in Houston, they compared 122 consecutive victims of non-cranial penetrating trauma transported by air and compared them to a cohort transported ny ground. NOT A SINGLE PATIENT ARRIVED FASTER BY HELICOPTER THAN BY GROUND and Houston is among the largest cities in the nation in terms of urban sprawl. Don't believe me? Read for yourself: J Trauma. 1997 Jul;43(1):83-6; discussion 86-8. Related Articles, Links Are scene flights for penetrating trauma justified? Cocanour CS, Fischer RP, Ursic CM. University of Texas Health Science Center at Houston, 77030, USA. OBJECTIVE: To evaluate the medical efficacy of helicopter scene flights for patients with noncranial penetrating injuries. DESIGN: A retrospective review of 122 consecutive victims of noncranial penetrating injuries evacuated by helicopter from the scene of injury to a level I trauma center. There were no medical criteria for accepting or rejecting a request for a scene flight by any public safety agency or emergency medical service (EMS). Flights were dispatched if the weather permitted and if a helicopter was available. RESULTS: The majority of patients were critically wounded. Their average Revised Trauma Score was 10.6, and 15.6% of the patients died (19 of 122), including all 11 patients who required prehospital cardiopulmonary resuscitation. Helicopter transport from the scene did not hasten trauma center arrival for any of the 122 patients. Ninety-two of the first-responder EMS units (75.4%) were advanced life support units (ALS) with crews of paramedics. The remaining 30 (24.6%) first-responder EMS units were basic life support units (BLS) with crews of emergency medical technicians (EMTs). Six of 122 patients (4.9%) required medical interventions by the medical flight crews beyond the capabilities of the ground EMS personnel. Only 3 of the 92 patients (3.3%) treated by first-responding paramedics received medical interventions by the medical flight crews beyond those authorized for paramedics (one cricothyroidotomy and two needle thoracenteses). Two of the 30 patients (6.7%) treated by first-responding EMTs received medical interventions by the medical flight crews not authorized for the EMTs. The on-scene paramedics performed endotracheal intubation on 10 patients. However, because of subsequent clinical deterioration, the medical flight crews performed endotracheal intubations on nine additional patients. In addition, two patients intubated by the first-responding paramedics required reintubation by the medical flight crews. CONCLUSIONS: Scene flights in this metropolitan area for patients who suffered noncranial penetrating injuries demonstrated that these flights were not medically efficacious. This conclusion rests on the findings that arrival at a trauma center was not hastened by scene flights and that only 4.9% of patients required prehospital care by the medical flight crew beyond the capabilities of the first-responding EMS personnel (2.5 and 6.7% for ALS and BLS responders, respectively). Based on this experience, we believe that in metropolitan areas, scene flights for victims of noncranial penetrating injuries should be restricted to critically injured patients likely to require prehospital care by the medical flight crew that is beyond the capabilities of the first responders or when the scene flight is likely to significantly hasten the arrival of the injured patient to an appropriate trauma center Bledsoe, DO, FACEP Midlothian, TX " Faith is believing what you know ain't so. " Mark Twain Following the Equator Don't miss EMStock 2004!http://www.emstock.com Re: I will gladly post a reply on the positive use of helo's in EMS. Not to long back while working a shift in Galveston the crew I was on was called to fly out to a rig and transport two patients. We flew via PHI out to a rig in Galveston Bay. On had a critical facial fracture with a very compromised airway. The second sever head lacerations. By small boat the two injured would have taken 45 mins or more to get help. By helo. less than 20. The guy with the facial fractures would have died. Helo's do save lives. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2004 Report Share Posted April 15, 2004 Nobody will argue with that. There is a role for helicopters (rescue, off-shore, limited access) in EMS. But, I'll bet you could get rid of 90% of the medical helicopters in Texas without any compromise in patient care or outcomes. That is a lot of money that could be re-directed to improving ground EMS care--especially rural EMS. What we need are a fleet of fixed-wing aircraft (King Airs, turboprops) that are faster, cheaper and can cover much greater distances than helicopters for a fraction of the cost. Helicopters (execpt the tilt rotors) will functionally never exceed 150 knots air speed. The only way for them to make a difference is for all to be placed in rural areas where they are closer to the people most like to benefit from them. They also need to be operated as a part of the EMS system (like Star Flight) instead of by hospitals and private companies. Using a helicopter in a suburban area is foolishness unless there is a SIGNIFICANT delay in traffic or a disaster. For example, in Houston, they compared 122 consecutive victims of non-cranial penetrating trauma transported by air and compared them to a cohort transported ny ground. NOT A SINGLE PATIENT ARRIVED FASTER BY HELICOPTER THAN BY GROUND and Houston is among the largest cities in the nation in terms of urban sprawl. Don't believe me? Read for yourself: J Trauma. 1997 Jul;43(1):83-6; discussion 86-8. Related Articles, Links Are scene flights for penetrating trauma justified? Cocanour CS, Fischer RP, Ursic CM. University of Texas Health Science Center at Houston, 77030, USA. OBJECTIVE: To evaluate the medical efficacy of helicopter scene flights for patients with noncranial penetrating injuries. DESIGN: A retrospective review of 122 consecutive victims of noncranial penetrating injuries evacuated by helicopter from the scene of injury to a level I trauma center. There were no medical criteria for accepting or rejecting a request for a scene flight by any public safety agency or emergency medical service (EMS). Flights were dispatched if the weather permitted and if a helicopter was available. RESULTS: The majority of patients were critically wounded. Their average Revised Trauma Score was 10.6, and 15.6% of the patients died (19 of 122), including all 11 patients who required prehospital cardiopulmonary resuscitation. Helicopter transport from the scene did not hasten trauma center arrival for any of the 122 patients. Ninety-two of the first-responder EMS units (75.4%) were advanced life support units (ALS) with crews of paramedics. The remaining 30 (24.6%) first-responder EMS units were basic life support units (BLS) with crews of emergency medical technicians (EMTs). Six of 122 patients (4.9%) required medical interventions by the medical flight crews beyond the capabilities of the ground EMS personnel. Only 3 of the 92 patients (3.3%) treated by first-responding paramedics received medical interventions by the medical flight crews beyond those authorized for paramedics (one cricothyroidotomy and two needle thoracenteses). Two of the 30 patients (6.7%) treated by first-responding EMTs received medical interventions by the medical flight crews not authorized for the EMTs. The on-scene paramedics performed endotracheal intubation on 10 patients. However, because of subsequent clinical deterioration, the medical flight crews performed endotracheal intubations on nine additional patients. In addition, two patients intubated by the first-responding paramedics required reintubation by the medical flight crews. CONCLUSIONS: Scene flights in this metropolitan area for patients who suffered noncranial penetrating injuries demonstrated that these flights were not medically efficacious. This conclusion rests on the findings that arrival at a trauma center was not hastened by scene flights and that only 4.9% of patients required prehospital care by the medical flight crew beyond the capabilities of the first-responding EMS personnel (2.5 and 6.7% for ALS and BLS responders, respectively). Based on this experience, we believe that in metropolitan areas, scene flights for victims of noncranial penetrating injuries should be restricted to critically injured patients likely to require prehospital care by the medical flight crew that is beyond the capabilities of the first responders or when the scene flight is likely to significantly hasten the arrival of the injured patient to an appropriate trauma center Bledsoe, DO, FACEP Midlothian, TX " Faith is believing what you know ain't so. " Mark Twain Following the Equator Don't miss EMStock 2004!http://www.emstock.com Re: I will gladly post a reply on the positive use of helo's in EMS. Not to long back while working a shift in Galveston the crew I was on was called to fly out to a rig and transport two patients. We flew via PHI out to a rig in Galveston Bay. On had a critical facial fracture with a very compromised airway. The second sever head lacerations. By small boat the two injured would have taken 45 mins or more to get help. By helo. less than 20. The guy with the facial fractures would have died. Helo's do save lives. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2004 Report Share Posted April 15, 2004 Actually, I have to apologize here. I did not take into account the 5-15 mile radius. If that is the case, then for the most part, the patient should be driven. It would be more expedient to do so. The only exception to that would be if the onscene crew is not able to transport (i.e. at about the 15 mi. mark and covered in mud trying to locate various equipment that sunk in said mud. been there). Beyond those extreme circumstances (and, I would have given this patient to a ground unit before STARFlight had one been there or available), I cannot see what benefit the flight would make. Also, I do not see the detriment aside from the OTHER factor (safety of flight, cost, awaiting arrival time onscene, etc.). Though I can think of a limited few anecdotal instances where a helo served my purposes, for the most part, they are not needed pre-hospitally, but I am certainly glad they are there sometimes. In our case (A/TCEMS), we utilize STARFlight as a first response vehicle for scenes that are a certain distance to the responding ambulance. In these cases, it is more prevalent for STARFlight to hand off the patient to us. This makes sense to me. So, I agree that they are overused, but for the most part, I do not see how a more rapid form of transport can be detrimental to the patient's presenting condition. I also agree that it might not be beneficial. I hope that clarifies my position. Mike > > > > Abstracts > Comparison between helicopter-EMS and ground-EMS transport time and > outcomes for severely injured patients in areas within a 5- to 15-mile > radius from a trauma center > > > > Jack F. Basil [MEDLINE LOOKUP] > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search & db=PubMed & te> & db=PubMed & te > rm=Bas > > & db=PubMed & term=Bas > ile+JF%20%5bAuthor%20Name%5d> > Barbara Sorondo [MEDLINE LOOKUP] > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search & db=PubMed & te> & db=PubMed & te > rm=Sor > > & db=PubMed & term=Sor > ondo+B%20%5bAuthor%20Name%5d> > > > > > > > > > > Objective > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > Helicopter transport has always provided numerous advantages in long > distance trauma scene flights (TSFs), but the discussion over the > effectiveness of helicopter transport for short distance TSFs still remains. > The aim of this study is to analyze and compare transport times and > patient outcomes for those severely injured patients (ISS>15) > transported by helicopter (HEMS) and those transported by ambulance > (GEMS) when the incident was located within a 5- to 15-mile radius > from a trauma center (TC). > > > > Methods > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > This is a descriptive, cross-sectional, population-based study using > CODES records from January 1995 to December 2000. All patients with an > ISS>15, transported to a TC within the 5-15-mile radius were included > in the analysis. Data were divided into two groups: HEMS and GEMS > transports, and compared using average transport time, ISS, MAIS, > mortality, and complications. > > > > Results > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > A total of 29,074 transports were analyzed; 4,640 were severely > injured cases, and 69% of those were transported to TC. A total of > 1,245 were EMS transports within the 5-15-mile radius. Of those, > 12.24% were HEMS compared with 87.66% of GEMS. The mean time of HEMS > was 5 minutes longer than the mean of GEMS time (40.07 vs 35.04; > p<0.005). When the on scene times were compared between the two > groups, there were no differences between scene time spent by the HEMS > versus the scene time spent by the GEMS. There were higher in-hospital > mortality rates, in-hospital mortality within 24 hours of admission > rates, and complications among patients transported by helicopters > than those transported by ambulance (p=0.001, 0.012, and 0.001, respectively). > > > > Conclusions > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > The average time of HEMS, when within a 5-15-mile radius of the > admitted hospital, is longer than the average time of transport of > patients by ambulance. After controlling for severity, there were > higher in-hospital mortality rates, in-hospital mortality within 24 > hours of admission rates, and complications among patients transported > by helicopters than those transported by ambulance. > > > Publishing and Reprint Information > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > * Philadelphia College of Osteopathic Medicine USA > > > * 56 > > > * > Copyright C 2004 by Prehospital Emergency Care > > > * doi:10.1197/S1090-3127(03)00372-1 > > > > Bledsoe, DO, FACEP > > Midlothian, TX > > > > " Faith is believing what you know ain't so. " > > Mark Twain > > Following the Equator > > > > > Don't miss EMStock 2004!http://www.emstock.com > <http://www.emstock.com/> > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2004 Report Share Posted April 15, 2004 Mike wrote: " So, I agree that they are overused, but for the most part, I do not see how a more rapid form of transport can be detrimental to the patient's presenting condition. I also agree that it might not be beneficial. I hope that clarifies my position. " Is this Kerry using Mike's email account again? Bledsoe, DO, FACEP Midlothian, TX " Faith is believing what you know ain't so. " Mark Twain Following the Equator Don't miss EMStock 2004!http://www.emstock.com > > > > Abstracts > Comparison between helicopter-EMS and ground-EMS transport time and > outcomes for severely injured patients in areas within a 5- to 15-mile > radius from a trauma center > > > > Jack F. Basil [MEDLINE LOOKUP] > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search & db=PubMed & te> & db=PubMed & te > rm=Bas > > & db=PubMed & term=Bas > ile+JF%20%5bAuthor%20Name%5d> > Barbara Sorondo [MEDLINE LOOKUP] > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search & db=PubMed & te> & db=PubMed & te > rm=Sor > > & db=PubMed & term=Sor > ondo+B%20%5bAuthor%20Name%5d> > > > > > > > > > > Objective > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > Helicopter transport has always provided numerous advantages in long > distance trauma scene flights (TSFs), but the discussion over the > effectiveness of helicopter transport for short distance TSFs still remains. > The aim of this study is to analyze and compare transport times and > patient outcomes for those severely injured patients (ISS>15) > transported by helicopter (HEMS) and those transported by ambulance > (GEMS) when the incident was located within a 5- to 15-mile radius > from a trauma center (TC). > > > > Methods > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > This is a descriptive, cross-sectional, population-based study using > CODES records from January 1995 to December 2000. All patients with an > ISS>15, transported to a TC within the 5-15-mile radius were included > in the analysis. Data were divided into two groups: HEMS and GEMS > transports, and compared using average transport time, ISS, MAIS, > mortality, and complications. > > > > Results > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > A total of 29,074 transports were analyzed; 4,640 were severely > injured cases, and 69% of those were transported to TC. A total of > 1,245 were EMS transports within the 5-15-mile radius. Of those, > 12.24% were HEMS compared with 87.66% of GEMS. The mean time of HEMS > was 5 minutes longer than the mean of GEMS time (40.07 vs 35.04; > p<0.005). When the on scene times were compared between the two > groups, there were no differences between scene time spent by the HEMS > versus the scene time spent by the GEMS. There were higher in-hospital > mortality rates, in-hospital mortality within 24 hours of admission > rates, and complications among patients transported by helicopters > than those transported by ambulance (p=0.001, 0.012, and 0.001, respectively). > > > > Conclusions > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > The average time of HEMS, when within a 5-15-mile radius of the > admitted hospital, is longer than the average time of transport of > patients by ambulance. After controlling for severity, there were > higher in-hospital mortality rates, in-hospital mortality within 24 > hours of admission rates, and complications among patients transported > by helicopters than those transported by ambulance. > > > Publishing and Reprint Information > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > * Philadelphia College of Osteopathic Medicine USA > > > * 56 > > > * > Copyright C 2004 by Prehospital Emergency Care > > > * doi:10.1197/S1090-3127(03)00372-1 > > > > Bledsoe, DO, FACEP > > Midlothian, TX > > > > " Faith is believing what you know ain't so. " > > Mark Twain > > Following the Equator > > > > > Don't miss EMStock 2004!http://www.emstock.com > <http://www.emstock.com/> > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2004 Report Share Posted April 15, 2004 Now, that was funny, especially with me coming from the 1,200 sq. mi. slab of dirt located to Boston's south. Mike > > > > Abstracts > Comparison between helicopter-EMS and ground-EMS transport time and > outcomes for severely injured patients in areas within a 5- to 15-mile > radius from a trauma center > > > > Jack F. Basil [MEDLINE LOOKUP] > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search & db=PubMed & te> & db=PubMed & te> & db=PubMed & te > rm=Bas > > & db=PubMed & term=Bas > ile+JF%20%5bAuthor%20Name%5d> > Barbara Sorondo [MEDLINE LOOKUP] > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search & db=PubMed & te> & db=PubMed & te> & db=PubMed & te > rm=Sor > > & db=PubMed & term=Sor > ondo+B%20%5bAuthor%20Name%5d> > > > > > > > > > > Objective > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > Helicopter transport has always provided numerous advantages in long > distance trauma scene flights (TSFs), but the discussion over the > effectiveness of helicopter transport for short distance TSFs still remains. > The aim of this study is to analyze and compare transport times and > patient outcomes for those severely injured patients (ISS>15) > transported by helicopter (HEMS) and those transported by ambulance > (GEMS) when the incident was located within a 5- to 15-mile radius > from a trauma center (TC). > > > > Methods > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > This is a descriptive, cross-sectional, population-based study using > CODES records from January 1995 to December 2000. All patients with an > ISS>15, transported to a TC within the 5-15-mile radius were included > in the analysis. Data were divided into two groups: HEMS and GEMS > transports, and compared using average transport time, ISS, MAIS, > mortality, and complications. > > > > Results > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > A total of 29,074 transports were analyzed; 4,640 were severely > injured cases, and 69% of those were transported to TC. A total of > 1,245 were EMS transports within the 5-15-mile radius. Of those, > 12.24% were HEMS compared with 87.66% of GEMS. The mean time of HEMS > was 5 minutes longer than the mean of GEMS time (40.07 vs 35.04; > p<0.005). When the on scene times were compared between the two > groups, there were no differences between scene time spent by the HEMS > versus the scene time spent by the GEMS. There were higher in-hospital > mortality rates, in-hospital mortality within 24 hours of admission > rates, and complications among patients transported by helicopters > than those transported by ambulance (p=0.001, 0.012, and 0.001, respectively). > > > > Conclusions > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > The average time of HEMS, when within a 5-15-mile radius of the > admitted hospital, is longer than the average time of transport of > patients by ambulance. After controlling for severity, there were > higher in-hospital mortality rates, in-hospital mortality within 24 > hours of admission rates, and complications among patients transported > by helicopters than those transported by ambulance. > > > Publishing and Reprint Information > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 > <http://www2.peconline.org/scripts/om.dll/serve?article=as109031270300 > 3721 & n > > & n > av=full#top> TOP > > * Philadelphia College of Osteopathic Medicine USA > > > * 56 > > > * > Copyright C 2004 by Prehospital Emergency Care > > > * doi:10.1197/S1090-3127(03)00372-1 > > > > Bledsoe, DO, FACEP > > Midlothian, TX > > > > " Faith is believing what you know ain't so. " > > Mark Twain > > Following the Equator > > > > > Don't miss EMStock 2004!http://www.emstock.com > <http://www.emstock.com/> > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2004 Report Share Posted April 15, 2004 Oh I believe you 100 % It was not my point to say that Helo vs. Ground, helo better. Not at all. I guess I did not come across as well as I should have. My point was helos do have there place, but never delay transportation by ground because you are waiting on a helicopter. That is what I was trying to say but did not pull it off . Lastly, Thank you Dr. Bledsoe for the gift. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2004 Report Share Posted April 15, 2004 Oh I believe you 100 % It was not my point to say that Helo vs. Ground, helo better. Not at all. I guess I did not come across as well as I should have. My point was helos do have there place, but never delay transportation by ground because you are waiting on a helicopter. That is what I was trying to say but did not pull it off . Lastly, Thank you Dr. Bledsoe for the gift. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2004 Report Share Posted April 15, 2004 Mr. Gandy, the only thing I can say is this, You just had to have been there to see it. Not much of a defense mind you but Please understand I only meant to say that helicopters do have a place is all. I am not saying that they should take place of ground units by any means. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2004 Report Share Posted April 15, 2004 Mr. Gandy, the only thing I can say is this, You just had to have been there to see it. Not much of a defense mind you but Please understand I only meant to say that helicopters do have a place is all. I am not saying that they should take place of ground units by any means. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 16, 2004 Report Share Posted April 16, 2004 In a message dated 4/15/2004 11:04:47 PM Central Daylight Time, Etlaesium@... writes: In our case (A/TCEMS), we utilize STARFlight as a first response vehicle for scenes that are a certain distance to the responding ambulance. In these cases, it is more prevalent for STARFlight to hand off the patient to us. So, you're saying the helicopter is used as a first responder unit, then when the medic unit gets there they transfer care to you for transport? Interesting....(that's not a neg. or pos. interesting btw...just an interesting!) Never heard of that being done before! Kathi Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 16, 2004 Report Share Posted April 16, 2004 In a message dated 4/15/2004 11:04:47 PM Central Daylight Time, Etlaesium@... writes: In our case (A/TCEMS), we utilize STARFlight as a first response vehicle for scenes that are a certain distance to the responding ambulance. In these cases, it is more prevalent for STARFlight to hand off the patient to us. So, you're saying the helicopter is used as a first responder unit, then when the medic unit gets there they transfer care to you for transport? Interesting....(that's not a neg. or pos. interesting btw...just an interesting!) Never heard of that being done before! Kathi Quote Link to comment Share on other sites More sharing options...
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