Guest guest Posted July 1, 2008 Report Share Posted July 1, 2008 Ken Mattox, my esteemed yet reserved colleague in Houston, has spread some interesting light on the HEMS issue. The wildland firefighter was evidently given antivenin for a presumed spider bite. The patient developed an anaphylactoid reaction to the antivenin. Mattox seems to think this was an interhospital transfer (where else would one get antivenin for a spider)? He is calling this a DOUBLE IATROGENIC DEATH. 1. There is no native spider in North America that requires antivenin. 2. Anaphylactoid reactions can be treated on scene and either kept or transported by ground. I hope some good comes out of the sacrifices these people made. The media is not letting up. The newspapers are doing detailed follow-ups and several magazines are in the fray. Mattox is one of the tallest hogs at the trough. I wish he were interviewed more by the media. BEB E. Bledsoe, DO, FACEP Midlothian, Texas Mark Your Calendars! EMStock 2008 September 25-28, 2008 http://www.emstock.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 1, 2008 Report Share Posted July 1, 2008 The official USFA LODD account states he was at a hospital and was being transferred. LNM from Baku, Azerbaijan - Angina Monologs Ken Mattox, my esteemed yet reserved colleague in Houston, has spread some interesting light on the HEMS issue. The wildland firefighter was evidently given antivenin for a presumed spider bite. The patient developed an anaphylactoid reaction to the antivenin. Mattox seems to think this was an interhospital transfer (where else would one get antivenin for a spider)? He is calling this a DOUBLE IATROGENIC DEATH. 1. There is no native spider in North America that requires antivenin. 2. Anaphylactoid reactions can be treated on scene and either kept or transported by ground. I hope some good comes out of the sacrifices these people made. The media is not letting up. The newspapers are doing detailed follow-ups and several magazines are in the fray. Mattox is one of the tallest hogs at the trough. I wish he were interviewed more by the media. BEB E. Bledsoe, DO, FACEP Midlothian, Texas Mark Your Calendars! EMStock 2008 September 25-28, 2008 http://www.emstock.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2008 Report Share Posted July 2, 2008 Over the years I have identified, anecdotally, some reasons for needless requests for air medivac. 1. Crew is unsure of themselves and feel that they're over their heads with the patient. 2. Crew has a " knee-jerk " reaction to dispatch information and says, " Start the bird. " 3. Crew arrives on-scene and sees a bundle of twisted metal and assumes that somebody will need air. 4. Crew finds patient entrapped and automatically calls air, regardless of what's really wrong with the patient. (This cost one patient with minor injuries his " brain " and an air medical service a big settlement because they RSI's him and intubated him when he didn't need it and didn't recognize that they had " tubed the goose " until his brain was damaged severely. His only injury was a fx of the 4th right metatarsal.) 5. Crew is lazy and doesn't want to do the transport because it will make them late getting off. 6. Variation on 2. Crew wants to go back to bed. 7. Service has boiler-plate protocols that require air evac based upon rigid but unrealistic criteria, such as (1) the MVC occurred at 40 mph or more, (2) another person was killed in the MVC, (3) there was a fall from more than " X " feet, and so forth. This is mindlessly stupid, yet courses like PHTLS promote these myths. They work against medic responsibility for intelligent assessment. 8. Service has a " special " relationship with the air medical service. (I'll let you figure that out). 9. Hospital has clueless doctors who don't have a clue about the risks of air vs. ground and the capabilities of each. So docs call air to transport a patient one mile to the other hospital. This has happened. 10. Hospital has a " pact with the devil " with the air medical service, which means that they have " sponsorships " of air medical programs (not owned) which put them on a preferred list for destinations. I have a BIG problem with that. There are other reasons. Most have nothing to do with the needs of the patient or the patient's welfare. Now, before you skewer me, I will say that there are certain times when air is very valuable. But ground EMS does a very bad job of deciding when it's indicated and when it's not. GG > > > http://www.delmarvahttp://www.dehttp://wwhttp://www.dhttp://wwwhttp://www.delmht\ tp: > > Excellent article Dr. B.? Although you are questioned, I find it odd that > again, ground guys are slammed to make the point of air medical being needed.? > One quote I take exception to is the one stating decisions have to be made by > people with a lot of hectic information from the scene...here' Excellent > article Dr. B.? Although you are questioned, I find it odd that again, ground > guys are slammed to make the point of air medical being needed.? One quote I > take exception to is the Excellent article Dr. B.? Although you are questioned, > I find it odd that again, ground guys are slammed to make the point of air > medical being needed.? One quote I take exception to is the > > Dudley > > Angina Monologs > > Ken Mattox, my esteemed yet reserved colleague in Houston, has spread some > interesting light on the HEMS issue. The wildland firefighter was evidently > given antivenin for a presumed spider bite. The patient developed an > anaphylactoid reaction to the antivenin. Mattox seems to think this was an > interhospital transfer (where else would one get antivenin for a spider)? He > is calling this a DOUBLE IATROGENIC DEATH. > > 1. There is no native spider in North America that requires antivenin. > > 2. Anaphylactoid reactions can be treated on scene and either kept or > transported by ground. > > I hope some good comes out of the sacrifices these people made. The media is > not letting up. The newspapers are doing detailed follow-ups and several > magazines are in the fray. Mattox is one of the tallest hogs at the trough. > I wish he were interviewed more by the media. > > BEB > > E. Bledsoe, DO, FACEP > > Midlothian, Texas > > Mark Your Calendars! > > EMStock 2008 > > September 25-28, 2008 > > http://www.emstock.htt > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2008 Report Share Posted July 2, 2008 Yes, what a concept. That air medical service ought to be called only after a competent assessment of the patient and a rational evaluation of the patient's needs. Air evac based purely upon the patient's needs? Never going to happen. Here in Tucson, University Medical Center's system says that if a patient is in a MVC where the collision was 40 mph or greater, the patient MUST be sent to the Level 1 trauma center, and helo transport is advised. I find that to be a mindless rule. It discourages medics from evaluating patients intelligently, making transport decisions based upon assessment, and doing what's the best thing for the patient. But it's GREAT for UMC. It insures that they will get many patients who would not normally come to them. It also creates a bonanza of billing for the air medical services. So what is the policy about? Patient care or MONEY? I'll let you decide. Does this happen in Texas? I regret to inform you that it does. Whose interests are served by air medical services? The patient's? Or the corporate entities that run these services? And don't blame the crews. They are just pawns in this game. They are the folks who get hurt, along with their patients, when things go wrong. The SUITS never get hurt. Pity. What role do medical directors of air services play in regulating the use of their services? Do they ever say " don't accept this call if it's not appropriate medically? " If you think they do, then I have some prime beachfront property here in AZ to sell you for $10,000 an acre. Since DSHS cannot regulate the air medical services, because federal law and the FAA have pre-empted the field, the only supervision that might make a difference in abuse vs. non-abuse can be done by system medical directors. Have they stepped up and made rules to minimize system abuse? Of course not. If they were to do so, they would be fired by the corporate SUITS that control air medicine, and some flack would be hired to sign the papers. DSHS cannot to ONE THING to stop that. The Texas Medical Board is not effective in regulating physicians's participation in air medical services. That's far below their horizon. So in Texas as well as most of the rest of the country, because of the federal law that gives FAA the power to regulate all air services, there is no effective regulation of air medical services. The FAA is somewhere in the second to last century in their understanding of air medical issues. The NTSB, which investigates air medical accidents, is on the leading edge. They have laid out what needs to be done, but the corporate moguls who run the air medical services have a lock on the FAA, so nothing gets done. Do I want to see an end to all air medical services? Absolutely not. They are essential in some contexts. But they are used much more often than they need to be. Do I want to see them regulated? Yes indeed. Will that happen? Probably not. Would I like to see medical directors with the balls to set rules that are patient oriented, not corporation oriented? You bet. Do I expect to ever see that. Hell no. I hate to be so cynical, but this will never happen. Human nature prevents it. GG GG > > AMEN Dudley! > > In the mid 1980's as a young upstart dispatcher I once dared to > question the logic of the " 10 minutes or 10 Mile " from the Level I > Trauma Center rule that said I as a dispatcher on dispatch information > alone COULD LAUNCH a Bird if I saw fit. > > My Administration (Countywide Dispatch Center) took it ONE step further > by using words like SHALL, MUST and WILL in our POLIVCY. > > If you looked at our county everything was 10+ miles from the Trauma > Center unless it was in the City of Camden or on the outlying > boundaries and if you factored traffic at rush hour most of that was > still in that rule. It was stupid then and would be today (it's been 5 > years since I left NJ and 19 since I left that gig). > > What a concept assess the Patient then treat the Patient based on that > assessment. Dudley you're a man ahead of his time! > > LNM > -- > Lou Molino, Sr. > FF/NREMT-B/FSI/ FF/ > From the road in Baku this week > (Cell Phone) > > Angina Monologs > > Ken Mattox, my esteemed yet reserved colleague in Houston, has spread > some > interesting light on the HEMS issue. The wildland firefighter was > evidently > given antivenin for a presumed spider bite. The patient developed an > anaphylactoid reaction to the antivenin. Mattox seems to think this was > an > interhospital transfer (where else would one get antivenin for a > spider)? He > is calling this a DOUBLE IATROGENIC DEATH. > > 1. There is no native spider in North America that requires antivenin. > > 2. Anaphylactoid reactions can be treated on scene and either kept or > transported by ground. > > I hope some good comes out of the sacrifices these people made. The > media is > not letting up. The newspapers are doing detailed follow-ups and several > magazines are in the fray. Mattox is one of the tallest hogs at the > trough. > I wish he were interviewed more by the media. > > BEB > > E. Bledsoe, DO, FACEP > > Midlothian, Texas > > Mark Your Calendars! > > EMStock 2008 > > September 25-28, 2008 > > http://www.emstock.htt > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2008 Report Share Posted July 2, 2008 http://www.delmarvanow.com/apps/pbcs.dll/article?AID=/20080702/DW01/807020306/-1\ /DW Excellent article Dr. B.? Although you are questioned, I find it odd that again, ground guys are slammed to make the point of air medical being needed.? One quote I take exception to is the one stating decisions have to be made by people with a lot of hectic information from the scene...here's a novel idea...how about that decision to fly the patient gets made by a medic on the scene after a thorough patient assessment, scene size-up, and thorough situational assessment/awareness.? I.E. " What is wrong, what else is going on, where are we right now and where to do we need to go and by when " .? Then make a decision with facts...not a " it looks really bad " 911 call.... Dudley Angina Monologs Ken Mattox, my esteemed yet reserved colleague in Houston, has spread some interesting light on the HEMS issue. The wildland firefighter was evidently given antivenin for a presumed spider bite. The patient developed an anaphylactoid reaction to the antivenin. Mattox seems to think this was an interhospital transfer (where else would one get antivenin for a spider)? He is calling this a DOUBLE IATROGENIC DEATH. 1. There is no native spider in North America that requires antivenin. 2. Anaphylactoid reactions can be treated on scene and either kept or transported by ground. I hope some good comes out of the sacrifices these people made. The media is not letting up. The newspapers are doing detailed follow-ups and several magazines are in the fray. Mattox is one of the tallest hogs at the trough. I wish he were interviewed more by the media. BEB E. Bledsoe, DO, FACEP Midlothian, Texas Mark Your Calendars! EMStock 2008 September 25-28, 2008 http://www.emstock.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2008 Report Share Posted July 2, 2008 AMEN Dudley! In the mid 1980's as a young upstart dispatcher I once dared to question the logic of the " 10 minutes or 10 Mile " from the Level I Trauma Center rule that said I as a dispatcher on dispatch information alone COULD LAUNCH a Bird if I saw fit. My Administration (Countywide Dispatch Center) took it ONE step further by using words like SHALL, MUST and WILL in our POLIVCY. If you looked at our county everything was 10+ miles from the Trauma Center unless it was in the City of Camden or on the outlying boundaries and if you factored traffic at rush hour most of that was still in that rule. It was stupid then and would be today (it's been 5 years since I left NJ and 19 since I left that gig). What a concept assess the Patient then treat the Patient based on that assessment. Dudley you're a man ahead of his time! LNM -- Lou Molino, Sr. FF/NREMT-B/FSI/EMSI From the road in Baku this week (Cell Phone) Angina Monologs Ken Mattox, my esteemed yet reserved colleague in Houston, has spread some interesting light on the HEMS issue. The wildland firefighter was evidently given antivenin for a presumed spider bite. The patient developed an anaphylactoid reaction to the antivenin. Mattox seems to think this was an interhospital transfer (where else would one get antivenin for a spider)? He is calling this a DOUBLE IATROGENIC DEATH. 1. There is no native spider in North America that requires antivenin. 2. Anaphylactoid reactions can be treated on scene and either kept or transported by ground. I hope some good comes out of the sacrifices these people made. The media is not letting up. The newspapers are doing detailed follow-ups and several magazines are in the fray. Mattox is one of the tallest hogs at the trough. I wish he were interviewed more by the media. BEB E. Bledsoe, DO, FACEP Midlothian, Texas Mark Your Calendars! EMStock 2008 September 25-28, 2008 http://www.emstock.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 3, 2008 Report Share Posted July 3, 2008 Oh let's not skewer you but on behave of the ground EMS', I'll just offer thanks for your candidness and overall general impression of ground EMS' abilities. These monologues have opened my eyes recently. Of course I have to wonder if many of these reasons listed could be avoided if the portable x-ray, MRI's and labs were utilized more often in the ground ambulances Again, thanks for your openness... LM Camp _____ From: texasems-l [mailto:texasems-l ] On Behalf Of wegandy1938@... Sent: Thursday, July 03, 2008 2:29 AM To: texasems-l Subject: Re: Angina Monologs Over the years I have identified, anecdotally, some reasons for needless requests for air medivac. 1. Crew is unsure of themselves and feel that they're over their heads with the patient. 2. Crew has a " knee-jerk " reaction to dispatch information and says, " Start the bird. " 3. Crew arrives on-scene and sees a bundle of twisted metal and assumes that somebody will need air. 4. Crew finds patient entrapped and automatically calls air, regardless of what's really wrong with the patient. (This cost one patient with minor injuries his " brain " and an air medical service a big settlement because they RSI's him and intubated him when he didn't need it and didn't recognize that they had " tubed the goose " until his brain was damaged severely. His only injury was a fx of the 4th right metatarsal.) 5. Crew is lazy and doesn't want to do the transport because it will make them late getting off. 6. Variation on 2. Crew wants to go back to bed. 7. Service has boiler-plate protocols that require air evac based upon rigid but unrealistic criteria, such as (1) the MVC occurred at 40 mph or more, (2) another person was killed in the MVC, (3) there was a fall from more than " X " feet, and so forth. This is mindlessly stupid, yet courses like PHTLS promote these myths. They work against medic responsibility for intelligent assessment. 8. Service has a " special " relationship with the air medical service. (I'll let you figure that out). 9. Hospital has clueless doctors who don't have a clue about the risks of air vs. ground and the capabilities of each. So docs call air to transport a patient one mile to the other hospital. This has happened. 10. Hospital has a " pact with the devil " with the air medical service, which means that they have " sponsorships " of air medical programs (not owned) which put them on a preferred list for destinations. I have a BIG problem with that. There are other reasons. Most have nothing to do with the needs of the patient or the patient's welfare. Now, before you skewer me, I will say that there are certain times when air is very valuable. But ground EMS does a very bad job of deciding when it's indicated and when it's not. GG In a message dated 7/2/08 9:51:15 PM, THEDUDMAN (AT) aol (DOT) <mailto:THEDUDMAN%40aol.com> com writes: > > > http://www.delmarva <http://www.delmarvahttp:/www.dehttp:/wwhttp:/www.dhttp:/wwwhttp:/www.delmht tp:> http://www.dehttp://wwhttp://www.dhttp://wwwhttp://www.delmhttp: > > Excellent article Dr. B.? Although you are questioned, I find it odd that > again, ground guys are slammed to make the point of air medical being needed.? > One quote I take exception to is the one stating decisions have to be made by > people with a lot of hectic information from the scene...here' Excellent > article Dr. B.? Although you are questioned, I find it odd that again, ground > guys are slammed to make the point of air medical being needed.? One quote I > take exception to is the Excellent article Dr. B.? Although you are questioned, > I find it odd that again, ground guys are slammed to make the point of air > medical being needed.? One quote I take exception to is the > > Dudley > > Angina Monologs > > Ken Mattox, my esteemed yet reserved colleague in Houston, has spread some > interesting light on the HEMS issue. The wildland firefighter was evidently > given antivenin for a presumed spider bite. The patient developed an > anaphylactoid reaction to the antivenin. Mattox seems to think this was an > interhospital transfer (where else would one get antivenin for a spider)? He > is calling this a DOUBLE IATROGENIC DEATH. > > 1. There is no native spider in North America that requires antivenin. > > 2. Anaphylactoid reactions can be treated on scene and either kept or > transported by ground. > > I hope some good comes out of the sacrifices these people made. The media is > not letting up. The newspapers are doing detailed follow-ups and several > magazines are in the fray. Mattox is one of the tallest hogs at the trough. > I wish he were interviewed more by the media. > > BEB > > E. Bledsoe, DO, FACEP > > Midlothian, Texas > > Mark Your Calendars! > > EMStock 2008 > > September 25-28, 2008 > > http://www.emstock. <http://www.emstock.htt> htt > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 6, 2008 Report Share Posted July 6, 2008 What would Jane Fonda have to say?????? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 6, 2008 Report Share Posted July 6, 2008 Tx1 wrote: " What would Jane Fonda have to say?????? " If she had something constructive to add, bring it on; otherwise, who cares? " A prudent man foresees the difficulties ahead and prepares for them; the simpleton goes blindly on and suffers the consequences. " Proverbs 22:3 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 6, 2008 Report Share Posted July 6, 2008 Larry I thought I knew you better. Who cares period! LNM from London, England - Re: Angina Monologs Tx1 wrote: " What would Jane Fonda have to say?????? " If she had something constructive to add, bring it on; otherwise, who cares? " A prudent man foresees the difficulties ahead and prepares for them; the simpleton goes blindly on and suffers the consequences. " Proverbs 22:3 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 6, 2008 Report Share Posted July 6, 2008 Sorry, not meant for the list, was intended for Dr. B. For those of you who don't keep up with the news or watch the Today Show on NBC,?it was just a little humor. Re: Angina Monologs Tx1 wrote: " What would Jane Fonda have to say?????? " If she had something constructive to add, bring it on; otherwise, who cares? ? " A prudent man foresees the difficulties ahead and prepares for them; the simpleton goes blindly on and suffers the consequences. " Proverbs 22:3 Quote Link to comment Share on other sites More sharing options...
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