Guest guest Posted October 1, 2008 Report Share Posted October 1, 2008 People consider it bad form to discuss incidents related to a tragedy following a tragedy. But, given that there have been 13 crashes in 9 months, when is the best time to discuss this problem? It seems the popular press--nonmedical reporters--recognize what we in EMS cannot. Mechanism of Injury alone has no role in trauma center transport or HEMS usage. To quote , and , " When will they ever learn? " These articles well define the arguments. baltimoresun.com Copter crash raises doubt Rules on trauma are questioned By Gadi Dechter and Brent October 1, 2008 The two young women whose car crash in County prompted a medevac flight that turned fatal early Sunday had only bruises and pain after the auto accident but no apparent injuries so severe they indicated need for a helicopter transport to a trauma center, officials said yesterday. Still, the ill-fated medevac call fit within national guidelines used by land's emergency medical system - guidelines the system's head now says need to be studied and perhaps revised. Dr. R. Bass, executive director of the land Institute for Emergency Medical Services Systems, which oversees the medevac program, said paramedic reports showed that the car crash victims had " chest pain, neck and back pain " and one had a large bruise between her ribs and hips. Those injuries, Bass said, " in and of themselves would not have been indicators to take to a trauma center. " The helicopter was summoned because one of the " mechanisms " of the accident suggested a probability of serious injury of more than 20 percent. In this case, the deciding factor was that an external part of the car " intruded " by more than a foot into the passenger compartment. In land, emergency medical personnel use triage guidelines developed by the American College of Surgeons when deciding whether to take a patient to a trauma center. If a trauma-bound patient is more than a 30-minute drive from the nearest trauma center, state helicopters are used. Under the triage guidelines, EMTs first look for physiological signs of serious injury, such as trouble breathing. Then, they look for anatomical indicators of grave injury, such as gunshot wounds or puncture wounds to the central part of the body. If none of those indicators is present, first-responders look at the mechanism of injury, such as the height of a fall. Some of these mechanisms are statistically linked with a likelihood of serious injury that may not be immediately apparent at the accident scene, such as internal bleeding. If first-responders only rely on visible signs of severe injury, " people will die, " Bass said. Still, deciding which mechanisms should automatically equate to a trauma transport has become a years-long struggle " within the trauma medical community, Bass said, because relying on mechanisms alone leads to " over-triage, " or unnecessary hospitalization in expensive trauma centers. The controversy flared up in land last month, when some state lawmakers noted that almost half of the patients flown by helicopter to land trauma centers are released within 24 hours - suggesting to them that the helicopters are overused. When transport to a trauma center involves medevac helicopters - which have been involved in a spate of nighttime accidents across the country recently - the risk of over-triage is magnified, according to Bass. This week's accident " raised the issue for us about what is the relative risk, and what is the right thing to do in terms of deciding to transport patients from the scene? " Bass said. While a federally funded project has recently come up with revised decision-making guidelines designed to reduce unnecessary trauma-center usage, there hasn't been a formal effort at building into triage criteria the added risk of helicopter transport, Bass said. The MIEMSS director said that land's vaunted medevac operation - which until this weekend had not had a fatal accident in more than 20 years - is particularly well-suited to that task of making those calculations, and Bass said he will suggest to his board of directors that land take up the issue. " Maybe it's time to grab the bull by the horn and get that done and see what kind of consensus guidelines we can come up with, because this is obviously an issue of national interest, " Bass said. Del. Dan K. Morhaim, co-chairman of the Joint Committee on Health Care Delivery and Financing, called last month's hearing, which was prompted in part by a legislative audit that criticized the state police's fiscal management and helicopter fleet maintenance. Morhaim, in an interview yesterday, said he still sees a need for medevac service but added that the system's reliance on the national triage guidelines needs to be re-evaluated. Between 4,500 and 5,000 patients are transported to hospitals by the state's medevac unit every year, at a cost to taxpayers of about $4,000 per trip. " One of the significant differences in land as opposed to other states is we have excellent paramedics able to deliver outstanding care in field and stabilize patients. Sometimes the need to transport by helicopter isn't as grave as in other states, " Morhaim said. Killed in the crash were the pilot, H. Bunker, 59; Tfc. Mickey Lippy, 34, a flight paramedic; Tonya Mallard, 38, an emergency medical technician from the Waldorf rescue squad; and J. Younger, 17, a passenger in one of the cars that collided. called her mother from the accident scene, which her mother went out to. " It's like I keep hearing her say, 'Mom, it's going to be OK. It's OK,' " Younger told WJZ TV. The lone survivor was Jordan Wells, 18, a college freshman who was driving the car in which was a passenger. She was in critical but stable condition last night at land Shock Trauma Center. State police spokesman Greg Shipley said in a news release last night that one of the 11 remaining medevac helicopters had been cleared for service. Shipley added that police hope to put others into operation as inspections and flight tests are completed over the next couple of days. And a quote from the Washington Post: " Younger called her mother just before 11 p.m. and calmly explained that she and Wells had just been in an accident. Her mother rushed to the scene with her best friend and Younger's grandmother. seemed fine, her mother recalled: no bleeding, no broken bones, just some chest pain. " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 1, 2008 Report Share Posted October 1, 2008 I just knew Dr B would be commenting.... MSP Crash People consider it bad form to discuss incidents related to a tragedy following a tragedy. But, given that there have been 13 crashes in 9 months, when is the best time to discuss this problem? It seems the popular press--nonmedical reporters--recognize what we in EMS cannot. Mechanism of Injury alone has no role in trauma center transport or HEMS usage. To quote , and , " When will they ever learn? " These articles well define the arguments. baltimoresun.com Copter crash raises doubt Rules on trauma are questioned By Gadi Dechter and Brent October 1, 2008 The two young women whose car crash in County prompted a medevac flight that turned fatal early Sunday had only bruises and pain after the auto accident but no apparent injuries so severe they indicated need for a helicopter transport to a trauma center, officials said yesterday. Still, the ill-fated medevac call fit within national guidelines used by land's emergency medical system - guidelines the system's head now says need to be studied and perhaps revised. Dr. R. Bass, executive director of the land Institute for Emergency Medical Services Systems, which oversees the medevac program, said paramedic reports showed that the car crash victims had " chest pain, neck and back pain " and one had a large bruise between her ribs and hips. Those injuries, Bass said, " in and of themselves would not have been indicators to take to a trauma center. " The helicopter was summoned because one of the " mechanisms " of the accident suggested a probability of serious injury of more than 20 percent. In this case, the deciding factor was that an external part of the car " intruded " by more than a foot into the passenger compartment. In land, emergency medical personnel use triage guidelines developed by the American College of Surgeons when deciding whether to take a patient to a trauma center. If a trauma-bound patient is more than a 30-minute drive from the nearest trauma center, state helicopters are used. Under the triage guidelines, EMTs first look for physiological signs of serious injury, such as trouble breathing. Then, they look for anatomical indicators of grave injury, such as gunshot wounds or puncture wounds to the central part of the body. If none of those indicators is present, first-responders look at the mechanism of injury, such as the height of a fall. Some of these mechanisms are statistically linked with a likelihood of serious injury that may not be immediately apparent at the accident scene, such as internal bleeding. If first-responders only rely on visible signs of severe injury, " people will die, " Bass said. Still, deciding which mechanisms should automatically equate to a trauma transport has become a years-long struggle " within the trauma medical community, Bass said, because relying on mechanisms alone leads to " over-triage, " or unnecessary hospitalization in expensive trauma centers. The controversy flared up in land last month, when some state lawmakers noted that almost half of the patients flown by helicopter to land trauma centers are released within 24 hours - suggesting to them that the helicopters are overused. When transport to a trauma center involves medevac helicopters - which have been involved in a spate of nighttime accidents across the country recently - the risk of over-triage is magnified, according to Bass. This week's accident " raised the issue for us about what is the relative risk, and what is the right thing to do in terms of deciding to transport patients from the scene? " Bass said. While a federally funded project has recently come up with revised decision-making guidelines designed to reduce unnecessary trauma-center usage, there hasn't been a formal effort at building into triage criteria the added risk of helicopter transport, Bass said. The MIEMSS director said that land's vaunted medevac operation - which until this weekend had not had a fatal accident in more than 20 years - is particularly well-suited to that task of making those calculations, and Bass said he will suggest to his board of directors that land take up the issue. " Maybe it's time to grab the bull by the horn and get that done and see what kind of consensus guidelines we can come up with, because this is obviously an issue of national interest, " Bass said. Del. Dan K. Morhaim, co-chairman of the Joint Committee on Health Care Delivery and Financing, called last month's hearing, which was prompted in part by a legislative audit that criticized the state police's fiscal management and helicopter fleet maintenance. Morhaim, in an interview yesterday, said he still sees a need for medevac service but added that the system's reliance on the national triage guidelines needs to be re-evaluated. Between 4,500 and 5,000 patients are transported to hospitals by the state's medevac unit every year, at a cost to taxpayers of about $4,000 per trip. " One of the significant differences in land as opposed to other states is we have excellent paramedics able to deliver outstanding care in field and stabilize patients. Sometimes the need to transport by helicopter isn't as grave as in other states, " Morhaim said. Killed in the crash were the pilot, H. Bunker, 59; Tfc. Mickey Lippy, 34, a flight paramedic; Tonya Mallard, 38, an emergency medical technician from the Waldorf rescue squad; and J. Younger, 17, a passenger in one of the cars that collided. called her mother from the accident scene, which her mother went out to. " It's like I keep hearing her say, 'Mom, it's going to be OK. It's OK,' " Younger told WJZ TV. The lone survivor was Jordan Wells, 18, a college freshman who was driving the car in which was a passenger. She was in critical but stable condition last night at land Shock Trauma Center. State police spokesman Greg Shipley said in a news release last night that one of the 11 remaining medevac helicopters had been cleared for service. Shipley added that police hope to put others into operation as inspections and flight tests are completed over the next couple of days. And a quote from the Washington Post: " Younger called her mother just before 11 p.m. and calmly explained that she and Wells had just been in an accident. Her mother rushed to the scene with her best friend and Younger's grandmother. seemed fine, her mother recalled: no bleeding, no broken bones, just some chest pain. " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 1, 2008 Report Share Posted October 1, 2008 Is that a slap at him, or an acknowledgement that at least one physician out there has the stones to address the topic? Rande M. McCrary, REMT-P/MICT wrote: > > I just knew Dr B would be commenting.... > > MSP Crash > > People consider it bad form to discuss incidents related to a tragedy > following a tragedy. But, given that there have been 13 crashes in 9 > months, > when is the best time to discuss this problem? It seems the popular > press--nonmedical reporters--recognize what we in EMS cannot. Mechanism of > Injury alone has no role in trauma center transport or HEMS usage. To > quote > , and , " When will they ever learn? " These articles well > define the arguments. > > baltimoresun.com > Copter crash raises doubt > Rules on trauma are questioned > By Gadi Dechter and Brent > October 1, 2008 > The two young women whose car crash in County prompted a medevac > flight that turned fatal early Sunday had only bruises and pain after the > auto accident but no apparent injuries so severe they indicated need for a > helicopter transport to a trauma center, officials said yesterday. Still, > the ill-fated medevac call fit within national guidelines used by > land's > emergency medical system - guidelines the system's head now says need to > be > studied and perhaps revised. > > Dr. R. Bass, executive director of the land Institute for > Emergency Medical Services Systems, which oversees the medevac program, > said > paramedic reports showed that the car crash victims had " chest pain, neck > and back pain " and one had a large bruise between her ribs and hips. Those > injuries, Bass said, " in and of themselves would not have been indicators > to > take to a trauma center. " The helicopter was summoned because one of the > " mechanisms " of the accident suggested a probability of serious injury of > more than 20 percent. In this case, the deciding factor was that an > external > part of the car " intruded " by more than a foot into the passenger > compartment. In land, emergency medical personnel use triage > guidelines > developed by the American College of Surgeons when deciding whether to > take > a patient to a trauma center. If a trauma-bound patient is more than a > 30-minute drive from the nearest trauma center, state helicopters are > used. > Under the triage guidelines, EMTs first look for physiological signs of > serious injury, such as trouble breathing. Then, they look for anatomical > indicators of grave injury, such as gunshot wounds or puncture wounds to > the > central part of the body. If none of those indicators is present, > first-responders look at the mechanism of injury, such as the height of a > fall. Some of these mechanisms are statistically linked with a likelihood > of > serious injury that may not be immediately apparent at the accident scene, > such as internal bleeding. If first-responders only rely on visible signs > of > severe injury, " people will die, " Bass said. Still, deciding which > mechanisms should automatically equate to a trauma transport has become a > years-long struggle " within the trauma medical community, Bass said, > because > relying on mechanisms alone leads to " over-triage, " or unnecessary > hospitalization in expensive trauma centers. > > The controversy flared up in land last month, when some state > lawmakers > noted that almost half of the patients flown by helicopter to land > trauma centers are released within 24 hours - suggesting to them that the > helicopters are overused. > When transport to a trauma center involves medevac helicopters - which > have > been involved in a spate of nighttime accidents across the country > recently > - the risk of over-triage is magnified, according to Bass. This week's > accident " raised the issue for us about what is the relative risk, and > what > is the right thing to do in terms of deciding to transport patients from > the > scene? " Bass said. While a federally funded project has recently come up > with revised decision-making guidelines designed to > reduce unnecessary trauma-center usage, there hasn't been a formal effort > at > building into triage criteria the added risk of helicopter transport, Bass > said. The MIEMSS director said that land's vaunted medevac operation - > which until this weekend had not had a fatal accident in more than 20 > years > - is particularly well-suited to that task of making those calculations, > and > Bass said he will suggest to his board of directors that land take up > the issue. " Maybe it's time to grab the bull by the horn and get that done > and see what kind of consensus guidelines we can come up with, because > this > is obviously an issue of national interest, " Bass said. > > Del. Dan K. Morhaim, co-chairman of the Joint Committee on Health Care > Delivery and Financing, called last month's hearing, which was prompted in > part by a legislative audit that criticized the state police's fiscal > management and helicopter fleet maintenance. Morhaim, in an interview > yesterday, said he still sees a need for medevac service but added that > the > system's reliance on the national triage guidelines needs to be > re-evaluated. Between 4,500 and 5,000 patients are transported to > hospitals > by the state's medevac unit every year, at a cost to taxpayers of about > $4,000 per trip. " One of the significant differences in land as > opposed > to other states is we have excellent paramedics > able to deliver outstanding care in field and stabilize patients. > Sometimes > the need to transport by helicopter isn't as grave as in other states, " > Morhaim said. > > Killed in the crash were the pilot, H. Bunker, 59; Tfc. Mickey > Lippy, 34, a flight paramedic; Tonya Mallard, 38, an emergency medical > technician from the Waldorf rescue squad; and J. Younger, 17, a > passenger in one of the cars that collided. called her mother from > the accident scene, which her mother went out to. " It's like I keep > hearing > her say, 'Mom, it's going to be OK. It's OK,' " Younger told WJZ > TV. The lone survivor was Jordan Wells, 18, a college freshman who was > driving the car in which was a passenger. She was in critical but > stable condition last night at land Shock Trauma Center. State police > spokesman Greg Shipley said in a news release last night that one of the > 11 > remaining medevac helicopters had been cleared for service. Shipley added > that police hope to put others into operation as inspections and flight > tests are completed over the next couple of days. > > And a quote from the Washington Post: > > " Younger called her mother just before 11 p.m. and calmly explained > that she and Wells had just been in an accident. Her mother rushed to the > scene with her best friend and Younger's grandmother. seemed fine, > her mother recalled: no bleeding, no broken bones, just some chest pain. " > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 1, 2008 Report Share Posted October 1, 2008 I'll jump in here Dr. B.? Dr. Bass is wrong...if you go strictly off physiologic signs then you will get those who need to be at a Level 1 Trauma Center quickly there quickly.? What you won't do is fly patients who are walking around a traffic accident scene calling their mother on their cellphone!!!! Certainly even those who very pro-flight can agree that this was not an appropriate use of an air-medical resource?? Even if for some reason, this patient needed to go to a Level 1....they could have gone by ground even if it took 2 or 3 hours.... In our RAC, we use criteria labeled Red/Blue. http://www.strac.org/Docs/Red_Blue%20Docs/STRAC_Red-Blue_Draft_Jan_8_2008.pdf? If the patient has one Red criteria or two Blue criteria they must go to a Level 1 Trauma Center.? If the patient has one blue and the paramedic feels other criteria dictate, the patient can be triaged to a trauma center (but flying wouldn't be appropriate).? If the patient has NO red or blue...the patient can be transported to any hospital of the patient's choice.? We have been monitoring this for 3 years and there have been no instances where patients with no red/blue have needed emergent (within 30 minutes of arrival at a non-Level 1 facility) transport to a Level 1.? There are patients every month that end up getting transported to a Level 1, but these patients are transferred with our regional transfer system promptly and more times than not, they are transferred for specialized care...not a missed traumatic injury. This criteria has worked so well, one of our local surgeons implemented it in Iraq for the flight crews when he was Chief of Trauma over there in 2006/7.? Not saying it is the panacea...but it has allowed us to work on getting away from mechanism as a reason to go to a trauma center. No offense, but we really must stop using risky transport (helicopters and lights and sirens on the ground) for things that we as medical professionals should be able to successfully manage during transport to an emergency room.? In the last couple of weeks I have heard patients being flown that had appendicitis, abdominal pain after an MVA (normo-tensive) and non-STEMI chest pain when the ED with a cath lab was 25 minutes away.? And all of the agencies are ones that would be considered " advanced " because of their extensive formulary carried on their units. Just my thoughts tonight. Dudley MSP Crash People consider it bad form to discuss incidents related to a tragedy following a tragedy. But, given that there have been 13 crashes in 9 months, when is the best time to discuss this problem? It seems the popular press--nonmedical reporters--recognize what we in EMS cannot. Mechanism of Injury alone has no role in trauma center transport or HEMS usage. To quote , and , " When will they ever learn? " These articles well define the arguments. baltimoresun.com Copter crash raises doubt Rules on trauma are questioned By Gadi Dechter and Brent October 1, 2008 The two young women whose car crash in County prompted a medevac flight that turned fatal early Sunday had only bruises and pain after the auto accident but no apparent injuries so severe they indicated need for a helicopter transport to a trauma center, officials said yesterday. Still, the ill-fated medevac call fit within national guidelines used by land's emergency medical system - guidelines the system's head now says need to be studied and perhaps revised. Dr. R. Bass, executive director of the land Institute for Emergency Medical Services Systems, which oversees the medevac program, said paramedic reports showed that the car crash victims had " chest pain, neck and back pain " and one had a large bruise between her ribs and hips. Those injuries, Bass said, " in and of themselves would not have been indicators to take to a trauma center. " The helicopter was summoned because one of the " mechanisms " of the accident suggested a probability of serious injury of more than 20 percent. In this case, the deciding factor was that an external part of the car " intruded " by more than a foot into the passenger compartment. In land, emergency medical personnel use triage guidelines developed by the American College of Surgeons when deciding whether to take a patient to a trauma center. If a trauma-bound patient is more than a 30-minute drive from the nearest trauma center, state helicopters are used. Under the triage guidelines, EMTs first look for physiological signs of serious injury, such as trouble breathing. Then, they look for anatomical indicators of grave injury, such as gunshot wounds or puncture wounds to the central part of the body. If none of those indicators is present, first-responders look at the mechanism of injury, such as the height of a fall. Some of these mechanisms are statistically linked with a likelihood of serious injury that may not be immediately apparent at the accident scene, such as internal bleeding. If first-responders only rely on visible signs of severe injury, " people will die, " Bass said. Still, deciding which mechanisms should automatically equate to a trauma transport has become a years-long struggle " within the trauma medical community, Bass said, because relying on mechanisms alone leads to " over-triage, " or unnecessary hospitalization in expensive trauma centers. The controversy flared up in land last month, when some state lawmakers noted that almost half of the patients flown by helicopter to land trauma centers are released within 24 hours - suggesting to them that the helicopters are overused. When transport to a trauma center involves medevac helicopters - which have been involved in a spate of nighttime accidents across the country recently - the risk of over-triage is magnified, according to Bass. This week's accident " raised the issue for us about what is the relative risk, and what is the right thing to do in terms of deciding to transport patients from the scene? " Bass said. While a federally funded project has recently come up with revised decision-making guidelines designed to reduce unnecessary trauma-center usage, there hasn't been a formal effort at building into triage criteria the added risk of helicopter transport, Bass said. The MIEMSS director said that land's vaunted medevac operation - which until this weekend had not had a fatal accident in more than 20 years - is particularly well-suited to that task of making those calculations, and Bass said he will suggest to his board of directors that land take up the issue. " Maybe it's time to grab the bull by the horn and get that done and see what kind of consensus guidelines we can come up with, because this is obviously an issue of national interest, " Bass said. Del. Dan K. Morhaim, co-chairman of the Joint Committee on Health Care Delivery and Financing, called last month's hearing, which was prompted in part by a legislative audit that criticized the state police's fiscal management and helicopter fleet maintenance. Morhaim, in an interview yesterday, said he still sees a need for medevac service but added that the system's reliance on the national triage guidelines needs to be re-evaluated. Between 4,500 and 5,000 patients are transported to hospitals by the state's medevac unit every year, at a cost to taxpayers of about $4,000 per trip. " One of the significant differences in land as opposed to other states is we have excellent paramedics able to deliver outstanding care in field and stabilize patients. Sometimes the need to transport by helicopter isn't as grave as in other states, " Morhaim said. Killed in the crash were the pilot, H. Bunker, 59; Tfc. Mickey Lippy, 34, a flight paramedic; Tonya Mallard, 38, an emergency medical technician from the Waldorf rescue squad; and J. Younger, 17, a passenger in one of the cars that collided. called her mother from the accident scene, which her mother went out to. " It's like I keep hearing her say, 'Mom, it's going to be OK. It's OK,' " Younger told WJZ TV. The lone survivor was Jordan Wells, 18, a college freshman who was driving the car in which was a passenger. She was in critical but stable condition last night at land Shock Trauma Center. State police spokesman Greg Shipley said in a news release last night that one of the 11 remaining medevac helicopters had been cleared for service. Shipley added that police hope to put others into operation as inspections and flight tests are completed over the next couple of days. And a quote from the Washington Post: " Younger called her mother just before 11 p.m. and calmly explained that she and Wells had just been in an accident. Her mother rushed to the scene with her best friend and Younger's grandmother. seemed fine, her mother recalled: no bleeding, no broken bones, just some chest pain. " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 2, 2008 Report Share Posted October 2, 2008 This is my first time to Reply to this Listserve. I apologize if I mess it up. While I do not speak for my service or for any other Air-Medical program, I want to assure you that I take Air-Medical Safety very seriously. As should we all. As the Chief Flight Nurse for an Air- Medical provider, and a veteran Paramedic of 22-years, I am responsible for ensuring Safety for my Staff, the Patient's we are entrusted to care for, bystanders, and the many agencies (EMS Services / Fire Departments / Hospitals / Law Enforcement) that we attempt to assist in the provision of health care. There have been Air-Medical accidents that were avoidable. This is non-disputable. We talk frequently about the Chain-of-Survival in medicine. There is also a Chain-of-Safety. Air-Medical services obviously MUST do a better job. With that said, I also want you to know that there are MANY Air-Medical providers that are doing things right! However, as with any chain, it is only as strong as its weakest link. The challenge for any leader of an organization, and anyone doing the work within an organization, is to identify the weakness before it breaks. As with any " non-forgiving " activity, when something fails the results can be catastrophic. This is plainly obvious with some of the Air-Medical accidents that have occured. With regards to whether or not Air-Medical transport makes a difference, there is still much evaluation that needs to be done. What are the two-most complicated words in medicine??? " Prove It. " As is the case with so much of Emergency Medicine, EMS and ED care included, there is much we do that is not proven. Civilian Air- Medical transport is younger than EMS...and " that ain't saying much. " We DO need more comprehensive research to evaluate the mode of transport and the procedures performed during that transport. I compliment Dr. Bledsoe, who I have the had the privelege of knowing for almost 20-years, for asking the tough questions of Air-Medical services. These questions are usually the catalyst for getting things moving. The only thing I can attest to, which will be viewed as " worthless " once I say it because it is not embedded in science, is: " I have witnessed the benefits. " Unfortunately, statements like these are anecdotal. I have my Rolodex of " miracles " from both my Ground-EMS experiences and my Air-Medical experiences. I " know " which patients would not be here if one of these modern miracles (Ground-EMS and Air-Medical transport) were not available to them. I also " know " which TRULY benefited from Air-Medical transport in conjunction with their Ground-EMS miracle. I " know " which benefited from Air-Medical transport from smaller-facilities that were transferring patient's to tertiary centers. I " know " which patients benefited from bypassing an ED and being taken DIRECTLY to the Operating Room upon arrival by helicopter from a remote accident site. The problem? I " know " but I can't prove it to you. I am very willing to participate in developing research that addresses the tough questions posed by others. It should be done. It needs to be done. Research is not my forte as statistical methodology sometime escapes me. I am surrounding myself with people who know far better than me how research needs to be done. Be patient, and be participative when asked how you can assist. With regards to appropriate utilization of Air-Medical assets, there is still much improvement that is needed. Air-Medical transport is no different than any other segment of medicine. When I worked on the ambulance, there were many calls that did not justify a response and certainly not a transport. When I worked in an Emergency Department, there were many patients that did not need to be there but they were and they were cared for. The use of a helicopter should be different, Right? After all, the people that are calling for its use are highly trained and qualified individuals, Right? Unfortunately, this filter is not always effective. I have received patients on the helicopter from Physicians and Paramedics alike whom did not warrant Air-Medical transport. The reasons are broad: ED overcrowding, Uncertainty about not " knowing " what the illness/injury is but " knowing " that something is wrong, no ground- ambulance available in a timely manner, and yes, misdiagnosis. However, most of the time, it is simply " over-triage. " The concept that some hightened sensitivity is called for to ensure that you aren't missing something. In the latter case, it is simply someone doing what they believe to be the best thing for the patient. As Dudley and others have stated, we need to continue to " Define " and " Refine " utilization criteria for Air-Medical activation. We have much to learn and I also believe that there is much we offer to the continuum of Emergency and Critical Care Medicine. Tough Questions are being asked and they deserve a response. Lastly, as a continuation of the Safety paragraph early in my " lengthy " post, I wanted to let you all know that a US Congressman, Mica, has requested a Congressional Hearing on Air Medical Safety. I support this initiative as well as the recommendations of improvement that have been encouraged by the NTSB, the Association of Air Medical Services, and other Senators/Congressmen that have Bills in the works. I have posted Congressman Mica's Press Release from today below. Sincerely, Salter NEWS RELEASE Committee on Transportation and Infrastructure Congressman L. Mica, Ranking Republican 2163 Rayburn H.O.B. Washington, D.C. 20515 republicans.transportation.house.gov For Immediate Release Contact: Harclerode October 2, 2008 Republican Leaders Call for Hearing on Air Ambulance Flight Safety Washington, D.C. – Transportation and Infrastructure Committee Republican leaders are requesting the Committee conduct a hearing into air ambulance flight safety when Congress returns for business next year. A September 28th crash of an emergency air medical flight near Washington, D.C. brought the number of such accidents in the past year to 15 (eight of the accidents have involved fatalities). " Air ambulance flights are responsible for saving numerous lives because of how quickly they can get a critically injured person into the hands of medical professionals, " said U.S. Rep. L. Mica (R- FL), Republican Leader of the Transportation and Infrastructure Committee. " So when an accident like this happens, it is particularly devastating because help was so close at hand. " With the recent increase in accidents and the reintroduction of the FAA reauthorization bill next year, a hearing on medical flight safety would bring some necessary focus to what safety improvements need to be made to help prevent these tragic incidents and provide oversight of the FAA's actions related to the safe operation of air medical flights, " Mica said. " Medical flight personnel risk their lives on missions of mercy, and their passengers are patients – wholly blameless and already undergoing medical emergencies, " said U.S. Rep. Tom Petri (R-WI), the ranking Republican on the Aviation Subcommittee. " We owe it to everyone involved, their loved ones, and to ourselves to get to the bottom of the apparent increase in medical flight accidents. " The National Transportation Safety Board (NTSB) has recommended measures to improve safety, including equipping aircraft with terrain awareness and warning systems (TAWS) and equipment to allow safer flight at night and in poor weather conditions. NTSB has also recommended adopting flight risk evaluation programs and procedures, and the appropriate pilot and crew training. The Federal Aviation Administration (FAA) formed a task force to look into the increased number of medical flight accidents and is in the process of developing enhanced safety rules that include several of the NTSB recommendations and development of better metrics to track general aviation operations, including air medical flights. > > I'll jump in here Dr. B.? Dr. Bass is wrong...if you go strictly off physiologic signs then you will get those who need to be at a Level 1 Trauma Center quickly there quickly.? What you won't do is fly patients who are walking around a traffic accident scene calling their mother on their cellphone!!!! > > Certainly even those who very pro-flight can agree that this was not an appropriate use of an air-medical resource?? Even if for some reason, this patient needed to go to a Level 1....they could have gone by ground even if it took 2 or 3 hours.... > > In our RAC, we use criteria labeled Red/Blue. http://www.strac.org/Docs/Red_Blue%20Docs/STRAC_Red- Blue_Draft_Jan_8_2008.pdf? > > If the patient has one Red criteria or two Blue criteria they must go to a Level 1 Trauma Center.? If the patient has one blue and the paramedic feels other criteria dictate, the patient can be triaged to a trauma center (but flying wouldn't be appropriate).? If the patient has NO red or blue...the patient can be transported to any hospital of the patient's choice.? We have been monitoring this for 3 years and there have been no instances where patients with no red/blue have needed emergent (within 30 minutes of arrival at a non- Level 1 facility) transport to a Level 1.? There are patients every month that end up getting transported to a Level 1, but these patients are transferred with our regional transfer system promptly and more times than not, they are transferred for specialized care...not a missed traumatic injury. > > This criteria has worked so well, one of our local surgeons implemented it in Iraq for the flight crews when he was Chief of Trauma over there in 2006/7.? Not saying it is the panacea...but it has allowed us to work on getting away from mechanism as a reason to go to a trauma center. > > No offense, but we really must stop using risky transport (helicopters and lights and sirens on the ground) for things that we as medical professionals should be able to successfully manage during transport to an emergency room.? In the last couple of weeks I have heard patients being flown that had appendicitis, abdominal pain after an MVA (normo-tensive) and non-STEMI chest pain when the ED with a cath lab was 25 minutes away.? And all of the agencies are ones that would be considered " advanced " because of their extensive formulary carried on their units. > > Just my thoughts tonight. > > Dudley > > > MSP Crash > > > > > > > People consider it bad form to discuss incidents related to a tragedy > following a tragedy. But, given that there have been 13 crashes in 9 months, > when is the best time to discuss this problem? It seems the popular > press--nonmedical reporters--recognize what we in EMS cannot. Mechanism of > Injury alone has no role in trauma center transport or HEMS usage. To quote > , and , " When will they ever learn? " These articles well > define the arguments. > > baltimoresun.com > Copter crash raises doubt > Rules on trauma are questioned > By Gadi Dechter and Brent > October 1, 2008 > The two young women whose car crash in County prompted a medevac > flight that turned fatal early Sunday had only bruises and pain after the > auto accident but no apparent injuries so severe they indicated need for a > helicopter transport to a trauma center, officials said yesterday. Still, > the ill-fated medevac call fit within national guidelines used by land's > emergency medical system - guidelines the system's head now says need to be > studied and perhaps revised. > > Dr. R. Bass, executive director of the land Institute for > Emergency Medical Services Systems, which oversees the medevac program, said > paramedic reports showed that the car crash victims had " chest pain, neck > and back pain " and one had a large bruise between her ribs and hips. Those > injuries, Bass said, " in and of themselves would not have been indicators to > take to a trauma center. " The helicopter was summoned because one of the > " mechanisms " of the accident suggested a probability of serious injury of > more than 20 percent. In this case, the deciding factor was that an external > part of the car " intruded " by more than a foot into the passenger > compartment. In land, emergency medical personnel use triage guidelines > developed by the American College of Surgeons when deciding whether to take > a patient to a trauma center. If a trauma-bound patient is more than a > 30-minute drive from the nearest trauma center, state helicopters are used. > Under the triage guidelines, EMTs first look for physiological signs of > serious injury, such as trouble breathing. Then, they look for anatomical > indicators of grave injury, such as gunshot wounds or puncture wounds to the > central part of the body. If none of those indicators is present, > first-responders look at the mechanism of injury, such as the height of a > fall. Some of these mechanisms are statistically linked with a likelihood of > serious injury that may not be immediately apparent at the accident scene, > such as internal bleeding. If first-responders only rely on visible signs of > severe injury, " people will die, " Bass said. Still, deciding which > mechanisms should automatically equate to a trauma transport has become a > years-long struggle " within the trauma medical community, Bass said, because > relying on mechanisms alone leads to " over-triage, " or unnecessary > hospitalization in expensive trauma centers. > > The controversy flared up in land last month, when some state lawmakers > noted that almost half of the patients flown by helicopter to land > trauma centers are released within 24 hours - suggesting to them that the > helicopters are overused. > When transport to a trauma center involves medevac helicopters - which have > been involved in a spate of nighttime accidents across the country recently > - the risk of over-triage is magnified, according to Bass. This week's > accident " raised the issue for us about what is the relative risk, and what > is the right thing to do in terms of deciding to transport patients from the > scene? " Bass said. While a federally funded project has recently come up > with revised decision-making guidelines designed to > reduce unnecessary trauma-center usage, there hasn't been a formal effort at > building into triage criteria the added risk of helicopter transport, Bass > said. The MIEMSS director said that land's vaunted medevac operation - > which until this weekend had not had a fatal accident in more than 20 years > - is particularly well-suited to that task of making those calculations, and > Bass said he will suggest to his board of directors that land take up > the issue. " Maybe it's time to grab the bull by the horn and get that done > and see what kind of consensus guidelines we can come up with, because this > is obviously an issue of national interest, " Bass said. > > Del. Dan K. Morhaim, co-chairman of the Joint Committee on Health Care > Delivery and Financing, called last month's hearing, which was prompted in > part by a legislative audit that criticized the state police's fiscal > management and helicopter fleet maintenance. Morhaim, in an interview > yesterday, said he still sees a need for medevac service but added that the > system's reliance on the national triage guidelines needs to be > re-evaluated. Between 4,500 and 5,000 patients are transported to hospitals > by the state's medevac unit every year, at a cost to taxpayers of about > $4,000 per trip. " One of the significant differences in land as opposed > to other states is we have excellent paramedics > able to deliver outstanding care in field and stabilize patients. Sometimes > the need to transport by helicopter isn't as grave as in other states, " > Morhaim said. > > Killed in the crash were the pilot, H. Bunker, 59; Tfc. Mickey > Lippy, 34, a flight paramedic; Tonya Mallard, 38, an emergency medical > technician from the Waldorf rescue squad; and J. Younger, 17, a > passenger in one of the cars that collided. called her mother from > the accident scene, which her mother went out to. " It's like I keep hearing > her say, 'Mom, it's going to be OK. It's OK,' " Younger told WJZ > TV. The lone survivor was Jordan Wells, 18, a college freshman who was > driving the car in which was a passenger. She was in critical but > stable condition last night at land Shock Trauma Center. State police > spokesman Greg Shipley said in a news release last night that one of the 11 > remaining medevac helicopters had been cleared for service. Shipley added > that police hope to put others into operation as inspections and flight > tests are completed over the next couple of days. > > And a quote from the Washington Post: > > " Younger called her mother just before 11 p.m. and calmly explained > that she and Wells had just been in an accident. Her mother rushed to the > scene with her best friend and Younger's grandmother. seemed fine, > her mother recalled: no bleeding, no broken bones, just some chest pain. " > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 3, 2008 Report Share Posted October 3, 2008 Ditto, Amen. gda  Don Abernathy,CCEMT-P AHA Regional Faculty MSP Crash > > > > > > > People consider it bad form to discuss incidents related to a tragedy > following a tragedy. But, given that there have been 13 crashes in 9 months, > when is the best time to discuss this problem? It seems the popular > press--nonmedical reporters--recogniz e what we in EMS cannot. Mechanism of > Injury alone has no role in trauma center transport or HEMS usage. To quote > , and , " When will they ever learn? " These articles well > define the arguments. > > baltimoresun. com > Copter crash raises doubt > Rules on trauma are questioned > By Gadi Dechter and Brent > October 1, 2008 > The two young women whose car crash in County prompted a medevac > flight that turned fatal early Sunday had only bruises and pain after the > auto accident but no apparent injuries so severe they indicated need for a > helicopter transport to a trauma center, officials said yesterday. Still, > the ill-fated medevac call fit within national guidelines used by land's > emergency medical system - guidelines the system's head now says need to be > studied and perhaps revised. > > Dr. R. Bass, executive director of the land Institute for > Emergency Medical Services Systems, which oversees the medevac program, said > paramedic reports showed that the car crash victims had " chest pain, neck > and back pain " and one had a large bruise between her ribs and hips. Those > injuries, Bass said, " in and of themselves would not have been indicators to > take to a trauma center. " The helicopter was summoned because one of the > " mechanisms " of the accident suggested a probability of serious injury of > more than 20 percent. In this case, the deciding factor was that an external > part of the car " intruded " by more than a foot into the passenger > compartment. In land, emergency medical personnel use triage guidelines > developed by the American College of Surgeons when deciding whether to take > a patient to a trauma center. If a trauma-bound patient is more than a > 30-minute drive from the nearest trauma center, state helicopters are used. > Under the triage guidelines, EMTs first look for physiological signs of > serious injury, such as trouble breathing. Then, they look for anatomical > indicators of grave injury, such as gunshot wounds or puncture wounds to the > central part of the body. If none of those indicators is present, > first-responders look at the mechanism of injury, such as the height of a > fall. Some of these mechanisms are statistically linked with a likelihood of > serious injury that may not be immediately apparent at the accident scene, > such as internal bleeding. If first-responders only rely on visible signs of > severe injury, " people will die, " Bass said. Still, deciding which > mechanisms should automatically equate to a trauma transport has become a > years-long struggle " within the trauma medical community, Bass said, because > relying on mechanisms alone leads to " over-triage, " or unnecessary > hospitalization in expensive trauma centers. > > The controversy flared up in land last month, when some state lawmakers > noted that almost half of the patients flown by helicopter to land > trauma centers are released within 24 hours - suggesting to them that the > helicopters are overused. > When transport to a trauma center involves medevac helicopters - which have > been involved in a spate of nighttime accidents across the country recently > - the risk of over-triage is magnified, according to Bass. This week's > accident " raised the issue for us about what is the relative risk, and what > is the right thing to do in terms of deciding to transport patients from the > scene? " Bass said. While a federally funded project has recently come up > with revised decision-making guidelines designed to > reduce unnecessary trauma-center usage, there hasn't been a formal effort at > building into triage criteria the added risk of helicopter transport, Bass > said. The MIEMSS director said that land's vaunted medevac operation - > which until this weekend had not had a fatal accident in more than 20 years > - is particularly well-suited to that task of making those calculations, and > Bass said he will suggest to his board of directors that land take up > the issue. " Maybe it's time to grab the bull by the horn and get that done > and see what kind of consensus guidelines we can come up with, because this > is obviously an issue of national interest, " Bass said. > > Del. Dan K. Morhaim, co-chairman of the Joint Committee on Health Care > Delivery and Financing, called last month's hearing, which was prompted in > part by a legislative audit that criticized the state police's fiscal > management and helicopter fleet maintenance. Morhaim, in an interview > yesterday, said he still sees a need for medevac service but added that the > system's reliance on the national triage guidelines needs to be > re-evaluated. Between 4,500 and 5,000 patients are transported to hospitals > by the state's medevac unit every year, at a cost to taxpayers of about > $4,000 per trip. " One of the significant differences in land as opposed > to other states is we have excellent paramedics > able to deliver outstanding care in field and stabilize patients. Sometimes > the need to transport by helicopter isn't as grave as in other states, " > Morhaim said. > > Killed in the crash were the pilot, H. Bunker, 59; Tfc. Mickey > Lippy, 34, a flight paramedic; Tonya Mallard, 38, an emergency medical > technician from the Waldorf rescue squad; and J. Younger, 17, a > passenger in one of the cars that collided. called her mother from > the accident scene, which her mother went out to. " It's like I keep hearing > her say, 'Mom, it's going to be OK. It's OK,' " Younger told WJZ > TV. The lone survivor was Jordan Wells, 18, a college freshman who was > driving the car in which was a passenger. She was in critical but > stable condition last night at land Shock Trauma Center. State police > spokesman Greg Shipley said in a news release last night that one of the 11 > remaining medevac helicopters had been cleared for service. Shipley added > that police hope to put others into operation as inspections and flight > tests are completed over the next couple of days. > > And a quote from the Washington Post: > > " Younger called her mother just before 11 p.m. and calmly explained > that she and Wells had just been in an accident. Her mother rushed to the > scene with her best friend and Younger's grandmother. seemed fine, > her mother recalled: no bleeding, no broken bones, just some chest pain. " > > > > > > > Quote Link to comment Share on other sites More sharing options...
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