RE: response to wes question

October 21, 2008

Our medical director will not allow us to bypass the nearest facility which

was a level IV.

Debbie

I have a scenario for you guys

Respond to a call were someone has been hit in the head by a tire. Will he

is airing it up it explodes. You arrive and find a 20-25 year old male

sitting with blood clotting in nose laceration to bridge of nose and

swelling to the forehead and nose and severe knee pain with laceration.

Patient is sitting in chair as we approach the foreman tells the patient to

put his head back, we stop that action and take manual c-spine the patient

states " what happened to me? " Due to the local hospital being level IV and

the nearest level III is 45 miles away we decide to airlift. The foreman

immediately states no helicopter! We tell him that whatever this young man

has cannot be fixed in our local hospital and that it would be best to have

him at a higher level of care as quickly as possible he again says no

helicopter and that we are wasting time we have the young man c-collared,

spiders, head blocks, backboard moved to unit monitors attached IVs

attempted pt begging to be airlifted and foreman still refusing helicopter

screaming we been on scene 45 minutes (in reality 15 minutes). He even

states that every time you come out here you have to airlift(we have been to

this plant 5 times airlifted one with all ribs separated from sternum due to

crushing injury from forklift).

What would you do?

Would you complain?

And if yes to who?

This is the highest man on the totem pole at this plant so where do you go

from here? Just forget it or is this something that can be taken up with

DSHS?

Debbie

October 21, 2008

Fire your medical director and get one that's not a drooling fool.

Now, Debbie, you're not going to like the rest of what I have to say, but I

say it respectfully, even though it's going to sound blunt. I'm old and

crotchety, let's face it.

I see no reason to have airlifted the patient based upon your description of

injury. Neither do I see any reason to have taken him anywhere but your

Level IV based upon your description of his injuries and condition. Presumably

they have X-ray there. Unless he's showing signs of Cushing's he probably

just needs to have his head x-rayed and his nose fixed. If he needs HEMS, they

can get it.

Even if it were appropriate to take him to the Level III there's no reason

that he could not have been grounded, would have got there within a few minutes

of when he would have got there by air, if you had put him into your truck and

left, which is what you should have done anyway rather than sitting there

arguing with the foreman.

Let the Level IV make the determination. Chances are he doesn't need a

neurosurgeon, and HEMS is not without risk, as we know. The foreman's concerns

about cost are legitimate, although he doesn't have the knowledge nor the power

to determine the method of treatment or transport.

Now, there are two ways to deal with the foreman. The first and best is get

your patient and you off the scene immediately. Go a mile down the road and

then do what you want.

Second is, as everybody has said, get LE involved and let them handle him.

Now, that will make him an enemy for life, but he's probably nobody you want

to invite over for dinner anyway. Of course, there is always that possibility

that LE will do nothing because they're afraid of his political clout, in

which case revert to plan one.

What alarms me most about this is the kneejerk decision to call HEMS. I see

no way that this patient needed to be flown nor would flying him do anything

to change his outcome. If he were unconscious with bradycardia, blown

pupils, and a BP of 200/130, that would be a different story MAYBE. I still

think

you'd be there within 10 minutes of air one way or another if you had gone by

ground. Your situation almost duplicates the one I worked in for the last 4

years of my working medic career, and we learned that if we did what ITLS and

PHTLS say (LOAD AND GO) we usually beat the chopper to the hospital and saved

our patient an $8,000 bill.

BTW, when I was your age I probably would have made the very same decision

you did. I was convinced that the magic smell of aviation fuel and the

thump-thump-thump of the rotors worked miraculous cures. I was wrong.

Respectfully,

Gene Gandy

>

> Our medical director will not allow us to bypass the nearest facility which

> was a level IV.

>

> Debbie

>

> I have a scenario for you guys

>

> Respond to a call were someone has been hit in the head by a tire. Will he

> is airing it up it explodes. You arrive and find a 20-25 year old male

> sitting with blood clotting in nose laceration to bridge of nose and

> swelling to the forehead and nose and severe knee pain with laceration.

> Patient is sitting in chair as we approach the foreman tells the patient to

> put his head back, we stop that action and take manual c-spine the patient

> states " what happened to me? " Due to the local hospital being level IV and

> the nearest level III is 45 miles away we decide to airlift. The foreman

> immediately states no helicopter! We tell him that whatever this young man

> has cannot be fixed in our local hospital and that it would be best to have

> him at a higher level of care as quickly as possible he again says no

> helicopter and that we are wasting time we have the young man c-collared,

> spiders, head blocks, backboard moved to unit monitors attached IVs

> attempted pt begging to be airlifted and foreman still refusing helicopter

> screaming we been on scene 45 minutes (in reality 15 minutes). He even

> states that every time you come out here you have to airlift(we have been to

> this plant 5 times airlifted one with all ribs separated from sternum due to

> crushing injury from forklift).

>

> What would you do?

>

> Would you complain?

>

> And if yes to who?

>

> This is the highest man on the totem pole at this plant so where do you go

> from here? Just forget it or is this something that can be taken up with

> DSHS?

>

> Debbie

>

October 21, 2008

That's odd to me. A medical director that will not allow an EMS service to

transport to a higher level of care facility. I could understand if the service

was BLS only but an MICU should not have any issue transporting that level of

patient. If one was to consider the air unit a higher level of care then there

would be a reason to not by-pass a facility as mentioned. A 45 minute transport

by ground one way is not enough alone, although some flight companies will

disagree, to warrant an air lift.

One must take in all the criteria before launching a helicopter.

Joby Berkley EMT-P

________________________________

To: texasems-l

Sent: Tuesday, October 21, 2008 4:23:40 PM

Subject: RE: response to wes question