RE: Panel supports fewer medevac flights (more detail)

[Guest guest]

Panel: State has too many helicopters

Edgewater

polis

Should add paramedic on emergencies, follow FAA rules

By ELISABETH HULETTE, Staff Writer

Published November 26, 2008

land probably has more helicopters than it needs, and on emergency calls

those helicopters should carry an additional paramedic, a panel studying the

state's medevac system concluded yesterday.

In their preliminary report, panelists also said the program should be

accredited and follow federal commercial aviation standards.

" It's just a matter of tweaking the system, " said Dr. Bledsoe, a

professor of emergency medicine at the University of Nevada School of

Medicine, who served on the panel. " It's not fractured, but it's got some

cracks. "

The panel was convened in response to a medevac crash in September that

killed four people. Critics have since said the helicopters are overused.

The panelists, a lineup of academics and hospital administrators with

expertise in trauma, got a rundown Monday morning on land's system.

C. MacKersie, director of trauma services at San Francisco General

Hospital in California and chairman of the panel, briefly read the

preliminary recommendations yesterday.

The panelists agreed land likely has too many helicopters and should

undertake further study to determine how many it really needs. The state had

12 before September's crash and now has 11.

Dr. Bledsoe, who has been vocal about the overuse of medical helicopters,

said he thinks land needs only six - four in use at any given time and

two for backup.

The panelists also suggested medevac comply with the Federal Aviation

Administration's regulations for commercial aviation, a set of stringent

rules for weather conditions and other protocol, said Tom Judge, executive

director of LifeFlight of Maine.

And it recommended the program be accredited by the Commission on

Accreditation of Medical Transport Systems. Going through that accreditation

process would require heftier reviews and likely further changes, including

adding a second paramedic on board medevac flights.

Deputy Majority Leader Dan Morhaim, D-Baltimore County, a former emergency

physician, said the recommendations are " a start. "

" Although I think it was a really expert panel, their focus was narrow, " he

said. Other facets of land's emergency medical system also should be

reviewed, he said, like the 500,000 ambulance runs and 2.5 million emergency

room visits in state hospitals each year.

Dr. Bledsoe added that the system needs a culture shift, away from thinking

of helicopters only as speedy transport to the hospital, and toward

prioritizing the care provided to patients once they're on board.

" That will be a radical change, " he said. " Speed is less important than the

quality of care. "

The State Emergency Medical Services Board will review the panel's

recommendations at its Dec. 9 meeting, and a written report will be released

in January.

" We're going to be considering these recommendations very carefully, " said

Dr. R. Bass, executive director of the land Institute for

Emergency Medical Services Systems. But he admitted the economy may make

implementing

changes difficult.

" We're in an austere fiscal environment, and that will present some

challenges as well, " he said

The panelists said more studies are needed before the state can truly reform

medevac. The data needed for such a review just wasn't there for this panel,

said Dr. A. , director of trauma at Vanderbilt University Medical

Center in Nashville, Tenn.

" You need to get people in here to look specifically at number and location

(of helicopters used), and who are empowered to make recommendations up

through the resource allocation channels, " he said. " But that is not what a

group of guys spending eight hours in land can do. "

From: texasems-l [mailto:texasems-l ] On

Behalf Of phillipsdo@...

Sent: Wednesday, November 26, 2008 11:44 AM

To: phillipsdo@...; westmetroplexems ;

texasems-l

Subject: Panel supports fewer medevac flights

This story was sent to you by: Don

Interesting.

--------------------

Panel supports fewer medevac flights

--------------------

By Little

November 26 2008

land's emergency medical helicopters could fly fewer accident victims to

hospitals without reducing survival or affecting quality of care for

patients, a panel of experts told state officials yesterday.

The complete article can be viewed at:

http://www.baltimoresun.com/news/health/bal-md.medevac26nov26,0,2360554.stor

y

[Guest guest]

> Deputy Majority Leader Dan Morhaim, D-Baltimore County, a former emergency

> physician, said the recommendations are " a start. "

> " Although I think it was a really expert panel, their focus was narrow, " he

> said. Other facets of land's emergency medical system also should be

> reviewed, he said, like the 500,000 ambulance runs and 2.5 million emergency

> room visits in state hospitals each year.

That's sure to thrill the glut of volunteer EMT-Bs that run EMS in that state.

> Dr. Bledsoe added that the system needs a culture shift, away from thinking

> of helicopters only as speedy transport to the hospital, and toward

> prioritizing the care provided to patients once they're on board.

> " That will be a radical change, " he said. " Speed is less important than the

> quality of care. "

I'll drink to that. But it pretty much leaves you in the same boat in land.

With so much EMS run by vollie EMT-Bs there, the helos are called for quality of

car just as much as they are for speed. And for some bizarre reason, a great

many paramedics still associate helicopters with advanced care themselves.

Consequently, it's going to take more than a quick re-education to change the

culture. Old habits, mistaken notions, and half-baked theories die hard. There

is no quick fix for the culture.

Rob

[Guest guest]

" Critics have since said the helicopters are overused. "

Being a provider in land I have been a critic of this abuse for nearly 20

years. The system is broke when family members and ground units make it to the

hospital before the patient in the helicopter does. Part of the problem is with

dispatching. The medevac's aren't on the initial dispatch, they are requested by

the ground units after they are responding or after they get to the scene. It is

a case of hurry up and wait. Another problem is that anyone can request the

helicopter. Anyone, basic EMT or the fire officer. Yes I said fire officer

meaning little to no EMS training. Scene time increases as the trooper medics

get on the scene and they do another full assessment before the patient is moved

to the helicopter. By this time the patient has or should have recieved two full

assessments. How soon we forget the " load and go " concept where most of these

patients should have a thorough assessment done enroute to the hospital.

We also have the glory seekers calling the helicopter because it makes for good

theatrics with all the tourists on the way to the beach watching the helicopter

land on the highway while it is blocked for an hour or more. Then you have the

field providers who think the trooper medics are the Sky Gods. No offense to the

Trooper Medics, that sarcasm was towards the field providers.

I really don't think that we have to many helicopters as I feel they are also

needed for the police work. I would hate to see us lose the ones we have. During

down times these trooper medics are available to do road duty and many of them

respond to medical emergencies they hear dispatched on the county radios. Many

in the state of Texas and other states would love to have 14 helicopters.

land does have a great Medevac system and I would hate to see us lose that.

I strongly feel that the system needs more oversight and system of educating the

field providers. One thing we don't need is privatizing the system like one of

our State Senators has been pushing for many years now. His position is

unethical as he has a vested interest in commercial helicopters.

By the way I think Texas has one of the best EMS systems in the country. Like

land there could be some fine tuning to make it better. Keep up the good

work.

Anyway sttepping down off my soapbox now.

I hope everyone had a wonderful Thanksgiving.

Larry W. Dodd

Salisbury, land

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