Re: ER vs helicopter times to doctor

[Guest guest]

If that's the case maybe we should also measure door to ultrasound times? Or

other studies??

Sent from my iPhone

All of this discussion makes me curious about several factors about txp times

and evaluation times to an ER physician. Does it vary between helicopter vs.

Ground at door time? Does the initial report have an outcome on the patient

outcome? Is there any studies to support any findings? What life saving

interventions can be done by air ems vs a competent ground medic, with time

being a factor? I know that over utilization of helicopters has been beaten to

death.... I however want to know if we are using them more because we are afraid

of pt presintation vs actual skill and training of a paramedic vs actual time to

envasive treatment.

I am always trying to learn from other people and this seems to be a vast wealth

of knowledge that is readily avalible.

Forgive me for my gramatical errors.

Sent from my iPhone

[Guest guest]

If that's the case maybe we should also measure door to ultrasound times? Or

other studies??

Sent from my iPhone

All of this discussion makes me curious about several factors about txp times

and evaluation times to an ER physician. Does it vary between helicopter vs.

Ground at door time? Does the initial report have an outcome on the patient

outcome? Is there any studies to support any findings? What life saving

interventions can be done by air ems vs a competent ground medic, with time

being a factor? I know that over utilization of helicopters has been beaten to

death.... I however want to know if we are using them more because we are afraid

of pt presintation vs actual skill and training of a paramedic vs actual time to

envasive treatment.

I am always trying to learn from other people and this seems to be a vast wealth

of knowledge that is readily avalible.

Forgive me for my gramatical errors.

Sent from my iPhone

[Guest guest]

I don't know of any time studies comparing door to doctor for each mode. It

would be interesting.

My own experience is that either mode that calls to report a serious patient is

met by " the team " at the bedside.

I would point out that the most lifesaving procedure can be done by any provider

in any setting, heck we can even talk lay persons through it over the

phone...open the airway! Not with a tube, with your hands. OPEN THE AIRWAY!

>

> All of this discussion makes me curious about several factors about txp times

and evaluation times to an ER physician. Does it vary between helicopter vs.

Ground at door time? Does the initial report have an outcome on the patient

outcome? Is there any studies to support any findings? What life saving

interventions can be done by air ems vs a competent ground medic, with time

being a factor? I know that over utilization of helicopters has been beaten to

death.... I however want to know if we are using them more because we are afraid

of pt presintation vs actual skill and training of a paramedic vs actual time to

envasive treatment.

>

> I am always trying to learn from other people and this seems to be a vast

wealth of knowledge that is readily avalible.

>

> Forgive me for my gramatical errors.

> Sent from my iPhone

>

>

>

>

>

>

>

>

[Guest guest]

I don't know of any time studies comparing door to doctor for each mode. It

would be interesting.

My own experience is that either mode that calls to report a serious patient is

met by " the team " at the bedside.

I would point out that the most lifesaving procedure can be done by any provider

in any setting, heck we can even talk lay persons through it over the

phone...open the airway! Not with a tube, with your hands. OPEN THE AIRWAY!

>

> All of this discussion makes me curious about several factors about txp times

and evaluation times to an ER physician. Does it vary between helicopter vs.

Ground at door time? Does the initial report have an outcome on the patient

outcome? Is there any studies to support any findings? What life saving

interventions can be done by air ems vs a competent ground medic, with time

being a factor? I know that over utilization of helicopters has been beaten to

death.... I however want to know if we are using them more because we are afraid

of pt presintation vs actual skill and training of a paramedic vs actual time to

envasive treatment.

>

> I am always trying to learn from other people and this seems to be a vast

wealth of knowledge that is readily avalible.

>

> Forgive me for my gramatical errors.

> Sent from my iPhone

>

>

>

>

>

>

>

>

[Guest guest]

Even examining " door to doctor " you would first have to evaluate the accuracy of

the times you're getting. I know of several places that the majority of the

'door to-' times are mostly a fiction. That's not to say that people are

deliberately lying (though I've seen that here and there) but rather that they

are largely viewed as immaterial and if even completed, are frequently a " best

guess " giving the benefit of the doubt to the provider/hospital. The most

accurate times are general those in the narrative of the nurse or physician

t-sheet (or other system) and even that is quite variable, and may not be

present for some things. Many times again that is a best guess, particularly

when doing computerized charting not at the bedside.

Austin

> I don't know of any time studies comparing door to doctor for each mode. It

would be interesting.

>

> My own experience is that either mode that calls to report a serious patient

is met by " the team " at the bedside.

>

> I would point out that the most lifesaving procedure can be done by any

provider in any setting, heck we can even talk lay persons through it over the

phone...open the airway! Not with a tube, with your hands. OPEN THE AIRWAY!

>

>

> >

> > All of this discussion makes me curious about several factors about txp

times and evaluation times to an ER physician. Does it vary between helicopter

vs. Ground at door time? Does the initial report have an outcome on the patient

outcome? Is there any studies to support any findings? What life saving

interventions can be done by air ems vs a competent ground medic, with time

being a factor? I know that over utilization of helicopters has been beaten to

death.... I however want to know if we are using them more because we are afraid

of pt presintation vs actual skill and training of a paramedic vs actual time to

envasive treatment.

> >

> > I am always trying to learn from other people and this seems to be a vast

wealth of knowledge that is readily avalible.

> >

> > Forgive me for my gramatical errors.

> > Sent from my iPhone

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

Even examining " door to doctor " you would first have to evaluate the accuracy of

the times you're getting. I know of several places that the majority of the

'door to-' times are mostly a fiction. That's not to say that people are

deliberately lying (though I've seen that here and there) but rather that they

are largely viewed as immaterial and if even completed, are frequently a " best

guess " giving the benefit of the doubt to the provider/hospital. The most

accurate times are general those in the narrative of the nurse or physician

t-sheet (or other system) and even that is quite variable, and may not be

present for some things. Many times again that is a best guess, particularly

when doing computerized charting not at the bedside.

Austin

> I don't know of any time studies comparing door to doctor for each mode. It

would be interesting.

>

> My own experience is that either mode that calls to report a serious patient

is met by " the team " at the bedside.

>

> I would point out that the most lifesaving procedure can be done by any

provider in any setting, heck we can even talk lay persons through it over the

phone...open the airway! Not with a tube, with your hands. OPEN THE AIRWAY!

>

>

> >

> > All of this discussion makes me curious about several factors about txp

times and evaluation times to an ER physician. Does it vary between helicopter

vs. Ground at door time? Does the initial report have an outcome on the patient

outcome? Is there any studies to support any findings? What life saving

interventions can be done by air ems vs a competent ground medic, with time

being a factor? I know that over utilization of helicopters has been beaten to

death.... I however want to know if we are using them more because we are afraid

of pt presintation vs actual skill and training of a paramedic vs actual time to

envasive treatment.

> >

> > I am always trying to learn from other people and this seems to be a vast

wealth of knowledge that is readily avalible.

> >

> > Forgive me for my gramatical errors.

> > Sent from my iPhone

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

Actually, I think that there's something to be said for looking at

door-to-doctor times. I think that a lot of times, EMS views definitive care as

" We got them from Point A to Point B: Definitive Care. " But patient care doesn't

stop as soon as you walk through those doors, and in some patients, definitive

care is an OR.

There is one hospital in particular that I can think of by me that posts STEMI

reports in their EMS Lounge, and evaluates how long it took us to get the

patient to them, when the AMI was called in, how long it took the cardiologist

to arrive, how long it took the patient to get into the OR, etc, etc.

Now... maybe it's just me being a newbie and thinking that these papers actually

mean something, maybe I've got it all wrong, but I personally like being able to

look up and see that the doctors are held to standards, too, and that these

patients are being followed and their care examined, and if something doesn't

get done fast enough, it's noticed, even if it's only noticed by the nurse who

keyed in the information.

And I never will forget when I was working in another town and there was a paper

posted on the inside of the door of the EMS breakroom showing a rather large AMI

and noting that this was the heart of one of our fellow medics. (It didn't give

the name, and I didn't know who it was, but it served as a reminder that we are

not above being patients.)

Alyssa Woods, NREMT-B

CPR Instructor

> I don't know of any time studies comparing door to doctor for each mode. It

would be interesting.

>

> My own experience is that either mode that calls to report a serious patient

is met by " the team " at the bedside.

>

> I would point out that the most lifesaving procedure can be done by any

provider in any setting, heck we can even talk lay persons through it over the

phone...open the airway! Not with a tube, with your hands. OPEN THE AIRWAY!

>

>

> >

> > All of this discussion makes me curious about several factors about txp

times and evaluation times to an ER physician. Does it vary between helicopter

vs. Ground at door time? Does the initial report have an outcome on the patient

outcome? Is there any studies to support any findings? What life saving

interventions can be done by air ems vs a competent ground medic, with time

being a factor? I know that over utilization of helicopters has been beaten to

death.... I however want to know if we are using them more because we are afraid

of pt presintation vs actual skill and training of a paramedic vs actual time to

envasive treatment.

> >

> > I am always trying to learn from other people and this seems to be a vast

wealth of knowledge that is readily avalible.

> >

> > Forgive me for my gramatical errors.

> > Sent from my iPhone

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

We get weekly reports from one of our facilities. They send us D2B and E2B

times for STEMI patients. This week we started getting E2F (EMS to

fibrinolytics) for patients that don't go to cath lab. I think it is really

good to get this kind of feedback.

Neil

On Sat, Jan 15, 2011 at 9:29 PM, jeremydriver jeremydriver@...>wrote:

>

>

> All of this discussion makes me curious about several factors about txp

> times and evaluation times to an ER physician. Does it vary between

> helicopter vs. Ground at door time? Does the initial report have an outcome

> on the patient outcome? Is there any studies to support any findings? What

> life saving interventions can be done by air ems vs a competent ground

> medic, with time being a factor? I know that over utilization of helicopters

> has been beaten to death.... I however want to know if we are using them

> more because we are afraid of pt presintation vs actual skill and training

> of a paramedic vs actual time to envasive treatment.

>

> I am always trying to learn from other people and this seems to be a vast

> wealth of knowledge that is readily avalible.

>

> Forgive me for my gramatical errors.

> Sent from my iPhone

>

>

>

--

Neil White, RN, LP