Airmed-evacs?

[Mark]

Is it just me or are some Medics over-doing some Air-Evacs in Maryland lately?
Example today Sunday 12pm somewhere in Cecil County MSP Trooper 1 is landing
to pick up patient for Shock Trauma who got clunked on head with a frying pan.
Patient is conscious and possible laceration as reported by ground Paramedic.
Like the old saying.. Is this trip really necessary?

Just seems like a waste of resources and expense at times not to mention putting Air crews in possible danger when not really needed.

Mark

 

[bwhite]

This came up a number of years back, perhaps 10 where I think UMMC was accused of some sort of impropiety by flying patients in to build up their business. I don't recall what came of it. I do recall back then hearing and reading about a number of flyouts where the patient was "treated and released". Seems like someone should be a bit more seriously injured for a flyout. I do know that there are EMS protocols for certain injuries/traumas where a flyout is part of the routine weather-permitting of course.

 

[gr8tff]

Trauma Decision Tree

The MD Trauma Decision Tree in the Protocols has 4 categories, A-D. There is specific information about when to consider aviation. I do agree that flight service in MD is misused often.

 

[Dispatcher308]

I have 2 questions

What does this have to do with Radio's???? And why are we arm chair quarterbacking a decision made by a provider that we no nothing about other than the info that was given???


Nathan

 

[Mark]

What does this have to do with Radio's???? And why are we arm chair quarterbacking a decision made by a provider that we no nothing about other than the info that was given???
Nathan

I was listening to scanner radio when i caught this MSP Med mission.
I thought it would interest a lot of you in that field as I am not.
But to keep on subject freqs heard were 46.180 MA and 47.660 Med-Evac.
By the way i think as Maryland residents we have every right to armchair our services.
It's the American way!

Mark

 

[fd2119]

I expect that we can expect to see more trauma referrals (both by ground and air) as a result of the trauma decision tree that MIEMSS has brought forth. This expands the mechanism category from only the physical factors seen on the scene (18" of intrusion on the patient's side, falls greater than six feet, etc), to include other factors, such as age (children and the elderly are, if I recall correctly, just about automatic traumas), as well as those with pre-existing medical conditions, such as heart and diabetes.

This is just what I recall from watching the video.

As for what it has to do with radios, those who scan EMS channels/talkgroups can expect to hear more transports to area trauma centers.

 

[bwhite]

What does it have to do with radios?
As a listener and participant I want that helo available for tasks where it is truly merited and not off doing a transport that may be questionable. Quite frustrating to be on scene with a serious trauma with an extended helo ETA because the appropriate nearer helo is unavailable.

 

[Mark]

What does it have to do with radios?
As a listener and participant I want that helo available for tasks where it is truly merited and not off doing a transport that may be questionable. Quite frustrating to be on scene with a serious trauma with an extended helo ETA because the appropriate nearer helo is unavailable.

Amen! B White.I like the fact Maryland has all these Helos for Med-Evac but just questioned some of the Med trips I have been hearing lately.
The above patient could have been in mobile ambulance at Christiana hospital
Class 1 Trauma center inside of 15 minutes instead of waiting to set up LZ zone etc
for Trooper 1 to haul all the way to Baltimore.
Now maybe Christiana had total divert at the time but that is very rare.
Just seems some more common sense needed here using these Helos costing $6k-$8k per hour flying time
only to have patient walk out of Trauma center after couple hours of minor Med treatment.

Mark

 

[fd2119]

Amen! B White.I like the fact Maryland has all these Helos for Med-Evac but just questioned some of the Med trips I have been hearing lately.
The above patient could have been in mobile ambulance at Christiana hospital
Class 1 Trauma center inside of 15 minutes instead of waiting to set up LZ zone etc
for Trooper 1 to haul all the way to Baltimore.
Now maybe Christiana had total divert at the time but that is very rare.
Just seems some more common sense needed here using these Helos costing $6k-$8k per hour flying time
only to have patient walk out of Trauma center after couple hours of minor Med treatment.

Mark;
Not knowing your background, please accept my apology in advance if it appears that I'm talking down to you; it's not my intention.

I'm not sure how many people are familiar with the concept in EMS of a mechanism trauma. The general concept is that a scene is observed, and a great deal of energy appears to have been transferred (high speed vehicle crashes, long falls, etc; anything you look at the whole scene and say to yourself, "This person should be much worse off!"), you can essentially call them a mechanism trauma.

I would encourage anyone who's interested in learning more to refer to this link, specifically page 128, for more information. Page 128 is the trauma decision tree.

 

[bwhite]

fd,
Know what you mean but it seems like better judgement might be indicated on some of these, I know everyone's afraid of the lawyers. I distinctly remember a flyout a number of years ago for a finger injury, (read this one in the newspaper), patient treated and released probably before the helo returned to base.
(Kinda reminds me of the school administrators where everything has to be black and white so that they don't have to use judgement.......got an Aspirin in school, then you have drugs, your suspended or expelled).

 

[Mark]

Mark;
Not knowing your background, please accept my apology in advance if it appears that I'm talking down to you; it's not my intention.

I'm not sure how many people are familiar with the concept in EMS of a mechanism trauma. The general concept is that a scene is observed, and a great deal of energy appears to have been transferred (high speed vehicle crashes, long falls, etc; anything you look at the whole scene and say to yourself, "This person should be much worse off!"), you can essentially call them a mechanism trauma.

I would encourage anyone who's interested in learning more to refer to this link, specifically page 128, for more information. Page 128 is the trauma decision tree.

Thanks for link fd.Medical acronyms and procedures a little over my head here but document and basic procedures look clearly spelled out.
I found page 32-33 interesting in regards to Helo transport.
Looks like to me on-scene paramedic has to make request for Helo thru Syscom
and they make the call.I would assume that Syscom reviews all Helo transport cases
and Med reports and if procedures were correctly used.
Like 308 said I may have only heard part of story here but on surface it seemed almost trivial.
Did paragraphs (b) (c) apply to above case?
That is someone elses call..

Mark

Page 32-33...
ALL REQUESTS FOR SCENE HELICOPTER TRANSPORTS SHALL BE MADE THROUGH
SYSCOM. (NEW ’05)
b) Consider utilization of a helicopter when the patient’s condition warrants
transport to a trauma or specialty referral center and the use of a
helicopter would result in a clinically significant reduction in time
compared with driving to a trauma/specialty center.
c) If the time of arrival at the trauma or specialty referral center via ground
unit is less than 30 minutes, there will generally not be a benefit in using
the helicopter, especially for Trauma Decision Tree classes “C” and “D”.

 

[jpsmith2]

Example today Sunday 12pm somewhere in Cecil County MSP Trooper 1 is landing to pick up patient for Shock Trauma who got clunked on head with a frying pan.

To help clarify what some may be hearing on the scanner... (does that keep this on topic?)

Cecil has an automatic dispatch policy with the medevacs for certain calls, because of a history of long response times to our area & long travel times by ground to a rated trauma center. Depending upon what the dispatcher who takes the call hears, a medevac will be automatically started prior to the arrival of a provider on scene.

Not sure of the specifics on this call, but if there was any indication that the "clunkee" had lost conciousness after being whacked that would certainly have warranted an automatic dispatch & transport to trauma. The individual may have also had a decreased level of conciousness that would have indicated transport to trauma.

With the helicopter already in the air, many times for Cecil by the time the providers arrive & assess the medevac is just about here so it's just as quick & easy to send them 'downtown' than it is to transport to a local facility, especially if there is any hint of an indication that they should go to trauma.

Overkill? Probably, but better to overkill on some calls than to have some seriously injured sucker laying alongside the road waiting 30 minutes or more for the situation to play out & MSP to arrive to take him to a decent hospital... and those were the kind of wait times we were getting in the past.

10 years ago it was almost an every call occurrance to try & decide to wait for the helo or beat feet to Christiana, or start towards Trauma & meet the medevac enroute somewhere in Harford County... or call SkyFlight Care from Brandywine or Trooper 4 from Delaware State Police. Entirely too dicey... especially in the western part of Cecil where it's a toss up either way.

Now, when providers arrive & confirm a need for the helo a pretty standard response ETA is about 8-10 minutes. Much better for all involved.

 

[bwhite]

Makes perfect sense JP, that sounds like forward thinking.

 

[maus92]

FYI, we should not worry about "putting Air crews in possible danger when not really needed." Helo operations/transports are not intrisically dangerous - in fact they are probably safer than transporting by ground with the exception of when the weather/visibility is poor. In the case of poor weather, the MSP helicopters are normally grounded. Flight crews are highly trained, the machines are well maintained, and ground units generally have the training and experience in selecting and securing landing sites.

CA
Annapolis

 

[Mark]

Always a danger though..

http://www.foxnews.com/story/0,2933,354984,00.html

Mark

 

[maus92]

Helicopters do and will crash from time to time, just like any other human operated and maintained machine. It is interesting to note that this was the operation's first crash since the program was implemented in 1985. The hospital spokesman said that the service averages about 3 or 4 missions a day. I wonder how that compares to terrestrial transports.... Anywho, from the press account at least, it sounds like the dreaded CFT accident - Controlled Flight into Terrain. Or as the NTSB puts it, Pilot failed to maintain the minimum safe altitude.

I'm always amazed that people continue to go apesh*t when a helicopter crashes, grounding aircraft "until the investigation is complete." Really more of a PR reaction than anything useful. The military will ground aircraft when there is evidence of a catastrophic structural failure, or a spate of accidents involving the same type. This doesn't seem to be the case in this accident. And on a side note, the US Army flies thousands of sorties a day, many to or from unprepared fields, without incident more than 99% of the time.


CA
Annapolis