Is That Helicopter REALLY Necessary?

Over at M.D.O.D., ERdoc85 wonders if some of his patients are being transported inappropriately via helicopter.

And the answer to that question is, “Hell yes, most of them.”

A great many ground EMS crews are infected with advanced rotoriasis, but the problem is not limited to the EMS profession. Quite a few rural ER docs are ate up with it, too.

I weary of refuting this foolish notion we’ve developed over the years that mechanism of injury is not simply a part of the assessment criteria, but the assessment itself, We need to stop triaging patients to trauma centers, and flying them on helicopters, based solely on that criteria, because of it.

I’ve written about it elsewhere, and you can read about it here.

Other, more well-known EMS leaders have, as well.

It’s stupid, dangerous and irresponsible, and doesn’t speak well of our ability to accurately assess patients. Most of the arguments to defend helicopter EMS abuse are easily refuted.

Next time you consider calling for the bird, think of our brethren dying in a helicopter crash, ask yourself if that flight is really necessary.

And if your primary justification for the flight is mechanism of injury, or the helicopter is the quickest way to clear an ER bed, or to allow your ground EMS crew to go back into service sooner, you’re part of the problem.

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  • Matt G

    You know my position on unnecessary birds. I've likewise seen helos landed in very tight spaces in the middle of a housing development, when there's a wide-open field of graded housing plots just 150 yards away. (Bad choice by the incident commander. Just because they CAN land there, technically, doesn't mean that they SHOULD.
    I've seen a girl CareFlighted to the trauma center at 01:00, and that same girl make her high school dance at 20:00, same date.
    I've seen a stable patient with a bad cut to the underside of the arm be flown away, even though the blood was dark red and oozing when I and the paramedics got there. (As a guy who had to help with the LZ, I kept wondering “Why?!?”)
    When I took a familiarization class with the CareFlight (or choose your helicopter ambulance company name) 9 years ago, they told us that the average lift to a trauma center was $26,000, partly because of all the false starts that they have to let go, which somebody has to pay for. And fuel's no cheaper, now. Think about that, the next time you call for a bird when you've got an uninsured patient who could be seen by your local hospital, and could go in the box.

    And don't you DARE make that bird wait on the ground for 20 minutes while you “complete your assessment.” If it's so all-phuquing-important to load this CRITICAL trauma patient aboard a helicopter, then look sharp about it once the bird hits the LZ. Otherwise, it's clear to the rest of us that you just wanted to spend $26k of someone else's money, to look important.

  • ZerCool

    There is definitely a bit of rotorwhacken out there.

    In my area, from the center of the county, it is:
    56 road miles to a Level 1 Trauma and teaching hospital
    58 road miles to a Level 1 Trauma
    46 road miles to a Level 2 Trauma

    For a helo flight, it's 20-25 minutes from request to “on the ground”, 10-15 minutes for patient package and transfer, 5 minutes to liftoff, and 15-20 air minutes to any of the above hospitals.

    Ambulances are either requesting a helicopter as they leave the station (based solely on dispatch information, which is spotty at best), or arriving on scene, doing a quick eval, and then requesting a helicopter – thereby delaying transport and arrival to “definitive care”.

    If a ground transport can be accomplished in less time than it will take to fly, WHY is anyone bothering with a helicopter? The ONLY thing that a helo has going for it is (1) whole blood and (2) some more advanced procedures (central lines and a few more drugs, iirc).

    I've had this debate with a few of the local medics over beers. We send them to an MVA *with unknown injuries* and they request “check on a helicopter”. They can't seem to understand that the helicopters don't do “checks”; it's either “on standby” or “in the air”. Either way, that resource is now unavailable for someone else who may have a legitimate need for it. The justification? “Well, protocols say to consider helicopter transport for accidents on roads with a speed limit above X mph.”

    Drives a dipsh… dispatcher nuts.

  • Ambulance_Driver

    Speaking of such, just helped set up an LZ for the most. Inappropriate. Helicopter. Flight. Evar.

    No, it wasn't my patient, and no, the patient didn't actually get transported, but only because he'd been refusing helicopter transport ever since the ground unit left the scene.

    And he was 100% justified in doing so. The helicopter shouldn't have been called in the first place.

  • HueyDoc

    As an exhelicopter pilot, I got out after friends of mine were killed or became quads after crashes and am now an ER doc. Yes, helicopters are called too often, but guess what? When the hospital buys that new 8 million dollar helicopter, they push hard for it to be used so it can pay for itself.

  • D_spaff

    You could say the same thing about transporting some patients by Ambulance. I see firefighters going to the hospital lights and sirens for minor complaints, such as back pain, minor cuts and abraisions, or even the simple crisis patient…..

  • Ed

    I find this article insulting. I work fixed wing now as a nurse/medic. Was working up until last year rotor wing for a county based ems system. I would say that the great majority of our calls were appropriate. Why? Due to well written protocols and frequent training with the ground crews.

    and yes I have lost friends in airmedical crashes, but I still continue to fly and support our system.

  • Khateer1

    I work in a rural area with the closest Level 1 over 100 miles away. I think a lot of meidcs I know love to call for a helicopter just because they can. Admin has got wind of it and are finally scrutinizing every helicopert transport. I have to justify to myself, after a good pt assesment, if I am going to fly soemone. I cannot concider myself a good pt advocate if I just burdenrd someone with a 30,000$+++ bill that may not be covered by insurance for nothing. The close level 2 hospital can fly the pt if they find something that wasn't obviously life threateningly apparent that they can't treat. I usually try to folow up on all flown pts for future reference and education. I did just fly a pt with a GSW to the lt anterior chest just lateral to midline about the 4th intercostal space, through and through exit at the scapula that turned out missed everything. We can't be correct 100%, but I felt justified for that one.

  • Medic by choice

    I have been working in EMS since 1988. I have done ground, rural, city, and now air (rotor and fixed wing) Although I completely agree that SOME flights are absolutely necessary… at least HALF are not. I (for one) am sick and tired of putting my butt at risk for “Bread & Butter” Flights. My coworkers and myself have been launched for “splinter in finger”, “red spot on boob”(<–red spot the size of a quarter), “diabetic wound care” (<– “wound” was a dime sized scab on leg) It's INFURIATING!! I have and will ALWAYS do the right thing for my patients, but when all I have to worry about is “pleasing the customer”… this is no longer worth risking my life.

  • Scott

    … you continue to support an industry which is generally poorly regulated, and continues to put responders at serious risk for a patient's life? An ambulance fails, generally people will survive. A helicopter fails, and gravity takes over.

    If you look at other systems, there are regions in the world with awesome HEMS coverage, and no crashes. Why? Dual-Engine, Redundant systems, and strict rules for flying conditions, as well as landing/takeoff zones.

  • Ambulance_Driver

    Ed, I'm sorry you find the article insulting. My intention is not to denigrate helicopter EMS. Earlier in my career, I did my hitch as a flight medic, too.

    My point is that helicopter EMS abuse is a very real issue, and flying patients based only on MOI is one of those practices that unnecessarily endangers you, and my friends who work on helicopters.

    Your area may have well-trained ground crews and super-duper, well-written protocols and launch criteria, but that is not the case in many other areas of the country. Metropolitan Phoenix, AZ has something like nine EMS helicopters serving that area. I've got a friend who spent 5 years as a flight medic there, and he's had scenes where they had more helicopters than patients.

    Helicopter EMS abuse is a problem, and not just because unnecessary flights unduly burden the patients with huge bills. They also endanger my friends and colleagues.

    I'll not even mention the scores of peer-reviewed studies that showed little or no benefit from helicopter EMS for the vast majority of patients, because that's Bryan Bledsoe's schtick, and he's more conversant with the numbers than I am.

    Instead, I'll direct you back to the original point of my article, which you may have missed because you felt insulted:

    Do you really feel it is appropriate to fly a patient for the sole reason of MOI, or getting a ground crew back into service quicker?

  • SmokeEater359

    if your chopper is 26 to 30K your doing yourself a bad service and trying to collect more funds for your self and not doing the people you help any good . I volunteer in a rural new mexico county where the nearest hospital is a 45 minute drive at the post speed of 65 mph. It takes my unit sometimes 5 to 10 minutes for the paid unit to get enroute at one or two clock in the morning. And another 5 to 7 minutes for my volunteer unit to get going this pretty much shoots the golden hour in the butt. the bird is the only thing that saves our pt's if they are a critical pt. as a volunteer we (check) to see if the bird is available if it is we launch them the few air crew that i have dealt with says they would rather be in the air and turned aroundin mid flight than to get called 20 minutes later and it taking them 20 minutes to get there again the golden hour by that time is done now it is up to the pt's ability to want to stay alive so that we can get them to the hospital. yes some use of the bird is a lost call. i had a paramedic call for a chopper for a baby that we volunteers had been working on for over 20 minutes because the medic did not want to loose a child on her shift it cost the family 5k for the dead baby to fly to the hospital just because a paramedic did not want to call the death of the child and sent his parents into town before the chopper got there. for us the chopper is a life saver sometime we get on scene and mess up about the chopper coming out but most of the time we are right about the use of the bird.

  • http://twitter.com/tbouthillet tbouthillet

    I think the “hard cases” are those situations where the patient has a significant MOI and altered mental status with the odor of ETOH on the patient. This happens a lot. There's a fine line between avoiding the inappropriate use of rotor-wing EMS and under-triage simply on the basis that a patient has been drinking.

  • Turk251

    I believe that the vast majority of flights are unwarranted. I know that this comment will upset a lot of EMS “professionals”, however it's a fact! If you have ever looked at the number of patients that are flown to Trauma facilities that either, didn't need to go there or were flown simply because of MOI, it's crazy. Over the years I have had medics try to justify flying patients due to distance, MOI, “I don't have x-ray vision”, “pt meets Trauma Alert Criteria”, and even the old “that's what they're there for”. Well I for one don't believe that our brothers on the helicopters are there to be used “just because they're on duty”.
    Helicopters should be used to get the patient to the needed trauma/surgical service that they need in the most timely manner possible. If you can get them there just as fast by ground, then STOP WAITING and load them in your rig and go. As an example, the service I once worked for (EMS only) responded to a MVC with another service (Fire based) where there were 2 patients. We chose to load our patient and ground transport while the other crew chose to fly their patient. Our patient was at the trauma facility, evaluated by the trauma team, moved to a surg. suite and the ER room cleaned before the second patient arrived by air. Patient number 2 was released the next day.
    Helicopters are an essential part of patient care WHEN NEEDED. I just believe they are severely over used and this is NOT in the best interest of of all involved.

  • Schmidty227

    i am sorry to hear that you get silly calls, but that is part of the job and you go when you are requested. if you dont take it then we get called as the ground crew, then you get to get back to your nap or tv show you are watching. just because you are in the helicoptor doesnt mean you are the gods of ems. i wish you guys would come back to reality and realize you once worked ground amb too. i am sorry but we ground crews put our lives at great danger too on the ground. if you dont like putting your life at danger then get off the rotor!!!! let others who want the job do it, and they wont complain of there request.

  • Ambulance_Driver

    I wrote the post he's agreeing with, and I am</> ground crew. And we ground crews run millions more calls and drive millions more miles than the helicopter flight crews, and still the death rate is far higher for flight crews. Their job is more dangerous than ours, and there is no disputing that.

    And yes, silly calls for stupid reasons are a fact of life for EMS. But when the silly calls for stupid reasons are being made by presumably educated medical professionals, it's inexcusable.

    That's why your “Suck it up and do the work, you helicopter prima donna” argument doesn't work.

  • CBEMT

    And another 5 to 7 minutes for my volunteer unit to get going this pretty much shoots the golden hour in the butt.

    If you still think the “golden hour” is a legitimate medical concept/term, I have serious questions about whether or not you should be able to call for a helicopter. Sorry.

  • T13

    I think if you study the situation you may find a correlation between State government Trauma systems pushing their idea of whats necessary for flights, onto ground services and a rise in unnecessary flights.

  • Matt G

    Danger? Most boxes aren't allowed to show up until the scene is secured. The death rate for helicopter crews is FAR higher than for anyone on a box. Schmidty, Khateer wasn't slamming ground crews generally– he was saying that there's no reason for an airlift in such circumstances as he described. If you can't see that, then you're a liability to EMS, sir.

  • http://www.arizonarangerems.blogspot.com The Ranger

    I agree on the helicopter thing, but as to the issue of c-spine based on MOI – or even helicopters being called thanks to that – has anybody consdiered that litigation may bear some consideration on such protocols?

    “…the words of Nancy Caroline, hand-written on papyrus leaves…” Jesus pleezus, that is funny…

  • Trish

    I totally agree here. I know of a case where a patient with AIDS (full case of it) O.D'd and was unresponsive. The ambulance drove this patient 15 minutes to a place where the helicopter could land. Didn't call for the helicopter until they got to the spot, waited another 45 minutes for the team to arrive, and once it did, the patient was responsive. The ambulance could made the entire trip to the ER in 25 minutes…useless call, I would say so.

  • 746HARP

    I WOULD RATHER BE SAFE THAN SORRY. I THINK IT IS MORE LIKELY TO HAVE AN WRECK IN AN AMBULANCE RATHER THAN A CRASH IN A HELICOPTER. AMBULANCE WRECKS HAPPEN EVERY DAY. YOU MIGHT BE RIGHT IF YOU WORK IN A BIG CITY BUT IN A SMALL TOWN, DON'T THINK SO. WE ARE 50 MILES FROM NEAREST TRAUMA CENTER, SO FOR TRAUMA THE HELICOPTER IS THE WAY TOP GO. DON'T KNOW IF YOU HAVE EVER WORKED IN A SMALL TOWN OR NOT, BUT YOU NEED TO WORK ALL AREAS BEFORE YOU MAKE A BLANK STATEMENT LIKE THIS.

  • CBEMT

    I WOULD RATHER BE SAFE THAN SORRY.

    First, stop shouting.

    Second, that has to be one of if not THE worst excuse for launching a helicopter there is. If you've such little confidence in your skills, or if your medical education is that lacking that you can't tell the difference between who needs REALLY one and who doesn't, then please- for the public's sake, turn in your card.

    . I THINK IT IS MORE LIKELY TO HAVE AN WRECK IN AN AMBULANCE RATHER THAN A CRASH IN A HELICOPTER.

    You think? I don't suppose you have any facts to back that up.

    AMBULANCE WRECKS HAPPEN EVERY DAY.

    And how often does someone die in an ambulance crash versus how often someone dies in a HEMS crash? Do you even know anything about this subject?

    YOU MIGHT BE RIGHT IF YOU WORK IN A BIG CITY BUT IN A SMALL TOWN, DON'T THINK SO.

    There you go with your thoughts and feelings again.

    DON'T KNOW IF YOU HAVE EVER WORKED IN A SMALL TOWN OR NOT, BUT YOU NEED TO WORK ALL AREAS BEFORE YOU MAKE A BLANK STATEMENT LIKE THIS.

    Since this is clearly the first of Kelly's blog posts you've ever seen, I suggest you 1) take your caps lock off, and 2) spend more time reading his blog and less time posting about things you have no knowledge of.

  • Ambulance_Driver

    I'm sure it plays a huge role.

    But if we let fear of litigation drive our practice more than medical research, we'd still be using rotating tourniquets for CHF and be giving lidocaine prophylactically to MI patients.

  • Ambulance_Driver

    I worked for 10 years in a system where we covered 962 square miles of rural countryside with two ambulances. Yeah, I know all about long response and transport times.

    Still, your opinion is incorrect. Ambulance crashes are more common, but only because we drive millions of more miles per year than those helicopters fly. Despite that, more flight medics die every year than ground medics.

    If your patient is hemodynamically stable and you're 50 miles from a trauma center, you need to be driving them, not flying them. The risk of flying for those stable patients is greater than the reward.

  • Ambulance_Driver

    And all to get back into service sooner.

    Yeah, that's a major problem as well, and one that many EMS agencies have begun to address.

  • Mick

    Data validates what all of you are saying.

    Forgive me for commenting in this forum as I am not a paramedic, and have no medical training, but I am a mathematician and co-developer of the evidence based Sacco Triage Method (STM). Following the fatal medevac crash in Maryland in 2008 (killed 4 including an 18 year old girl that called her mom following her minor auto crash to let her know she was ok, but was apparently flown due to MOI criteria), we analyzed data on more than 100,000 trauma patients. While STM uses physiology only, we extended this and statistically evaluated each of the various triage criteria (physiological, anatomical, MOI, etc) by age group and determined the impact of each criteria on survival probability.

    Based on this, the specific model (i.e. field criteria) is well defined. Here are the results:

    • 62% of flights are eliminated if you exclude patients with predictive survival probabilities of 95% and above with little or no expected deterioration for at least 90 minutes.
    • almost 50% of flights are eliminated if you exclude patients with predictive survival probability of 98% and above with little or no expected deterioration for at least 90 minutes.
    • Mortality rates actually decrease, primarily through evidence-based increases in air medical transport for older patients (who are significantly less likely to be air transported than younger patients with similar presentations)

    Note: This state’s database did NOT include patients whose were flown, but not admitted, so one could expect a further reduction in the number of flights.

    These results have not yet been published as we hope to we conduct some validating studies on data from other states.

    Again please forgive my intrusion in your forum, but I thought you might find this of interest.

  • Medic by choice

    IF you can manage to reread my post…It says nothing about me thinking I am a God of EMS or anything. I never have thought I was better than anyone else… especially because I remember where i came from and how I got here. I have “been there done that” in the streets for MOST of 22 years. I was elaborating on the point made my the writer that we get the BS flights just like you get the BS calls. AND… to be perfectly honest, IF the ground crews around here had better training (or skills) and smaller egos, this industry would probably shrink expedentially!!! YES a moderate of flights we do ARE necessary, but MOST are not. In fact, hospital “dumping” is rediculous in this area too… So pull the bug out of your butt, this wasn't a personal attack on YOU or what you do. We are all in this together, and THIS was my OPINION. You want my job Ricky Rescue… come take it. As for Ambulance_Driver, I appreciate your words and your forum. I apologize for the disruption. Stay safe brother.

  • User8332

    Does anyone remember or know how helicopters became so popular for EMS transport? As with quite a few advances in EMS we have the military to thank. And it worked great in a combat zone with few roads and sometimes long distances to a safe rear area MASH unit. No doubt many lives were saved but last time I looked most of us don't live in a combat zone. Here is one of many examples. I work in an area about 40 miles from a level 1 trauma center. Drive time is about 45-60 minutes depending on time of day. Now consider the amount of time required to fly the same patient. You request the bird and launch time is about 3-4 minutes, response time of about 25 minutes, landing and shut down about 5 minutes, ground time is rarely less than 15 minutes and often time greater than 25 even if you rag on the flight crew to get moving. Lift off and transport time another 20-30 minutes. Transport from the hospital pad to the E.D. usually about 5 minutes. So count all that up. Under the best conditions we have not been able to document a patient delivery time of less than one hour by helicopter. So what have we saved? Nothing. There is less room to work on a patient, fewer people to help due to weight restrictions in most aircraft, and a huge and I mean huge bill for transport for what. No change in patient outcome. Add to that you risk the flight crew and anyone on the ground in a crash. Of course that never happens right? My point is simple. Helicopter use has become a much over used resource. As a manager every single use must be given a very close Q.A. investigation. Stop and consider your options before you jump into something that is being shown to be unnecessary.

  • Medic by choice

    I agree that litigation has driven protocol changes. It's a shame too because over the years I have seen it evolve from “it's all about the patient” into “did you get the releases signed and the billing info?”. It's sad that 1-800-LAWYER is the norm now.

  • Ambulance_Driver

    Good points.

    And while helicopter EMS traces its roots to the Korean War and more closely to Vietnam's Dustoff units, they didn't really proliferate dramatically until medicare increased its helicopter reimbursement in the mid 1990s.

    It was all about the money.

  • http://www.flightweb.com Ultravioletb

    then seriously, you need to work for a different company if you actually launch for that kind of fluff. your company should exercise better judgment, because your program is not getting paid for those types of transports no matter how you write it up.

  • Wing and a Whim

    Speaking as Jane Random Public, but for y'all bitching about length of road to the hospital, at least you have roads. Working here at Merrill Field, I see the lifeflight jets and helis headed back in just as likely from the villages and coastal towns, the boats and processors as from somewhere on the road system. If you can't be thankful you have that asphalt alternative, at least be wise enough to use it when it is a good option.

    That said, for all the people brought in with heart attacks and severe injuries all over, when a helicopter launched one bad-weather day and didn't come back, and the bodies of people I knew have never been recovered, it was for a regular treatment that could have just as easily waited til the next day and taken the regular airline flight to Anchorage. That leaves a lot of bad feeling, and a sour taste in the mouth of the public. When [not if] the FAA decides to crack down because Congress cried “Do Something!” and the regulations end up strait-jacketing lifeflights, you'll not find sympathetic ears here unless you can prove you've drastically changed your tune. I do not support lodge owners who knowingly break regulations and good sense and pointlessly put their passenger's lives at risk, and I won't support medics who do it either.

  • Drgarygoodman

    I am an Emergency Medicine Physician. We work out of a large community hosptial where we do not have access to a cath lab or trauma center. I utilize helicopters as needed. I argue that there is occasional shortsidedness in helo use but I can argue that we use them as needed and often. I dont regret it.

  • Ambulance_Driver

    Dr. Goodman, evolving MI or stroke is a legitimate reason to call a helicopter, if the helicopter is significantly faster. Time is tissue, and no one questions that.

    Likewise, severe trauma requiring rapid surgical intervention is a legitimate reason to use a helicopter for inter-facility transport. If you can't stabilize the patient at your facility, you must transfer him to someone who can. No one disputes that, either.

    But, let me provide a few examples of flights I've seen reported in the past few months. Keep in mind that few of these involve my own agency, because the doctors at our Level II trauma centers utilize helicopter EMS appropriately, for the most part.

    Isolated tib/fib fracture, no neurovascular compromise. Flown to a trauma center 70 ground miles away.

    Burn patient with 40% second-degree burns flown to a burn center 180 ground miles away. No airway compromise, patient's fluid needs were being met, no associated traumatic injuries. In other words, not time-sensitive.

    The medical helicopter that crashed in Arizona last year was carrying a patient with a suspected black widow spider bite from one facility to another. He was stable, with no signs of anaphylaxis.

    I transported an MI patient to a large heart hospital two nights ago. She had been in the local hospital for a week. She was hemodynamically stable, no arrhythmias, and only a heparin drip. Hers was a N-STEMI, and her cardiac enzymes had already started to decline. Likely, her MI had been several days before. We transported her by ground only because the helicopter was refused due to weather. The ICU doctor was visibly pissed that the helicopter wasn't available, because the skies overhead were clear. Of course, the skies over the destination weren't, and the MI had largely run its course by then. So why did he want a helicopter? I asked him just that, and he couldn't articulate a reason other than “the helicopter is faster.”

    I agree that helicopter EMS abuse is more prevalent among prehospital providers than ER doctors, but I have no data upon which to base that assumption. The point is, rotoriasis can affect anyone.

  • BEMTNM

    I live in town that is 3 hours from any Level I or II trauma centers. And a majority of the smaller towns around us have only BLS on their volunteer services. Does Air Ambulance have a place here? (and yes I work for that air ambulance)

    What I find disgusting is when we pick up an MI that was taken to the local cath lab to find out: “oh yeah, we can't treat him here.” What is the purpose of that delay?

    Or better yet, when we get launched for an MVA and then declined because they end up taking the patient to the local hospital. Then invariably we're called about 4 hours later to pick up a soup sandwhich and take them to the Level I trauma center. And what was the Rx given at the hospital, other than a cashechtomy? I can't say… I won't deny that we don't pick up occasional “infected hang-nail” but certainly the abuse goes both ways.

  • http://www.facebook.com/sandro.rettinger Sandro Rettinger

    So, as someone in B school, who is still learning the field, can you possibly elaborate on your EMS Newbie site the reasons one should call for the bird?

  • http://roguemedic.blogspot.com/ Rogue Medic

    Mick,

    Excellent comments. There is no reason for you to feel that you should not comment.

    The problem is that not enough people are pointing out the problems with endangering patients by unnecessary helicopter flights.

  • http://roguemedic.blogspot.com/ Rogue Medic

    I WOULD RATHER BE SAFE THAN SORRY.

    Then don't endanger your patients by putting them in a helicopter, unless the benefit outweighs the significant risks.

    I THINK IT IS MORE LIKELY TO HAVE AN WRECK IN AN AMBULANCE RATHER THAN A CRASH IN A HELICOPTER. AMBULANCE WRECKS HAPPEN EVERY DAY.

    Please provide something more than I THINK to support your claim.

    YOU MIGHT BE RIGHT IF YOU WORK IN A BIG CITY BUT IN A SMALL TOWN, DON'T THINK SO. WE ARE 50 MILES FROM NEAREST TRAUMA CENTER, SO FOR TRAUMA THE HELICOPTER IS THE WAY TOP GO.

    Why?

    Provide some evidence of benefit to flying patients.

    DON'T KNOW IF YOU HAVE EVER WORKED IN A SMALL TOWN OR NOT, BUT YOU NEED TO WORK ALL AREAS BEFORE YOU MAKE A BLANK STATEMENT LIKE THIS.

    Maybe if you read some of the blog before you jump to conclusions you would realize that Ambulance Driver has worked in areas that make your location seem almost like a big city.

    Furthermore, if you actually read the articles that he linked to, you would realize that there is little benefit to patients from being put in a helicopter.

    You really want to be safe, rather than sorry, but you make a fool of yourself by prattling on about things you do not understand. Did you read any of the articles AD linked to?

    Do you follow up on the patients you send to the trauma center by helicopter and compare the outcomes with those you send by ambulance?

  • http://roguemedic.blogspot.com/ Rogue Medic

    BEMTNM,

    Nobody is stating that helicopters should never be used.

    We are stating that helicopters, and their crews, should not be abused.

    What I find disgusting is when we pick up an MI that was taken to the local cath lab to find out: “oh yeah, we can't treat him here.” What is the purpose of that delay?

    That sounds as if you have a problem with the local doctors.

    Aren't MI patients supposed to go to cath labs?

    Are you suggesting that all MI patients by-pass the cath lab, by helicopter?

    what percentage of the MI patients are transferred out by helicopter?

    Or better yet, when we get launched for an MVA and then declined because they end up taking the patient to the local hospital. Then invariably we're called about 4 hours later to pick up a soup sandwhich and take them to the Level I trauma center.

    Invariably?

    If you end up being called back 4 hours later every single time you are canceled, you really should do something about it. Go to the state medical board, or the media, or the medical directors, et cetera.

    The plural of anecdote is Myth.

  • http://roguemedic.blogspot.com/ Rogue Medic

    What Golden Hour?

    The Golden Hour is purely a marketing tool, like Rich Corinthian Leather.

    There is no basis for the Golden Hour, other than a few doctors sitting around, drinking beers, and trying to come up with a way to sell trauma centers.

    Trauma centers are important, but that does not mean that there is any validity to the Golden Hour.

    We need to recognize the truth. It is the Bogus Hour, not the Golden Hour.

  • http://roguemedic.blogspot.com/ Rogue Medic

    I find this article insulting.

    I recommend a reading comprehension course.

    If you are insulted by articles you do not understand, what are you going to do in the real world of EMS, where patients and coworkers die because of the kind of abuse described by Ambulance Driver in the article.

    If your protocols include flights for mechanism of injury, then your claim that your protocols are well written, is based on ignorance.

    I know. I know. You are insulted, again. The real world does not always provide support for your imaginary world. Accepting this is a part of growing up.

  • http://roguemedic.blogspot.com/ Rogue Medic

    That is also a huge problem.

    We should all be more critical of any type of abuse.

    Abuse of EMS helicopters endangers people.

    Abuse of lights and sirens endangers people.

  • http://www.facebook.com/profile.php?id=1382495132 Raymond Sparrow

    As i type this the FD has just launched the helicopter for a 30ft fall awake and alert. No i am not on scene i am in dispatch (yes AD I am one of those evil mouth breathing, slaves of the church of Jack Stout) but its only 20 minutes to the trauma center and the ambulance is only 5-6 minutes away from the scene. I have this knot forming in my gut now because it was my friend that is the only survivor of the crash here in Oklahoma and the same service that we are sending out now. Is it really necessary? I have good medics on the ambulance. How much time will the flight crew spend on the ground stabilizing their pt prior to flight? I think of all the patients that over the years we have flown based on mechanism alone, why because that pretty full color brochure with the helicopter on the front of it gave us criteria for scene flights. Hospital transfers by air simply because the local EMS did not have a paramedic and the DR had ordered K+ in the IV for no acute reason (been there done that) and would not saline lock it for the hour transport. Missing limbs, ROSC, fence post sticking out your chest some sort of real EMERGENCY Life or Limb reason for a helicopter. Otherwise suck it up and drive your buns into town. It is not worth our friends and family dying for “BETTER SAFE THAN SORRY” I think we have proven that its NOT SAFE and we are SORRY. And just so everybody knows i started EMS on a Vol FD on the KS/OK Line with a 92 mile one way transport to the trauma center in Wichita, Combat Medic in the Army, Hospital based EMS, and 2 of the top 10 busiest services in the nation over 26 years now. Its still not worth it just to save a medic from having to drive into the city, or to pay a shareholder a dividend. Lets not leave another family fatherless and another wife a widow needlessly. To steal a line from the MIA/POW folks “Gone but not forgotten” RIP Brothers

  • Matt G

    But the fatality rate of helo wrecks is far higher.

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  • http://www.facebook.com/people/Christian-Miller/100002129729103 Christian Miller

    This doesn’t touch on the REAL issue with helicopter medical transport.  The REAL problem is the exorbitant cost.  $36,000 for an HOUR!??  Nothing costs $36,000 an hour!!!

    And how is the patient supposed to pay for this?  The patient may have had NO input into the decision to transport by helicopter, but the patient–or the family–will ge the bill. Literally out of the blue and with no financial preparation or wherewithal to pay it.  Get a helicopter ambulance bill, and the next stop for most people will be Federal bankruptcy court.

    And were will the EMS guy be who made that call for the ambulance with this financial disaster destroying the individual and his/her family?   Well, the EMS won’t be in bankruptcy court, we know that.

    NOBODY has the right to send me a bill for $36,000 for ANYTHING there is no signed contract for–NOBODY!   You want to fly a helicopter, YOU pay for it.

    And what is this?  Pay us or you die?!  Fly us and file for personal bankruptcy?  Is this the real state of medical care now?

    A lot of health coverage plans do NOT cover medical air evacuation for this very reason–THEY don’t want to go bankrupt, so they don’t cover it.  This is crazy business that MUST be elevated to the public sphere, at the county & city level.  The people need to know about these financial time bombs sitting out there in the countryside, and what the emergency medical professions are prepared to do to them financially.  They WILL break you.

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Kelly Grayson

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