Sunday, October 23, 2011

Question for the EMTs...

 Note: I am NOT an EMT, nor a Doctor, and I am NOT trying to pass judgement on the below referenced professionals....I would assume (and hope!) that they know more about emergency care and transport than I do.....But I do have some questions:

Sunday, 10/23/11
05:25AM: I wake up hearing an unusual disturbance across the street. Look out and there are lots of emergency vehicles in a (more or less) circle around a field. I have seen this before: Someone is going to get a helicopter ride to a hospital.

05:43 AM: Helicopter wakes me up as it lands across the street: this has happened before as the field is convenient for Lifeflight copters to get into and out of.

06:10 AM: ambulance arrives (presumably) with patient.

06:54 AM: Lifeflight helicopter takes off.

Question: Does the 44 minutes on the ground loading the patient not negate the "Golden Hour" when you have at least a 20 minute flight time (even by air and with priority routing) to a Level One Trauma Center?

I mean, on a Sunday morning, I could have driven 3/4 of the way to the nearest Level One Trauma Center in the time they spent loading the patient before taking off (without lights and sirens and just driving normally) . Add in the flight time, and I could have the patient at the same place in the same amount of time. Possibly less.

Seriously. And that is assuming that they went to a Level One center. A Level Three center is much closer and likely faster by ground ambulance.

Generally the time between ambulance arrival and helicopter departure is like 10 minutes MAX. Not so this time.

As the 'copters engines were shut down, I could hear the laughing and joking going on by the assorted crews. No real sense of urgency.

Now, while I really don't want to criticize the emergency responders (and I must point out that I do not know the nature of the injury) I do have a few questions:

If the injury is serious enough to require a whirlybird ride to a trauma center, why no rush to get the patient there? Why spend all the time on the ground?  I was serious about being able to drive most of the distance in the time that they sat, with the patient, on the ground. I don't know what the cost is for a helicopter ride, but it has to be HUGE. (I also need to point out that I don't know the details of the incident, but it looks strange from here)

If there was no rush, then why the 'copter? If the 'copter was needed, then why the delay?

Enquiring minds want to know, and all that.....

Interestingly, Ambulance Driver has a comment on this subject as well


Unknown said...

While I agree helicopters are over used and sometimes an unnecessary financial burden to the patient, there are a couple of factors to consider (I am not saying these were a factor in this call. A) many life flight birds bring a doctor to the scene who can use advanced airway techniques and other immediate life saving skills that are not available from a paramedic. B) Sometimes stabilization is necessary at the scene and this can be time consuming, but without it, there is no sense in taking a dead person to the E.R.

I do agree that air ambulance are an often overused gimmick, but each call is different, you just hope those making the decisions are making the right call. If they are not, you hope they can be replaced or retrained.

B said...

Good point about the doctor, hadn't thought of that. Wouldn't stabilization take place at the scene of the accident/incident or in the ground ambulance on the way to the helicopter? Or in the air? Rather, I mean, than waiting on the ground?

The Helicopter pick up site is 10 miles from a level 3 Trauma Center. 6 minutes or so in an ambulance. If the trauma to the patient is that great, wouldn't you be better moving them to an ER for stabilization, then to a better hospital by helicopter rather than working in a field for 45 minutes?

I hate to second guess the professionals here, but 44 minutes in the field/on the ground doesn't make sense.

Unknown said...

I didn't comprehend the distances. It makes little sense in this case unless a doctor was needed. A lot of medics do not know when its time to "load and go" instead of "stay and play".

Ambulance Driver said...

The distances you cite tell me this was a raging case of rotoriasis on the part of the ground medics.

Craig, just how common are doctors on air med crews? The statistics show this is an exceedingly rare crew configuration, with the vast majority of crews being nurse/medic and a few being dual medic crews.

And while the doctor may have more skills, and given the sorry state of airway education in EMS these days, your-run-of-the-mill ER doc shouldn't have appreciably greater airway skills and tools than an experienced helicopter flight crew. An anesthesiologist, yes, but just an ER doc? Not in my experience.

The "send a doctor to the scene" mindset isn't necessarily valid, and quite often the doctors are even worse than medics at realizing when it's time to load and go or stay and play.

Case in point: Princess Diana. The doctors stayed on scene with her for nearly an hour after extrication, and she died from injuries that may well have been survivable had her accident happened in the U.S. Had someone managed her airway, started some lines and driven her really fast to a surgical suite somewhere, rather than doing improvised meatball surgery in a friggin' traffic tunnel, she might still be alive today.

B said...

yeah, I mean, I can DRIVE to Loyola Med Center in Chicago in about an hour from my home. Arguably one of the best centers in the Midwest.

Had they loaded and gone, then the 'copter makes sense, depending on the injury. But in less than 6 minutes farther, they could have had this patient in an ER. Maybe not a Level 1, but it's gotta be better than a field, and if the local ER decided to transport him/her, then it's only another 3 minutes or so airtime(probably less) farther from the hospital than from the field.

B said...

I do need to reiterate. I don't know the details, I only know what it looked like this morning from the outside. I would hope that the people involved would know what they are doing. There may be details of which I am unaware.

One would hope that their judgement would be better than it appears.

Anonymous said...

Having worked on rescue crews in the past, I observed many EMTs that wanted to "play" but not deal with the "hassles" of transport. Easier to just dump it onto the chopper crew.

Since I wasn't EMT - only first responder/extraction/driver/scene grunt - my opinion didn't count...although I had the experience to recognize the difference between need for paramedic (by chopper - rarely did an MD show up. Once or twice in 10 years) and simple stabilization for the 45 minute ride into town.

On the other hand - not knowing the details of the case you mention - the patient may very well have been getting critically needed care for stabilization without the immediate need of the majority of the crew standing around. The crew then has adrenaline to burn off - and every EMT/rescue crew I've worked with has a "different" sense of humor - often expressed "loudly".

Old NFO said...

Interesting, and at 40 minutes, it 'really' would have probably made more sense to package and go in the ambulance. Your point is well made, but I can tell you if they shut the bird down, the emergency wasn't that bad... Having flown MAST back in the day, we never shut down on a scene, and rarely were we there over 10 minutes total.

B said...

Old NFO:

my point exactly.

My hope is that they didn't take their time because the person dies en-route to the transfer....

Divemedic said...

Not that it is true in this case, but many times a delay where a helicopter sits on the ground waiting on a patient is because there is an extrication or some sort of special rescue going on.
Cutting a car open to get to a patient is sometimes a lengthy process.

Jake (formerly Riposte3) said...

I'm guessing that the engines shut down before the patient got there (I doubt the pilot would idle on the ground for 27 minutes)? The laughing and joking in that situation is normal. For the crew handling the LZ, there is no real urgency, they're just sitting around and waiting.

The 44 minutes between the ambulance arriving and liftoff is very strange. The only thing I could think of is that you may have missed that ambulance leaving to take the flight crew to the scene and then returning with the patient. We have done that with prolonged extrications, because the flight crew can perform certain interventions that we can't. If that wasn't it, then I don't know what could account for it.

Unknown said...

@Ambulancedriver: We have 4 different air ambulance companies near the Cleveland area. I am in a semi-rural volunteer/part time area. Many of the medics in the area have issues with limited calls+little experience even after years on the F.D. 1 air service (Metro Life Flight) has a doc that rides, but it is a crap shoot as any rotation could have a podiatrist, but in their promo, it IS a doc. Funny 10 years ago we had 2 air providers and still fly roughly the same amount in the area. Problem is, much of their responsibility is propaganda, coming out to the f.d.'s, for inservices and brainwashing the brass. For a while we had the ridiculous policy of flying all suspected CVAs and stemis. I was written up for coming on to a basic scene and not flying a suspected CVA, on the word of the EMT-B crew. It was removed from my file when the Chief finally read the run report and saw the problem was a glucose level of 18. That would have been a very expensive flight for an amp of D-50.

Ambulance Driver said...

The fact that there are four helicopter services now instead of two, and still fighting over the same number of flights, demonstrates the problem: helicopter EMS proliferated because it was lucrative, not because it was necessary, and that's a situation ripe for abuse.

And the sad thing is, the places that really need helicopters will never get helicopters, because there's no money in it. So what you wind up with is a pack of helicopters clustered around an urban area, all fighting for their piece of the pie.

The Phoenix metropolitan area has nine helicopter services, but get out in the frontier away from the urban centers, and you won't find a one.