Some Md. ambulance crews 'skittish, '...

Some Md. ambulance crews 'skittish, ' officials say

There are 13 comments on the Baltimore Sun story from Nov 24, 2008, titled Some Md. ambulance crews 'skittish, ' officials say. In it, Baltimore Sun reports that:

State emergency medical officials say some ambulance crews in Maryland are "skittish" since the September medevac helicopter crash and might have become too reluctant to transport accident victims to the ...

Join the discussion below, or Read more at Baltimore Sun.


Hyattsville, MD

#1 Nov 24, 2008
Have you ever seen ambulance and fire apparatus responding to an incident? They are reluctant to send a patient by air? I am surprised that most patients don't suffer heart attacks while being driven to the hospital by ambulance. Volunteers firefighters mainly. Take my chances with the air any day. Not to discredit any ambulance of fire fighters (have the most respect for them and the hard work they do). Just musing about their driving. I would like to get my hands on the steering wheel of one of these vehicles. Good job guys and gals.
Rogue Medic

Capitol Heights, MD

#2 Nov 24, 2008
Clearly Dave has not been a patient in a helicopter. If he is scared by fire trucks, a helicopter ride will not have him feeling comfortable. While he is extremely critical of ambulance drivers, they arrive at the hospital safely much more often than the helicopters do.

The increased risk of death for the patient and helicopter crew is real. This has been demonstrated repeatedly at the expense of the lives of fight crews and patients.

On the other hand, the risks to the patient of death from an unrecognized injury, an injury that is only apparent in the damage to the car, that will be prevented by transport by helicopter - that risk is theoretical. That theoretical risk is, to quote from the article, "a concept that has also never been validated by scientific evidence."

United States

#3 Nov 28, 2008
Every talks about increase in accidents ready to cast blame. Really how many more flights are made today than 10 yrs ago. How do true percentages compare? As we improve time and quality of care over decades why are we so ready to revert to back to dinosaur days. dont try and destroy a proven life saver. promote safety and patient outcomes!

Minneapolis, MN

#4 Dec 1, 2008
Maybe if other drivers could learn to yield to emergency vehicles there would be less need for air transport. Other drivers are the problem as far as getting patients to their destination safely. I think all residents of their county should be required to do one ride along so they can see how poorly people respond to the emergent vehicle.

Baltimore, MD

#5 Dec 2, 2008
Get a grip.
Rogue Medic

Capitol Heights, MD

#6 Dec 2, 2008

Helicopter transport has not been proven to improve outcomes in the way that Maryland has been using it. The way it has been used, until the crash, actually delayed transport frequently, so that the patient could go to the hospital by helicopter. This is not good patient care.

Why is Maryland not operating to the same standards as others helicopter services? Why is Maryland satisfied with only one paramedic providing care? Taking a ground ambulance basic EMT is not the answer.

Baltimore, MD

#7 Dec 2, 2008
Agreed, Maryland should require two medics on board. Where have the lawmakers been for the past twenty or so years?

Helicopter transport is considered when deemed quicker than ground transport, or when ground transport is in excess of 30 minutes. There is nothing saying patients MUST be transported by air. It is to be considered. The ground providers make the judgement. Lets better train them...thats my opinion.
Rogue Medic

Capitol Heights, MD

#8 Dec 2, 2008

I completely agree about improving the education of the ground providers.

I think that the 30 minute time frame is arbitrary. The decision to fly is a bit more complex. Is the flight going to make a significant difference in travel time. Is the difference in transport time likely to have a significantly effect on outcome for the patient.

There is no reason to limit flights to trauma patients.

Baltimore, MD

#9 Dec 2, 2008
Indeed, it is arbitrary. However, I believe every patient should be seen within one hour of injury. Dr. Cowley is correct with this concept of a "golden hour." It's silly to reject this notion. Of course, it have never been scientifically proven, but better outcomes are seen. It's hard to beleive people reject this idea that injury is time related.

I think most flights are reasonable within our system. However, there are always laps of judgement in triage due to the stressful situations in which these decisions are made. Over triage is a national standard. I think what it boils down to is Dr. Cowley's original vision... Every person in Maryland should have quick access to trauma care from anywhere in the state, free of charge. Yes, we can improve, but will cutting back helicopters improve the system?

I think trauma patients are at the forefront of this "debate" because those patients make up a majority of medical flights. There is a greater need for in Maryland for medical transfer helicopters. Even to transfer a medical patient to another facility should be flown if the drive time is greater than one hour...maybe increase the MSP Aviation duties to include this and add another paramedic/RN to the aircraft? Just some thoughts...
Rogue Medic

Capitol Heights, MD

#10 Dec 2, 2008

The Golden Hour was purely a marketing tool developed by Dr. Cowley (the founder of Shock Trauma). There is no scientific basis for one half hour, or 3 hours, or one half day for time to trauma center.

The questions are how much does time matter? For what conditions does time matter? What amount of time matters? None of these are clear.

For example, will the drive of an hour to the trauma center make any difference?

We do need to better educate the ground providers, so that they can better assess the patient and decide what is the best means of transport.

I do not see any reason why trauma transport by helicopter should be free of charge to the patient. Why is this different from the billing for other medical care and transport?

The panel of trauma experts did recommend looking at using helicopters for non-trauma patients. They also looked at expanding the level of care that could be provided by flight crews.

Baltimore, MD

#11 Dec 4, 2008
I would not go as far as to say that Dr. Cowley's concept was a marketing tool. How can we actually scientifically prove this? We see better results when a patient is seen as quickly as possible. Over an hour transport time to a trauma center is too long. If you were critically injured, would you wait and drive 45 mins in an ambo to deliver you to a trauma center? Or would you rather fly and get there within 20 mins or so?

Dr. Cowley once said that the only people who understand the importance of a trauma/medevac system are the ones who have had loved ones saved by this system or the ones who see this lifesaving work everyday.

Of course, mechanism of injury wasn't something he had to worry about back then. We need definitive research done on all aspects of our system before we can adjust it. The system right now, with the medical consultations before dispatch, is working very well. Do you think the estimated number of flights at this rate are better than past years? If this is working well with the current protocols, why should we fix it.

Maybe introduce MSP Aviation into other arenas of medical transport, and have them transfer all patients between hospitals for the cost benefit to the patient?

I think the serious questions that need to be addressed are not being addressed by lawmakers, becuase, again they want control.
Rogue Medic

Capitol Heights, MD

#12 Dec 7, 2008
I have no problem with flying a critically injured patient if it will make a big difference in transport time. It is only when the transport time by ground gets to around an hour that this difference seems to matter.
Dr. Cowley was quite the salesman. A lot of what he said should be ignored. He set up a system that had some good ideas. That does not mean that all that he did was good.
One of the problems with Maryland's approach to helicopter EMS is the desire to fly everyone who might be injured. This is dangerous and irresponsible.
We need definitive research done before we can encourage interventions. To suggest keeping treatments that are not supported by research, just because that is the way things have been done, is not good science. There is not evidence to support flying patients for mechanism. There is research to oppose it.
We should look at how much things improve with the current system. We do not know if the system is working very well, but will need to observe it long enough to obtain enough data.
Of course, we have to wonder why there is a need to even consult medical command for mechanism only patients. There never was a good reason to put them in a helicopter. Not half an hour from the trauma center, not 2 hours from the trauma center. The helicopter is the wrong means of transport for those with minor injuries, or with no injuries.
The tax payers should not be subsidizing transportation for patients. This only encourages waste.
A lot of this is about control. If you want to make this to be a handout to patients from tax payers, you need to put the legislature in control. They are the ones elected to decide how tax dollars are spent, or in this case, given away.

Gwynn Oak, MD

#13 Dec 7, 2008
Dave wrote:
Have you ever seen ambulance and fire apparatus responding to an incident? They are reluctant to send a patient by air? I am surprised that most patients don't suffer heart attacks while being driven to the hospital by ambulance. Volunteers firefighters mainly. Take my chances with the air any day. Not to discredit any ambulance of fire fighters (have the most respect for them and the hard work they do). Just musing about their driving. I would like to get my hands on the steering wheel of one of these vehicles. Good job guys and gals.
Well then there's the problem of your up and not injured after an accident, but they're trying to talk you into going to the hospital based on the size of the dent in your car.

I had the front of my car ripped off by a teenager who thought a yellow light instantly gave her the same right of way as a left turn arrow. No one in either car was injured. Both were totaled.

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