Officials: Medevac crews hesitant sin...

Officials: Medevac crews hesitant since crash

There are 24 comments on the Baltimore Sun story from Nov 25, 2008, titled Officials: Medevac crews hesitant since crash. In it, Baltimore Sun reports that:

State emergency medical officials said yesterday that some ambulance crews in Maryland are "skittish" since a fatal medevac helicopter crash in September and might be too reluctant to transport accident victims ...

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

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Eastern Shoreman

United States

#1 Nov 25, 2008
Your headline is misleading. The helicopter crews are not skittish or hesitant, a situation that would give me great concern. The details in the article state that the personnel on the ground have different protocols to deal with, specifically consulting with a doctor, prior to calling for helicopter transport.
classic Sun mistake

Cockeysville, MD

#2 Nov 25, 2008
you're correct. that headline is completely misleading. though it gets people to read the article, which i think is an important one, because we have overused the medevac system.
Marie

Gwynn Oak, MD

#3 Nov 25, 2008
Why did Dr. Scalea hold a press conference with the poor young woman whose leg amputation was caused by the Medevac crash? Talk about tacky and exploitative! Another example of Dr. Scalea's defensiveness. He claims the system is "under attack," when all that's happening is that a panel of experts is reviewing protocols to increase the safety and quality of care for patients and EMT crews.
George from Pasadena

Glen Burnie, MD

#4 Nov 25, 2008
Why don't they ask the brave men and women who fly in the aircraft what they think. So many lives have been saved by their bravery in bad weather. We need to give them the tools to do the job safely.
George from Pasadena

Glen Burnie, MD

#5 Nov 25, 2008
Once again the Sun Paper with their yellow dog journialism style gets it sooooooooooooo wrong. This paper is a Loooooooooooooser!!!!!!!!!!
Surf52

Baltimore, MD

#6 Nov 25, 2008
Marie wrote:
Why did Dr. Scalea hold a press conference with the poor young woman whose leg amputation was caused by the Medevac crash? Talk about tacky and exploitative! Another example of Dr. Scalea's defensiveness. He claims the system is "under attack," when all that's happening is that a panel of experts is reviewing protocols to increase the safety and quality of care for patients and EMT crews.
Scalea's a pompous publicity hound, a fact that should be self evident by now. Remember, he knows better than everyone else. And he also has the ulterior motive of keeping UMSTC running at projected capacity.
Surf52

Baltimore, MD

#7 Nov 25, 2008
George from Pasadena wrote:
Why don't they ask the brave men and women who fly in the aircraft what they think. So many lives have been saved by their bravery in bad weather. We need to give them the tools to do the job safely.
Because they would opt to go anyway and we're back to inappropriate utilization.
Old Grunt

Baltimore, MD

#8 Nov 25, 2008
There are several items in play here:
1. Maryland has a system in place that has been the envy of the world. The problem is that the entire concept has not been scientifically validated. Therefore, it is a "feel good" concept. Undoubtedly, it has saved lives, but we have no evidence that these lives would not have been saved anyway.

2. The paramedics in service today are a quantum leap ahead of the old "scoop and run" ambulance attendants of years ago. They have the skills to assess patients, start IV lines and resuscitation long before the patient ever gets to a hospital. This extends the "golden Hour".

3. The physicians in MIEMMS need to remember that the object is to get the patient in the field to the APPROPRIATE level of care in the shortest time. That will probably NOT be helicopter transport in most cases.

4. Is there a financial aspect to this? Will a decrease in the number of patients flown mean a decrease in the number of patients coming to Shock Trauma? Will this mean that there will be less need for a unit of its current size? How many patients are sent to Shock Trauma and discharged home or a lower level faciolity within 2-3 days? Dose this imply that these patients did not need that level of care in the beginning?

Just because the protocols are being reviewed does not mean that the system is under attack. It means that we are trying to find the correct answers to unanswered questions about patient care.
JASTCLC

Baltimore, MD

#9 Nov 25, 2008
Marie and Surf52:

I would be very interested to know if you have had any interactions with Dr. Tom Scalea, or if you realize the work he does, day in and day out.

Marie: If you were unaware, the system has been under attack by the State Senate and House of Delegates. This crash was just what they were waiting for...this isn't new, it has been going on for a long time. And now that something has happened that the public is very privy to, they have received the perfect chance to attack the system further. A slight correction...it was not his decision to hold the press conference on this young lady, the media wanted it and if she did not want to participate she wouldn't have. Dr. Scalea should be defensive in preserving the system he has helped to improve through hard work and dedication.

Surf52: Dr. Scalea does what is best for the PEOPLE. He makes decisions quite often that reduce the number of patients to Shock Trauma, however, he would never deny a patient that needs the service. I hope you never get injured in Maryland, because you should NEVER be welcome to Shock Trauma. It makes me wonder if you have some type of "ulterior motive" in attacking him? Is your occupation more noble than his? I would love you see you try to save a life...
Old Grunt

Baltimore, MD

#10 Nov 25, 2008
why is it that every fireman and policeman who is injured goes to UMSTC regardless of injury?
JASTCLC

Baltimore, MD

#11 Nov 25, 2008
Because fireman and policeman choose to be treated at the Shock Trauma Center. Many ask to be taken to the STC.

Part of the reason is the long history of treating public service workers and the success in treatment.
There_R_no_liber ties

Estero, FL

#12 Nov 25, 2008
Read this: http://en.wikipedia.org/wiki/Air_Ambulance then justify why Police have to run the program.
Old Grunt

Baltimore, MD

#13 Nov 25, 2008
One of the tenets of the ambulance transportation program is that patients are transported to the NEAREST hospital capable of handling the patients problem. Patients don't necessarily get to choose. Is there some selective prejudice against other metro hospitals going on here?

BTW,the all public service workers, including sanitation and road workers get to choose? NOT. Rethink your answer
JASTCLC

Baltimore, MD

#14 Nov 25, 2008
Never cite Wikipedia as a credible source. Yes, the MSP Aviation Command's flight crew are State Troopers. However, these men and women providing care are TRAINED PARAMEDICS. I'm not sure if you know this or not...but they are an EMT-P. Most ground providers (ambulances) are EMT-I or EMT-B. These troopers offer the highest level of emergency care.

This is also a huge cost benefit to the state. These helicopters are used for other purposes as well, not just med-evacs. Would you rather pay somewhere around 10,000 dollars for an emergency flight?
JASTCLC

Baltimore, MD

#15 Nov 25, 2008
Actually, ambulance transportation does not mean that the patient is taken to the nearest hopsital that is capable of handing the patients needs. There is no prejudice, it is called the triage system, and it is in place for good reason. This was changed years ago... because of the influence of Dr. R Adams Cowley.
A patient always has the right to choose... if they do not want to be seen at Shock Trauma, there is nothing saying they have to (as long as they of sound mind). If they request to be seen at Shock Trauma, and there is a legitment reason, the EMT will "TraumaLine" the patient and confer with the attending trauma physician. Almost always, the trauma physician will honor the patients request.
For example, if there is a patient who is the driver involved in a motor vehicle collision, and the passenger dies, the driver will be taken to a trauma center for evaluation due to the mechanism and death in the same compartment. Could this patient be seen at a local facility and properly evaluated? Sure. If here is something wrong with that patient, will they transfer to a trauma center? Without hesitation. Will that cost the patient valuable time? Absolutley. I encourage you to look into protocols.
For clarification, the public service workers I was refering to were police, firemen and EMTs. Why is there a problem with these men and women being treated at Shock Trauma? They put their life on the line for the public everyday, why shouldn't they decide where they want to be treated?
Rogue Medic

Capitol Heights, MD

#16 Nov 25, 2008
The rate of helicopter transport is down by more than half. Will there be any difference in the trauma fatality rate?

Probably not.

JASTCLC,

There are plenty of paramedics in the state. The idea that we need to bring a paramedic to the trauma patient is not supported by research. The idea that flying apparently uninjured patients is good patient care is also not supported by research.

The cost is paid for by all of us. Not charging the patient does not mean it is good patient care.

What is under attack is increasing the risk to flight crews and increasing the risk to patients, but for no benefit to the patient.
JASTCLC

Baltimore, MD

#17 Nov 25, 2008
The rate of helicopter transport is down, indeed. However, it seems as if there is a large increase in the number of transfer patients to the Shock Trauma Center. Any explanations? I won't insult your intelligence.

Trauma patients should be treated by paramedics. In my opinion, that is correct. These are complex patients that are injured, remember!

Who is to say we are flying "uninjured patients?" Some patients flown by the MSP may not be AS critical as others, however, the majority of patients are critically injured, or show sings of having potentially life threatening injuries.

Are you complaining about paying $7 per year? Look up how the MSP is funded...

If these flight crews believe they are at such a high risk, do you think they would continue to work under these so called "hazardous" conditions? I think not. I've personally spoken with many MSP Aviation crew members, and they believe this IS a benefit. Private companies will take over, either way...there will always be helicopter transport in some way, shape or form.

If this will always exist... free to the patient or a very large bill??

May I ask of your relation to the MD EMS system?
Rogue Medic

Capitol Heights, MD

#18 Nov 25, 2008
JASTCLC,

Transferring patients to a trauma center does not mean that they are receiving inferior care. I am not suggesting that these patients should not go to a trauma center. These patients can be transported by ground ambulance just as safely, if not more safely. What we should be looking for is a change in outcomes. Only about 40% as many patients are being flown. I do not believe that this will result in worse outcomes.

I do not see any reason for the majority of patients to go by helicopter. Dr. Norman McSwain (Trauma Director, Charity Hospital Trauma Center, New Orleans, LA) has been recommending that the patients be transported to the closest hospital and transferred by ground later.

Trauma patients have not been shown to have any better outcome when treated by paramedics. Perhaps this is because paramedics tend to run a lot of IV fluid in to attempt to compensate for blood loss. It may be that this actually causes more harm than benefit and may counter any other benefit provided by paramedic care.

While using the "uninjured patients" quote may make you feel that you have caught me stating something inaccurate, what I wrote was "apparently uninjured patients." Patients being flown for mechanism criteria are not showing signs of serious injury. Some are not showing signs of any injury. Showing signs of potentially life threatening injuries is something you can claim. If Dr. Scalea and/or Dr. Bass tell people that these mechanisms criteria are signs of potentially life threatening injuries, many people will believe them. Where is the research to support this?

I am complaining about hundreds of millions of dollars, that could be spent on things that would be better at improving the lives of Maryland residents.

I know some flight crews, who are critical of the unnecessary flights. I know others, who are not. Some flight personnel have left the field. Others have not. There is a benefit from some flights, but most are an pointless increase in risk for everyone. Many flights delay the arrival of the patient at the trauma center. Delaying arrival at the trauma center, just so the patient can take a more risky means of transport, is not good patient care.

Cutting back on flights does not mean that private companies will take over. It means that there will be fewer flights.

There is no such thing as free. If the patient is really going to benefit from the flight, why do you keep bringing up cost? Should we have the state set up a system to pay for cardiac catheterizations, so that patients do not have to? What about delivering healthy babies? Surely that should be free? Being "free" is not really an issue, unless you want to examine how this is unfair to other patients, who are not provided with "free" care. Being "free" is just a marketing tool.

There is no research to support the aggressive flight program that Maryland has been using.

I choose not to disclose my relation to the MD EMS system. I do not work for a private helicopter service. Whatever the result, it will not affect me financially.
Tom

Pasadena, MD

#19 Nov 26, 2008
Are blacks TRYING to reach the bottom of the societal ladder? How much violence can these people perpetrate? My god - rape in Towson, assualt in Timonium, stabbing in Catonsville, now teachers beaten and students stabbed. Add to that the idiotic clothing, the moronic slang, the loud music, the mocking of education - is it any wonder people cringe when they think of black "youths". One thing they are succeeding at - being laughed at by the rest of the country.
There_R_no_liber ties

Estero, FL

#20 Nov 26, 2008
Tom wrote:
Are blacks TRYING to reach the bottom of the societal ladder? How much violence can these people perpetrate? My god - rape in Towson, assualt in Timonium, stabbing in Catonsville, now teachers beaten and students stabbed. Add to that the idiotic clothing, the moronic slang, the loud music, the mocking of education - is it any wonder people cringe when they think of black "youths". One thing they are succeeding at - being laughed at by the rest of the country.
The only ones laughing at the class of persons you describe are those who didn't get educated enough to know the Civil War is over and white hoods are out of fashion.

You are a disgrace to mankind with your statement. Grow up.

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