What is wrong with this picture?

[DwayneEMTP]

HEMS, just like an endotracheal tube and a defibrillator, is another modality that can benefit a very finite number of patients. Can it make a difference? Maybe? Does the literature support HEMS overall? No. EVERY DOLLAR SPENT ON HEMS IS A DOLLAR TAKEN AWAY FROM GROUND EMS. The money spent on a single flight will buy 4-6 AEDs or send two EMTs to paramedic school.

Man, when I started this thread I was actually pretty OK with my questions, and the logic used to generate them. Then I see this and think “Oh my God...I'm still a stone cold idiot!”

The 'counsel of elders' constantly tries to force us to think outside the box, yet my questions were so far inside the box I think they might have been boxed inside the box!

It's truly embarrassing when we have Dust, Rid, Asys, AZ, oh man...and a ton of other really smart people telling us to “look at EMS as a profession”, “find the big picture”, “be part of the changes”, and then come to realize I can't even find the right questions! They seem obvious after you have spelled them out.

Thanks to all of you 'old guys' for taking the time to look out for the rest of us...

Dwayne

[Lucky~13]

I just made my first post after many suggested I read this list (which I quite enjoyed). I did not realize I was supposed to use a pseudonym and don't have a clue what an avitar is. Pardon me if I violated the rules. I guess I used my real name because I can't use the pseudonyms my wife calls me.

:wav:

[weasel 108]

I just made my first post after many suggested I read this list (which I quite enjoyed). I did not realize I was supposed to use a pseudonym and don't have a clue what an avitar is. Pardon me if I violated the rules. I guess I used my real name because I can't use the pseudonyms my wife calls me.

It's an honor to have you aboard. Welcome :cheers:

[AZCEP]

The 'counsel of elders' constantly tries to force us to think outside the box, yet my questions were so far inside the box I think they might have been boxed inside the box!

If you don't know what's in "the box", how can you know when you are thinking outside of it?

Ask the questions, think through the problem, make yourself better. More providers need to have the same desire to do these simple things. Eventually, you will be able to dynamite "the box" through your ability to...wait for it...THINK[/font:fbd3f7b356].

[becksdad]

Welcome, Doc! We are so glad to have you here!

The quality of this board just keeps improving, and I hope you stay to continue the trend. Us newbies need it.

[tniuqs]

This is a very timely discussion. This whole air medical thing is a house of cards that is about to fall. Several things are occurring.

Good: Just as an outsider here but I have some experience in your system (got in late to Katrina) was frankly blown away that a single pilot, single medic team (don't get me going on that either) night operations to boot, in a BK 105 would dare to land at a stadium for a suspected spinal at a high school football game...good grief batman. My thoughts where " when he hits the wire how many injuries would I have to deal with now?

It certianly took a long time for these fact to gain any attention, I have stacks of info on accident rates.

It appears that FINALLY a evidence based view has been utilized, not a potential profit margin.

1. The accident rate (although better this year) has gotten the attention of the NTSB and FAA. Tougher regulations (135 at all times, NVG, IFR and maybe dual pilots) is probably on the horizon.

IFR why the delay on implementation of this factor as if weather has not been in a vast majority of cases, duh?

Pushing the envelope is not good, and now proven in spades.

What about Mission informed vs Non-mission informed pilots as well a good start.

Nothing get's the fly boys blood boiling like going like a sick kid vs well you fill in the blank.

Physical Separation of Pt. vs Pilots and birds that could accommodate are vastly more expensive, I suspect the smaller can I say fly by night operations may not survive this implementation of this strategic "criteria".

There is one thing that studies do suggest and that is Skill vs Speed the Flight medics / RNs / RRTs are better educated, allowed more latitude in scope of practice my god take one tenth of the aviation costs and funding and relocate those monies into an improved education system.

bb:HEMS, just like an endotracheal tube and a defibrillator, is another modality that can benefit a very finite number of patients. Can it make a difference? Maybe? Does the literature support HEMS overall? No. EVERY DOLLAR SPENT ON HEMS IS A DOLLAR TAKEN AWAY FROM GROUND EMS. The money spent on a single flight will buy 4-6 AEDs or send two EMTs to paramedic school.

Oops say this way to late, apologies svp, I do like the way you think, but further: Frankly speaking the myth of the "Golden Hour of Trauma" needs to dashed to bloody bits in my opinion, this as been the impetus for far too many flight operations in the US.

Who is to blame?

1. First, us doctors. We set the criteria and sign the memoranda of transport. Perhaps doctors who authorize or sign for flights that are medically unnecessary should be billed when the private insurance fails to pay.

-1 for not us as opposed to we Doctors I know this is you first post and all....

Yes and No, who is to say what the end diagnosis may be, a due diligence factor must be weighted and good ER Doc (s) are a very valuable asset, I wonder sometimes how many have been lost to frivolus lawsuits looking for a scapegoat?

2. The industry. In our great capitalistic society there was an opening when Medicare changed reimbursement rates and criteria for HEMS in 2001. Operators saw this and we went from 300 helicopters to 1000. If this were not the case, why are there 19-20 helicopters in affluent areas (Dallas, Phoenix, Nashville) and few in impoverished areas (Detroit)?

That would be a rhetorical statement I suspect, ever here about Sildenafil and determining signs of death? I digress.

3. EMS. There is nothing more exciting for many EMS providers than stopping traffic on the interstate, calling in the "birds", and shipping patients out under dubious conditions. The smell of the Jet A, the flashing lights, the noise--orgasmic. We rationalize this with such ridiculous arguments as "we sent them by air to keep the ground ambulance free." That is like saying, "We went ahead and removed the gall bladder just in case he gets gall stones later in life."

YES :The EMS Adrenalin Syndrome.

Cold load vs Hot this could be a idea for new criteria. I know that could blow the on-scene times out of the water but safe is safe period.

ROTOR BREAKS may be another idea.

COST: Here is a suggestion, maybe on the TLC Channel they should include this proviso:

NO the Patient Died, and He didn't have insurance, so his Wife and Kids lost their house and now are living in a CAR!

4. The payers. rest assured they are now aware and reacting.

Somewhere along the way we forgot the patient. We are placing patient's at risk when they do not stand to benefit from helicopter transport. We are placing flight crews at risk by asking them to transport non-serious cases. We should be ashamed.

Ashamed not really, without statistics how can one prove any argument, just a damn shame we have lost so many good people.

Doczilla' is right. A large majority of patients transported by air go home from the ED (in our Jounal of Trauma article the number was 25%). In PEDS it is much higher. I would be pissed if my 6-year-old grandson was placed in a helicopter when he could just as safely and more comfortably gone by ground at 10% of the cost.

Doczilla's always right :wink:

This one struck a nerve.....sorry for the tirade and my compliments to Doczilla and the others (AZCEP) who have the ability to see this for what it is.

Bryan Who? Not bad for a first post, have you ever thought of publishing some of this information, you may be on to something here.

cheers from a turnip.

[bbledsoe]

turnip (sic) wrote,

Bryan Who? Not bad for a first post, have you ever thought of publishing some of this information, you may be on to something here.

Maybe you are onto something. I might try my hand at writing one of these days. :roll:

BEB

[Dustdevil]

quote]Bryan Who? Not bad for a first post, have you ever thought of publishing some of this information, you may be on to something here.

[BushyFromOz]

It smells like... napalm!

I thought youd be one to love the smell of napalm in the morning

now if i can just remember what flick that line cam from :?:

[Michael]

flick

http://news.bbc.co.uk/1/hi/entertainment/film/3362603.stm