Pedestrian vs Auto w/ Medvac - Rte 9 I/F/O Alpine Commons 8/17/08

[Guest Photounit]

im sorry, dont know why i said that, its not that but old hopewell rd- tired, very little sleep

I knew what you meant..... Been there/Done that.......

[grumpyff 1,159]

I knew the speed limit change somewhere in that area I've driven in the area several times, either way not a good mechanism of injury.

[PVFD233 68]

You do what you've gotta do but if she was as bad as stated, its a straight shot to Saints ~10 minutes during that time of day (pretty much green lights right up Rt. 9). Have saints stabilize and call the chopper if it merits.

Really doesn't matter to me either way, i guess i was thinking "out loud." If FD called for the chopper (which i really don't think they should be doing) then so be it, might as well continue it in.

I guess I will agree with you Goose.

And 10 Minutes at that time of night is correct.

[Guest wfems05]

are you sure, i do think grumpyff is correct, it changes to 45 right there, accually just before All Angels traffic light

Yes when traveling South on 9 the speed limit changes to 55 at the Meyers/Middlebush Intersection. Coming north it is a 55 zone from the Village of fishkill line (north side) to the Meyers/Middlebush Intersection

[Guest alsfirefighter]

ALS, I completely agree that closest isn't always best, however this patient required zero extrication. Flight time of what, 20 minutes each way, plus start-up, packaging and assessment. How long are you going to sit there looking at someone before you send them somewhere closer where they can pump you with some packed cells and maybe stop the bleeding.

I'm not saying I don't understand what each of you are saying. However without being ther person in direct patient care I can't say why one versus the other. Also extrication means nothing to me in the decision of level 1 versus level 2. I've cut deceased victims out of cars, to those who RMA'd, clinical findings are clinical findings.

Also how long am I going to sit there? That's a tough question. However if the criteria fits for a Level 1 I will sit there as long as it takes if they tell me a reasonable ETA. Bleeding is one thing...massive head trauma is another. Like I said if it fits the criteria for a level 1 I am going to do my damndest to get them there.

You do what you've gotta do but if she was as bad as stated, its a straight shot to Saints ~10 minutes during that time of day (pretty much green lights right up Rt. 9). Have saints stabilize and call the chopper if it merits.

And what if the difference as a clinician you make means the difference in that patient outcome? If it fits the criteria get them to the appropriate facility. I've seen many many times what may happen when decision are made to transport someone in the hopes of "stabilization" and then hoping to fly them out later. What you are failing to add in is they will "attempt" to stabilize, secondly in some cases that initial transfer may be the only one they will be able to tolerate to get to higher difinitive care. A decision was made and anyone can argue the mertis of either..but without being there...you can't say you would have done one or the other. Level 2's are a great resource, they are stop gap measure that are critical to areas like Dutchess County and the like, but nothing in the end beats Level 1 care, staffing and resources and as I keep pointing out...with some criteria the only place to go.

[Goose 188]

ALS i respect your opinion and input, likewise i respect the decision of the medic & emt at this job. I was never second guessing or Monday morning quarterbacking this. I always give field units the benefit of the doubt (unless its obvious they were grossly negligent) and this is no different. Like i said in a previous post, i was thinking "out loud" more than anything else.

I did my stint in Dutchess and i had a few nasty traumas but never felt a chopper was merited because I've got a Level 2 in my backyard that was capable of dealing with/stabilizing some pretty nasty stuff. And in all honesty WMC isn't all that great, at least not in my experience. I've brought some decent trauma there and have had a lackluster experience. Doctor's jumping the gun and screaming for RSI when the patient was maintaining his own airway without an adjunct or being completely unprepared for us when they got an initial report and two subsequent updates on a patient with serious head trauma, ECG changes, etc.

In the end, it doesn't really matter. I was just curious, not second guessing.

[x129K 1,393]

You do what you've gotta do but if she was as bad as stated, its a straight shot to Saints ~10 minutes during that time of day (pretty much green lights right up Rt. 9). Have saints stabilize and call the chopper if it merits.

Really doesn't matter to me either way, i guess i was thinking "out loud." If FD called for the chopper (which i really don't think they should be doing) then so be it, might as well continue it in.

Who are you to say that the "FD" who calls for a chopper (in general, not the HFD job) isnt someone with EMS experience? That "I am paramedic, it's MY decision" crap doesnt fly with me...(no pun intended). I absolutley HATE that BS....I have dealt with it time and time again as a FD IC with medics not even on scene....

In this day and age, a large portion of FD members are atleast EMT's...not clueless firemen...

I AM positive the Brothers from HFD acted in the best interest of the patient....pretty sure this wasnt their first rodeo....

[Goose 188]

First of all, I'm not a paramedic. It should be the collective decision of the medical authorities on scene aka EMS. I could care less if every FF on my scene is an EMT - the likelihood is that i would have far more experience than they would in treating patients. If a FF happened to be a career EMT or Medic then by all means i would welcome their opinion if they spoke up. But that's an exception rather than the rule in my experience. Been to far too many incidents where a bird is launched by the FD to only be canceled enroute or wasted on something like a shoulder injury.

[STAT213 332]

First...awesome pics. Sure nice to see a new Air 2. N202HN/N118NY was tired.

As for the whole trauma center discussion...Does St. Francis have neurosurgical coverage? If not, there is NO reason to go there to stabilize the patient unless they need an airway. The whole stabilization idea only leads to delays that can last hours. Remember, that ED doc now has to call WMC and get the patient accepted, do a CT, etc etc. Tick tock. In my opinion, it is best to set up your camp and wait for that a/c.

[16fire5 693]

First of all, I'm not a paramedic. It should be the collective decision of the medical authorities on scene aka EMS. I could care less if every FF on my scene is an EMT - the likelihood is that i would have far more experience than they would in treating patients. If a FF happened to be a career EMT or Medic then by all means i would welcome their opinion if they spoke up. But that's an exception rather than the rule in my experience. Been to far too many incidents where a bird is launched by the FD to only be canceled enroute or wasted on something like a shoulder injury.

How does the age in your profile show 21-24 and you probably have far more experience? These days I'm just a CFR but I can read and understand the protocol and know when the Helicopter is warranted. I have called for the helicopter and believe that this enhances patient care and helps get the patient to definitive care in the appropriate facility as quick as possible. Isn't that the goal? I don't see how waiting for a paid bus to arrive and have a committe decide benifits the patient. I know cases where the NYSP has called for the helicopter and I'm not sure if the on scene trooper was an EMT but these cases were warranted. I understand the point your getting at and there is some merrit to the fact that helicopters are probably over used but remember 20 years ago they were almost non existant in this area and now we've come full circle. Education is the key. Do a class at your local FD. But being proactive and calling for help early is something good that has evolved in the emergency services. It wasn't that long ago that many chiefs waited far too long to call for Mutual Aid, and EMTs only requested ALS (if it was available then) for only the most critical patients.

[RNMedic08 0]

You know it really is easy for everyone to Monday morning quarterback the Medic and FF's on scene decision to launch a bird. I am sure they did what was in the best interest of the patient based on MOI, and assessment findings. In the short time I have been a Medic I've learned that everyone has something to say and that no matter what you do someone will always disagree or better yet question your judgement and competence because they can do it better !!!!!!

As a Medic I recently had a MVA on Rte 82 in Fishkill in the Rombout Fire District, originally the call sounded benign enough on initial dispatch, while enroute to the scene I was updated by County that Rombout was requesting me to expedite to the scene for seroius head trauma and that a "bird " was being requested to go on standby. The victim took a direct hit on the drivers side with significant intrusion into the drivers compartment. About 1-2 minutes later I arrived on scene, quickly assessed my patient who was still in the vehicle, he was conscious but definitely + AMS, had + LOC, long bone deformity and bleeding from bilateral forearms, I looked up and across the vehicle to the IC and requested the bird. Less than 12 minutes later the bird was at the LZ. I would have preferred a Level 1 trauma center however do to weather conditions changing down in Westchester the 2 Flight Medics eleced to fly him to St's. If not for the quick actions of the Rombout FF's on scene the time from the accident to a Trauma center would have taken more than 20 minutes.

I made it my point to thank the FF's at the LZ and asked to extend my thanks to all those on scene as I was now OOS for decon and needed to get to St's. with my paperwork and restock.

I think we forget at times that WE and I mean WE are a team of individuals with certain skill sets and that together we are a Team.....as a wise man once said to me "There is no I in teamwork."

[Guest]

You do what you've gotta do but if she was as bad as stated, its a straight shot to Saints ~10 minutes during that time of day (pretty much green lights right up Rt. 9). Have saints stabilize and call the chopper if it merits.

Really doesn't matter to me either way, i guess i was thinking "out loud." If FD called for the chopper (which i really don't think they should be doing) then so be it, might as well continue it in.

Y dont you think the F.D should call for a chopper ?

[50-65 205]

ALS and NWFD (and others), I only asked about why not go to St's that is just up the road. NOT being on scene and NOT being a medic, I wasn't second guessing or Monday morning quarterbacking. Just asking.

BTW, what is the criteria for Level 1 vs. Level 2? It has been a while since I worked at St.'s or been active in EMS.

[Guest]

How does the age in your profile show 21-24 and you probably have far more experience? These days I'm just a CFR but I can read and understand the protocol and know when the Helicopter is warranted. I have called for the helicopter and believe that this enhances patient care and helps get the patient to definitive care in the appropriate facility as quick as possible. Isn't that the goal? I don't see how waiting for a paid bus to arrive and have a committe decide benifits the patient. I know cases where the NYSP has called for the helicopter and I'm not sure if the on scene trooper was an EMT but these cases were warranted. I understand the point your getting at and there is some merrit to the fact that helicopters are probably over used but remember 20 years ago they were almost non existant in this area and now we've come full circle. Education is the key. Do a class at your local FD. But being proactive and calling for help early is something good that has evolved in the emergency services. It wasn't that long ago that many chiefs waited far too long to call for Mutual Aid, and EMTs only requested ALS (if it was available then) for only the most critical patients.

What does that mean "a PAID bus" and a commitee , Is that the issue here? I dont understand what paid has to do with anything. The end result is that it is up to the paramedic to decide if transport by air is neccesarry, not the FD IC or the SP , putting them on stand by is a good idea, but the paramedic is the best one to determine if a patient can tolerate ground transport, the only time a PT is technically unstable in an ALS enviroment is if there is not a patent airway.............

[helicopper 1,050]

Who are you to say that the "FD" who calls for a chopper (in general, not the HFD job) isnt someone with EMS experience? That "I am paramedic, it's MY decision" crap doesnt fly with me...(no pun intended). I absolutley HATE that BS....I have dealt with it time and time again as a FD IC with medics not even on scene....

In this day and age, a large portion of FD members are atleast EMT's...not clueless firemen...

I AM positive the Brothers from HFD acted in the best interest of the patient....pretty sure this wasnt their first rodeo....

This isn't a slam against the fire service or anyone else associated with this particular call. In fact it isn't even about this particular call anymore, it's about the responsibilities of those who respond to the scene. The FD may respond with EMT's (even off-duty paramedics) but it is the responsibility of the paramedic assigned to the job (read on-duty) on the ALS unit/ambulance to make the decisions about treatment and transportation for a patient. There are plenty of clueless firemen but I also know plenty of clueless cops, EMT's and medics. Conversely, some of the smartest people I know also have those same titles. It just doesn't matter so don't get so defensive. FD may be a part of the EMS system and will likely be responsible for establishing an LZ but it won't be your certification on the line, it will be the EMT or medic with his/her name/number on the PCR.

You want to make it better - have a meeting with your local EMS providers and discuss how you're going to handle medevac requests and adopt a policy for your area (i.e. FD/PD/other first responders put it on stand-by and EMS request a launch). Specify who is going to do what and how they're going to communicate these actions to each other. Failing that you're going to be back here with the same rant next time.

...I don't see how waiting for a paid bus to arrive and have a committee decide benifits the patient... ...Education is the key...

You're not waiting for a "bus" to respond. You're waiting for the highest trained EMS provider with ultimate responsibility for the patient to arrive and decide. It shouldn't be a committee decision either. It should be the decision of the medic or EMT who is ultimately responsible for the patient's care - not just on the scene with the first responders but also during transportation.

Education is the key! You're darn right! It almost always is.

As for the whole trauma center discussion...Does St. Francis have neurosurgical coverage? If not, there is NO reason to go there to stabilize the patient unless they need an airway. The whole stabilization idea only leads to delays that can last hours. Remember, that ED doc now has to call WMC and get the patient accepted, do a CT, etc etc. Tick tock. In my opinion, it is best to set up your camp and wait for that a/c.

Excellent points, STAT! Thanks for that perspective!

I think we forget at times that WE and I mean WE are a team of individuals with certain skill sets and that together we are a Team.....as a wise man once said to me "There is no I in teamwork."

That's for sure! We are all on the same team and should really be able to work together better.

[Guest]

why wait up to 20 minutes for a helicopter when you can have a patient at a hospital in that time !!helicopters do fly to hospitals!!!

[Guest alsfirefighter]

why wait up to 20 minutes for a helicopter when you can have a patient at a hospital in that time !!helicopters do fly to hospitals!!!

Because as has been said already in several posts...just getting a patient "to a hospital" isn't always the answer. Just as in the fire service that conditions often dictate tactics...a patients injuries, status and condition dictate transport decisions. Yes Helicopters do fly to hospitals...the ones that they feel they need to get the patient to based on patient status. Not all hosptials are the same and good Paramedics make good decisions based on that mentioned and what the patient needs, not to what is convenient. Taking a patient to a underprepard and underequipped hospital certainly isn't the answer.