Medevac Decision Making - was in Somers MVA photo thread

[ny10570 745]

I still don't get it. No extrication means Somers to WMC is faster by bus than by bird and we still fly out patients. Yet every time this comes up no one come up with a reason why these people are still being flown. If it is true that everyone actually agrees that many of these flights are unnecessary, too many medics/chiefs/vac capts/etc read and comment on this board for nothing to have changed.

[Remember585 815]

I still don't get it. No extrication means Somers to WMC is faster by bus than by bird and we still fly out patients. Yet every time this comes up no one come up with a reason why these people are still being flown. If it is true that everyone actually agrees that many of these flights are unnecessary, too many medics/chiefs/vac capts/etc read and comment on this board for nothing to have changed.

Not knowing all of the facts and information on this specific incident, I wouldn't question the decision made for the flyout. Knowing Somers and where this incident was, and the potential response time for the ambulance, the bird might be the right choice.

Assuming.....

First unit on scene requests the chopper, and that chopper has an ETA of 15-20 minutes. If the ambulance takes 10 minutes just to get there, not factoring in the time to get out the door, the time to package and perform the medic's job working the patient, by the time they are loaded into the bus, the bird can already be on the ground. I don't see an issue with that. As long as transport isn't delayed awaiting advanced care (Medics, Helo, etc.) then I never see an issue with using that invaluable resource. I'm of the old school train of thought that if we are loaded and the Medic isn't there, or if our Medic is on board and the chopper isn't already on scene, GO TO THE E.D.!

Somers has a lot of windy, dark and unusual roadways, so the drive time can be a lot longer then what everyone assumes based on their own experiences of driving on the main roads.

10570, if the ambulance is on scene with ALS almost right away, that's one thing. But I doubt the ambulance was on scene in less then five minutes - that rarely happens anywhere.

[jack10562 414]

OK, So there was no apparent extrication...Unless there is something I missed in the post, we have no idea as to the extent or nature of the injuries to the patient, or whether they were determined to be life threatening by personnel on the scene.

Perhaps the victim was unrestrained and flew around the cabin a few times and landed upside down on the floor in the back seat....unconscious...

[220LT188 11]

In repsonse to the question of wether or not the pt should of been flown out.

1) while the pt was not entrapped in the car, he had crawled out of the car..(per witnesses on scene) he was partially under the car and face down in heavy thick brush. This made not only treatment but removal of the pt very difficult.

2) From time on scene to the order to launch of stat-flight was three minutes. Stat-Flight had a 12 minute eta.

3) By the time pt was packaged assesed treated and in the ambulance the heli was moments away. Both the heli and the amb arrived at the LZ at the same time.

4) Driving side roads at 4am with a unstable pt in the back for a 20 minute ride is not in the pts best intrest.

5) stat flight is able to do things that medics can not. Pt was combative and had an unstable airway. flight crew was able to immoblize and intubate the pt.

[Tapout 42]

In repsonse to the question of wether or not the pt should of been flown out.

1) while the pt was not entrapped in the car, he had crawled out of the car..(per witnesses on scene) he was partially under the car and face down in heavy thick brush. This made not only treatment but removal of the pt very difficult.

2) From time on scene to the order to launch of stat-flight was three minutes. Stat-Flight had a 12 minute eta.

3) By the time pt was packaged assesed treated and in the ambulance the heli was moments away. Both the heli and the amb arrived at the LZ at the same time.

4) Driving side roads at 4am with a unstable pt in the back for a 20 minute ride is not in the pts best intrest.

5) stat flight is able to do things that medics can not. Pt was combative and had an unstable airway. flight crew was able to immoblize and intubate the pt.

Great job. The decision to fly was obviously the right one.

[Guest alsfirefighter]

In repsonse to the question of wether or not the pt should of been flown out.

1) while the pt was not entrapped in the car, he had crawled out of the car..(per witnesses on scene) he was partially under the car and face down in heavy thick brush. This made not only treatment but removal of the pt very difficult.

2) From time on scene to the order to launch of stat-flight was three minutes. Stat-Flight had a 12 minute eta.

3) By the time pt was packaged assesed treated and in the ambulance the heli was moments away. Both the heli and the amb arrived at the LZ at the same time.

4) Driving side roads at 4am with a unstable pt in the back for a 20 minute ride is not in the pts best intrest.

5) stat flight is able to do things that medics can not. Pt was combative and had an unstable airway. flight crew was able to immoblize and intubate the pt.

This is always a great topic to discuss and I hope it doesn't turn into a pissing contest. So I'm going to attempt to continue the discussion.

1. What can stat flight do...that I cannot? If your being agency specific that's fine, but don't generalize the term "medics." A medic is a medic...just because you add "flight" in front of it...doesn't make them superman. There's not all that much room in there and in the very few times I use them my patients are well packaged and appropriately treated prior to their arrival.

2. How is a 20 minute ride with a trained advanced provider not in their best interest? Take away the launch time and the inbound flight. If its a 12 minute flight...couple that with the time on the ground for any advanced airway skills they performed, which many ground agencies can do the same your looking at the same and even possibily a shorter ride time. So in some cases a 20 minute ride time on ground is in the patients best interest. Whether it be 4 am...or 4 pm. Brush or not...sometimes the best initial treatment is BLS treatment and that means just simply getting your patient to an area where they can be worked on. Which in trauma means the bus and work while moving.

Yet again I see a posting of how apparantly flight crews can do things "medics cannot." So I pose this question (yet) again. What is it that so many apparantly think is so? Is there some sort of magic air up at 100' that I don't know of? What I can attest to is the dedication and experience the flight crews have to offer...maybe I'm just lucky that where I work any one of us could put on a flight suit and do what we do in the air that we do on the ground.

[Goose 188]

Great reply ALS. All very valid questions. Sounds as though maybe this was an RSI issue?

And...whats with transporting unstable patients at 4am on back roads? I do it all the time. In fact i would rather do it at 4am as appose to 4pm.

Lately, as these threads pop up, i've been thinking it would be interesting to get the stat crew's opinion on these matters.

[helicopper 1,050]

Great reply ALS. All very valid questions. Sounds as though maybe this was an RSI issue?

And...whats with transporting unstable patients at 4am on back roads? I do it all the time. In fact i would rather do it at 4am as appose to 4pm.

Lately, as these threads pop up, i've been thinking it would be interesting to get the stat crew's opinion on these matters.

I'd also be interested in learning more about the dispositions of patients flown to a trauma center when, arguably, they could arrive in the same amount of time by ground. Unfortunately, the QA/QI programs don't seem to address this and I don't think we'll ever get an official answer from LifeNet as their jobs depend on call volume.

Combative and in weeds does not a trauma patient make. Could it have been alchohol or drugs that caused the combativness. He self extricated from the car so he obviously had use of all his appendages.

Are you saying that the ground medic couldn't intubate him or that the flight crew paralyzed him to do it? Doesn't make a compelling argument for flying but it does make a compelling argument for the re-evaluation of protocols for ground medics.

What road was this on? How far from any of the major thoroughfares in Somers was this? If it is a 20 minute trip to the medical center, only a fraction of that time would be on back roads.

Finally, does it bother anyone else that the helicopter and ambulance had the same response time? About 15 minutes give or take. What about that issue?

This is not about Somers - it's about the pathetic inconsistencies in EMS in general. You could apply these questions to many incidents in many places so don't take this as criticism of Somers FD or EMS.

[RushTheBus 10]

Apparently the ambulance was a Westchester EMS Alpha Unit coming from Mt Kisco because Somers had to go Mutual Aid.

[Tapout 42]

I have to ask a question and will duck if I have to in order to ask it... and I'll direct it specifically at the medics here who take this debate to heart every single time it rears its ugly little head:

Why is it that EVERY time the copter is called, a collective firestorm brews and rallies AGAINST those who called the bird? Every time, quite literally. Response time... road conditions... distance to hospital... "what can't I do that he can do?" It's as though, regardless of circumstances and the judgments of those ON-SCENE at the time, the call was the wrong one. Why does it always seem to be an "either/or situation where you chose the wrong one so now justify your choice to the rest of us" discussion?

Perhaps, just once, this could remain a situation where EITHER a ground medic OR a flight medic could have been the right choice, but on THAT night the flight one was chosen. I maintain my previous position. Good choice. I'd say the SAME if he was in the same condition, went by ground and lived to get tucked in at the WMC ED.

[medic327 0]

Good job by all. I think we should stop questioning the choices made by medic or other personal on the scence at the time of the incident. Those individuals made the decision to fly that patient out and the time they felt this was the best decison in the pt. Interest and outcome. Again good job by al.

[x635 4,066]

When distance and long, back,windy,bumpy country roads are an issue and I'm not near a trauma center with any patient that may have a spinal injury, I prefer to fly them out. Quicker, smoother and keeps you in service. Also great for when traffic poses an issue.

Aviation is a GREAT resource when used properly. It's even better when it's not run by a for profit company, rather by a local agency. Personally, Ihave felt that WCPD aviation should take over for Stat-Flight, giving WC a dedicated helicopter. Maybe a similar program to the one linked below.

Check this out: http://www.starflightrescue.com/

[Goose 188]

I have to ask a question and will duck if I have to in order to ask it... and I'll direct it specifically at the medics here who take this debate to heart every single time it rears its ugly little head:

Why is it that EVERY time the copter is called, a collective firestorm brews and rallies AGAINST those who called the bird? Every time, quite literally. Response time... road conditions... distance to hospital... "what can't I do that he can do?" It's as though, regardless of circumstances and the judgments of those ON-SCENE at the time, the call was the wrong one. Why does it always seem to be an "either/or situation where you chose the wrong one so now justify your choice to the rest of us" discussion?

Perhaps, just once, this could remain a situation where EITHER a ground medic OR a flight medic could have been the right choice, but on THAT night the flight one was chosen. I maintain my previous position. Good choice. I'd say the SAME if he was in the same condition, went by ground and lived to get tucked in at the WMC ED.

I really don't think anyone is questioning any ones judgement. I think the core issue is that given all westchester departments proximity to a level 1 trauma center and the nature of calls in westchester, very, very few patients fit the narrow criteria for air evacuation.

I'm not a medic so i can't really speak to any of the clinical issues, but i've been on jobs where patients were combative and had horrendously compromised airways due to nasty accidents and even without RSI capabilities the patient was effectively treated and had a positive overall outcome - all without the helicopter.

[x635 4,066]

I really don't think anyone is questioning any ones judgement. I think the core issue is that given all westchester departments proximity to a level 1 trauma center and the nature of calls in westchester, very, very few patients fit the narrow criteria for air evacuation.

I'm not a medic so i can't really speak to any of the clinical issues, but i've been on jobs where patients were combative and had horrendously compromised airways due to nasty accidents and even without RSI capabilities the patient was effectively treated and had a positive overall outcome - all without the helicopter.

I agree, however, I've heard medics gloating about not having to use the helicopter (when they should have). Pride should be put aside. There are other reasons besides clinical to use a helicopter for EMS. It's also a resource that should be used, and called if needed as soon as the thought pops in your head....you can always cancel them. ALL factors should be considered, and NOT just clinical (travel time, level of care, traffic, available units in your area, number of patients on scene, etc)

Also, given the recent medical helicopter crashes, that's due to a number of technical internal aviation issues as well as some policy and procedural incidents.

Aviation is a resource. It should be used, when needed. Especially in a time where "use it or lose it" is being considered...........

As a side note, having the experience of working as a Medic and Dispatcher in Somers, as well as formerly dispatching Stat Flight from 60, I can attest to the fact that they use Stat-Flight quite wisely and efficiently. My opinion is based on numerous calls that Somers FD has used Stat Flight.

[Jybehofd 85]

The patient needed RSI. and only 2 agencies in the county have it.

[ja3kfd 34]

what is RSI??

[Guest alsfirefighter]

Jybe...I replied to your PM...great job period. You'll see the rest in my reply to you.

Tapout..I know you don't have to go that far to get some of those questions answered...lol. So maybe you might have to duck later..ha. However, with that said...most of the conversation that occurs on here in discussion of medevac often involves the fact that the distance could be covered quicker by ground...with the same level of treatment. Not to mention that a high percentage of patients who are flown are not done so based on physiological signs and rarely meet any of the mechanism criteria...which in turn reverts back to the primary issue...distance and time. Many patients are discharged the next if not the same day.

To continue on with some of taps questions and in line with x635's remarks. I've never seen anyone gloat about not using the helicopter. I rarely, rarely, rarely fly...you know that as you know me...my colleagues know that and not once has QA/QI picked up on any reason why I should have. Why...because its actually a few minutes quicker by ground for my area and I have skill. I have no grandeur about calling for a helicopter or seeing it land...or carrying my patient to it as some proud moment. As far as getting back in service quicker....that is the only comment I've ever seen you make in all our years of friendship and as fellow medics that made me scratch my head. Which is there more of? ALS units...or medevacs? The wasting of air resources that occurs in Westchester...keeps it from being able to be in service for the outlying regions who critically need the faster flight times.

Most of us know someone (personssss) who is/are a habitual offender(s) of inappropriate air use. And a couple of them are farther south then I am. In fact funny thing is I can think of a few who's agencies they work for transport medical patients and BLS transports to the med center...but have had providers medevac a trauma to it. In a couple cases right from the major highway that runs right by the place that from where the bird landed you could see the strobes from atop the radio antenna in between the highway and WMC. Does that make sense?

Secondly...to be open I'm not questioning anyone...however...if you have an unstable airway, protocol dictates closest appropriate facility...so what is your ETA versus getting to your local? What about alternative airway devices? RSI is a great tool to have...but its one of only many.

I think we should stop questioning the choices made by medic or other personal on the scence at the time of the incident.

No disrespect intended....but based on that comment...should we throw away call audits and reviews? Every thing about medicine is questioning yourself and often being questioned. One of the first things I learned as a medic sitting in (good, quality) call audits...is if someone questions you about what you did or didn't do...is first don't take it personal...second...be professional and you better know why you did or didn't and make your case. I hate run of the mill call audits where you know something wasn't done or something was improper and no one wants to get it in the open. How is anyone not suppose to make the same mistake?

[x635 4,066]

what is RSI??

RSI: Rapid Sequence Intubation, a style of intubating the patient using the assistance of narcotics and techbique, largely used for head injuries and for patient who are breathing but cannot protect their own airway

[DOC22 1]

I'd also be interested in learning more about the dispositions of patients flown to a trauma center when, arguably, they could arrive in the same amount of time by ground. Unfortunately, the QA/QI programs don't seem to address this and I don't think we'll ever get an official answer from LifeNet as their jobs depend on call volume.

Combative and in weeds does not a trauma patient make. Could it have been alchohol or drugs that caused the combativness. He self extricated from the car so he obviously had use of all his appendages.

Are you saying that the ground medic couldn't intubate him or that the flight crew paralyzed him to do it? Doesn't make a compelling argument for flying but it does make a compelling argument for the re-evaluation of protocols for ground medics.

What road was this on? How far from any of the major thoroughfares in Somers was this? If it is a 20 minute trip to the medical center, only a fraction of that time would be on back roads.

Finally, does it bother anyone else that the helicopter and ambulance had the same response time? About 15 minutes give or take. What about that issue?

This is not about Somers - it's about the pathetic inconsistencies in EMS in general. You could apply these questions to many incidents in many places so don't take this as criticism of Somers FD or EMS.

Chris here's one of what you mentioned.

Several years ago we were dispatched to a "serious PIAA" at a relatively dangerous intersection in North Salem. One vehicle was struck broadside on the passenger side severely pinning and injuring the elderly female passenger. Statflght was utilized. A year later the passenger stopped at the firehouse inquiring who had called for Stat Flight. As it turned out, she said that the docs in the ER told her that due to the mechanism of injury and distance, she would not have survived had she been transported by ground

[helicopper 1,050]

Chris here's one of what you mentioned.

Several years ago we were dispatched to a "serious PIAA" at a relatively dangerous intersection in North Salem. One vehicle was struck broadside on the passenger side severely pinning and injuring the elderly female passenger. Statflght was utilized. A year later the passenger stopped at the firehouse inquiring who had called for Stat Flight. As it turned out, she said that the docs in the ER told her that due to the mechanism of injury and distance, she would not have survived had she been transported by ground

Thanks, Doc! I'm glad there are those kinds of cases. Unfortunately, as ALS indicated there are entirely too many cases where the patient is discharged the very same day so it begs to have the questions asked.

I've also seen the requests where the start-up and shutdown of the helicopter is longer than the flight - it simply defies logic!

Also along the lines of what ALS was talking about, I think too many providers perceive call audits and QA/QI programs as obstacles they have to negotiate during the year and not as the learning experiences they're supposed to be. I've learned TONS at call audits and through QA/QI programs and have learned a lot about how to be a good provider. But this is for another thread...

What do we do when the weather is bad or the helicopter is committed to another call? We do our job and we transport by ground! That's the point.

[khas143 13]

Thanks, Doc! I'm glad there are those kinds of cases. Unfortunately, as ALS indicated there are entirely too many cases where the patient is discharged the very same day so it begs to have the questions asked.

I've also seen the requests where the start-up and shutdown of the helicopter is longer than the flight - it simply defies logic!

Also along the lines of what ALS was talking about, I think too many providers perceive call audits and QA/QI programs as obstacles they have to negotiate during the year and not as the learning experiences they're supposed to be. I've learned TONS at call audits and through QA/QI programs and have learned a lot about how to be a good provider. But this is for another thread...

What do we do when the weather is bad or the helicopter is committed to another call? We do our job and we transport by ground! That's the point.

Chris... with all due respect... this begs the question of Emergency Medical Air Response in general... Where do we draw the line regarding how many "saves" makes utilization of resources worthwhile. I am sure there are several arguments to this (including, but not limited to... what if a patient in more dire straights needs the services of StatFlight) but where do we as providers draw the line. So the question is posed to all of you "HOW MANY LIVES SAVED ARE NEEDED TO BE CONFIRMED AS COMPARED TO HOW MANY LIVES WOULD HAVE SURVIVED IF TRANSPORTED BY GROUND AND NOT AIR?"

How many times do we hear that one saved life is priceless (Thanks Doc for your input). Hey, the court system puts a price on a life based on varying factors. (age, income, life expectency, etc.). Should we start evaluating patients based on a system before calling on air resources.

Hey the question has been asked in different forms but thats what it is. I don't know what the "answer" is but can somebody here enlighten me.

So???? This issue has been raised multiple times here so if you want to make your point..... Give us a number/ratio.

Edited July 16, 2009 by khas143

[x635 4,066]

As far as getting back in service quicker....that is the only comment I've ever seen you make in all our years of friendship and as fellow medics that made me scratch my head. Which is there more of? ALS units...or medevacs? The wasting of air resources that occurs in Westchester...keeps it from being able to be in service for the outlying regions who critically need the faster flight times.

I should have clarified....my comments refer to my Texas job. I work in rural Texas per-diem as a Paramedic (to keep my skills sharp), and we're AT LEAST 1 hour away from the hospital. However, if I have a critical burn patient let's say, I'm not going to waste my time going to the primary and only hospital, which is also Level I, for them just to be transferred out by helicopter immediately. I'm not going to waste my time driving 2-3hrs to Parkland Burn Center in Dallas or Brooks Army Medical Center in San Antonio. Put the patient on a helicopter, he/she gets to their true definitive care facility quickly and without detour, and I stay in service available for the next call. If I take the patient by ground to a burn center, which, being CC certified, I am able to, would leave me out of service for probaly most of my shift....and the next closest ambulance for my area probaly about 40 minutes away if not more. I've also flown patients whereas traffic was a nightmare and would cause a significant delay in getting to the hospital. If I'm in the City running calls, then I never fly a trauma or other patient (unless it's a burn)

I think there are times a helicopter is called because people like the excitement, but avaiation is a great resource and when needed, it is never a waste. I also think that Stat Flight has really slacked off in recent years with community outreach and interfacing with EMS personel on the street. Which, again, is why Westchester County PD should do EMS aviation, so we don't have to worry about stripping other communities. Especially now that Stat Flight's a for-profit company that wrecked what was a great and promising aviation program. (A lot has to do with the mis-management of WMC, but that's a whole 'nother story).

Again, here's an example of one of the best EMS aviation systems:

http://www.starflightrescue.com/

[helicopper 1,050]

Chris... with all due respect... this begs the question of Emergency Medical Air Response in general... Where do we draw the line regarding how many "saves" makes utilization of resources worthwhile. I am sure there are several arguments to this (including, but not limited to... what if a patient in more dire straights needs the services of StatFlight) but where do we as providers draw the line. So the question is posed to all of you "HOW MANY LIVES SAVED ARE NEEDED TO BE CONFIRMED AS COMPARED TO HOW MANY LIVES WOULD HAVE SURVIVED IF TRANSPORTED BY GROUND AND NOT AIR?"

How many times do we hear that one saved life is priceless (Thanks Doc for your input). Hey, the court system puts a price on a life based on varying factors. (age, income, life expectency, etc.). Should we start evaluating patients based on a system before calling on air resources.

Hey the question has been asked in different forms but thats what it is. I don't know what the "answer" is but can somebody here enlighten me.

So???? This issue has been raised multiple times here so if you want to make your point..... Give us a number/ratio.

If I didn't know better I'd swear you were trying to get a rise out of me

Don't misunderstand me - I am a staunch advocate of air ambulance service. I just think the judgment that is used in requesting them or not requesting them can be better - in some cases. There are places that call air ambulances too often for reasons other than the patients condition or ohter appropriate criteria and there are areas that don't call them often enough!

You do bring up another good point, what if the nearest medevac is tied up because someone wanted to get back in service faster and someone who is in dire straits does without or waits longer for the resource.

My main issue is when you're closer by ground than by air and people still wait around for the helicopter.

When someone errs on the side of caution and uses the helicopter on a borderline call, no problem. But when an agency's motto is to use the helicopter whenever the EMT feels like it (as evidenced by some people's T-shirts), that's inappropriate.

I don't think there is/should be a number or ratio but I'd like our quality assurance/improvement programs to be just that and provide feedback when someone is discharged the same day as the flight so EMT's and medics can improve their decision making skills.

[Guest alsfirefighter]

what is RSI??

Depends on who you ask...but in the text book sense it stands for "Rapid Sequence INDUCTION." Many call it Rapid Sequence Intubation.

Khas...my point is how many patients may not have the needed resources because of inappropriate use of the resource.

[Tapout 42]

Excellent posts, ALS, KHAS, Seth, and Chris. From your collective perspectives, it seems the primary argument for air transport should focus less on the skill level and judgments of the medic on-scene and more on the geographic area in which it is used and occasionally misused. Is that correct? If I am correct, I agree with you.

During my years at WMC as an ER RN, receiving about 1 Stat Flight patient a day, we never ever got one that didn't need the rushed ride. They were always in bad shape, or were at least by mechanism of injury (fell off a roof, got hit by lightning, etc.) in need of quick transport. Not always in need of the bird, mind you, but always in need of quick arrival. More than a few of those patients brought by the red suits (back in the day when they were red and cool and still respected-LOL-sorry blue suits on this site) raised our eyebrows because the accident happened literally 5-10 minutes by ground from the med center. The minimum on-scene time was always 20minutes. That never made sense! Why sit on the road in the back of the copter for 20 when you could be rolling to the med center and AT the med center in under 15? Seriously! That said, though, I never even once in 3 years in that ER discharged a Statflight patient same day. They always stayed in-house for legit reasons.

My point is that, while I do not have an issue with the occasional use of the bird, it just seems more like it is nearly always unnecessary down here in Westchester, where we have so many major highways/parkways that'll lead us to WMC. In the northern counties (Putnam north and NW), where that is not always the case, perhaps the air choice should be used.

[220LT188 11]

In reposne...

The medic called for stat-flight, bls...chief...fd had no call in the matter so why not ask other medics. They are the highest level of care and they are the ones that made the decision.

Our medics can not paralyze the pt. That is what they cant do - that 'flight' can. I do not know what it is anywhere else but that is how it is here.

The pt was combative becuase of a seriuos head injury

We can go back and forth all day....the call was made (by a paramedic) the pt is alive....job well done to ALL the people that came out in the early morning to save some kids life.

Why is it we can not offer constructive criticism? But we all just go after each other and lump all calls and all situations together. This forum used to be about helping each other out....learning from each other experiences and trying to be better at our jobs. Vollie / paid , fire / ems/ police / oem / comms, als / bls / cfr whatever the hell you are! Why cant people offer help and allow others to learn from the experiences and knowledge you may be able to offer. Have a question on why something is done, find out the facts and then have a constructive discussion on how we can do our jobs better. I ve been in fire / ems for thirteen years and have seen a lot and learned a lot, and I still look to elders, senior guys, school, training, courses, whatever to make myself better so that I can do my job better....get everyone home alive and help another human being in their time of need!

[helicopper 1,050]

In reposne...

The medic called for stat-flight, bls...chief...fd had no call in the matter so why not ask other medics. They are the highest level of care and they are the ones that made the decision.

Our medics can not paralyze the pt. That is what they cant do - that 'flight' can. I do not know what it is anywhere else but that is how it is here.

The pt was combative becuase of a seriuos head injury

We can go back and forth all day....the call was made (by a paramedic) the pt is alive....job well done to ALL the people that came out in the early morning to save some kids life.

Why is it we can not offer constructive criticism? But we all just go after each other and lump all calls and all situations together. This forum used to be about helping each other out....learning from each other experiences and trying to be better at our jobs. Vollie / paid , fire / ems/ police / oem / comms, als / bls / cfr whatever the hell you are! Why cant people offer help and allow others to learn from the experiences and knowledge you may be able to offer. Have a question on why something is done, find out the facts and then have a constructive discussion on how we can do our jobs better. I ve been in fire / ems for thirteen years and have seen a lot and learned a lot, and I still look to elders, senior guys, school, training, courses, whatever to make myself better so that I can do my job better....get everyone home alive and help another human being in their time of need!

Nobody is disputing your points. This is just a discussion about the usefulness of a helicopter in close proximity to a trauma center and we're all (I think) in agreement that there are times when it is appropriate and other times when it is not.

I'd like to know why a medic in a flightsuit is qualified to perform RSI and a medic in a uniform is not? Train the ground medics to perform RSI and the need for airway management won't necessitate a helicopter to provide it.

Good discussion.

[Mark Z 18]

I'd like to know why a medic in a flightsuit is qualified to perform RSI and a medic in a uniform is not? Train the ground medics to perform RSI and the need for airway management won't necessitate a helicopter to provide it.

Good discussion.

Medical Control is more the issue than anything else. I can remember when you were looked down on if you called for a paramedic too often and now they are dispatched simultaneously for the same type of calls. Med control is an issue for another thread, but to get back on topic, I have called for a bird only once and the pt was in Dutchess County and in very bad shape, no doubt in my mind flight was needed MVA with prolonged entrapment.

[Tapout 42]

As a follow-up (and irrelevant aside): According to Lohud, the 19yo driver was charged today at his WMC bedside for DWI. Ah, well- it would explain at least some of the on-scene combativeness...

http://www.lohud.com/article/20090716/NEWS01/907160481

[Goose 188]

Nobody is disputing your points. This is just a discussion about the usefulness of a helicopter in close proximity to a trauma center and we're all (I think) in agreement that there are times when it is appropriate and other times when it is not.

I'd like to know why a medic in a flightsuit is qualified to perform RSI and a medic in a uniform is not? Train the ground medics to perform RSI and the need for airway management won't necessitate a helicopter to provide it.

Good discussion.

Someone correct me if i'm wrong, but don't the flight crew have their own set of protocols & standing orders?