Trauma in the air Victims wait for help

[Andrew J Bowman]

Load and go with my mom, in the vast majority of the US air EMS is not a
benefit. Load and go by ground.

Andrew

----- Original Message ----- 
From: "Forrest Robleto" <farcpr at gmail.com>
To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
Sent: Monday, April 30, 2007 3:26 PM
Subject: Re: Trauma in the air Victims wait for help


If I am 30 minutes by ground from the local trauma center and I know that
the helo can get there in five and the helo is 10 minutes away I will try to
get the helicopter.  What would you want me to do for your mom.

Forrest


On 4/30/07, rescsteve at aol.com <rescsteve at aol.com> wrote:
>
> Show me the data that the use of the copter makes a difference in patient
> outcomes.
>
> Steve
>
> -----Original Message-----
> From: farcpr at gmail.com
> To: trauma-list at trauma.org
> Sent: Mon, 30 Apr 2007 1:41 PM
> Subject: Re: Trauma in the air Victims wait for help
>
>
> I replied from my phone earlier, but your call that the 28 minutes was
> outrageous has me stumped. If you were the EMS crew on the ground and you
> thought that it would take you 20 minutes to get to the local trauma
> center
> and the helo would take 8 minutes would you package the patient and leave
> after 8 minutes? Would you give up after 12 minutes? If you were expecting
> the helo in 8 minutes when would you leave without them? If the helo took
> 15 minutes to arrive and you left after 14 how could you justify that? If
> you have to wait you are delaying transport? I guess I will never wait for
> a helo again.
>
> On 4/29/07, Anthony caruso <medic541 at hotmail.com> wrote:
> >
> > Prêt, please tell me that crews did not wait on scene for the amount of
> > time
> > that they stated? 28 minutes? That's outrageous! Shame on them if they
> > delayed transport with an ETA like that. I'm not sure how close they
> were
> > to a level 1 trauma center (or level 2 for that matter) but if you
> figure
> > that, add 28 minutes of flight time, plus the time it takes the crew to
> > land
> > assess the patient, package and become airborne from the scene with that
> > patient. Looking at a time of possibly 36 minutes give or take? Way too
> > long for me anyway. I do recall a statement in the protocols stating "do
> > not delay transport". What's your take?
> > Anthony Caruso NREMT-P.
> >
> > >From: "Pret Bjorn" <p.bjorn at netzero.net>
> > >Reply-To: "Trauma & Critical Care mailing list"
> > ><trauma-list at trauma.org>
> > >To: "'Trauma & Critical Care mailing list'" <trauma-list at trauma.org>
> > >Subject: RE: Trauma in the air Victims wait for help
> > >Date: Sun, 29 Apr 2007 08:46:16 -0400
> > >
> > >Well done, Forrest. Good to be reminded that there're two sides to
> every
> > >story.
> > >
> > >As I was scanning Steve's original post, it was easy to imagine the
> true
> > >motives behind a competitive private air ambulance. I think many states
> > >have experienced similar rogue providers with varying results.
> > >
> > >A visit to www.monoc.org is instructive: their web site an electronic
> > >monument to the Paramedical Industrial Complex. Note the prominent
> > >conservative icons: the Terror Threat barometer and the 9/11 memorial
> > >(urging punishment for the terrorists and those who harbor them).
> > >
> > >Drilling further, it doesn't take long to find the "Save NJ Paramedics"
> > >organization, whose mission it seems to declare New Jersey prehospital
> > care
> > >on the brink of a disaster, which only unrestricted private billing can
> > >resolve. Even an amateur Google detective will soon discover that their
> > >ostensibly grass-roots coalition is represented by Winning Strategies,
> > one
> > >of the leading public relations firms in the northeast.
> > >
> > >In its proper context, the Astbury Park Press article is cynical and
> > >sickening. One can only hope that the good people of New Jersey wise up
> > to
> > >the manipulation.
> > >
> > >
> > >Pret Bjorn, RN
> > >Bangor, ME USA
> > >
> > >
> > >-----Original Message-----
> > >From: trauma-list-bounces at trauma.org
> > >[mailto:trauma-list-bounces at trauma.org]
> > >On Behalf Of Forrest Robleto
> > >Sent: Sunday, April 29, 2007 7:12 AM
> > >To: Trauma &amp, Critical Care mailing list
> > >Subject: Re: Trauma in the air Victims wait for help
> > >
> > >But there is more to the story....
> > >
> > >
> >
>
http://www.app.com/apps/pbcs.dll/article?AID=/20070427/OPINION/704270390/103
> > >0/POLITICS
> > >
> > >
> > >On 4/29/07, S Schecter <schecters at gmail.com> wrote:
> > > >
> > > > Posted by the Asbury Park
> > > > Press<
> > > >
> > >
> >
>
http://www.app.com/apps/pbcs.dll/misc?URL=/misc/register_zago.pbs&Category=z
> > >ago&Destination=http%3A//www.app.com/
> > > > >on
> > > > 04/22/07
> > > >
> > > > BY JAMES W. PRADO ROBERTS <JWR at APP.COM>
> > > > STAFF WRITER
> > > >
> > > > If your house is burning, the closest firefighters douse the flames.
> > > >
> > > > If a burglar is prowling, the closest police officer gives chase.
> > > >
> > > > If you are critically injured in an automobile accident and need to
> be
> > > > airlifted to a trauma center, you'd think you would always get the
> > >closest
> > > > available medevac helicopter crew.
> > > >
> > > > Not in New Jersey.
> > > >
> > > > Across the state, victims of horrific auto accidents and other major
> > > > trauma
> > > > injuries have waited up to a half-hour longer than necessary for
> > >state-run
> > > > air rescue crews to reach them. Private medevac helicopters that are
> > >much
> > > > closer to some accident scenes are often deliberately not called by
> > >state
> > > > medevac dispatchers, the Asbury Park Press has found.
> > > >
> > > > At least 24 times since July, state medevac dispatchers sent a State
> > > > Police
> > > > helicopter to pick up seriously injured victims in Ocean and
> > Burlington
> > > > counties, even though a closer medevac operated by MONOC could have
> > > > arrived
> > > > to fly the patients to a trauma center faster, according to MONOC
> and
> > a
> > > > review of state medevac dispatch recordings.
> > > >
> > > > Patients in those cases faced delays of three to 28 minutes,
> according
> > >to
> > > > MONOC, a nonprofit regional emergency response organization, and
> > records
> > > > reviewed by the Press.
> > > >
> > > > "I think it's a turf battle, and they are playing it with people's
> > >lives,"
> > > > said Assemblyman Peter J. Biondi, R-Somerset, sponsor of a bill that
> > >would
> > > > require the closest-available medevac to be dispatched to a trauma
> > >scene.
> > > >
> > > > On at least two occasions, ground-based rescue crews canceled the
> > >medevac
> > > > and drove to a hospital rather than wait for a state helicopter,
> > >according
> > > > to Jeff Behm, MONOC's vice president of operations.
> > > >
> > > > In February, Miguel A. Flores of Toms River waited an estimated 17
> > >minutes
> > > > longer than needed for an air transport. A State Police helicopter
> was
> > > > called first, even though a MONOC medevac craft was much closer.
> > Members
> > > > of
> > > > his family assumed that everything possible was done to help Flores,
> > who
> > > > later died from his injuries.
> > > >
> > > > "I want to know what the heck happened," said his sister, Maritza
> > >Flores.
> > > > "We have been in the dark."
> > > >
> > > > The New Jersey State Police say their two medevac units have saved
> > > > thousands
> > > > of patients - including Gov. Corzine, who was seriously injured in a
> > >motor
> > > > vehicle accident April 12 on the Garden State Parkway. They also say
> > > > private
> > > > medevac operators aren't as safe, while MONOC said its program is as
> > >safe
> > > > or
> > > > safer than any in the industry.
> > > >
> > > > "Our record speaks for itself. In every case we've delivered our
> > >patients
> > > > safely," said State Police spokesman Capt. Al Della Fave.
> > > >
> > > > Because traumas by their nature are life-threatening, no one has
> said
> > >for
> > > > sure if transportation delays led to permanent disability or death
> for
> > > > patients in these cases.
> > > >
> > > > But at least two victims, Flores in Toms River, and another in
> Sparta,
> > > > Sussex County, later died of their injuries in hospitals.
> > > >
> > > > Flores, 31, was critically injured shortly before 2 a.m. Feb. 22
> when
> > >his
> > > > Toyota severed a utility pole adjacent to Hooper Avenue in Toms
> River.
> > > > Flores was thrown through his driver-side window and landed 42 feet
> > >away.
> > > >
> > > > At the time, MONOC's air ambulance was available seven miles away at
> > the
> > > > Robert J. Miller Airpark in Berkeley, MONOC said.
> > > >
> > > > But the state's medevac dispatchers sent a New Jersey State Police
> > > > helicopter dubbed SouthSTAR (Southern Shock Trauma Air Rescue). It
> was
> > >42
> > > > miles away in Voorhees.
> > > >
> > > > It took SouthSTAR 27 minutes to arrive, according to recordings of
> > State
> > > > Police radio transmissions.
> > > >
> > > > MONOC says it could have been on the scene within 10 minutes.
> > > >
> > > > After SouthSTAR arrived, Flores' heart rate dropped, and he
> eventually
> > > > needed CPR, according to the dispatch recordings. As a result, he
> > >couldn't
> > > > be airlifted to the region's trauma center, Jersey Shore University
> > > > Medical
> > > > Center in Neptune. Instead, an ambulance drove Flores to Community
> > >Medical
> > > > Center in Toms River, where he died at 3:21 a.m.
> > > >
> > > > Flores was in bad shape - and he may have died even if MONOC's
> > >helicopter
> > > > was dispatched, said Behm of MONOC. But because he was not flown to
> a
> > > > trauma
> > > > center by the closest medevac, there is no way of knowing, Behm
> said.
> > > >
> > > > In another accident, just after 10 a.m. on Sept. 17 in Sparta, Gary
> J.
> > > > Wasilewski's motorcycle collided with a Honda CR-V. Paramedics at
> the
> > > > scene
> > > > asked that a nearby private medevac be dispatched, according to
> > > > Assemblyman
> > > > Biondi and dispatch recordings. It could have arrived in 12 minutes,
> > he
> > > > said.
> > > >
> > > > The request was rebuffed by the dispatcher, who said, "You know what
> > the
> > > > rules are, and I'm not gonna, with the atmosphere here, I'm not
> gonna
> > > > change
> > > > anything."
> > > >
> > > > The State Police's helicopter NorthSTAR, which had been in Mercer
> > >County,
> > > > didn't arrive until 27 minutes after it was dispatched, radio
> > recordings
> > > > show.
> > > >
> > > > "The policy is State Police first; however, we expect dispatchers to
> > get
> > > > the
> > > > most appropriate helicopter there," said David W. Gruber, a senior
> > > > assistant
> > > > commissioner in the state Department of Health and Senior Services.
> > > >
> > > > When NorthSTAR brought the 54-year-old Wasilewski to the roof of
> > > > Morristown
> > > > Memorial Hospital, his heart stopped, according to Biondi.
> Wasilewski
> > >fell
> > > > into a coma and was taken off life support a week later, according
> to
> > >his
> > > > fiancee, Denise Danzeisen.
> > > >
> > > > "Why? Why? They were sitting right there," she said of the private
> > >medevac
> > > > helicopter located in Netcong and operated by the Atlantic Health
> > >hospital
> > > > chain. "Why couldn't they do it? It makes no sense."
> > > >
> > > > The state health department is currently reviewing its medevac
> > dispatch
> > > > policy, and an independent consultant's report is due in June. It is
> > >also
> > > > reviewing whether the State Police should put a third medevac
> > helicopter
> > > > into service in central New Jersey.
> > > >
> > > > NorthSTAR has been dispatched since 1988 by University Hospital in
> > >Newark.
> > > > The hospital took over dispatch responsibilities for SouthSTAR last
> > >fall.
> > > >
> > > > Anna Farneski, a spokeswoman for the University of Medicine and
> > >Dentistry
> > > > of
> > > > New Jersey, which operates University Hospital, declined to comment
> on
> > > > specific dispatches, citing patient privacy laws. The Press asked
> > > > specifically about dispatch decisions, not patients' conditions.
> > > >
> > > > "We are unable to address misinformation disseminated by those who
> > would
> > > > turn New Jersey's medevac service into a for-profit enterprise,"
> > >Farneski
> > > > said.
> > > > *
> > > > First hour is critical*
> > > >
> > > > It's called the golden hour.
> > > >
> > > > Since the Vietnam War, emergency medical professionals have
> maintained
> > > > that
> > > > 60 minutes can mean the difference between life and death for the
> > > > critically
> > > > injured.
> > > >
> > > > Beginning in 1988, the New Jersey State Police have safely flown
> > >thousands
> > > > of patients to trauma centers within that time. State health
> > department
> > > > policy gives the State Police a virtual monopoly over air rescues,
> as
> > >long
> > > > as a helicopter is available.
> > > >
> > > > Private operators are called only if the state's medevac helicopters
> > >can't
> > > > respond, according to official dispatch rules and state policy
> > letters.
> > > >
> > > > Most other states rely on private medevac operations to ferry the
> > > > critically
> > > > injured to trauma centers. But until two years ago, NorthSTAR and
> > > > SouthSTAR
> > > > - the State Police's two helicopter rescue units - had operated here
> > > > virtually without competition.
> > > >
> > > > Last year, the agency's medevac helicopters responded to 1,261
> > accident
> > > > scenes, and transported another 314 patients from one medical
> facility
> > >to
> > > > another.
> > > >
> > > > But to settle a lawsuit, in 2004 New Jersey decided to allow private
> > > > medevac
> > > > helicopters to be based in the state. There are now three private
> air
> > > > ambulances in the state, including MONOC's, which had its first
> flight
> > >in
> > > > April 2006.
> > > >
> > > > By way of comparison, Maryland State Police, who pioneered
> nonmilitary
> > > > medevac operations in 1970, also relegate private medevac
> helicopters
> > to
> > > > accident scenes only if the Maryland police can't respond. But
> > Maryland
> > > > State Police ferry five times the number of trauma victims that New
> > >Jersey
> > > > State Police do, with eight medevac helicopters on standby
> throughout
> > >the
> > > > state. Maryland has only a third more land and fewer residents - 5
> > > > million,
> > > > compared to 8.7 million in New Jersey.
> > > >
> > > > "We can have a helicopter anywhere in the state from 12 to 18
> > minutes,"
> > > > said
> > > > First Sgt. Richard Bruns, flight operations supervisor for the
> > Maryland
> > > > State Police.
> > > >
> > > > The Sikorsky helicopters used by the New Jersey State Police for
> > medevac
> > > > operations, originally built to fly CEOs, not patients, are larger
> and
> > > > faster than some private air ambulances: At a cruising speed of 150
> > >knots,
> > > > the State Police medevac could fly from the tip of Sandy Hook to the
> > tip
> > > > of
> > > > Cape May in 41 minutes - 4 minutes and 30 seconds
> > > > faster than MONOC's Eurocopter, which has a cruise speed of 135
> knots.
> > > >
> > > > But MONOC - which is owned and operated by a consortium of 20
> > hospitals
> > > > from
> > > > Hudson to Cape May counties, including Jersey Shore - says it is
> wrong
> > >for
> > > > the state health department to force trauma patients to wait longer
> > for
> > > > the
> > > > State Police when another helicopter is closer.
> > > >
> > > > "This is a no-brainer," Behm said. "This needs to be changed now."
> > > >
> > > > MONOC's medevac does respond when SouthSTAR is unavailable, and Behm
> > >said
> > > > MONOC's helicopter has seen an increase in accident scene calls
> since
> > > > Flores
> > > > died on Feb. 22.
> > > > *
> > > > Assembly bill considered*
> > > >
> > > > In March, Assemblyman Herb Conaway Jr., a medical doctor, held a
> > hearing
> > > > on
> > > > a bill similar to Biondi's that would require the state to dispatch
> > the
> > > > closest medevac helicopter to a trauma scene.
> > > >
> > > > Conaway, D-Burlington, asked Dr. Eric Munoz, a fellow member of the
> > > > Assembly
> > > > Health and Senior Services Committee, who teaches at UMDNJ and is a
> > >trauma
> > > > surgeon at University Hospital: "You are the trauma doc here. . . .
> > Does
> > > > 10
> > > > minutes matter?"
> > > >
> > > > Munoz, R-Union, responded: "I don't think I've had once where I've
> > said
> > >if
> > > > the helicopter got there earlier, this person would be alive. . . .
> > I've
> > > > been working in Newark 20 years, I can't remember an incident."
> > > >
> > > > Other agencies measure response times in seconds.
> > > >
> > > > In New York City last April, officials announced that a pilot
> program
> > to
> > > > install global positioning satellite equipment in ambulances had
> > reduced
> > > > its
> > > > emergency medical response times to the most serious calls by just
> 33
> > > > seconds. The city then spent nearly $50 million to install the
> > equipment
> > > > in
> > > > 1,565 emergency response vehicles.
> > > >
> > > > "In an emergency," New York Mayor Michael Bloomberg said at the
> time,
> > > > "every
> > > > second counts."
> > > > *
> > > > Financial incentives?*
> > > >
> > > > The question of which helicopter is asked to respond to trauma calls
> > is
> > > > not
> > > > just a question of patient care, as MONOC maintains - it's also a
> cash
> > > > competition, some say.
> > > >
> > > > While the State Police itself does not charge patients for the
> > flights,
> > > > the
> > > > hospitals that provide in-flight medical staff charge a flat fee of
> > >$1,337
> > > > for each patient. A typical private medevac fee for an auto accident
> > > > victim
> > > > is $8,000 or more, most of which is paid for by insurance.
> > > >
> > > > The State Police medevac program is suppose to be funded by an
> annual
> > > > vehicle registration fee surcharge, which increased from $1 to $3 in
> > >July.
> > > >
> > > > The medevac's revenue would have increased to $21.5 million, which
> > could
> > > > have been used to replace the State Police's aging Sikorsky S76-B
> > > > helicopters. However, most of the money was diverted into the
> general
> > > > treasury for other purposes. This year, the medevac unit will
> receive
> > >the
> > > > same amount of money as it did in 2006 - approximately $8.5 million.
> > > >
> > > > In addition to trauma rescue, the medevac helicopters perform
> various
> > > > police
> > > > and security missions. The most junior State Police trooper pilot
> will
> > > > receive a $56,820 salary this year, according to Capt. Della Fave.
> > There
> > > > are
> > > > 22 medevac pilots.
> > > >
> > > > Hospitals that supply medical personnel on the flights will receive
> a
> > > > total
> > > > of $2.5 million billing this year from the state, on top of the
> > $817,000
> > > > they expect from patient flights.
> > > >
> > > > The hospitals involved in the program are University Hospital,
> Virtua
> > >West
> > > > Jersey Hospital in Voorhees and Cooper University Hospital in
> Camden.
> > > >
> > > > >From 2001 through 2006, University Hospital and Virtua received
> $10.2
> > > > million from the state, not including as much as $5 million more in
> > > > patient
> > > > billings. Last year, the hospitals won a three-year grant to
> continue
> > >the
> > > > service. Income to the hospitals was expected to be $3.3 million
> this
> > > > year.
> > > >
> > > > The real reason private operators want to be called first, said Dr.
> > >Steven
> > > > Ross, chief of Cooper's trauma unit, is that auto accident victims
> in
> > >New
> > > > Jersey have good insurance policies that will pay for medevac
> > services.
> > > >
> > > > "You want my honest answer? It's a pure and simple profit motive.
> > >There's
> > > > money to be made," Ross said.
> > > >
> > > > Stephen D. Olsen, MONOC's chief flight paramedic, disagrees.
> > > >
> > > > "What we think this is is a patient care issue. If there was a fire,
> > >you'd
> > > > want the closest fire truck," he said. "This is the same thing."
> > > > --
> > > > trauma-list : TRAUMA.ORG
> > > > To change your settings or unsubscribe visit:
> > > > http://www.trauma.org/index.php?/community/
> > > >
> > >
> > >
> > >
> > >--
> > >V/R
> > >
> > >Forrest Robleto
> > >R House Health & Safety
> > >www.RHouseTraining.com
> > >FRobleto at RhouseTraining.com
> > >609-792-9047
> > >--
> > >trauma-list : TRAUMA.ORG
> > >To change your settings or unsubscribe visit:
> > >http://www.trauma.org/index.php?/community/
> > >
> > >
> > >
> > >--
> > >trauma-list : TRAUMA.ORG
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> > >http://www.trauma.org/index.php?/community/
> >
> > _________________________________________________________________
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>
>
> -- V/R
>
> Forrest Robleto
> R House Health & Safety
> www.RHouseTraining.com
> FRobleto at RhouseTraining.com
> 609-792-9047
> --
> trauma-list : TRAUMA.ORG
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>



-- 
V/R

Forrest Robleto
R House Health & Safety
www.RHouseTraining.com
FRobleto at RhouseTraining.com
609-792-9047
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
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