EMS management/crush injury

[pjcabdds at mchsi.com]

Roy,
The trauma committee will be a good meeting, and I am going to try to avoid 
confrontation, polarization, etc. It needs to be a learning experience. All 
parties, including me, need to keep an open mind. 

--
Kind regards,
Phil
Phil Caropreso, MD, FACS
1813 Grand Avenue
Keokuk, Iowa, USA, 52632
pjcabdds at mchsi.com


----------------------  Original Message:  ---------------------
From:    Roy Danks <roydanks at hotmail.com>
To:      "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Subject: RE: EMS management/crush injury
Date:    Tue, 12 Jun 2007 18:10:58 +0000

> Pret,
>  
> I'm not sure we can come to any conclusion as yet.  I don't think the EMS people 
> communicated effectively.  The general notion that "bigger is better" 
> (University v community setting) has little weight.  They (EMS) need to keep 
> medical control informed in a situation such as this.  It doesn't sound as if it 
> was  moving at break-neck speed and they had a good handle on what was going on 
> at the scene. And, don't get me started on helicopters.  I love aircraft of all 
> kinds, esp rotor wing.  Aeromed saves lives, but are, in general, over priced 
> flying billboards for many hospitals and for their own private gain when not 
> affiliated with a hospital.  Ever see a aeromed crew get to the scene and say 
> "this pt doesn't need us...take him by ground"???  Nope.  Doesn't happen.
>  
> As for HIPPA.  B.S.!  Why even bother Googling anything?  I'm pretty net savvy 
> and never even considered it.  I don't see any patient identifiers AND the 
> patient never went to Phil's hospital.  That's crap.  You sound like one of 
> "them" (Gov't folks).
>  
> But, since you went there (HIPPA).  Are you familiar with another gov't ape 
> known as EMTALA?  Having a surgeon or EM doc stroll out to the helipad at the 
> hospital  to "eyeball" the patient then send them on is, as far as I understand 
> it, a violation of EMTALA.  We had a surgeon do that "Somewhere in Missouri 
> where I trained"...meeting the ambulance in the bay and telling them "we can't 
> handle that here"...and were fined a substantial penalty.  The presence of the 
> helipad at the hospital and using it as a "meeting point" is of concern as well.  
> One might argue, convincingly: you pulled into the parking lot of a level III 
> trauma center, with a surgeon inside....perhaps 100? or 50? yards away and 
> didn't get the patient evaluated?  Ohhhhh....I don't know...sounds likes a nice 
> bonus for some blood sucking attorney when the patient exsanguinates en route to 
> the university.
>  
> Phil:  This is how I see it.  Sit down with EMS and talk communications.  EMS 
> people on this thread are going to come to the defense of their colleagues.  I'm 
> going to play the devil's advocate and tell you that they over-stepped their 
> boundaries.  The reason you and your hospital are called "medical control" is 
> because you are there to help them make decisions.  Not all the time...not for 
> every patient.  This was hardly and "every patient" encounter and they would be 
> wise to learn from this situation.
>  
> Roy
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