Trauma in the air Victims wait for help

[Anthony Caruso]

Ok, Sorry Pret.  It's fixed.  Take care!

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Bjorn, Pret
Sent: Monday, April 30, 2007 8:46 AM
To: Trauma & Critical Care mailing list
Subject: RE: Trauma in the air Victims wait for help


Anthony,

First, please instruct your spell checker that I am not a French adjective.
(Every day I'm grateful that my last name is not Porter, and my middle
initial is not 'A.')
 
There is no argument that time is the principle performance indicator in
prehospital trauma care.  But time is relative to other factors, such that
comparing a small handful of whole numbers is at best a piss-poor
performance improvement strategy, and at worst a slimy scheme.

In air medicine, the vehicle is merely the most conspicuous part of the
system.  Just because you and I both have helicopters, doesn't mean we start
out even.  You can compare a half dozen anecdotal response times, but I'm
well within my rights to expand on that metric, and further to inquire into
your on-scene intervals, service and provider credentials, experience,
equipment, medical control, safety training, costs, charges, and willingness
to work cooperatively within the EMS system (as opposed to sabotaging other
services, and by extension, the system at large).

Problem is, the truth is too complex and boring for many American news
consumers, and any energetic nitwit with rudimentary media savvy can
convince a couple of thousand lemmings to call their elected representative
in support of a patently stupid idea.  If said nitwit's got a dog in the
fight, the results can be truly amazing.  And sadly, the truth rarely
inspires or reimburses counter-nitwits.

Best of luck, New Jersey.

Pret



-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Anthony caruso
Sent: Sunday, April 29, 2007 8:31 PM
To: trauma-list at trauma.org
Subject: RE: Trauma in the air Victims wait for help

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 &amp; Critical Care mailing list"
><trauma-list at trauma.org>
>To: "'Trauma &amp; 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/70427039
>0/103
>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&Categ
>ory=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."
> > --
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> >
>
>
>
>--
>V/R
>
>Forrest Robleto
>R House Health & Safety
>www.RHouseTraining.com
>FRobleto at RhouseTraining.com
>609-792-9047
>--
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>
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