Richey and Helicopters

Wed Jul 2 15:05:12 BST 2008

Helicopters have been flying billboards in the past, but very few
systems can afford to use them that way today.  For the most part they
have to pay their own way.

The issue is really one of how best to move patients to the appropriate
facility where they can receive care.  Both Air and Ground EMS have
their risks and benefits.  There is no doubt that both are used
inappropriately at times.  We have reasonably good literature describing
the patient benefits and cost effectiveness of air ambulances, and we
have similar literature looking at ground EMS.  We also have a body of
knowledge regarding air ambulance crashes, which highlights the risks of
that mode.  What we do not have is a body of literature describing the
risk of ground ambulance transport.  We know that there are crashes and
deaths of ground ambulances throughout the country, but only the most
spectacular of these make the newspapers.  Unfortunately there is no
NTSB mandate to investigate ambulance crashes, and there is no uniform
database for these crashes.  This makes it extremely difficult to
compare the risk of air vs. ground.

To describe any form of medical care as "Russian Roulette" is
inflammatory, especially when published in the popular press.  Such
comments do little to advance the science, which should be our goal.

Dave Thomson

David P. Thomson, MS, MD, FACEP, CMTE, CHC
National Medical Advisor
PHI Air Medical

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Subject: trauma-list Digest, Vol 61, Issue 7

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Today's Topics:

   1. Re: trauma-list Digest, Vol 61, Issue 4 (Stephen Richey)
   2. RE: blunt carotid injury advice (Timothy Craig Hardcastle)

----------------------------------------------------------------------

Message: 1
Date: Wed, 2 Jul 2008 04:58:25 -0400
From: "Stephen Richey" <stephen.richey at gmail.com>
Subject: Re: trauma-list Digest, Vol 61, Issue 4
To: trauma-list at trauma.org
Message-ID:
	<4a5fc68a0807020158l3d1c55eat5235cec9fb8d2ea2 at mail.gmail.com>
Content-Type: text/plain; charset=ISO-8859-1

>
> How many times have you seen a billboard or TV advertisement featuring

> the helicopter?
>

The one that comes to mind for here in Michigan is the "Hail to the
conquering heroes one" for the U of M Medical System.  They have a shot
of a helicopter (I think it's called Survival Flight or something
equally overly
enthusiastic) crew member during a "flight".  Personally, I think they
should be required to counterbalance that with a shot of the roof of
Spectrum Health in Grand Rapids on fire after the AeroMed crash.

I was called yesterday by a magazine reporter out in Arizona who learned
of my research while doing background review for an article about this
subject.  They were wondering what my take on the series of crashes
were, from the perspective of some who researches crew and passenger
survival.  I told her that effectively many of these operations are
quite frankly playing Russian roulette with the lives of their crews for
little benefit to patients in most areas.  The reporter seemed quite
shocked that I would use such a "harsh" analogy.  That response was a
perfect example of how clueless persons outside of the medical field are
regarding the risks.

Sincerely,

------------
Stephen L. Richey, CRT
Aviation Injury Research Project Leader
Saginaw Valley State University
Phone: 248-366-4452

------------------------------

Message: 2
Date: Wed, 2 Jul 2008 11:11:37 +0200
From: "Timothy Craig Hardcastle" <TimothyHar at ialch.co.za>
Subject: RE: blunt carotid injury advice
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Message-ID: <36BA31504543804886C1E8967FEC9229BDF75B at alsex.ialch.co.za>
Content-Type: text/plain;	charset="US-ASCII"

Daniel

Anticoagulate and wait - would also suggest a catheter angio first to
exclude a small fasle aneurysm - would not want to give heparin to that
situation.

What was the 5 on the GCS - 4 for eyes and 1 motor or was the motor
score 3 or better - which offers him some prognosis?

Tim
Dr Timothy C Hardcastle
M.B., Ch.B. (Stell); M. Med (Chir) (Stell); FCS (SA) Principal
Surgeon-Lecturer / Sub-specialist: Trauma and Critical Care Deputy
director: Trauma Unit and Trauma ICU Inkosi Albert Luthuli Central
Hospital / UKZN 800 Bellair Road Mayville, Durban

Postal: PostNet Suite 27
Private Bag X05
Malvern, 4055
KwaZulu Natal

timothyhar at ialch.co.za 

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of daniel simon
Sent: 29 June 2008 14:19
To: trauma-list at trauma.org
Subject: blunt carotid injury advice

32 YO MVA victim, was  intubated and ventilated on site for a GCS of 7
and maxilo-facial injury. He was evacuated to a local hospital where a
Rt chest-tube was inserted for pneumothorax. Brain CT showed sub
arachnoid hemorrhage with some small contusions , a C1 fracture was
found as well.
He
was then transferred to a Level 1 Trauma Center. On admission he had a
GCS of 5 (t) with right hemiparesis. Neck CT -angio  showed dissection
of the left internal carotid artery. What  shall we do now?
thanks
Daniel Simon

------------------------------

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