Flagstaff Tragedy

[KMATTOX at aol.com]

Jules:   Good points, but in those areas that had HEMS and GEMS  and then 
lost HEMS and where they studied the impact of the LOSS of HEMS before  and after 
the fact,  even for relatively rural and wilderness transports,  the HEMS 
made NO DIFFERENCE on survival and outcomes.      Many MANY of the assumptions 
and foundations to support HEMS are not based on  fact and indeed, in and of 
themselves need to be re-examed.   
 
k
 
 
In a message dated 7/2/2008 11:34:12 A.M. Central Daylight Time,  
jkaymdc at aim.com writes:

I've  watched, read, and listened to the comments about this on here and  many
other forums. I just have a couple comments..

Let me preface it  by saying I know things are different everywhere....

Here in the  rural/heartland of America, as it is sometimes called, we are AT
LEAST an  hour from any level I or II trauma center. We rely on having HEMS
as a  option. I say "option" because over the years, it has become
increasingly  often they will not/can not fly to us anyway. It gets a bit
more stingent  each time there is an accident, which is a good thing!
However the problem  still remains, how do we get the patient to definitive
care in the safest,  quickest manner?

Here in Iowa, (NW Iowa specifically), we often  transport the patient the
closest hospital for stablization, because HEMS  usually cannot get to the
scene before we extricate the patient. In the  urban setting, I have heard
people comment how stupid it is to fly someone  from a hospital because they
should be stable enough to go by  ground...well...walk in our shoes is all I
can say. Sometimes yes,  sometimes no.

The pilots have the choice of whether they should fly or  not...if no, and
that happens more often than not, especially following an  HEMS accident,
then the patient is put into the back of a ground ambulance,  often times
with a crew unqualified to monitor the chest tubes, etc....The  solution for
a many of these very rural, often times "band-aid" station  type of
hospitals, is to through a nurse in the back with the medics to  cover the
"critical care" transport criteria....unfortunately, the nurse  often has NO
CLUE how to do critical care. In fact, I've transported chest  tubes with a
nurse present who was a brand new OB nurse grad and had never  seen the back
of an ambulance.

So..what is the answer? We like, need  and utilize our HEMS here...mostly
appropriately when following the  "protocol" in your service for calling the
helo...is it appropriate they  were called to begin with? sometimes not. I've
transported many by ground  that have been discharged to home from the ED,
often times beating the  ambulance back home.

Shouldn't we be figuring out what is best for the  patient? in some areas and
specific times that is flying them to defiinite  care (or frankly just the
right level of care), Sometimes not. But putting  them on the ground for a 90
minute transport with an OB nurse who doesn't  KNOW or want to KNOW how to
monitor a critical care patient (chest tube,  etc puking all the way),..isn't
helping anyone either...except the billing  department.

Jules



On Wed, Jul 2, 2008 at 10:56 AM,  Connie Potter <Connie at traumafoundation.org>
wrote:

> The  critical comments re: Flagstaff's tragic crash appear to come mostly
>  from those least familiar with the rural nature of emergency care and
>  distances, the diminishing numbers of "volunteer EMT's" able to leave
>  their primary catchment area to transport a patient, AND the lack of
>  access to even LIV trauma care in the great mass of this US, but who
>  wish to second guess those who are no longer alive to rebut statements
>  that they flew/died for nothing.
>
> Many trauma systems review  every airmedical use. Portland OR's ATAB
> forbids them within 40 miles  of the scene because they delay care.   The
> rest of the  rural American often does not have the luxury of even
> calling for  airmed resources because there are none.  Rural hospitals
> are  losing specialists at an alarming rate so patients are being
>  transported for "routine stuff"?   Sorry, but not to an  FP.
>
> No problems with spiders?  Where do you live?  A  Brown Recluse caused
> one of my patients to lose her arm by the time it  necrosed to the bone.
> This time the unlucky patient was a college  student at U of M in
> Missoula, a firefighter from my home town.   We at home will think of him
> as having died in service, thank you very  much.
>
> Except for a few of this list, the callous comments any  time one of
> flights goes down becomes increasingly demeaning to those  who get out
> daily to place their life and safety on the line.   No, we don't try to
> fly when it is unsafe and we do flight following  because it is.  My
> flight crew was in the air on the Columbia  Gorge when Mt St. Helens
> blew: Should we have factored that  possibility into all of our flight
> plans?  And if flying is so  easy, why did Scott Crossfield die after his
> plane tore apart in a  thunderstorm?  Even the best don't always make it.
> God Rest Them  and Give Them Peace and pray for the survivor.  And, don't
> preach  unless you've been there.
>
> Connie  Potter
>
>
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