1. #1
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    Question Med. Helicopter ABUSE:

    Thursday, Dec. 03, 2009: Dallas/Fort Worth, TX

    1. Dana Strittmatter was boiling water in her kitchen in July when it spilled on her leg. After paramedics from Benbrook’s Emergency Medical Services arrived, they called for a medical helicopter from PHI Air Medical...she was treated and released in an hour. One doctor told him that abuse of medical helicopters is a growing problem. The hospital expected her to arrive by ambulance. The final bill was $17,500.

    2. Abuse of medical helicopters "goes on every day in this country," said Dr. Bryan Bledsoe, an emergency room physician in Midlothian and a vocal critic of the air ambulance industry. Bledsoe said, a patient was brought by helicopter to his emergency room with a sore throat.

    3. Some air ambulance companies court the paramedics who make the decisions about whether to use a helicopter. Some companies, he said, offer paramedics small gifts such as pizza dinners, baseball caps or coffee mugs.


    story here - - >http://www.star-telegram.com/804/story/1809462.html
    Last edited by 1OLDTIMER; 12-05-2009 at 01:30 PM. Reason: additional comment

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    Interesting topic. We have an air ambulance company (happens to be mentioned in the article) around here that sells memberships. They go so far as to tell the people that they can call their service, rather than calling 911 or an ambulance, and they'll take care of things on the patient's behalf. They'll actually call the ambulance to transport the patient to the LZ.

    On the flip side, I've seen where EMS has abused the system as well. What seems to be a growing trend is a Helicopter Emergency Lift Protocol (HELP). With this, a dispatcher automatically lifts a helicopter based upon the patient's complaint. The intent is to reduce the time it takes those patients with true life-threats (stroke, heart attack, etc) to get to the facility capable of handling their emergency. However, with on area I'm familiar with, they don't have EMD. So, when someone calls in and says they have chest pain, the helicopter is lifted. When the ambulance gets on scene to find out the patient was hit in the chest at a bar fight two days ago and his chest is till hurting, they have to disregard the helicopter that's already lifted and is burning fuel.

    With the increasing competition for flights, I can see why all of the area air ambulances are entering into these agreements, as it ensures they're going to get their share. I've also seen the "bribing" of medics (I've recieved my share of hats, mugs, meals, etc). In our rural area of SW Missouri, we have no less than 6 helicopters within a 20-25 minute flight of us when there used to be two or three, so competition is pretty fierce between them.

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    For awhile our dispatch (not the normal people with common sense but the smarter than you know it alls) had a policy to stand by the helicopter for ALL personal injury car crashes. Just stand by .. well if they are on stand by for us they cant fly to anybody else.

    Took about a month for the big wigs to learn how they screwed up.

    Not even confirmed PI crash just reported. Same kind of thing .. abuse.

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    We are fortunate in Maryland to have a helo service operated by the State Police. We have protocols for who is a candidate for helo and a system to catagorize them. The call for the helo isn't even made until an EMT evaluates the patient and makes the decision. For some injuries they must consuld with the trauma center and local hospital, and for others they can make the call.

    It doesn't eliminate flying people that don't need it, but at least we have a process and protocalls to follow. The people that wrote the protocalls made a decision that it's better to fly some who don't need it than to not fly 1 person who really does need to be flown. It's not a perfect system, but at least some attempt has been made to lay out standard procedures.

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    We have PHI and also a helicopter service provided by the local trauma hospital downtown. We don't call for a helicopter until we are on scene and it is usually only for severe entrapments that can offset the response time of the helicopter during extrication. By the time we activate them, it usually takes about 30 min before a crew is on the ground (best case about 20 min). Flight time back to the trauma center is about 10-15 min. Ground transport with lights and siren can be done in about 15-20 min during times of no traffic, but during the day will take 30-45 min. Our local hospital can handle most minor trauma so we only have to head downtown once every two weeks or so.

    And one of the helicopters is usually out doing "training" for us every year or so and they usually bring cheap freebies. However, dispatch is the one that calls the air dispatch and sees who can respond the quickest. Both usually get the call and they'll make the decision based on response time.

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    Quote Originally Posted by Eng34FF View Post
    We are fortunate in Maryland to have a helo service operated by the State Police. We have protocols for who is a candidate for helo and a system to catagorize them. The call for the helo isn't even made until an EMT evaluates the patient and makes the decision. For some injuries they must consuld with the trauma center and local hospital, and for others they can make the call.

    It doesn't eliminate flying people that don't need it, but at least we have a process and protocalls to follow. The people that wrote the protocalls made a decision that it's better to fly some who don't need it than to not fly 1 person who really does need to be flown. It's not a perfect system, but at least some attempt has been made to lay out standard procedures.
    I have to say I've heard some stories about your system: Children flown for broken arms, not able to respond do to a demonstration for kindergartners, just to name a few.

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    Quote Originally Posted by FireRescue61 View Post
    I have to say I've heard some stories about your system: Children flown for broken arms, not able to respond do to a demonstration for kindergartners, just to name a few.
    Do you know the facts of what you are citing? Some companies need to be bashed, but I can't stand when it is done by uninformed people. Fractures in children may require surgery to save the limb. They may have been giving one of the kids a ride. Do they need to make scene with a minor on board?
    FF/Paramedic

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    Quote Originally Posted by FireRescue61 View Post
    I have to say I've heard some stories about your system: Children flown for broken arms, not able to respond do to a demonstration for kindergartners, just to name a few.
    It’s not a perfect system and I've seen people flown that didn't really need to be because the protocols said to fly them. Most common is for mechanism of injury, especially from auto accidents. The thinking is that it's easy to miss internal injuries in the field and it's better to fly them than take a chance.

    My only point is that having a standard set of protocols helps prevent frivolous fly-outs and a conscious decision to fly a few people who might not need it in order to save a few that might be missed otherwise has been made ahead of time.

    As for not being able to respond because they were at a demonstration for kindergartners, I need more details. There were probably very good reasons for not responding and they may have made arrangements for another helo to cover their area. In our area, we have 3 troopers that can respond within an acceptable timeframe as well as park police.
    Last edited by Eng34FF; 12-17-2009 at 12:41 PM.

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    Uh huh. And how about Trooper's policy of taking personnel from the scene to assist in flight? Sounds like a great program when they take Basics off the ground to help with a patient that supposedly needs the highest level pre-hospital care available.

    Just the fact that they're flying with one paramedic makes them a fail. Nevermind the rest of it.

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    Quote Originally Posted by emt161 View Post
    Uh huh. And how about Trooper's policy of taking personnel from the scene to assist in flight? Sounds like a great program when they take Basics off the ground to help with a patient that supposedly needs the highest level pre-hospital care available.

    Just the fact that they're flying with one paramedic makes them a fail. Nevermind the rest of it.
    Not quite sure what the problem is here. A patient needs more attention than the flight medic can provide for whatever reason and you have a problem taking an EMT to assist? I've only seen this happen a handful of times.

    Also, how many medics do you want them to carry? Not a lot of room for more people, and weight can also be an issue.

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    Here, our primary helicopter is run by the local private EMS company. Staffed with a pilot, flight nurse and flight paramedic. The company routinly does classes for the fire departments in the area on how and when to setup a landing zone, and also when to call for the helicopter if thier ground ambulance isnt already on scene. Most of the time the paramedic working the ground ambulance will be the one to call.

    Does the helicopter sometimes fly without being needed? Sure. Is the system in this area abused? I would have to say no. The EMS company is pretty good about making sure people know the helicopter is for serious trauma or other situations only, even if they would be the ones making the money off of every little stubbed toe ride.
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    Unnecessary medical flights are a risk and a great burden on the EMS system; SOP's and/or protocols should be a great help in minimizing unnecessary or abusive medivac flights. Back in the mid to late 1980's, my area received its first medivac unit. The chopper was abused more times than a cat at a dog show. The unit was short lived: killed by abuse and insurance companies balking at the high transport cost in an area dotted with more medical facilities (including a level I trauma center) than you could swing a dead cat at.

    My personal issues with these medivac companies? First, many are in business because the insurance companies (now) pay pretty good for air transport. Even the fed government reimbursement is very good. In most cases, there are too many providers competing for the available calls. This leads to abuse and/or misuse of the resource. Second, I'm appalled the providers aren't required to have/use night vision goggles, infrared radar (FLIR), and other technologies which would reduce the crash rate these services suffer from.

    In the end, a good medical director should be heavily involved in developing protocols for proper resource deployment. Fortunately, my area has just the guy needed to do the job: ex-Green Beret doc; he left the service with rank of major. That dude gets crap done!

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    here in virginia the dispatch center calls the state EOC and the closest helo is dispatched. this eliminates the bias and put the pt's need in front of billing. Unless the provider onscene needs a special helo for a specfic reason. after the call my pt time department QA's the reports and feedback is given to the medic. Usually we only transport by medi-vac for pts that are trapped for extended periods of time, or pts that have serious tramatic injuries. We have protocals that recommend certain situations the medic consiider medi-vac. they are QA to the deciding factor for transport or not needs to be documented for QA purposes. We do have certain people in the county that have been flaged in the cad that get a automatic meddi-vac alert for one of the local hospitals, this is due to having specialzied equipment that are experimental (meaning only a few in the country) and the flight medics for that hospital have been trained in the operation of such.

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    Quote Originally Posted by Eng34FF View Post
    Also, how many medics do you want them to carry? Not a lot of room for more people, and weight can also be an issue.
    Find me another HEMS service that flies with one medical provider. Find me another HEMS service that grabs people off the scene to fly without any helicopter safety training or protective equipment.

    Maryland is the birthplace of the Golden Hour, which has been completely destroyed as a valid medical phenomenon. We shouldn't be that surprised that their EMS/HEMS system could use some work.

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    Aside from a paramedic's discretion as to whether an air ambulance is needed, many system have protocols in place that make those decisions for a paramedic. Additionally, the amount of time needed for a ground ambulance to transport someone to a hospital can be long (as in hours - not minutes). Add to the equation the potential for permanent disability and/or death, as in the "routine" arm fracture listed above, and sometimes the use of an air ambulance doesn't seem so "off the wall".

    Although I live on the outskirts of a large, metro area, the paramedics here frequently call for an air ambulance for the very reason mentioned above. The "head, neck, and back pain" from an MVC in the city gets a helo response because the closest trauma center is 45 - 60 min away (without traffic). In town, it'd be a no-brainer because you are 10 - 15 min from a trauma center regardless of your location when you are in the city.
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