Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Can EPs Fix the Helicopter EMS System?

Over at Emergency Physicians Monthly, Dr. Bryan Bledsoe writes Can EPs Fix the Helicopter EMS System?

Dr. Bledsoe, an EP (Emergency Physician), starts with the following paragraph that puts things in a perspective quite a bit different from what we think of, when we think of helicopter EMS –

Imagine that several times a year (approximately every 50,000 procedures) there was a cardiac catheterization lab accident in which the medical team (cardiologist, nurse and technician) perished along with their patient. There would be an immediate outcry to make the procedure safer (technology, practices, safeguards) and reduce risk for the patient and providers. Second, all cath lab procedures would undergo intense scrutiny to assure appropriate utilization. Although such a scenario may seem outrageous, it is essentially the same risks that helicopter EMS (HEMS) crews face on a daily basis. In fact, HEMS transport is the only medical procedure that holds a much higher morbidity and mortality for the providers than it does for the patient.

The only other category of medical personnel that has had a higher fatality rate than their patients is the military medic. That is because the opposing military views killing/disabling the medic as an important way to demoralize the troops served by that medic.

The difference is that nobody is intentionally trying to kill flight crews, are they?

Unintentionally, there is a lot done that does increase the danger for flight crews. Dr. Bledsoe is trying to decrease the unnecessary risks of being a flight medic, flight nurse, flight physician, or EMS pilot.

So why do so many of those he is trying to help view him as the enemy?

Ignorance is the only answer I can think of.

Dr. Bledsoe speaks all over the world about EMS and the things we need to improve for our patients and for ourselves. While there are some out there who understand what he is doing, most seem to automatically oppose anything that does not fit in with the way they want to do things.

Their motto seems to be, Screw the patients – this is about our egos.

We put the safety of flight crews in the hands of the most ignorant providers in EMS – those who think that it is cool to call for a helicopter, or those who are not comfortable taking care of unstable patients, or those who want a shiny pin to put on their shirt, or just those who do not want to drive 20 minutes to a trauma center. After all, the patient will be the one paying for this, so what do they care?

Why are the most irresponsible people in EMS encouraged to make these mistakes?

We should be treating fight crews as if they are valuable. They are supposed to be specialists, but they are called for every little thing that might be twisted into an excuse to call a helicopter.

We should not be defending this abuse of patients. We should not be justifying this abuse of flight crews.

I did make a bit of a misrepresentation, the article is written by Michael Abernethy, MD, Bryan Bledsoe, DO & Dale Carrison, DO. This is not just Dr. Bledsoe. There are other emergency physicians aware of HEMS abuse and willing to speak out about HEMS abuse.