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

- Rogue Medic

Two Children Abducted by EMS Helicopter for One Laceration

 

What happens when a paramedic tells the parents that their children need to be flown to the hospital?

The parents agree, the parents don’t decide right away, or the parents refuse.

What happens when the parents refuse and their children are taken from them in spite of those objections?
 


Image credit.
 

According to the emergency call logs, help was on the way at 3:15 and part-time paramedic Troy Cain of the West Lincoln EMS arrived seven minutes later and went to work.

“With what I saw and the mechanism of injury, I elected to fly the first one to the University of Kentucky Medical Center,” stated the six year paramedic. He said in those moments time is important.

“(She) had an open wound that I could see the skull,” he said, “We’re taught to send them to the most appropriate facility.”[1]

 

Do trauma protocols include anything about being able to see bone through a laceration?

My protocols do not.

What about the special case of seeing skull bone through a laceration?

My protocols do not.

My trauma protocols exclude patients who are awake, alert, and oriented unless there is some indication of serious injury.

A laceration is usually not a serious injury. A laceration to an artery, or a laceration compromising the airway would be examples of injuries that would be expected to be serious. A laceration that might need stitches is not a reason to fly a patient.

What about What if . . . ?

What if there is a serious brain injury that is not yet presenting symptoms?

We do not know, because there is barely any mention of an assessment anywhere in the article. The article does not provide enough information to be able to tell if any assessment beyond look at the boo-boo! was ever done. The mother mentions that the paramedic did not treat an injury to the back of one child, but that does not mean the paramedic did not identify the injury.

The way the article is written, the paramedic is stating in one place that he flew one girl because he could see her skull, while elsewhere he is saying that he flew her because of mechanism. Bad reporting? Or did the paramedic make both statements? We do not know, but reading the article does not encourage confidence in the reporting.

The article makes it very difficult to tell what happened, but we too often see EMS come in and tell everyone that we are going to fly a patient for minor injuries, or even for no injuries.

There is a question we should be asking.

Why is EMS not being billed for inappropriate flights?

Where is the benefit from this more dangerous and much more expensive method of transport?

None.

A helicopter is taken out of service in order to keep a local ambulance in service.

Why is the local ambulance more important than the helicopter that is no longer available for true emergencies for a much larger territory?

It isn’t, but EMS logic doesn’t work the way real logic works.
 


Data source.[2]
 

These patients are so seriously injured that they must be flown to the hospital.

But . . .

They are so healthy that most of them walk out of the hospital soon after landing.
 

The helicopter ride is not curing these patients, so most of the patients were not seriously injured to begin with.
 

We encourage incompetence.
 

The comments include a lot of the We’re too stupid to assess patients defense of low standards.

Dr. Thomas Scalea of ShockTrauma in Baltimore made similar comments when the Maryland EMS protocols were being changed to require medical command permission to fly patients based on mechanism.
 

“Whenever someone says they want to ratchet it back,” says Dr. Thomas M. Scalea, physician in chief at Shock Trauma, “I tell them ‘OK, how many people can die next year to make that worthwhile?’”[3]

 

The ever-subtle Dr. Scalea has not does not appear to have mentioned any deaths due to dramatically cutting the number of EMS helicopter flights.

Does anyone believe that he would not be saying I told you so?

Where are the bodies?

These bodies appear to exist only in the fevered imaginations of those crippling EMS with lowest common denominator people, rather than teaching better assessment skills.

Consent does not appear to have been present in this case, but coercion does.

We scare people to get them to do whatever they would not ordinarily agree to.
 

The most stringent protection of free speech would not protect a man in falsely shouting fire in a theatre and causing a panic. It does not even protect a man from an injunction against uttering words that may have all the effect of force.[4]

 

We are often the ones falsely shouting fire.

We are often the ones using words that may have all of the effect of force when people are vulnerable.

We are often the clear and present danger.

Footnotes:

[1] Lincoln Co. girls put on AirEvac flight for minor injuries despite parent’s wishes
By: Tim Johnston
Updated: Tue 11:36 PM, Sep 17, 2013
WKYT
Article

[2] Not all mechanisms are created equal: A single-center experience with the national guidelines for field triage of injured patients.
Stuke LE, Duchesne JC, Greiffenstein P, Mooney JL, Marr AB, Meade PC, McSwain NE, Hunt JP.
J Trauma Acute Care Surg. 2013 Jul;75(1):140-5.
PMID: 23940858 [PubMed – indexed for MEDLINE]

[3] Advantages of medevac transport challenged
Baltimore Sun
October 5, 2008
Article

[4] Schenck v. United States – 249 U.S. 47 (1919)
U.S. Supreme Court
Nos. 437, 438
Argued January 9, 10, 1919
Decided March 3, 1919
Justice Oliver Wendell Holmes writing the unanimous opinion

.

Comments

  1. Brilliant, sir!

  2. Ive been a medic before some or lol many of you were born so I do have a little experience in this matter… This article leaves soooo many questions and quite honestly im confused as to why it was even written in the first place… We DO NOT know the actual mechinism of injury nor do we know transport time…. So everything is speculation… If your gonna write an article about a particular incident then do your due diligence and interview the medic and goto original sourcing……We have enough speculation coming from the media and lawyers.. We dont need this from our own…

  3. Rouge, I see what you’re getting at, but the problem is not so much with the medic, its what/how he was taught. If in his area they are taught if you see skull you fly, then he did everything right. Where is your outcry against the flight crew that made the decision to fly the second child?? Why not crucify the flight nurse too?! I agree with rick in the fact that we should not be ridiculing each other, we get enough of that. But I agree with you that issues DO need to be addressed, but we need to look at the initial educators. As a fairly recent paramedic graduate, I can tell you that medics are being taught to be cookbook medics, we are not taught to think. One of the biggest things I recall is SVT. I was “taught” greater than 150=SVT. I went on thinking this was fact. I was not taught svt is a class of rhythms, not a rhythm by itself. Do not blame the medic for not knowing what someone else never took the time to pass along.

    • In all of that I forgot to mention, I agree that they should not have been flown, ESPECIALLY since mom was against it, but I wasn’t there and it wasn’t my call. I do think way too many people are flow, and even more people are backboarded that don’t require it. We need to improve critical thinking and assessments BEFORE applying devices and treatments, but that’s a whole new blog!

      • H Steve M. Two things.

        1) Regardless of the mothers wishes. Regardless of distance or time. Regardless of skull visible or no skull visible, regardless of flight nurse or medic opinion, these two children should not have been flown to the hospital in any universe ever.

        2) Being taught not to think is not an excuse not to think.

        Thanks for being a thinking medic and thanks for bringing your thoughts to this forum.

        Steve

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