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.

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The Maryland Panel Meets

From an article about the Helicopter EMS review panel that met today,[1] in a meeting that was closed to outsiders. Outsiders, such as the media, and those who pay for all of this with their tax dollars. Evil outsiders.

State emergency medical officials said today that some ambulance crews in Maryland are “skittish” since a fatal medevac helicopter crash in September and might be too reluctant to transport accident victims to the hospital by air.[1]

Allow me to translate that from politician/doctor speak into English.

The State emergency medical officials are the politician/doctors. Some ambulance crews in Maryland are the people who have been looking at the research comparing transport by ground with transport by air. The politician/doctors are finding that EMS workers are not as gullible as they would like. The ambulance crews are actually interested in what is best for their patients.

The ambulance crews in Maryland want to see some evidence that the helicopter transport is going to provide a benefit for their patients.

The ambulance crews in Maryland want some evidence that the helicopter transport is not going to create unnecessary risks for their patients.

Claiming that the ambulance crews in Maryland are “skittish” since a fatal medevac helicopter crash in September is misleading. They are not skittish. This is not some irrational fear to just get over. Take a Xanax and it will pass.

Claiming that the ambulance crews in Maryland . . . might be too reluctant to transport accident victims to the hospital by air, suggests that there is an actual benefit to transporting these patients by air.

Where is the evidence?

Where is the research that shows any improvement in outcome for patients transported by helicopter when the difference in transport time is frequently the opposite of what would be expected – the helicopter transport takes longer?

Where is the evidence that delaying arrival at the hospital. Just so they can arrive in a helicopter?

Why are the two doctors (Dr. Scalea and Dr. Bass) pushing for aggressive flight criteria, allowed to continue in their roles?

We need objective oversight.

Whitewash is not a solution to real problems.

Whitewash only works on purely political problems.

Patients’ lives should not be politics.

The research on injuries to the vehicle the patient was driving does not support aggressively flying these patients.

After hearing presentations from emergency medical officials today, panel members were largely complimentary of Maryland’s emergency medical system, calling it a national model.[1]

Largely complimentary is to be expected when you choose the members of the panel from those who support the program. When you put one, or two, token critics on the panel, you can claim that the panel did represent divergent views. You can claim that all participants were allowed to speak. You can relax and wait for the hand picked members of the panel to reach the conclusion that everything is excellent. Pay no attention to the helicopters falling out of the sky. Ignore the fact that these patients are being put at risk for an imaginary benefit.

Any members of the panel rude enough to mention that the emperor is stark naked can be ignored, because they have only one, or two, voices. They have only one, or two, votes.

But is that wrong?

Where is the evidence?

Where is the objectivity?

Where is the concern for the lives of the flight crews?

Where is the concern for the lives of the patients?

Dr. Scalea, put some clothes on.

Dr. Bass, put some clothes on.

Footnotes:

generateDate(‘Nov 24, 2008 19:58 -0500’, ‘7:58 PM’); 

^ 1 Some Md. ambulance crews ‘skittish,’ official says. Panel to offer state recommendations in wake of Sept. copter crash that killed 4

7:58 PM EST, November 24, 2008

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