I have worked in several different types of EMS systems on nearly ever level throughout my career (27 plus yrs). I have seen a big shift in how things are done, and, for the most part, it has been about improvement, providing better care and doing it in a timely manner.
With that being said, I have a question that has been spurred by some frustration on my part. Please understand that this is just my anecdotal assessment and I am sure that there is a good reason why I have seen a hesitation to call for a helicopter to the scene. I would like to hear from any and all of you out there. It doesn’t matter to me what your level of training or experience is. I don’t care if you are, like me, in your third decade of EMS or just starting your career, paid or volunteer, it doesn’t matter. Just tell me what goes into the decision to call for a helicopter where you work.
What I am saying is that I have seen countless times when there is a call for a significant trauma patient in a rural setting (some 30+ min response time) and the ambulance rolls out to the scene Code 3 (lights and siren). Once on the scene, they realize that this is “really bad”. Then they call for a helicopter and are given an ETA and decide to transport the patient or patients to the small local hospital, because the ETA of the helicopter/helicopters is about the same as the transport time to the small local hospital. Then requiring transfer to a larger Trauma Facility and delaying definitive care.
The next paragraph is just an example of several calls I have been involved with and not necessarily a particular one just representative of a particular type of scenario that seems to repeat itself.
We have been put on stand-by and gone out to the helicopter with the rest of the crew waiting for the go, or no-go call. Some 20-30 minutes later, we hear an ambulance running Code 3 by the airport where we are based. We look at each other and shake our heads. We could have been to the scene of the accident by this time. We continue to wait to get the go or no go call. Another 20 minutes goes by and then we are told to stand down. We assume that the ambulance arrived to find the patient was not injured as bad as first thought. After we go back inside we hear the ambulance returning in the other direction (again Code 3) another 20-30 minutes later. We look at each other and again shake our heads. Some more time passes and we get paged out for an inter-facility call from the local hospital to the nearest trauma facility. After we arrive we find out that indeed this is the original patient we were put on stand-by for and then cancelled. The patient is indeed “really bad” and probably won’t make it. And the definitive care has been delayed not by minutes but, by over an hour.
I promise I am not a vulture who is trying to horn in on trauma calls. I really just want to provide patients who are the unfortunate victims of some crazy accident the appropriate care for the injuries they have encountered. This means getting them to the only cure for significant trauma. A surgeon or team of surgeons and an operating room standing-by by the fastest means possible. I know what I would hope was done!
First, if you get sent out on something that is a long way from where you are posted or where the local hospital is and the incident is significant, or has the potential to be “really bad” why don’t responders request a helicopter right from the time they are dispatched? Second, is it a state, local, service directed protocol or just dependent on the crew who is responding?
I just want to conclude by saying that I am not trying to steal anybody’s thunder or generate more revenue for the company I work for. I am just trying to figure out why people don’t try to move OUR patients to the right place as soon as possible. If it was your family or loved one, what would you want the responders to do?
