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?
Great ? I have worked as a Flight Nurse for 13 years and encounter the same thing. While our closest hospital is a level 2 trauma center there are still known traumatic injuries that they always ship to a level 1 and this information is distributed to the surrounding agencies however they do the same thing. The only thing we can do is to try to continue to educate them and hopefully one day it will sink in. Having said that I have had the opposite occur where we are dispatched for calls that I questioned the necessity of the flight. That is the exception rather than the rule. Thanks for broaching a great topic for discussion.
ReplyDeleteThanks Lisa! I am glad to hear that I am not the only one that has experienced this issue. And I completely agree that we just need to keep trying to educate. We just have to do it gently so that it isn't taken the wrong way. Just keep the patient needs front and center. Fly safe!
ReplyDeleteHow about a slightly different perspective? I'm a full time Paramedic (been in EMS for 14 years) and currently work for a rural EMS service. Closest ER is 30 minutes away (Level 3) and its 40-50 minutes to a Level 1 facility. And that's under good road conditions. Here in Michigan we have 4 legitimate seasons so its always a toss up if conditions are decent let alone to even be ok to fly in.
ReplyDeleteWhat you outlined is a we deal with out here too. Ive heard it on the radio a number of times and each time it bothers me. There's no reason for it.
From my perspective being a ground Medic there are a couple factors at play here.
1) Chicken Little Syndrome. Nobody wants to be calling for the everything and the kitchen sink because they are afraid of looking like they can't manage the patient. That's the perception. "Oh you called for a bird because you couldn't handle the unrestrained pt ejected from a car vs tree hu?" Then the person who makes that statement proceeds to say everything THEY would have done which of course always goes flawlessly because they are not really there and don't have to deal with the changes in the patient's condition and response or lack of response to a treatment. Which makes people second guess their decisions. We're a proud bunch so nobody wants to be perceived as incompetent or a "wuss" because you acted in the patients best interest.
2) Many ground crews really don't understand how flight crews operate. Many times here in Michigan we get told you can't get a helicopter because of.....weather or some other reason not disclosed to us from dispatch. It looks perfectly fine out here so what the heck? Well screw them load up and lets give a diesel bolus! It is fair? Absolutely not but its perception and unfortunately I've heard that exact statement out of other crews before.
3) Tunnel vision. We hear the call go out we're enroute and we automatically start thinking about the call. Even in school the concept of "consider air transport" is part of the picture but its just typically just a line in a list of things in the textbook. Contacting flight to give them get to the scene doesn't always factor in. Its only once we make the scene and get to the pt and say "Oh ^%@# ! " do we realize the severity of the patient and they need to be air lifted.
4) Communication. How many times has dispatch been wrong? Its not their fault they are going on what they were given. It happens. Something simple turns out to be critical and something described as critical turns out to be a whole lot of to do about nothing.
I think sometimes there is a real disconnect between the flight crews and ground crews. Education is important but also understanding how each other works can bring about significant improvement for the patients....which is why we're all here.
Stay safe out there
Jared,
DeleteVery glad to hear your comments! You had several great points that were well thought out, and this is exactly what I was hoping to get from somebody out there. I am going to respond to each one of your bullets individually, just to help keep them straight. And by all means, I am not trying to be argumentative or discount you or your perspective, I am talking about what’s on the other side of the coin, to open up discussion and to facilitate better team work that will lead to the best care for OUR patients.
I also want to apologize for the delay in responding to your comments. I was working on the ground ambulance yesterday and slept in a little bit today.
As to your point:
1) I completely understand this point. Attitudes like these (bravado, indestructability, invisibility, etc.) are dangerous for everyone involved, including ground crews, flight crews, and the patients. These ways of thinking, “we can make it, the weather isn’t that bad” or “this LZ isn’t as tight as the one we landed in the other day”, should be red flags to those in the air. And when I am working ground ambulance, I try not to worry about what somebody else may think of me if I am making a decision based on what’s in the best interest of the patient.
As to your point:
2) Again, I totally get it! I have felt exactly the same way. That is one of the reasons we do LZ training, and I always encourage the local crews to swing by to visit, come to CE classes and/or call our base to ask for our thoughts about a situation. The door to my base is always open (well, I’ll answer if you knock). Let’s keep the lines of communication open.
As to your point:
3) Absolutely! That’s where the experience kicks in. Every time I go on a call, flight or ground (yes, I do both), I start going over worst-case scenarios with my partner or partners to cover all the “check boxes”.
As to your point:
4) You are so correct about this one! And I am glad that you didn’t blame the Dispatchers. Sometimes we forget how hard their jobs can be. But, here are my thoughts on this. When in doubt, call to activate. You said that where you work you have all types of weather. We do as well. It can be “clear, blue and 22” in the morning and by the afternoon blowing at 40+ knots with snow and freezing rain. When we have bad weather, we keep the helicopter in a hanger or maybe blade tie downs on. In the summer, we may have an air conditioner hooked up so that it’s not 175 degrees in the cabin. It does take us a few minutes to start and launch (we aim for less than 10 minutes under ideal conditions), which is significantly longer than it takes an ambulance to start their response. Me, and most of the folks I work with, would rather get launched and canceled once you, or somebody, realize that “it’s no biggie”. And if it sounds like a stubbed toe, and turns out to be an amputated lower leg when you get to scene, don’t be afraid to call for an intercept. That is always another option.
It's scary to think that someone could die when they don't have to!
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